The factors incorporated in the CHA2DS2-VASc scoring system damage LA function through several mechanisms such as fibrosis, insulin resistance, oxidative stress in patients with diabetes [42], fibrosis in aging [43], hypertension [44], estrogen effect in postmenopausal women [45], neurohormonal activation in heart failure [46], renin–angiotensin–aldosterone system activation in patients with myocardial infarction [47], and occult AF in patients with stroke [48]. Here, INS is linked to atrial fibrillation.