Introduction: Atrial fibrillation (AFib) is one of the ma-jor causes of cardiovascular death worldwide causing stroke, heart failure and sudden cardiac death. Moreo-ver, cardiovascular risk factors like arterial hypertensi-on and type 2 diabetes mellitus (DM) are comorbidities commonly associated with atrial fibrillation and may determine coronary artery disease and stroke.
Objective: To evaluate lipid and glycemic control by reporting LDL cholesterol and glycated hemoglobin in a cohort of patients with type 2 diabetes mellitus and arterial hypertension with or without atrial fibrillation. Methods: We performed a retrospective analysis span-ning over two years – from January 2016 to February 2017 – on patients admitted to our hospital. Data was collected from a total of 1078 patients (40.6% men and 59.4% women) with concurrent arterial hypertension and type 2 DM, out of whom 29.4% also had atrial fi-brillation. Laboratory tests including lipid profile (cho-lesterol and its fractions: LDL cholesterol and HDL cholesterol) and glycemic control (fasting glucose and glycated hemoglobin) were taken into account. All pa-tients were over the age of 40 and had very high car-diovascular risk based on the association of DM and arterial hypertension. Thus, for this particular group of patients, the glycemic and lipid targets that should be aimed for are a HbA1c under 7% and LDL cholesterol (LDL c) under 70 mg/dl.
Results: The mean participant age was 69.0 years±9.88 years, with a slightly older population in the AFib group – mean age of 73.1 years±8.7 years as oppo-sed to 67.3 years±9.9 years in those without atrial fi-brillation, p<0.001. Better control of glycemic values was recorded in patients with atrial fibrillation both in terms of fasting blood glucose – average glycemia of 133.1 mg/dl±60.4 mg/dl (p=0.008) – and HbA1c of 6.8%±1.6% (p<0.001) versus 145.6 mg/dl±74.8 mg/ dl and 7.4%±1.7% respectively in those without AFib. Under a third of atrial fibrillation patients had glycated hemoglobin values under 7%. Moreover, atrial fibrilla-tion patients proved to have better serum LDL-c with an average LDL-c of 67.2±27.1 mg/dl versus 81.0±30.2 mg/dl, p<0.001. However, only 38.4% of atrial fibrillati-on patients achieved LDL-c values under 7%.
Conclusions: Diabetes mellitus, arterial hypertension and dyslipidemia constitute risk factors for coronary artery and cerebrovascular disease, by promoting athe-rogenesis while atrial fibrillation, even when adequa-tely treated with anticoagulant drugs, may give rise to cardio-embolic stroke. Thusly, patients diagnosed with atrial fibrillation should maintain tighter control of car-diovascular risk factors. However, the current analysis showed that inadequate lipid and glycemic control is achieved in patients with atrial fibrillation, though re-sults are superior to those obtained from the general population.