https://orcid.org/0000-0002-6942-6312
Atrial fibrillation (AF) has gone from a boring disease to a very hot condition.1–9 Patients with AF have a higher risk of ischemic stroke or systemic embolism with a greater risk for female patients. In a paper from HongKong, the authors aimed to evaluate the risk of ischemic stroke or systemic embolism and bleeding following COVID-19 vaccination in patients with AF and the sex differences. They found that the risk of ischemic stroke or systemic embolism after COVID-19 vaccination was only increased in female patients with AF.
Atrial fibrillation has a recognized association with not only stroke, but also neurocognitive impairment and both vascular and Alzheimer's dementia. Effective management of AF can reduce the risk of such complications. In a narrative review article, Dr Lip and co-workers from UK discuss the pathophysiological links between AF and dementia, as well as the benefits of adherence to the guideline recommended ‘ABC’ Pathway.
In a paper from Korea, Dr Kim and co-workers sought to investigate the impact of statin therapy on dementia risk in AF patients receiving OAC. In the Korean National Health Insurance Service database, 91 018 non-valvular AF (NVAF) patients from January 2013 to December 2017 were included in the analysis. Of the total, 17 700 patients (19.4%) were in the statin therapy group, and 73 318 patients (80.6%) were in the non-statin therapy group. The primary endpoint was the occurrence of dementia. The median duration of follow-up was 2.1 years. Statin therapy was associated with a significantly lower dementia risk than non-statin therapy for CHA2DS2-VASc scores ≥2. The authors concluded that in NVAF patients who received OAC, statin therapy lowered the dementia risk compared with no statin therapy. Furthermore, statin therapy was associated with a dose-dependent reduction in dementia risk.
Evidence regarding the risks of serious hypoglycaemia for patients with AF and diabetes mellitus (DM) taking antidiabetic medications with concurrent nonvitamin K antagonist oral anticoagulants (NOACs) vs. warfarin is limited.10 In a paper from Taiwan, Dr Tu and co-workers aimed to investigate this knowledge gap. In a retrospective cohort study they used nationwide data from Taiwan's National Health Insurance Research Database and including a total of 56 774 adult patients treated with antidiabetic medications and oral anticoagulants. They report that compared to concurrent use of antidiabetic drugs with warfarin, those with NOACs showed a significantly lower risk of serious hypoglycaemia.
This paper is commented on in an editorial by Dr Lip and co-workers.
Sodium–glucose cotransporter-2 inhibitors (SGLT-2is) are antidiabetic drugs that have beneficial direct effects on the myocardium by impacting cardiac ion channels and exchangers that control cardiac electrophysiology.11–14 Dr Eroglu and co-workers investigated the relationship between SGLT-2is in comparison to glucagon-like peptide-1 receptor agonists (GLP1as) and out-of-hospital cardiac arrest (OHCA) in individuals with type 2 diabetes. They used data from Danish registries and conducted a nationwide nested case-control study in a cohort of individuals with type 2 diabetes between 2013 and 2019. The authors concluded that use of SGLT-2i was associated with a reduced risk of OHCA compared with use of GLPPowered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation 1a in type 2 diabetes.
While SGLT2i improves clinical outcomes in patients with heart failure (HF), there is limited evidence of SGLT2i use on early-phase acute coronary syndrome (ACS). In a study from Japan, Dr Iwanaga et al. aimed to determine the association of early SGLT2i use compared with either non-SGLT2i or dipeptidyl peptidase 4 inhibitor (DPP4i) in hospitalized patients with ACS. In a retrospective cohort study that used the Japanese nationwide administrative claims database included patients hospitalized with ACS. Among 388 185 patients included, 115 612 and 272 573 with and without severe HF, respectively. The authors reported that SGLT2i use in patients with early-phase ACS showed a lower risk of primary outcome in patients with severe HF but the effect was not apparent in patients without severe HF.
Studies have found an increased risk of myocardial infarction (MI) in association with some non-steroidal anti-inflammatory drugs (NSAIDs).16 They found that initiators of high- and low-dose diclofenac had comparable increased cardiovascular risks. This finding provides evidence against the assumption that low-dose diclofenac is risk-neutral.
At last we are happy to present a review entitled ‘Antithrombotic treatment strategies in patients with established coronary atherosclerotic disease’ by Marco Valgimigli et al. The aim of the authors was to reach comprehensiveness of available evidence. They systematically reviewed and performed meta-analyses by means of both direct and indirect comparisons to inform the present consensus document.
