title: Metabolic syndrome, atrial fibrillation, and stroke: Tackling an emerging epidemic.
abstract: The prevalence of atrial fibrillation (AF) and AF-related stroke is set to increase dramatically in coming decades, with developing regions such as Latin America experiencing the greatest impact. These trends are primarily driven by aging populations and by the increasing prevalence of the metabolic syndrome. The metabolic syndrome describes an association between diabetes, hypertension, obesity, and dyslipidemia and an increased risk of cardiovascular disease. It is in large part the result of unbalanced diet and sedentary lifestyle. These essentially modifiable risk factors are becoming more prevalent with the widespread adoption of so-called Western lifestyles. This review examines the physiology underlying the link between the metabolic syndrome and AF. Next, it highlights the importance of addressing lifestyle-related risk factors to mitigate the trend toward increasing AF prevalence. It then goes on to discuss the importance of stroke prevention therapy in patients with established AF, focusing on the relative merits of various available options for anticoagulation. Given the recent availability of comprehensive data on the 4 currently available non-vitamin K antagonist oral anticoagulant drugs, this review concludes by discussing the relative merits of specific agents in individual patient groups.
authors.affiliation: British Heart Foundation Centre of Cardiovascular Excellence, St. Thomas' Hospital, London, United Kingdom. Electronic address: reza.hajhosseiny@kcl.ac.uk.
authors.forename: Reza
authors.initials: R
authors.lastname: Hajhosseiny
authors.affiliation: Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Gareth K
authors.initials: GK
authors.lastname: Matthews
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom,; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D008875:Middle Aged; D020380:Needs Assessment; D015995:Prevalence; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Atrial fibrillation; Metabolic syndrome; NOACs; Stroke; Warfarin