Pre-Diabetes Increases Stroke Risk in Patients With Nonvalvu
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Diabetes and prediabetes were associated with increased risk for stroke in patients with nonvalvular atrial fibrillation (AF), according to a study.

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.
In a historical cohort study, researchers examined data on 44,451 adults (median age, 75 years; 53% women) with a first diagnosis of nonvalvular atrial fibrillation between 2010 and 2016. This included 17,754 people with diabetes mellitus as well as 6,574 people with prediabetes.

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.

After accounting for age, sex, socioeconomic status, BMI, estimated glomerular filtration rate, hypertension, congestive heart failure, previous stroke, previous transient ischemic stroke, vascular disease, and oral anticoagulant use, both prediabetes and diabetes were significantly associated with incident stroke.

“We know that some of the metabolic changes that lead to diabetes mellitus, mainly insulin resistance in peripheral tissue, increased circulating insulin levels and hyperglycemia can be present long before the diagnostic criteria for diabetes mellitus are met,” said researchers of Soroka University Medical Center in Beer Sheva, Israel.

“This metabolic disarray can promote inflammation and influence clot formation, which is probably what leads to the increase in stroke risk that we observed in our study, in the setting of atrial fibrillation,” they added.

While diabetes was significantly associated with mortality, researchers did not find a significant association between prediabetes and mortality.

One limitation of the study is that researchers used data on lab tests for diabetes mellitus and prediabetes at the time of nonvalvular atrial fibrillation diagnosis, instead of a coded diagnosis in medical records. In addition, 20% of participants had not been previously screened for diabetes, and they might differ in some way from those who did receive screening, the researchers note.

Still, if these results are confirmed by additional research, the findings might help to identify patients at increased risk for stroke who might benefit from anticoagulation treatments, the study team concludes.

“Additional studies will be needed as to whether or not prediabetes should be considered for inclusion in risk scores that are used to help guide whether or not an atrial fibrillation patient is eligible for oral anticoagulation,” they said.

Source:
https://www.jacc.org/doi/10.1016/j.jacc.2020.12.030
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