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Stroke risk higher with AF, insulin-requiring diabetes vs. without insulin
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In a recently published analysis, patients with atrial fibrillation and insulin-requiring diabetes showed an increased thromboembolic risk, whereas patients with AF and diabetes not requiring insulin had a similar risk to those with atrial fibrillation and no diabetes.
Giuseppe Patti, MD, from the department of cardiovascular sciences, Campus Bio-Medico University of Rome, and colleagues conducted a study to evaluate thromboembolic risk in patients with diabetes and AF comparing patients requiring insulin with those who did not require insulin therapy.
The researchers examined patient data from the prospective, real-world, multicenter PREFER in AF registry. Rates of stroke or systemic embolism at 1 year were compared between patients with various diabetes statuses: patients without diabetes; patients with diabetes not prescribed insulin therapy; and patients with diabetes prescribed insulin therapy.
A total of 5,717 patients were included in the evaluation. All patients had AF. Of those, 1,288 had diabetes. Among the patients with diabetes, 22.4% were prescribed insulin therapy.
According to the researchers, there was a significant increase in the risk for stroke or systemic embolism at 1 year in patients with diabetes who were on insulin vs. patients with no diabetes (5.2% vs. 1.9%; HR = 2.89; 95% CI, 1.67-5.02). The risk also was higher for patients with diabetes who were on insulin vs. diabetes without insulin treatment (5.2% vs. 1.8%; HR = 2.96; 95% CI, 1.49-5.87). There was no difference in risk between those with diabetes without insulin treatment and those without diabetes (HR = 0.97; 95% CI, 0.58-1.61).
“Our findings robustly indicated that insulin-requiring diabetes, essentially type 2 diabetes, largely contributed to the overall increase of thromboembolic risk in AF, but the mere presence of diabetes without insulin treatment did not apparently convey a negative prognostic value. Our investigation still supported that early diabetes has lower thromboembolic risk than later diabetes and, in our population, the reduced thromboembolic risk in patients without insulin treatment may be caused by the shorter duration of the disease,” Patti and colleagues wrote.
In an accompanying editorial comment, Jonathan P. Piccini, MD, MHS, and Christopher B. Granger, MD, from the Duke Center for Atrial Fibrillation, Duke University Medical Center, wrote: “This study provides a perspective on how risk prediction might be improved regarding diabetes. The observed associations suggest that insulin-treated diabetes may be a better predictor of stroke in patients with AF than the simple presence or absence of diabetes. However, this hypothesis requires further validation followed by additional testing in large contemporary cohorts, including patients with and without anticoagulant therapy, and in the context of predictive biomarkers.” – by Suzanne Reist
Disclosure: Patti reports speaking, consulting or serving on an advisory board for AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daiichi Sankyo, Eli Lilly and Merck Sharp & Dohme. Please see the full study for a list of the other researchers’ relevant financial disclosures. Granger and Piccini report financial ties with numerous pharmaceutical and device companies.
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