In nonvalvular AF, prediabetes confers elevated risk for stroke
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Diabetes and prediabetes were associated with increased risk for stroke in patients with nonvalvular atrial fibrillation, according to a study published in the Journal of the American College of Cardiology.
The connection between diabetes and stroke risk in this population was well known, but the connection between prediabetes and stroke risk was not, the researchers wrote.
“Diabetes mellitus is a risk factor for the development of AF and is associated with embolic complications in AF, increasing the risk of ischemic stroke compared with persons without diabetes,” Louise Kezerle, MD, attending physician at Soroka Medical Center, Ben-Gurion University of the Negev in Beer-Sheva, Israel, and colleagues wrote. “The association between prediabetes and ischemic stroke in nonvalvular atrial brillation, however, is less well established, with some studies in the general population indicating an increased risk of stroke in individuals without AF with impaired glucose metabolism, whereas others failed to show an association between these two conditions.”
In a historical cohort study, researchers analyzed 44,451 patients with nonvalvular AF (median age, 75 years; 53% women) for the association between prediabetes and increased risk for stroke and death and stratified the cohort by whether they were normoglycemic, had prediabetes or had diabetes.
During a mean follow-up of 38 months, incidence rates of stroke were 1.14 per 100 person-years in normoglycemic patients, 1.4 per 100 person-years in patients with prediabetes and 2.15 per 100 person-years in patients with diabetes.
The researchers found a strong association between diabetes and prediabetes with an increased risk for stroke compared with normoglycemic patients (adjusted HR for diabetes = 1.56; 95% CI, 1.37-1.79; aHR for prediabetes = 1.19; 95% CI, 1.01-1.4).
Compared with normoglycemic patients, patients with diabetes had elevated risk for mortality (aHR= 1.47; 95% CI, 1.41-1.54), but patients with prediabetes did not (aHR= 0.98; 95% CI, 0.92-1.03), the researchers wrote.
“We found that prediabetes was associated with a 19% increase in the risk of stroke compared with normoglycemic individuals. This association remained signicant after adjustment for other known risk factors and taking into consideration individual CHA2DS2-VASc risk factors, as well as oral anticoagulation use,” Kezerle and colleagues wrote. “Furthermore, there was a graded relationship between glycemic category status and the risk of stroke.”
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