Clinical implications of the interaction between metabolic risk factors, coronary artery disease and atrial fibrillation

Atrial fibrillation (AF) and coronary artery disease (CAD) frequently coexist due to shared risk factors such as obesity and diabetes. The interrelationship between these diseases carries important therapeutic implications, given the fact that both AF and CAD are associated with an increased risk for cardiovascular events such as stroke, myocardial infarction, heart failure and cardiovascular mortality. In this review, we elucidate our current understanding of the epidemiological and pathophysiological links between AF and CAD, with particular focus on the impact of obesity, diabetes and systemic inflammation as common drivers. We discuss the implications for patient management, including antithrombotic therapy, lifestyle modifications and metabolic risk reduction. Beyond antithrombotic therapy, we highlight the importance of rate and rhythm control strategies in case of coexisting of AF and CAD. Novel pharmacological approaches for patients with CAD and type 2 diabetes, such as GLP-1 receptor agonist and SGLT2 inhibitors, provide additional cardiometabolic benefits by reducing the risk of major adverse cardiovascular events. Finally we propose a framework for integrated management of AF and CAD that aligns with contemporary guidelines and emerging evidence. This holistic approach, including metabolic risk factor modification, represents a paradigm shift in the care of patients with both AF and CAD.