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Primary prevention of atrial fibrillation in patients with metabolic syndrome: correction of modifiable risk factors

https://doi.org/10.23946/2500-0764-2020-6-2-103-115

Abstract

Currently, around 34 million people worldwide suffer from atrial fibrillation (AF), with the number projected to double by 2060. Despite the treatment of AF has been significantly improved during the recent years, AF is still associated with an increased risk of severe complications such as systemic thromboembolism, progression of heart failure, stroke, and myocardial infarction. Due to a high risk of disability and mortality, AF represent a major socioeconomic problem for the healthcare in most countries, also because of related financial costs. Obesity, most often represented by metabolic syndrome, is widely recognized as an epidemic of the XXI century. Here we review the features of AF development in patients with metabolic syndrome, suggesting novel avenues for the primary prevention of AF. 

About the Authors

A. I. Olesin
Mechnikov North-West State Medical University
Russian Federation

MD, DSc, Professor, Department of Clinical Therapy and Cardiology, 

41, Kirochnaya Street, St. Petersburg, 191015



I. V. Konstantinova
Mechnikov North-West State Medical University
Russian Federation

MD, PhD, Assistant Professor, Department of Clinical Therapy and Cardiology, 

41, Kirochnaya Street, St. Petersburg, 191015



References

1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42(5):373-498. https://doi.org/10.1093/eurheartj/ehaa612

2. Nyström PK, Carlsson AC, Leander K, de Faire U, Hellenius ML, Gigante B. Obesity, metabolic syndrome and risk of atrial fibrillation: a Swedish, prospective cohort study. PLoS One. 2015;10(5):e0127111. https://doi.org/10.1371/journal.pone.0127111

3. Kim YG, Choi KJ, Han S, Hwang KW, Kwon CH, Park GM, Won KB, Ann SH, Kim J, Kim SJ, Lee SG, Nam GB, Kim YH. Metabolic Syndrome and the Risk of New-Onset Atrial Fibrillation in Middle-Aged East Asian Men. Circ J. 2018;82(7):1763-1769. https://doi.org/10.1253/circj.CJ-18-0113

4. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr; International Diabetes Federation Task Force on Epidemiology and Prevention; Hational Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640- 1645. https://doi.org/10.1161/CIRCULATIONAHA.109.192644

5. GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1859-1922. https://doi.org/10.1016/S0140-6736(18)32335-3

6. Mamedov MN. Metabolicheskii sindrom v Rossii: rasprostranennost', klinicheskie osobennosti i lechenie. Moscow : Izvestiya Upravleniya delami Prezidenta RF; 2011. 160 p. (in Russ.).

7. Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A, Witteman JC, Stricker BH, Heeringa J. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34(35):2746-2751. https://doi.org/10.1093/eurheartj/eht280

8. Foy AJ, Mandrola J, Liu G, Naccarelli GV. Relation of Obesity to New-Onset Atrial Fibrillation and Atrial Flutter in Adults. Am J Cardiol. 2018;121(9):1072-1075. https://doi.org/10.1016/j.amjcard.2018.01.019

9. Tedrow UB, Conen D, Ridker PM, Cook NR, Koplan BA, Manson JE, Buring JE, Albert CM. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women's health study). J Am Coll Cardiol. 2010;55(21):2319-2327. https://doi.org/10.1016/j.jacc.2010.02.029

10. Elagizi A, Kachur S, Lavie CJ, Carbone S, Pandey A, Ortega FB, Milani RV. An Overview and Update on Obesity and the Obesity Paradox in Cardiovascular Diseases. Prog Cardiovasc Dis. 2018;61(2):142- 150. https://doi.org/10.1016/j.pcad.2018.07.003

11. Lee H, Choi EK, Lee SH, Han KD, Rhee TM, Park CS, Lee SR, Choe WS, Lim WH, Kang SH, Cha MJ, Oh S. Atrial fibrillation risk in metabolically healthy obesity: A nationwide population-based study. Int J Cardiol. 2017;240:221-227. https://doi.org/10.1016/j.ijcard.2017.03.103

12. Pandey A, Gersh BJ, McGuire DK, Shrader P, Thomas L, Kowey PR, Mahaffey KW, Hylek E, Sun S, Burton P, Piccini J, Peterson E, Fonarow GC. Association of Body Mass Index With Care and Outcomes in Patients With Atrial Fibrillation: Results From the ORBIT-AF Registry. JACC Clin Electrophysiol. 2016;2(3):355-363. https://doi.org/10.1016/j.jacep.2015.12.001

13. Lavie CJ, Pandey A, Lau DH, Alpert MA, Sanders P. Obesity and Atrial Fibrillation Prevalence, Pathogenesis, and Prognosis: Effects of Weight Loss and Exercise. J Am Coll Cardiol. 2017;70(16):2022-2035. https://doi.org/10.1016/j.jacc.2017.09.002

