Should atrial fibrillation be considered a vascular disease? The need for a comprehensive vascular approach

Expert Rev Cardiovasc Ther. 2023 Jul-Dec;21(11):779-790. doi: 10.1080/14779072.2023.2272652. Epub 2023 Dec 10.


Introduction: Atrial fibrillation (AF) cannot be considered an isolated disease. Patients with AF should be managed using a comprehensive approach that is not limited to stroke prevention.

Areas covered: In this manuscript, the potential role of AF as a vascular disease that is managed as part of a holistic approach was reviewed.

Expert opinion: The residual risk of stroke in patients with AF reaches 1-2% annually, despite appropriate anticoagulation therapy. Additionally, patients with AF may develop cognitive impairment through stroke-independent pathways. Furthermore, patients with AF may have a higher risk of developing atherosclerotic vascular disease in various vascular beds and chronic kidney disease; conversely, patients with atherosclerotic disease may have an increased risk of developing AF. AF should be considered a truly systemic vascular disease, since it brings together several hemodynamic and systemic changes, including inflammation, oxidative stress, activation of the renin-angiotensin-aldosterone and sympathetic systems, as well as a prothrombotic state and endothelial dysfunction. In this regard, patients with AF should be treated based on a holistic approach that is not limited to oral anticoagulation but includes complete vascular protection.

Keywords: Atherosclerosis; atrial fibrillation; chronic kidney disease; coronary artery disease; diabetes; peripheral artery disease; vascular disease.

MeSH terms

  • Anticoagulants / therapeutic use
  • Atherosclerosis* / complications
  • Atrial Fibrillation* / complications
  • Humans
  • Risk Factors
  • Stroke* / etiology
  • Stroke* / prevention & control


  • Anticoagulants