Insulin-Requiring Versus Noninsulin-Requiring Diabetes and Thromboembolic Risk in Patients With Atrial Fibrillation: PREFER in AF
Jazyk angličtina Země Spojené státy americké Médium print
Typ dokumentu časopisecké články
Grantová podpora
FS/13/43/30324
British Heart Foundation - United Kingdom
PubMed
28126158
DOI
10.1016/j.jacc.2016.10.069
PII: S0735-1097(16)37123-6
Knihovny.cz E-zdroje
- Klíčová slova
- CHA(2)DS(2)-VASc score, registry, risk prediction, stroke, systemic embolism,
- MeSH
- diabetes mellitus 1. typu komplikace MeSH
- fibrilace síní MeSH
- inzulin terapeutické užití MeSH
- komplikace diabetu * MeSH
- lidé MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- tromboembolie etiologie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- inzulin MeSH
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.
Cardiology and Arrhythmology Georges Pompidou Hospital René Descartes University Paris France
Daiichi Sankyo Europe Munich Germany
Daiichi Sankyo Italy Rome Italy
Department of Cardiology University Hospital Ramòn y Cajal Madrid Spain
Department of Cardiovascular Sciences Campus Bio Medico University of Rome Rome Italy
G d'Annunzio University of Chieti Chieti Italy
G d'Annunzio University of Chieti Chieti Italy; Fondazione G Monasterio Pisa Italy
Institute of Informatics Academy of Sciences of Czech Republic Prague Czech Republic
Citace poskytuje Crossref.org
