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J Am Coll Cardiol. 2017 Jan 31;69(4):409-419. doi: 10.1016/j.jacc.2016.10.069.

Insulin-Requiring Versus Noninsulin-Requiring Diabetes and Thromboembolic Risk in Patients With Atrial Fibrillation: PREFER in AF.

Author information

1
Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy. Electronic address: g.patti@unicampus.it.
2
Daiichi-Sankyo Europe, Munich, Germany.
3
Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
4
G. d'Annunzio University of Chieti, Chieti, Italy.
5
Institute of Informatics, Academy of Sciences of Czech Republic, Prague, Czech Republic.
6
Daiichi-Sankyo Italy, Rome, Italy.
7
Cardiology and Arrhythmology, Georges Pompidou Hospital, René Descartes University, Paris, France.
8
Department of Cardiology, University Hospital Ramòn y Cajal, Madrid, Spain.
9
Institute of Cardiovascular Sciences, University of Birmingham and Sandwell and West Birmingham Hospitals and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom; Hospital of the University of Münster, Münster, Germany.
10
G. d'Annunzio University of Chieti, Chieti, Italy; Fondazione G. Monasterio, Pisa, Italy. Electronic address: rdecater@unich.it.

Abstract

BACKGROUND:

Diabetes is a known risk predictor for thromboembolic events in patients with atrial fibrillation (AF), but no study has explored the prognostic weight of insulin in this setting.

OBJECTIVES:

This study evaluated the differential role of insulin versus no insulin therapy on thromboembolic risk in patients with diabetes and AF.

METHODS:

We accessed individual patient data from the prospective, real-world, multicenter, PREFER in AF (European Prevention of thromboembolic events-European Registry in Atrial Fibrillation). We compared the rates of stroke/systemic embolism at 1 year according to diabetes status (no diabetes, diabetes without insulin therapy, diabetes on insulin therapy).

RESULTS:

In an overall population of 5,717 patients, 1,288 had diabetes, 22.4% of whom were on insulin. For patients with diabetes who were on insulin, there was a significantly increased risk of stroke/systemic embolism at 1 year versus either no diabetes (5.2% vs. 1.9%; hazard ratio: 2.89; 95% confidence interval: 1.67 to 5.02; p = 0.0002) or diabetes without insulin treatment (5.2% vs. 1.8%; hazard ratio: 2.96; 95% confidence interval: 1.49 to 5.87; p = 0.0019). Notably, rates of stroke/embolism were similar in patients with diabetes not receiving insulin versus patients without diabetes (hazard ratio: 0.97; 95% confidence interval: 0.58 to 1.61; p = 0.90). The selective predictive role of insulin-requiring diabetes was independent of potential confounders, including diabetes duration, and was maintained in various subpopulations, including the subgroup receiving anticoagulant therapy.

CONCLUSIONS:

In this cohort of anticoagulated patients with AF, the sole presence of diabetes not requiring insulin did not imply an increased thromboembolic risk. Conversely, insulin-requiring diabetes contributed most, if not exclusively, to the overall increase of thromboembolic risk in AF.

KEYWORDS:

CHA(2)DS(2)-VASc score; registry; risk prediction; stroke; systemic embolism

PMID:
28126158
DOI:
10.1016/j.jacc.2016.10.069
[Indexed for MEDLINE]
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