Clinicians should consider screening for asymptomatic (subclinical or silent) AF in type 2 diabetes patients in light of new research showing that this underlying condition is relatively more common and significantly increases the risk of stroke in such patients.
In a cohort of 464 patients with type 2 diabetes, the prevalence of cerebral infarcts (as detected by MRI) was significantly higher in patients with asymptomatic compared with those without asymptomatic AF (61 percent vs 29 percent, respectively). Similarly, stroke events were significantly higher in patients with asymptomatic AF (17.3 percent vs 5.9 percent, respectively; p<0.01).
The researchers matched the diabetic patients to 240 healthy controls. Patients were screened for episodes of asymptomatic AF at 3, 6, 9 and 12 months and then yearly for another 3 years using a 48-hour Holter monitor. The mean age of the patients was 52. Those with symptomatic AF at baseline were excluded from the study.
After a mean follow-up of 3 years, they found that patients with diabetes were more likely to develop asymptomatic AF than healthy controls (11 percent vs 1.6 percent, respectively; p<0.001). Overall, 27 diabetics with asymptomatic AF developed ischemic stroke compared with 16 without asymptomatic AF. By contrast, rates of cerebral infarct and stroke were lower (1.5 percent and 0.5 percent, respectively) in the control group.
The authors said the data indicate that brief episodes of asymptomatic AF are frequent in diabetics. The 11 percent incidence of AF in the study may even be an underestimation given that monitoring was done intermittently. “On the basis of these data, we cannot establish a temporal link between silent AF and cerebrovascular disease. The silent cerebral infarcts are probably due to similar AF that occurred in patients with silent AF before this study.” [Source]