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Brief Episodes of Silent Atrial Fibrillation Predict Clinical Vascular Brain Disease in Type 2 Diabetic Patients
Study Questions:
Do subclinical episodes of atrial fibrillation (AF) increase the risk of silent cerebral infarcts (SCIs) and stroke in diabetic patients?
Methods:
This was a longitudinal observational study of 464 patients with type 2 diabetes who were younger than 60 years (mean age 52 years) and had no history of AF, stroke, or transient ischemic attacks. Ninety-nine percent of patients were taking aspirin, 75-325 mg/day. Quarterly 48-hour ambulatory monitoring was performed and patients were followed for a mean of 37 months. Magnetic resonance imaging of the brain was performed to look for SCIs. Two hundred age- and gender-matched healthy subjects served as a control group.
Results:
Subclinical episodes of AF were observed significantly more often in the diabetic patients (11%) than in the control group (1.6%). Strokes during follow-up also were significantly more prevalent in the diabetic patients (43 events) than in the control group (0 events). Among the diabetic patients, SCIs were significantly more common in the patients with (61%) than without (29%) silent AF, as were strokes (17.3% vs. 5.9%, respectively). Silent AF in the diabetic patients was independently associated with a 4.4-fold higher risk of SCIs and a 4.6-fold higher risk of stroke.
Conclusions:
the authors concluded that clinically unrecognized AF is more common in diabetic patients than in healthy controls, and is an independent predictor of SCIs and stroke.
Perspective:
An important clinical implication of these results is that diabetic patients should be screened with 48-hour Holter monitors even if they do not have symptoms suggestive of an arrhythmia, and treated with an oral anticoagulant if episodes of AF are seen.
Keywords: Stroke, Cerebral Infarction, Diabetes Mellitus, Type 2, Atrial Fibrillation
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