Atrial fibrillation, type 2 diabetes, and non–vitamin K antagonist oral anticoagulants: A review

Anna Plitt, Darren K McGuire, Robert P. Giugliano

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

IMPORTANCE: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a 5-fold increase in the risk for stroke. Type 2 diabetes is an independent risk factor for both stroke and atrial fibrillation, and in the setting of AF, type 2 diabetes is independently associated with a 2% to 3.5% increase in absolute stroke rate per year. The overlap in the pathophysiologies of AF and type 2 diabetes are not well understood, and current practice guidelines provide few recommendations regarding patients with both conditions. OBSERVATIONS: In this article, we review the epidemiology and pathophysiology of the nexus of AF and type 2 diabetes. Furthermore, we analyze the subgroup of patients with type 2 diabetes enrolled in phase 3 clinical trials of non–vitamin K antagonist oral anticoagulants in prevention of arterial thromboembolism in AF, highlighting the greater absolute benefit of non–vitamin K oral anticoagulants in patients with type 2 diabetes. Finally, we offer recommendations on risk stratification and therapy for patients with concomitant AF and type 2 diabetes. CONCLUSIONS AND RELEVANCE: We highlight the increased thromboembolic risk with coexisting AF and type 2 diabetes. We recommend that further studies be done to evaluate the potential benefits of anticoagulation for all patients who have both and the potential for non–vitamin K oral anticoagulants to have greater benefits than risks over vitamin K antagonists.

Original languageEnglish (US)
Pages (from-to)442-448
Number of pages7
JournalJAMA Cardiology
Volume2
Issue number4
DOIs
StatePublished - Apr 1 2017

Fingerprint

Anticoagulants
Atrial Fibrillation
Type 2 Diabetes Mellitus
Stroke
Phase III Clinical Trials
Vitamin K
Thromboembolism
Practice Guidelines
Cardiac Arrhythmias
Epidemiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Atrial fibrillation, type 2 diabetes, and non–vitamin K antagonist oral anticoagulants : A review. / Plitt, Anna; McGuire, Darren K; Giugliano, Robert P.

In: JAMA Cardiology, Vol. 2, No. 4, 01.04.2017, p. 442-448.

Research output: Contribution to journalReview article

@article{a47f12c55fc0411dabb77a3dc7ceff6e,
title = "Atrial fibrillation, type 2 diabetes, and non–vitamin K antagonist oral anticoagulants: A review",
abstract = "IMPORTANCE: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a 5-fold increase in the risk for stroke. Type 2 diabetes is an independent risk factor for both stroke and atrial fibrillation, and in the setting of AF, type 2 diabetes is independently associated with a 2{\%} to 3.5{\%} increase in absolute stroke rate per year. The overlap in the pathophysiologies of AF and type 2 diabetes are not well understood, and current practice guidelines provide few recommendations regarding patients with both conditions. OBSERVATIONS: In this article, we review the epidemiology and pathophysiology of the nexus of AF and type 2 diabetes. Furthermore, we analyze the subgroup of patients with type 2 diabetes enrolled in phase 3 clinical trials of non–vitamin K antagonist oral anticoagulants in prevention of arterial thromboembolism in AF, highlighting the greater absolute benefit of non–vitamin K oral anticoagulants in patients with type 2 diabetes. Finally, we offer recommendations on risk stratification and therapy for patients with concomitant AF and type 2 diabetes. CONCLUSIONS AND RELEVANCE: We highlight the increased thromboembolic risk with coexisting AF and type 2 diabetes. We recommend that further studies be done to evaluate the potential benefits of anticoagulation for all patients who have both and the potential for non–vitamin K oral anticoagulants to have greater benefits than risks over vitamin K antagonists.",
author = "Anna Plitt and McGuire, {Darren K} and Giugliano, {Robert P.}",
year = "2017",
month = "4",
day = "1",
doi = "10.1001/jamacardio.2016.5224",
language = "English (US)",
volume = "2",
pages = "442--448",
journal = "JAMA Cardiology",
issn = "2380-6583",
publisher = "American Medical Association",
number = "4",

}

TY - JOUR

T1 - Atrial fibrillation, type 2 diabetes, and non–vitamin K antagonist oral anticoagulants

T2 - A review

AU - Plitt, Anna

AU - McGuire, Darren K

AU - Giugliano, Robert P.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - IMPORTANCE: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a 5-fold increase in the risk for stroke. Type 2 diabetes is an independent risk factor for both stroke and atrial fibrillation, and in the setting of AF, type 2 diabetes is independently associated with a 2% to 3.5% increase in absolute stroke rate per year. The overlap in the pathophysiologies of AF and type 2 diabetes are not well understood, and current practice guidelines provide few recommendations regarding patients with both conditions. OBSERVATIONS: In this article, we review the epidemiology and pathophysiology of the nexus of AF and type 2 diabetes. Furthermore, we analyze the subgroup of patients with type 2 diabetes enrolled in phase 3 clinical trials of non–vitamin K antagonist oral anticoagulants in prevention of arterial thromboembolism in AF, highlighting the greater absolute benefit of non–vitamin K oral anticoagulants in patients with type 2 diabetes. Finally, we offer recommendations on risk stratification and therapy for patients with concomitant AF and type 2 diabetes. CONCLUSIONS AND RELEVANCE: We highlight the increased thromboembolic risk with coexisting AF and type 2 diabetes. We recommend that further studies be done to evaluate the potential benefits of anticoagulation for all patients who have both and the potential for non–vitamin K oral anticoagulants to have greater benefits than risks over vitamin K antagonists.

AB - IMPORTANCE: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a 5-fold increase in the risk for stroke. Type 2 diabetes is an independent risk factor for both stroke and atrial fibrillation, and in the setting of AF, type 2 diabetes is independently associated with a 2% to 3.5% increase in absolute stroke rate per year. The overlap in the pathophysiologies of AF and type 2 diabetes are not well understood, and current practice guidelines provide few recommendations regarding patients with both conditions. OBSERVATIONS: In this article, we review the epidemiology and pathophysiology of the nexus of AF and type 2 diabetes. Furthermore, we analyze the subgroup of patients with type 2 diabetes enrolled in phase 3 clinical trials of non–vitamin K antagonist oral anticoagulants in prevention of arterial thromboembolism in AF, highlighting the greater absolute benefit of non–vitamin K oral anticoagulants in patients with type 2 diabetes. Finally, we offer recommendations on risk stratification and therapy for patients with concomitant AF and type 2 diabetes. CONCLUSIONS AND RELEVANCE: We highlight the increased thromboembolic risk with coexisting AF and type 2 diabetes. We recommend that further studies be done to evaluate the potential benefits of anticoagulation for all patients who have both and the potential for non–vitamin K oral anticoagulants to have greater benefits than risks over vitamin K antagonists.

UR - http://www.scopus.com/inward/record.url?scp=85028076059&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028076059&partnerID=8YFLogxK

U2 - 10.1001/jamacardio.2016.5224

DO - 10.1001/jamacardio.2016.5224

M3 - Review article

C2 - 28122078

AN - SCOPUS:85028076059

VL - 2

SP - 442

EP - 448

JO - JAMA Cardiology

JF - JAMA Cardiology

SN - 2380-6583

IS - 4

ER -