Prediabetes and atrial fibrillation risk stratification, phenotyping, and possible reversal to normoglycemia

Abstract

Patients admitted with prediabetes and atrial fibrillation are at high risk for major adverse cardiac or cerebrovascular events independent of confounding variables. The shared pathophysiology between these three serious but common diseases and their association with atherosclerotic cardiovascular risk factors establish a vicious circle culminating in high atherogenicity. Because of that, it is of paramount importance to perform risk stratification of patients with prediabetes to define phenotypes that benefit from various interventions. Furthermore, stress hyperglycemia assessment of hospitalized patients and consensus on the definition of prediabetes is vital. The roles lifestyle and metformin play in prediabetes are well established. However, the role of glucagon-like peptide agonists and metabolic surgery is less clear. Prediabetes is considered an intermediate between normoglycemia and diabetes along the blood glucose continuum. One billion people are expected to suffer from prediabetes by the year 2045. Therefore, real-world randomized controlled trials to assess major adverse cardiac or cerebrovascular event risk reduction and reversal/prevention of type 2 diabetes among patients are needed to determine the proper interventions.

Keywords: Major adverse cardiac or cerebrovascular event; Prediabetes; Risk stratification; Phenotype; Stress hyperglycemia; Reversal to normoglycemia

Core Tip: Patients admitted with prediabetes and atrial fibrillation are at high risk of major adverse cardiac or cerebrovascular events independent of confounding variables, as shown by Desai et al. The shared pathophysiology between the three serious and common diseases establish a vicious circle, culminating in high atherogenicity. In another study, Batta and Hatwal raised important points regarding risk stratification, timeline the role of metformin use among patients with prediabetes, and the impact of reversion of prediabetes to normoglycemia on major adverse cardiac or cerebrovascular events. We congratulate Desai et al for their valuable results and Batta and Hatwal for their insights and future directions. We believe and support the above. However, the studies approached inpatients retrospectively. Another important issue that can influence diabetes outcomes is stress hyperglycemia. Here, we give broader insight into proper interventions to reduce the risk of major adverse cardiac or cerebrovascular events in particular glucagon-like peptide-1 agonists, sodium-glucose cotransporters-2 inhibitors, and bariatric surgery.