José Carlos Arévalo Lorido, Jesús Casado Cerrada and Ana Lorenzo Almorós.
The diabetes and atrial fibrillation are two pathologies treated by the internist in which the relationship is becoming mayr both in the diagnosis with common phenotypes and the predisposition to suffer both as the treatment with common and effective drugs to treat both pathologies. This has been revealed in the joint table between the Diabetes, Obesity and Nutrition Working Group, and the Heart Failure and Atrial Fibrillation Working Group, both belonging to the Spanish Society of Internal Medicine (SEMI).
At the table held during the XVI meeting of the Diabetes, Obesity and Nutrition GT and which has been moderated by Jesús Casado Cerrada, internists at the University Hospital of Getafe, with the participation of Ana Lorenzo Almorós, attached to the Internal Medicine Service of the Gregorio Marañón University Hospital and member of the Heart Failure GT; and José Carlos Arévalo Lorido, attached to the Internal Medicine Service of the Badajoz University Hospital Complex and a member of both groups.
For Lorenzo Almoros the relationship between diabetes and atrial fibrillation (AF) is “very important” and it is scientifically proven: “The development of AF in diabetic patients has been related to increased symptoms, worse quality of life, increased hospitalization, higher rates of overall and cerebrovascular mortality and increased risk of complications such as strokes and embolisms”.
While on the other hand, patients with type 2 diabetes (DM-2) have a two-fold increased risk of AF than non-diabetics. “There is a 40 percent increased risk in men and 60 percent in women, and in pre-diabetes the risk is increased by 20 percent,” highlights the specialists, who despite placing the focus on DM-2 also remember that in DM-1 also have a 13 to 63 percent increased risk of AF than non-diabetics.
“In general, the prevalence of diabetes in studies of atrial fibrillation is between 22 and 40 percent, and the reverse is 15 percent,” details Lorenzo Almorós, who assures that the The relationship between both pathologies is “clearly” causal: “Both are directly interrelated through mitochondrial stress and indirect factors such as epicardial fat.”
What are the phenotypes they share in common?
Both diseases share many comorbidities and risk factors, so there is common phenotypes that can help classify them. “Phenotypes help us better understand the potential group variations within a certain entity, and can be useful in the context of precision medicine and to establish new lines of research”, details Arévalo Lorido.
According to the specialist, within heart failure (HF) and DM we can discover two phenotypes: “One is vascular-ischemic basis and another is derived from a cardiomyopathy developed by the metabolic and inflammatory alterations of DM. Both phenotypes include the full spectrum of left ventricular ejection fraction (LVEF).” However, according to Arévalo Lorido, for the time being their development has not led to variations in the syndromic treatment of HF, which remains adjusted to phenotypes related to LVEF.
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