Fast Five Quiz: Atrial Fibrillation and Diabetes

Atrial fibrillation (AF) is a major risk factor for stroke, heart failure (HF), hospitalization, and death. Both type 1 and type 2 diabetes mellitus (DM) are also associated with several serious outcomes, including stroke, myocardial infarction, chronic kidney disease, blindness, and amputation. Recently, there has been increasing interest in the association between AF and diabetes, with one study showing that patients treated for DM have a 40% increased risk for AF.

Researchers continue to conduct studies to clarify and further understand the association between these two diseases. How much do you know about AF and DM? Check your knowledge with our short quiz.

According to epidemiologic studies, with the exception of North America, patients from Australia have the highest rate of AF worldwide. In addition, Australia has the highest rate of death from AF. The high rates of AF in Australia have been attributed to both the country's increasing aging population and incidence of clinically relevant risk factors for AF, including type 2 DM.

Persons of Asian descent are among patients with the lowest risk for AF. Although the US Centers for Disease Control and Prevention reports that persons of European descent are more likely than African Americans to develop AF, both groups have lower rates of AF than patients from Australia.

Learn more about the epidemiology of AF and its association with DM.

Researchers have demonstrated a dose-response relationship between circulating blood glucose levels and the development of AF. Thiazolidinedione use has been associated with a decreased risk of developing AF in patients with diabetes. Researchers have shown that better A1c control is associated with decreased thromboembolic risk. A recent study showed that AF is more common among persons with diabetic kidney disease.

Learn more about the relationship between blood glucose levels and AF risk.

Electrical, structural, and autonomic processes are probably involved in the pathogenesis that leads to AF in patients with DM.

LV hypertrophy in response to increased afterload is associated with hypertensive cardiac remodeling. Profibrotic cytokine and mediator release are associated with cardiac remodeling after viral myocarditis. RV dysfunction results from hypoxemia among persons with chronic lung disease.

Learn more about the mechanisms involved in diabetes and atrial fibrillation.

A recent large, population-based study demonstrated that having DM increases the risk for sudden cardiac death among patients with AF. The same study showed that the presence of DM was not associated with an increased risk for worsening AF, new-onset HF, or bleeding complications requiring hospitalization.

Learn more about sudden cardiac death in patients with AF and DM.

The decision of whether or not to place a patient with AF on anticoagulation therapy should be based on their individual estimated risk for thromboembolism using the CHA₂DS₂-VASc score for stroke-risk assessment, which includes DM as a risk factor.

Although consideration of patient adherence is important in treatment decisions, not all patients with AF require anticoagulation. In a recent study of patients with DM and AF, the duration of diabetes was more important than glycemic control in predicting stroke risk. Although electrical cardioversion is highly effective in the acute care setting, patients often revert to AF within 1 year. Chemical cardioversion has not been well-studied in patients with DM.

Learn more about the atrial fibrillation CHA₂DS₂-VASc score calculator.