14. Verdecchia P, Angeli F, Reboldi G. Hypertension and Atrial Fibrillation: Doubts and Certainties From Basic and Clinical Studies. Circ Res. 2018;122(2):352-368. https://doi.org/10.1161/CIRCRESAHA.117.311402

15. Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GY, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Heart Rhythm. 2017;14(1):e3-e40. https://doi.org/10.1016/j.hrthm.2016.05.028

16. De Sensi F, De Potter T, Cresti A, Severi S, Breithardt G. Atrial fibrillation in patients with diabetes: molecular mechanisms and therapeutic perspectives. Cardiovasc Diagn Ther. 2015;5(5):364-373. https://doi.org/10.3978/j.issn.2223-3652.2015.06.03

17. Wong CX, Ganesan AN, Selvanayagam JB. Epicardial fat and atrial fibrillation: current evidence, potential mechanisms, clinical implications, and future directions. Eur Heart J. 2017;38(17):1294-1302. https://doi.org/10.1093/eurheartj/ehw045

18. Nakamori S, Nezafat M, Ngo LH, Manning WJ, Nezafat R. Left Atrial Epicardial Fat Volume Is Associated With Atrial Fibrillation: A Prospective Cardiovascular Magnetic Resonance 3D Dixon Study. J Am Heart Assoc. 2018;7(6):e008232. https://doi.org/10.1161/JAHA.117.008232

19. Heckbert SR, Wiggins KL, Blackshear C, Yang Y, Ding J, Liu J, McKnight B, Alonso A, Austin TR, Benjamin EJ, Curtis LH, Sotoodehnia N, Correa A. Pericardial fat volume and incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis and Jackson Heart Study. Obesity (Silver Spring). 2017;25(6):1115-1121. https://doi.org/10.1002/oby.21835

20. Smorodinova N, Blaha M, Melenovsky V, Rozsivalova K, Pridal J, Durisova M, Pirk J, Kautzner J, Kusera T. Analysis of immune cell populations in atrial myocardium of patients with atrial fibrillation or sinus rhythm. PLoS One. 2017;12(1):e01726911. https://doi.org/10.1371/journal.pone.0172691

21. Venteclef N, Guglielmi V, Balse E, Gaborit B, Cotillard A, Atassi F, Amour J, Leprince P, Dutour A, Clément K, Hatem SN. Human epicardial adipose tissue induces fibrosis of the atrial myocardium through the secretion of adipo-fibrokines. Eur Heart J. 2015;36(13):795-805a. https://doi.org/10.1093/eurheartj/eht099

22. Packer M. Epicardial Adipose Tissue May Mediate Deleterious Effects of Obesity and Inflammation on the Myocardium. J Am Coll Cardiol. 2018;71(20):2360-2372. https://doi.org/10.1016/j.jacc.2018.03.509

23. Wu L, Emmens RW, van Wezenbeek J, Stooker W, Allaart CP, Vonk ABA, van Rossum AC, Niessen HWM, Krijnen PAJ. Atrial inflammation in different atrial fibrillation subtypes and its relation with clinical risk factors. Clin Res Cardiol. 2020;109(10):1271-1281. https://doi.org/10.1007/s00392-020-01619-8

24. Saxton SN, Heagerty AM, Withers SB. Perivascular adipose tissue: An immune cell metropolis. Exp Physiol. 2020;105(9):1440-1443. https://doi.org/10.1113/EP087872

25. Javed S, Gupta D, Lip GYH. Obesity and atrial fibrillation: making inroads through fat. Eur Heart J Cardiovasc Pharmacother. 2021;7(1):59-67. https://doi.org/10.1093/ehjcvp/pvaa013

26. Mahajan R, Lau DH, Brooks AG, Shipp NJ, Manavis J, Wood JP, Finnie JW, Samuel CS, Royce SG, Twomey DJ, Thanigaimani S, Kalman JM, Sanders P. Electrophysiological, Electroanatomical, and Structural Remodeling of the Atria as Consequences of Sustained Obesity. J Am Coll Cardiol. 2015;66(1):1-11. https://doi.org/10.1016/j.jacc.2015.04.058. PMID: 26139051

27. Nattel S. Molecular and Cellular Mechanisms of Atrial Fibrosis in Atrial Fibrillation. JACC Clin Electrophysiol. 2017;3(5):425-435. https://doi.org/10.1016/j.jacep.2017.03.002

28. Al-Rawahi M, Proietti R, Thanassoulis G. Pericardial fat and atrial fibrillation: Epidemiology, mechanisms and interventions. Int J Cardiol. 2015;195:98-103. https://doi.org/10.1016/j.ijcard.2015.05.129

