The Metabolic Syndrome, Atrial Fibrillation, and Stroke: Tackling An Emerging Epidemic

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 metabolic syndrome. Metabolic syndrome describes an association between diabetes, hypertension, obesity, dyslipidaemia 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 metabolic syndrome and AF. Next it highlights the importance of addressing lifestyle-related risk factors to mitigate the trend towards 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 the various available options for anticoagulation. Given the recent availability of comprehensive data around the four currently available non-vitamin K antagonist oral anticoagulant drugs (NOACs), it concludes by discussing the relative merits of specific agents in individual patient groups.