Effect of Diabetes and Glycemic Control on Ischemic Stroke Risk in AF Patients: ATRIA Study.
Effect of Diabetes and Glycemic Control on Ischemic Stroke Risk in AF Patients: ATRIA Study.
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DOI：
10.1016/j.jacc.2015.10.080
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发表时间：
2016-01-26
影响因子：
24
通讯作者：
Singer DE
中科院分区：
文献类型：
--
作者：
Ashburner JM;Go AS;Chang Y;Fang MC;Fredman L;Applebaum KM;Singer DE
确诊的糖尿病（DM）是房颤（AF）患者缺血性卒中的一个一致记录的风险因素。为了评估糖尿病病程和HbA 1c升高与糖尿病合并AF患者卒中风险之间的相关性，我们在ATRIA加州基于社区的AF患者队列（研究年份1996-2003）中评估了这种相关性，其中所有事件均由临床医生裁定。我们使用考克斯比例风险回归，根据估计的糖尿病持续时间（≥3年与<3年相比）和HbA 1c值（≥9.0%和7.0-8.9%与<7.0%相比）的时变指标，估计糖尿病患者的缺血性卒中发生率，重点关注患者未接受抗凝治疗的时期。持续时间分析纳入了2，101例糖尿病患者，基线时40%的持续时间<3年，60%的持续时间≥3年。在纳入HbA 1c分析的1933例糖尿病患者中，基线时46%的HbA 1c <7.0%，36%在7.0 - 8.9%之间，19% ≥9.0%。与病程<3年相比，糖尿病病程≥ 3年与缺血性卒中发生率增加相关（校正HR：1.74，95% CI：1.10-2.76）。在老年（≥75岁）和年轻（<75岁）个体中观察到卒中发生率增加。与HbA 1c <7.0%的患者相比，血糖控制不佳（HbA 1c ≥ 9.0%，校正HR：1.04，95% CI：0.57-1.92）或HbA 1c中度升高（7.0- 8.9%，校正HR：1.21，95% CI：0.77-1.91）均与缺血性卒中发生率升高无显著相关性。在糖尿病合并AF患者中，糖尿病病程是比血糖控制更重要的缺血性卒中预测因子。
Diagnosed diabetes mellitus (DM) is a consistently documented risk factor for ischemic stroke in patients with atrial fibrillation (AF). To assess the association between duration of diabetes and elevated HbA1c with risk of stroke among diabetics with AF. We assessed this association in the ATRIA California community-based cohort of AF patients (study years 1996-2003) where all events were clinician adjudicated. We used Cox proportional hazards regression to estimate the rate of ischemic stroke in diabetic patients according to time-varying measures of estimated duration of diabetes (≥3 years compared to <3 years) and HbA1c values (≥9.0% and 7.0-8.9% compared to <7.0%), focusing on periods where patients were not anticoagulated. There were 2,101 diabetic patients included in the duration analysis, 40% with duration <3 years and 60% with duration ≥3 years at baseline. Among 1933 diabetic patients included in the HbA1c analysis, 46% had HbA1c <7.0%, 36% between 7.0 and 8.9%, and 19% ≥9.0% at baseline. Duration of diabetes ≥ 3 years was associated with an increased rate of ischemic stroke compared to duration <3 years (adjusted HR: 1.74, 95% CI: 1.10-2.76). The increased stroke rate was observed in older (≥75 years) and younger (<75 years) individuals. Neither poor glycemic control (HbA1c ≥9.0%, adjusted HR: 1.04, 95% CI: 0.57-1.92) or moderately increased HbA1c (7.0-8.9%, adjusted HR: 1.21, 95% CI: 0.77-1.91) were significantly associated with an increased rate of ischemic stroke compared with patients who had HbA1c <7.0%. Duration of diabetes is a more important predictor of ischemic stroke than glycemic control in patients who have diabetes and AF.