Insulin use predicts worse cerebrovascular outcomes in DM with Afib

  • Mentias A & al.
  • Am Heart J
  • 10.05.2019

  • von Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Among patients with Afib, insulin-requiring diabetes (IRD) is associated with heightened thromboembolic and atherothrombotic outcome risk compared with non-IRD (NIRD) and nondiabetes (ND).
  • IRD may derive least risk reduction from anticoagulation.

Why this matters

  • Diabetes mellitus (DM) is present in about 15% of patients with Afib, and significantly increases cardiovascular event risk.

Study design

  • Retrospective data analysis of 798,592 Medicare beneficiaries (6.7% IRD, 31.3% NIRD, 62% ND).  
  • Funding: US Agency for Healthcare Research and Quality, Department of Veterans Affairs.

Key results

  • In adjusted model, IRD had higher stroke risk than NIRD and ND:
    • HRs, 1.15 and 1.24, respectively (both P<.001>
  • NIRD had higher stroke risk than ND:
    • HR, 1.08 (P<.001>
  • Overall HR for stroke with anticoagulant use was 0.85 (P<.001>
  • Anticoagulants prevented stroke in:
    • ND: HR, 0.74 (P<.001>
    • NIRD: 0.86 (P<.001>
    • But not in IRD: 0.94 (P=.09).
  • In adjusted model, overall HR for myocardial infarction (MI) associated with anticoagulant use was 0.86 (P<.001>
  • Anticoagulants prevented MI in ND (HR, 0.84; P<.001 nird p but not ird>

Limitations

  • Prognostic variables (i.e., diabetes duration, HbA1c, insulin dose) lacking.
  • MI definition based on ICD-9.
  • Short follow-up after Afib diagnosis.
  • No control for anticoagulation adherence.