29. Mason FE, Pronto JRD, Alhussini K, Maack C, Voigt N. Cellular and mitochondrial mechanisms of atrial fibrillation. Basic Res Cardiol. 2020;115(6):72. https://doi.org/10.1007/s00395-020-00827-7

30. Al-Kaisey AM, Parameswaran R, Kalman JM. Atrial Fibrillation Structural Substrates: Aetiology, Identification and Implications. Arrhythm Electrophysiol Rev. 2020;9(3):113-120. https://doi.org/10.15420/aer.2020.19

31. Zhou M, Wang H, Chen J, Zhao L. Epicardial adipose tissue and atrial fibrillation: Possible mechanisms, potential therapies, and future directions. Pacing Clin Electrophysiol. 2020;43(1):133-145. https://doi.org/10.1111/pace.13825

32. Anter E, Di Biase L, Contreras-Valdes FM, Gianni C, Mohanty S, Tschabrunn CM, Viles-Gonzalez JF, Leshem E, Buxton AE, Kulbak G, Halaby RN, Zimetbaum PJ, Waks JW, Thomas RJ, Natale A, Josephson ME. Atrial Substrate and Triggers of Paroxysmal Atrial Fibrillation in Patients With Obstructive Sleep Apnea. Circ Arrhythm Electrophysiol. 2017;10(11):e005407. https://doi.org/10.1161/CIRCEP.117.005407

33. Shantha G, Pelosi F, Morady F. Relationship Between Obstructive Sleep Apnoea and AF. Arrhythm Electrophysiol Rev. 2019;8(3):180- 183. https://doi.org/10.15420/aer.2019.35.2

34. Morillo CA, Banerjee A, Perel P, Wood D, Jouven X. Atrial fibrillation: the current epidemic. J Geriatr Cardiol. 2017;14(3):195-203. https://doi.org/10.11909/j.issn.1671-5411.2017.03.011

35. Himmelreich JCL, Veelers L, Lucassen WAM, Schnabel RB, Rienstra M, van Weert HCPM, Harskamp RE. Prediction models for atrial fibrillation applicable in the community: a systematic review and metaanalysis. Europace. 2020;22(5):684-694. https://doi.org/10.1093/europace/euaa005

36. Alonso A, Krijthe BP, Aspelund T, Stepas KA, Pencina MJ, Moser CB, Sinner MF, Sotoodehnia N, Fontes JD, Janssens AC, Kronmal RA, Magnani JW, Witteman JC, Chamberlain AM, Lubitz SA, Schnabel RB, Agarwal SK, McManus DD, Ellinor PT, Larson MG, Burke GL, Launer LJ, Hofman A, Levy D, Gottdiener JS, Kääb S, Couper D, Harris TB, Soliman EZ, Stricker BH, Gudnason V, Heckbert SR, Benjamin EJ. Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGEAF consortium. J Am Heart Assoc. 2013;2(2):e000102. https://doi.org/10.1161/JAHA.112.000102

37. Himmelreich JCL, Lucassen WAM, Harskamp RE, Aussems C, van Weert HCPM, Nielen MMJ. CHARGE-AF in a national routine primary care electronic health records database in the Netherlands: validation for 5-year risk of atrial fibrillation and implications for patient selection in atrial fibrillation screening. Open Heart. 2021;8(1):e001459. https://doi.org/10.1136/openhrt-2020-001459

38. Olesin AI, Litvinenko VA, Al-Barbari AV, Konstantinova IV, Smolin ZYu, Prosyanikova ON. Atrial fibrillation onset risk in patients with metabolic syndrome: prospective study. Russian journal of cardiology. 2014;19(12):25-30. (In Russ.). http://dx.doi.org/10.15829/1560-4071-2014-12-25-30

39. Olesin AI, Litvinenko VA, Shlapakova AV, Konstantinova IV. Estimation of atrial fibrillation risk development in patients with metabolic syndrome during atrial extrasystole registration. Mezhdunarodnyi zhurnal serdtsa i sosudistykh zabolevanii 2016;4(11):17-27. (In Russ.). http://dx.dоi: 10.15829/2311-1623-4-11

40. Olesin AI, Litvinenko VA, Konstantinova IV, Shlapakova AV. A possibility to use antiarrhythmic medications from ii class and modulated kinesitherapy as primary prevention of atrial fibrillation in metabolic syndrome patients. Russian Journal of Cardiology. 2015;20(11):75-80. (In Russ.). http://dx.doi.org/10.15829/1560-4071-2015-11-75-80

41. Olesin AI, Litvinenko VA, Shalapakova AV, Konstantinova IV, Zhyeva YS. Antiarrhythmic drug therapy possibilities for primary prevention of atrial fibrillation in patients with metabolic syndrome and premature atrial contractions: a prospective study. Antiarrhythmic drug therapy possibilities for primary prevention of atrial fibrillation in patients with metabolic syndrome and premature atrial contractions: a prospective study. International Journal of Heart and Vascular Diseases. 2019;7(22):22-28. (In Russ.). http://doi:10.15829/2311-1623-7-22

