Key result
A combination of early rhythm control and healthy lifestyle modification was associated with a 42% lower risk of ischemic stroke (HR 0.58) compared to neither strategy in patients with concurrent atrial fibrillation and type 2 diabetes.
Why the study?
Patients with concurrent AF and diabetes mellitus have a high risk of complications but are less engaged in comprehensive treatment, leaving the impact of early rhythm control combined with lifestyle modification unclear.
Does the combination of early rhythm control and healthy lifestyle modification reduce ischemic stroke and diabetes-related complications in patients with concurrent atrial fibrillation and type 2 diabetes mellitus?
Cohort (n=47,940)
Does the combination of early rhythm control and healthy lifestyle modification reduce ischemic stroke and diabetes-related complications in patients with concurrent atrial fibrillation and type 2 diabetes mellitus?
In patients with concurrent atrial fibrillation and type 2 diabetes, integrating early rhythm control with healthy lifestyle modifications synergistically reduces the risk of ischemic stroke and other cardiovascular complications.
Supports combined early rhythm control and lifestyle modification in AF with diabetes; hypothesis-generating pending RCT confirmation.
BACKGROUND: Patients with concurrent atrial fibrillation (AF) and diabetes mellitus (DM) [AF-DM] have a high risk of cardiovascular and diabetes-related complications, but are less engaged in a comprehensive treatment approach. We evaluated the association of early rhythm control (ERC), lifestyle modification (LSM), and a combination of ERC and LSM with cardiovascular or diabetes-related complication risk in patients with AF-DM (type 2). METHODS: From the National Health Information Database, 47,940 patients diagnosed with AF-DM in 2009-2016 were included. We defined ERC as rhythm control therapy within two years of AF diagnosis and LSM as adherence to ≥ 2 of the healthy behaviors among non-current smoking, non-drinking, and regular exercise. We compared the primary (ischemic stroke) and secondary (macro- and microvascular complications, glycemic emergency, and all-cause death) outcomes in four groups: non-ERC and non-LSM (group 1), LSM only (group 2), ERC only (group 3), and both ERC and LSM (group 4). RESULTS: Of total, 10,617 (22%), 26,730 (55.8%), 2,903 (6.1%), and 7,690 (16.0%) were classified into groups 1 to 4, in sequence. The mean duration from AF diagnosis to ERC was 25.6 ± 75.5 days. During 4.0 (interquartile range: 2.5-6.2) years' follow-up, groups 2 and 3 were associated with 23% and 33% lower risks of stroke than group 1, respectively. Group 4 was associated with the lowest risk of stroke: hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.51-0.67, p < 0.001. Regarding secondary outcomes, the lowest risks were also observed in group 4; macro- and microvascular complications, glycemic emergency, and all-cause death had HRs (95% CIs) of 0.63 (0.56-0.70), 0.88 (0.82-0.94), 0.72 (0.62-0.84), and 0.80 (0.73-0.87), respectively, all p < 0.001. CONCLUSIONS: For AF-DM patients, ERC and LSM exert a synergistic effect in preventing cardiovascular and diabetes-related complications with the greatest lowered risk of stroke. A comprehensive treatment approach should be pursued in AF-DM patients.
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Lee et al. (2023) conducted a cohort in Concurrent atrial fibrillation and type 2 diabetes mellitus (n=47,940). Combination of early rhythm control and lifestyle modification vs. No early rhythm control and no lifestyle modification was evaluated on Ischemic stroke (HR 0.58, 95% CI 0.51-0.67, p=<0.001). A combination of early rhythm control and healthy lifestyle modification was associated with a 42% lower risk of ischemic stroke (HR 0.58) compared to neither strategy in patients with concurrent atrial fibrillation and type 2 diabetes.
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