Diabetes + abnormal heart rhythm = higher heart disease risk
Diabetics who have atrial fibrillation (abnormal heart rhythm) have a stronger chance of succumbing to other heart-related problems and death, new research shows. The results from the ADVANCE[2] study, conducted by an international group of scientists, were recently published in the European Heart Journal. The scientists assessed 11,140 patients with type 2 diabetes. When those who had atrial fibrillation (AF) at the start of the trial were compared with the diabetic patients without atrial fibrillation, the team discovered that they had a 61% increased risk of dying from any cause, a 68% increased risk of developing heart failure or other cerebrovascular troubles, and a 77% increased risk of dying from cardiovascular incidences like stroke. But what the scientists also found was that if the diabetic AF patients were given more aggressive treatments, they ran a lower risk of dying or developing any of these complications. For the ADVANCE[2] study, the patients were given a combination of blood pressure lowering drugs like indapamide. Diabetic patients without AF were given the same treatment and a lower risk of mortality or developing any complication was reported. 'Active treatment produced similar relative benefits to patients with and without AF,' explained Professor Anushka Patel, head of the Cardiovascular Division at The George Institute for International Health of the University of Sydney in Australia. 'However, because of their higher risk at the start of the study, the absolute benefit associated with active treatment was greater in patients with AF than without. We estimate that 5 years of active treatment would prevent 1 death among every 42 patients with AF and 1 death among every 120 patients without AF.' Professor Patel, who led the study, underlined that a number of factors such as age and other health problems influence the prevalence of AF. 'It ranges between 4% in primary care settings to 15% in hospitalised patients,' she said. 'In our study, 847 (7.6%) of the 11,140 patients had AF at baseline and a further 352 patients developed AF over an average follow-up of 4.3 years.' For this population, the overall prevalence reached 11%. Past studies have shown that the prevalence of AF in diabetics is double compared to non-diabetics. According to Professor Patel, the number of diabetic patients will reach 380 million by 2025. 'We might expect that about 40 million of these will also have AF,' she explained, adding: 'The study findings have direct implications for a large number of individuals globally.' The scientists also discovered a strong link between AF and deaths from cardiovascular disease in women compared with men. Women with AF were twice as likely to die compared with women without AF, and men with AF were 50% more likely to die than men without AF. Studies have shown that healthy women have a lower risk of death from heart disease versus men of a similar age. Is AF frequently detected in diabetics? According to Professor Patel, it's not. 'The current analysis highlights the importance of actively evaluating diabetic patients for the presence of AF, to identify those at particularly high risk of cardiovascular events,' the study's leader said. 'Routine administration of blood pressure-lowering treatment, as well as greater use of antiplatelet or anticoagulant agents and statins, may be expected to reduce the incidence of a broad range of adverse outcomes in these patients.' The scientists postulate that this latest research will have significant implications for the management of diabetics and for policy in this area.