Atrial fibrillation susceptibility in metabolic syndrome: Simply the sum of its parts?

The report by Watanabe et al in this issue of Circulation provides support for the view that MS increases susceptibility to AF. Whether the increased AF risk in MS patients is due to the syndrome as a whole or simply the sum of the risks of its individual component parts is perhaps not unequivocally settled. Nevertheless, the observations of Watanabe et al, in conjunction with the disturbingly high prevalence of MS in the general population (≈20% in the United States), highlight an underappreciated but important adverse MS health risk, namely increased AF susceptibility. Furthermore, given the mounting evidence, it seems increasingly clear that physicians must, in their AF prevention and treatment strategies, focus aggressively on addressing blood pressure control, diabetes and glucose intolerance management, weight reduction, and the recognition and treatment of obstructive sleep apnea.