Atrial fibrillation in diabetes A cause for concern英文文献资料.docVIP

Vol.2, No.4, 378-385 (2012) Journal of Diabetes Mellitus /10.4236/jdm.2012.24059 Atrial fibrillation in diabetes: A cause for concern?* 1# Benjamin R. Szwejkowski , Sushma Rekhraj 1 2 , Andrew D. Morris , Allan D. Struthers 1 1 # 2 Centre for Cardiovascular and Lung Biology, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK; Corresponding Author: b.szwejkowski@dunde.ac.uk Biomedical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK Received 13 July 2012; revised 16 August 2012; accepted 26 August 2012 ABSTRACT Why is AF important in patients with diabetes? It is becoming increasingly recognised that in addition to tra- ditional risk factors for AF, such as hypertension, is- chaemic heart disease and heart failure, diabetes is also a risk factor for AF. The exact pathophysiology for this observation is unclear but is important because dia- betes may mask the cardiac symptoms associated with the onset of AF and this masking of symptoms is a po- tential mechanism for the increased risk of stroke in pa- tients with diabetes, i.e. if AF is under diagnosed then anti-coagulation will be delayed or not considered. The development of AF in patients with diabetes has also been shown to increase the risk of stroke [5]. Stroke risk is most commonly measured by the well validated “CHADS2” score whereby diabetes scores one point, giving an adjusted stroke rate of 2.8% per year with a 95% confidence interval of 2.0 - 3.8 [6,7]. The increasing incidence of both AF and diabetes, and the association between the two conditions, highlights a potentially important unmet need and under researched cause of morbidity and mortality in patients with diabe- tes. In many ways, this may be comparable to the in- creased risk of ischaemic heart disease in patients with di