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Effect of Diabetes and Glycemic Control on Ischemic Stroke Risk in AF Patients: ATRIA Study

Jeffrey M Ashburner1, Alan S Go2, Yuchiao Chang3

  • 1Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Epidemiology Department, Boston University School of Public Health, Boston, Massachusetts.

Journal of the American College of Cardiology
|January 23, 2016
PubMed

Insights

Diabetes duration, not HbA1c levels, significantly increases ischemic stroke risk in atrial fibrillation patients. Longer diabetes duration (≥3 years) is linked to higher stroke rates, highlighting its importance in risk assessment.

Area of Science:

  • Cardiology
  • Endocrinology
  • Neurology

Background:

  • Diabetes mellitus (DM) is a known risk factor for ischemic stroke in patients with atrial fibrillation (AF).
  • Understanding specific risk factors within this population is crucial for effective stroke prevention strategies.

Purpose of the Study:

  • To investigate the association between the duration of diabetes and elevated hemoglobin A1c (HbA1c) levels with the risk of stroke.
  • To differentiate the impact of diabetes duration versus glycemic control on stroke risk in diabetic patients with AF.

Main Methods:

  • Analysis of the ATRIA California cohort (1996-2003) of atrial fibrillation patients.
  • Cox proportional hazards regression used to assess time-varying measures of diabetes duration (≥3 vs. <3 years) and HbA1c levels (≥9.0%, 7.0%-8.9%, <7.0%).
  • Focus on non-anticoagulated periods to isolate risk factors.

Main Results:

  • Diabetes duration of ≥3 years was associated with a significantly increased rate of ischemic stroke (adjusted HR: 1.74).
  • This increased risk was observed across different age groups (≥75 and <75 years).
  • Elevated HbA1c levels (≥9.0% or 7.0%-8.9%) were not significantly associated with increased stroke risk compared to HbA1c <7.0%.

Conclusions:

  • Diabetes duration is a more significant predictor of ischemic stroke than glycemic control in patients with both diabetes and atrial fibrillation.
  • Clinical risk stratification for stroke in this population should consider the duration of diabetes.
Abstract

Keywords:
atrial fibrillationdiabetes mellitusstroke

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