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Review
. 2019 Jul 15:287:162-173.
doi: 10.1016/j.ijcard.2018.11.123. Epub 2018 Nov 30.

The imminent epidemic of atrial fibrillation and its concomitant diseases - Myocardial infarction and heart failure - A cause for concern

Christin S Börschel  1 , Renate B Schnabel  2
Affiliations
Review

The imminent epidemic of atrial fibrillation and its concomitant diseases - Myocardial infarction and heart failure - A cause for concern

Christin S Börschel et al. Int J Cardiol. .

Abstract

Atrial fibrillation (AF) is increasingly common in the general population. It often coincides with myocardial infarction (MI) and heart failure (HF) which are also diseases in older adults. All three conditions share common cardiovascular risk factors. While hypertension and obesity are central risk factors for all three diseases, smoking and diabetes appear to have less impact on AF. To date, age is the single most important risk factor for AF in the general population. Further, epidemiological studies suggest a strong association of AF to MI and HF. The underlying pathophysiological mechanisms are complex and not fully understood. Both MI and HF can trigger development of AF, mainly by promoting structural and electrical atrial remodeling. On the other hand, AF facilitates HF and MI development via multiple mechanisms, resulting in a vicious circle of cardiac impairment and adverse cardiovascular prognosis. Consequently, to prevent and treat the coincidence of AF and HF or MI a strict optimization of cardiovascular risk factors is required.

Keywords: Atrial fibrillation; Cardiovascular risk factors; Epidemiology; Heart failure; Myocardial infarction; Population-attributable risk.

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Figures

Fig. 1
Fig. 1
Population-attributable risk of classical cardiovascular risk factors for atrial fibrillation (AF), myocardial infarction (MI) and heart failure (HF) in community studies [4,13,30].
Fig. 2
Fig. 2
Possible pathophysiologic interactions of cardiovascular risk factors in atrial fibrillation (AF), myocardial infarction (MI) and heart failure (HF). Incidence of AF, MI and HF has been related to classical cardiovascular risk factors. These risk factors generate a pro- inflammatory environment and fibrosis which are a common basis of all three diseases. Furthermore, there are disease specific changes that increase the susceptibility for AF, MI or HF. While AF facilitates development of MI and HF, both also result in an increased risk of AF. Their co-occurrence leads to progressive cardiac impairment and an adverse cardiovascular prognosis.
See this image and copyright information in PMC

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