Duration of Diabetes Mellitus and Risk of Thromboembolism and Bleeding in Atrial Fibrillation Nationwide Cohort Study
Duration of Diabetes Mellitus and Risk of Thromboembolism and Bleeding in Atrial Fibrillation Nationwide Cohort Study
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DOI：
10.1161/strokeaha.115.009371
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发表时间：
2015-08-01
期刊：
影响因子：
8.3
通讯作者：
Larsen, Torben Bjerregaard
中科院分区：
文献类型：
--
作者：
Overvad, Thure Filskov;Skjoth, Flemming;Larsen, Torben Bjerregaard
背景和目的-指南提倡对所有房颤合并糖尿病的患者进行抗凝治疗。对糖尿病进行细分可能会对血栓栓塞风险分层进行潜在的细化，但尚未探讨。目的是调查糖尿病的持续时间作为房颤患者血栓栓塞和抗凝剂相关出血的预测因子。方法使用丹麦全国范围内的登记处，我们确定了2000年至2011年所有出院的房颤患者。血栓栓塞和出血的危险比与95%的置信区间，根据糖尿病持续时间的类别（0-4，5-9，10-14，和>= 15），并作为一个连续变量使用三次样条计算考克斯regression.Results-The研究人群包括137 222例房颤患者，其中12.4%有糖尿病。与非糖尿病患者和调整抗凝治疗和CHA（2）DS（2）VASc组分后的患者相比（充血性心力衰竭、高血压、年龄、既往卒中史、血管疾病和性别），血栓栓塞的风险在0 - 4年持续时间类别中最低（危害比，1.11; 95%可信区间，1.03-1.20），最长持续时间类别>= 15年（危害比，1.48; 95%可信区间，1.29-1.70）最高。当作为一个连续变量进行分析时，糖尿病的持续时间与血栓栓塞的风险呈剂量反应依赖性，但与抗凝治疗过程中出血的风险较高无关。结论在房颤患者中，糖尿病持续时间较长与血栓栓塞的风险较高相关，但与抗凝相关出血的风险较高无关。考虑到预防血栓栓塞和避免出血之间的关键平衡，糖尿病持续时间较长可能有利于开始抗凝治疗。
Background and Purpose-Guidelines advocate anticoagulant treatment to all patients with atrial fibrillation and concomitant diabetes mellitus. The potential refinement to thromboembolic risk stratification that may spring from subdividing diabetes mellitus is unexplored. The purpose was to investigate duration of diabetes mellitus as a predictor of thromboembolism and anticoagulant-related bleeding in patients with atrial fibrillation.Methods-Using nationwide Danish registries, we identified all patients discharged from hospital with an incident diagnosis of atrial fibrillation from 2000 to 2011. Hazard ratios with 95% confidence intervals for thromboembolism and bleeding according to years of diabetes mellitus duration in categories (0-4, 5-9, 10-14, and >= 15) and as a continuous variable using cubic splines were calculated by Cox regression.Results-The study population comprised 137 222 patients with atrial fibrillation, of which 12.4% had diabetes mellitus. Compared with patients without diabetes mellitus and after adjustment for anticoagulant treatment and CHA(2)DS(2)VASc components (congestive heart failure, hypertension, age, previous stroke, vascular disease, and sex), the risk of thromboembolism was lowest in the 0 to 4 years duration category (hazard ratio, 1.11; 95% confidence interval, 1.03-1.20), and highest in the longest duration category of >= 15 years (hazard ratio, 1.48; 95% confidence interval, 1.29-1.70). When analyzed as a continuous variable, duration of diabetes mellitus was associated with risk of thromboembolism in a dose-response-dependent manner, but not with a higher risk of bleeding during anticoagulant treatment.Conclusions-In patients with atrial fibrillation, longer duration of diabetes mellitus was associated with a higher risk of thromboembolism, but not with a higher risk of anticoagulant-related bleeding. Considering the critical balance between preventing thromboembolism and avoiding bleeding, longer duration of diabetes mellitus may favor initiation of anticoagulant therapy.