Metabolic Syndrome: A Strange Companion of Atrial Fibrillation; A Blessing in Disguise from the Neuropsychiatric Point of View

Background: The concept of metabolic syndrome (MetSy) brings together components that individually represent a risk factor for cardiovascular diseases, which over time can prove to be more harmful if a combined effect of these is exhibited. Method: A single-centre retrospective study in an academic medical unit was conducted. We analysed the link between the MetSy and the occurrence of neuropsychic complications among atrial fibrillation (AF) patients. We sifted through the files of the patients admitted during 2015–2016 to the Municipal Emergency University Hospital Timisoara, Romania, with the diagnosis of AF. We divided these AF patients into two groups: the first group comprised patients with atrial fibrillation and MetSy (267 patients), while the second group comprised AF patients without MetSy (843 patients). We analysed the occurrence of neuropsychic changes (stroke, Parkinson’s disease, dementia, cognitive impairment, and silent lacunar infarction) among the two groups. Results: Cognitive impairment (p-value = 0.0081) and dementia (p-value < 0.0001) were less frequent in patients with AF and MetSy than in those with AF without MetSy. Regarding the presence of stroke and Parkinson’s disease (PD), we could not demonstrate the existence of any statistically significant difference between the two groups. Using logistic regression (enter test), we found that MetSy might have a protective effect (OR = 0.4040, 95% CI [0.2132; 0.7654], p-value = 0.0054) for the occurrence of dementia in those patients. Furthermore, obesity was the only factor with a possible protective effect from all the constituents of the MetSy when analysed together (with a significance level of p-value = 0.0004 for the logistic regression). The protective effect of MetSy against stroke occurrence was supplementarily proven by a longer period of survival without stroke from the AF diagnosis (3.521 years, p = 0.0304) compared to patients with AF without MetSy (3.286 years to first stroke occurrence). Conclusions: Metabolic syndrome might offer protection against the occurrence of dementia among patients with AF, but no effect was noted when compared with the presence of stroke. Further studies on larger cohorts can help us reach a conclusion regarding the positive effects of the metabolic syndrome.

[1]  T. Benfield,et al.  Circulating Adiponectin Levels Are Inversely Associated with Mortality and Respiratory Failure in Patients Hospitalized with COVID-19 , 2023, International journal of endocrinology.

[2]  Klaus P. Ebmeier,et al.  Association of gout with brain reserve and vulnerability to neurodegenerative disease , 2022, medRxiv.

[3]  K. Tsilidis,et al.  Metabolic syndrome and cognition: A systematic review across cognitive domains and a bibliometric analysis , 2022, Frontiers in Psychology.

[4]  A. Ducharme,et al.  Atrial Electrical Remodeling in Mice With Cardiac‐Specific Overexpression of Angiotensin II Type 1 Receptor , 2022, Journal of the American Heart Association.

[5]  Leonida Gherasim Md PhD PhD,et al.  Association of Atrial Fibrillation with Diabetes Mellitus, High Risk Comorbidities. , 2022, Maedica.

[6]  M. Bała,et al.  The role of glucose in cognition, risk of dementia, and related biomarkers in individuals without type 2 diabetes mellitus or the metabolic syndrome: A systematic review of observational studies , 2022, Neuroscience & Biobehavioral Reviews.

[7]  J. Luchsinger,et al.  Metabolic Syndrome and Cognitive Function , 2021, Current Cardiology Reports.

[8]  Meng Wang,et al.  Association between adiponectin‐to‐leptin ratio and heart rate variability in new‐onset paroxysmal atrial fibrillation: A retrospective cohort study , 2021, Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc.

[9]  Chiadi E. Ndumele,et al.  Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association , 2021, Circulation.

[10]  E. Roselló-Lletí,et al.  Adipokines and Inflammation: Focus on Cardiovascular Diseases , 2020, International journal of molecular sciences.

[11]  G. Mancia,et al.  Hyperuricaemia and gout in cardiovascular, metabolic and kidney disease. , 2020, European journal of internal medicine.

[12]  S. Whitehead,et al.  White matter inflammation and cognitive function in a co-morbid metabolic syndrome and prodromal Alzheimer’s disease rat model , 2020, Journal of Neuroinflammation.

[13]  P. Whelton,et al.  High Blood Pressure and Cardiovascular Disease , 2019, Hypertension.

[14]  Y. Uspensky,et al.  Pathogenetic pathways of cognitive dysfunction and dementia in metabolic syndrome. , 2019, Life sciences.

[15]  S. Black,et al.  Preventing dementia by preventing stroke: The Berlin Manifesto , 2019, Alzheimer's & Dementia.

[16]  Ming-Hsiu Wu Adiponectin: a pivotal role in the protection against cerebral ischemic injury , 2019, Neuroimmunology and Neuroinflammation.

[17]  S. Liatis,et al.  Obesity and cardiovascular disease: revisiting an old relationship. , 2019, Metabolism: clinical and experimental.

[18]  V. Trischitta,et al.  The Adiponectin Paradox for All-Cause and Cardiovascular Mortality , 2017, Diabetes.

[19]  A. Pandey,et al.  Obesity and Atrial Fibrillation Prevalence, Pathogenesis, and Prognosis: Effects of Weight Loss and Exercise. , 2017, Journal of the American College of Cardiology.

[20]  A. Dominiczak,et al.  Allopurinol and Cardiovascular Outcomes in Adults With Hypertension , 2016, Hypertension.

[21]  S. Sharma,et al.  Lowering Uric Acid With Allopurinol Improves Insulin Resistance and Systemic Inflammation in Asymptomatic Hyperuricemia , 2015, Journal of Investigative Medicine.

[22]  G. Lip,et al.  Metabolic syndrome, atrial fibrillation, and stroke: Tackling an emerging epidemic. , 2015, Heart rhythm.

[23]  R. Mahajan,et al.  The implications of obesity for cardiac arrhythmia mechanisms and management. , 2015, The Canadian journal of cardiology.

[24]  Moyses Szklo,et al.  Blood Lipids and the Incidence of Atrial Fibrillation: The Multi‐Ethnic Study of Atherosclerosis and the Framingham Heart Study , 2014, Journal of the American Heart Association.

[25]  C. Murray,et al.  Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study , 2014, Circulation.

[26]  J. Yue,et al.  Cross-sectional study examining the association between metabolic syndrome and cognitive function among the oldest old. , 2013, Journal of the American Medical Directors Association.

[27]  Tong Liu,et al.  Renin-angiotensin system inhibition is associated with reduced risk of left atrial appendage thrombosis formation in patients with atrial fibrillation. , 2013, Cardiology journal.

[28]  M. Böhm,et al.  Prevention of Atrial Fibrillation by Renin-Angiotensin System Inhibition , 2010 .

[29]  Paul L. Huang A comprehensive definition for metabolic syndrome , 2009, Disease Models & Mechanisms.

[30]  M. Kivipelto,et al.  Metabolic Syndrome and Cognitive Function: A Population-Based Follow-Up Study in Elderly Women , 2006, Dementia and Geriatric Cognitive Disorders.

[31]  V. Abedi,et al.  Obesity and mortality after the first ischemic stroke: Is obesity paradox real? , 2021, PloS one.

[32]  S. Suzuki "Cholesterol paradox" in atrial fibrillation. , 2011, Circulation journal : official journal of the Japanese Circulation Society.