Pre-Diabetes Increases Stroke Risk in Patients With Nonvalvular Atrial Fibrillation |
| |
| Authors: | Louise Kezerle Meytal Avgil Tsadok Amichay Akriv Adi Berliner Senderey Asaf Bachrach Maya Leventer-Roberts Moti Haim |
| |
| Affiliation: | 1. Cardiac Electrophysiology and Pacing, Cardiology Department, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel;2. Clalit Research Institute, Chief Physician''s Office, Clalit Health Services, Tel Aviv, Israel;3. Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA |
| |
| Abstract: | BackgroundDiabetes mellitus (DM) increases the risk of embolism in nonvalvular atrial fibrillation (NVAF). The association between pre-diabetes and risk of ischemic stroke has not been studied separately in this population.ObjectivesThe purpose of this study was to evaluate whether pre-diabetes is associated with increased risk of stroke and death in patients with NVAF.MethodsWe conducted a historical cohort study using the Clalit Health Services electronic medical records. The study population included all members aged ≥25 years, with a first diagnosis of NVAF between January 1, 2010, and December 31, 2016. We compared 3 groups of individuals: those with pre-diabetes, those with diabetes, and normoglycemic patients.ResultsA total of 44,451 cases were identified. The median age was 75 years, and 52.5% were women. During a mean follow-up of 38 months, the incidence rates of stroke (per 100 person-years) were: 1.14 in normoglycemic individuals, 1.40 in those with pre-diabetes, and 2.15 in those with diabetes. In both univariate and multivariate analyses, pre-diabetes was associated with an increased risk of stroke compared with normoglycemic persons (adjusted hazard ratio [adjHR]: 1.19; 95% confidence interval [CI]: 1.01 to 1.4) even after adjustment for CHA2DS2-Vasc risk factors and use of anticoagulants, while diabetes conferred an even higher risk (vs. normoglycemia (adjHR: 1.56; 95% CI: 1.37 to 1.79). The risk for mortality was higher for individuals with diabetes (adjHR: 1.47; 95% CI: 1.41 to 1.54) but not for those with pre-diabetes (adjHR: 0.98; 95% CI: 0.92 to 1.03).ConclusionsIn this cohort of patients with incident NVAF, pre-diabetes was associated with an increased risk of stroke even after accounting for other recognized risk factors. |
| |
| Keywords: | atrial fibrillation pre-diabetes stroke risk assessment BMI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0030" }," $$" :[{" #name" :" text" ," _" :" body mass index DM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" diabetes mellitus HbA1c" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" glycated hemoglobin HR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" hazard ratio NVAF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" nonvalvular atrial fibrillation |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