42. Isakadze N, B P, B S, Patel R, Baer J, Isiadinso I, Alonso A, Lloyd M, Sperling L. Life's Simple 7 Approach to Atrial Fibrillation Prevention. J Atr Fibrillation. 2018;11(3):2051. https://doi.org/10.4022/jafib.2051

43. Wang W, Norby FL, Rooney MR, Zhang M, Gutierrez A, Garg P, Soliman EZ, Alonso A, Dudley SC Jr, Lutsey PL, Chen LY. Association of Life's Simple 7 with Atrial Fibrillation Burden (From the Atherosclerosis Risk in Communities Study). Am J Cardiol. 2020;137:31-38. https://doi.org/10.1016/j.amjcard.2020.09.033

44. Vyas V, Lambiase P. Obesity and Atrial Fibrillation: Epidemiology, Pathophysiology and Novel Therapeutic Opportunities. Arrhythm Electrophysiol Rev. 2019;8(1):28-36. https://doi.org/10.15420/aer.2018.76.2

45. Zheng Y, Xie Z, Li J, Chen C, Cai W, Dong Y, Xue R, Liu C. Metaanalysis of metabolic syndrome and its individual components with risk of atrial fibrillation in different populations. BMC Cardiovasc Disord. 2021;21(1):90. https://doi.org/10.1186/s12872-021-01858-1

46. Jamaly S, Carlsson L, Peltonen M, Jacobson P, Sjöström L, Karason K. Bariatric Surgery and the Risk of New-Onset Atrial Fibrillation in Swedish Obese Subjects. J Am Coll Cardiol. 2016;68(23):2497-2504. https://doi.org/10.1016/j.jacc.2016.09.940

47. Meng X, Xu X. What Is the Ideal Blood Pressure Treatment Target for Primary Prevention and Management of Atrial Fibrillation? Front Cardiovasc Med. 2020;7:586183. https://doi.org/10.3389/fcvm.2020.586183

48. De Vecchis R, Paccone A, Di Maio M. Upstream Therapy for Atrial Fibrillation Prevention: The Role of Sacubitril/Valsartan. Cardiol Res. 2020;11(4):213-218. https://doi.org/10.14740/cr1073

49. Fang WT, Li HJ, Zhang H, Jiang S. The role of statin therapy in the prevention of atrial fibrillation: a meta-analysis of randomized controlled trials. Br J Clin Pharmacol. 2012;74(5):744-756. https://doi. org/10.1111/j.1365-2125.2012.04258.x

50. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC Jr, Virani SS, Williams KA Sr, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. https://doi.org/10.1161/CIR.0000000000000678

51. Golub IV. Physiological Mechanisms of the Effect of Modulated Kinesotherapy on the Circulatory System. Fiziologiya cheloveka. 2002;28(6):119-126 (In Russ.). https://doi.org/10.1023/A:1021172927503

52. Larsen JR, Dima L, Correll CU, Manu P. The pharmacological management of metabolic syndrome. Expert Rev Clin Pharmacol. 2018;11(4):397-410. http://doi:10.1080/17512433.2018.1429910

53. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. J Clin Sleep Med. 2019;15(2):301-334. https://doi.org/10.5664/jcsm.7638

54. O'Neal WT, Kamel H, Judd SE, Safford MM, Vaccarino V, Howard VJ, Howard G, Soliman EZ. Usefulness of Atrial Premature Complexes on Routine Electrocardiogram to Determine the Risk of Atrial Fibrillation (from the REGARDS Study). Am J Cardiol. 2017;120(5):782-785. https://doi.org/10.1016/j.amjcard.2017.06.007

55. Menezes AR, Lavie CJ, DiNicolantonio JJ, O'Keefe J, Morin DP, Khatib S, Milani RV. Atrial fibrillation in the 21st century: a current understanding of risk factors and primary prevention strategies. Mayo Clin Proc. 2013;88(4):394-409. https://doi.org/10.1016/j.mayocp.2013.01.02

56. Martin K, Beyer-Westendorf J, Davidson BL, Huisman MV, Sandset PM, Moll S. Use of the direct oral anticoagulants in obese patients: guidance from the SSC of the ISTH. J Thromb Haemost. 2016;14(6):1308-1313. https://doi.org/10.1111/jth.13323


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Olesin A.I., Konstantinova I.V. Primary prevention of atrial fibrillation in patients with metabolic syndrome: correction of modifiable risk factors. Fundamental and Clinical Medicine. 2021;6(2):103-115. (In Russ.) https://doi.org/10.23946/2500-0764-2020-6-2-103-115

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