Insulin-treated versus noninsulin-treated diabetes and risk of ischemic stroke in patients with atrial fibrillation

Thomas Jensen; Kevin Kris Warnakula Olesen; Raffaele De Caterina; Morten Würtz; Steen Dalby Kristensen; Michael Maeng

doi:10.1016/j.vph.2020.106809

Insulin-treated versus noninsulin-treated diabetes and risk of ischemic stroke in patients with atrial fibrillation

Thomas Jensen, Kevin Kris Warnakula Olesen, Raffaele De Caterina, Morten Würtz, Steen Dalby Kristensen, Michael Maeng^*

^*Corresponding author for this work

Department of Clinical Medicine - The Department of Cardiological Medicine B

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

BACKGROUND: Diabetes mellitus (DM) and atrial fibrillation (AF) are known risk factors for ischemic stroke. Recent data, however, suggest that only insulin-treated DM is a risk factor for ischemic stroke among AF patients.

OBJECTIVES: To evaluate the risk of stroke in patients with insulin and noninsulin treated DM.

METHODS: We included AF patients undergoing coronary angiography in Western Denmark between 2003 and 2016. Patients were categorized as 1) insulin treated DM, 2) noninsulin treated DM, or 3) nonDM patients. The main outcome was ischemic stroke >30 days after CAG.

RESULTS: AF patients (n = 21,223) were included, of whom 17,181 (81%) did not have DM, 2890 (14%) had noninsulin-treated DM and 1152 (5%) had insulin-treated DM. Median follow-up was 5.3 years. Ischemic stroke rates were 0.83 per 100 person-years for nonDM, 1.19 for noninsulin-treated DM and 1.40 for insulin-treated DM. Insulin-treated DM (adjusted hazard ratio (HRadj) 1.48, 95% CI 1.15-1.91) and noninsulin-treated DM patients (HRadj 1.30, 95% CI 1.09-1.54) had higher risks of ischemic stroke than nonDM patients. There was no difference between insulin-treated DM and noninsulin-treated DM (HRadj 1.09, 95% CI 0.82-1.46). Stratification by coronary artery disease yielded comparable risk estimates.

CONCLUSION: In patients with AF, DM increases the risk of ischemic stroke, regardless of treatment.

Original language	English
Article number	106809
Journal	Vascular Pharmacology
Volume	136
ISSN	1537-1891
DOIs	https://doi.org/10.1016/j.vph.2020.106809
Publication status	Published - Feb 2021

Keywords

CHA DS -VASc score
Diabetes mellitus
Insulin
Ischemic stroke
Thromboembolism

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10.1016/j.vph.2020.106809

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@article{bf1d260811104b8585a6ca3c386396c3,

title = "Insulin-treated versus noninsulin-treated diabetes and risk of ischemic stroke in patients with atrial fibrillation",

abstract = "BACKGROUND: Diabetes mellitus (DM) and atrial fibrillation (AF) are known risk factors for ischemic stroke. Recent data, however, suggest that only insulin-treated DM is a risk factor for ischemic stroke among AF patients.OBJECTIVES: To evaluate the risk of stroke in patients with insulin and noninsulin treated DM.METHODS: We included AF patients undergoing coronary angiography in Western Denmark between 2003 and 2016. Patients were categorized as 1) insulin treated DM, 2) noninsulin treated DM, or 3) nonDM patients. The main outcome was ischemic stroke >30 days after CAG.RESULTS: AF patients (n = 21,223) were included, of whom 17,181 (81%) did not have DM, 2890 (14%) had noninsulin-treated DM and 1152 (5%) had insulin-treated DM. Median follow-up was 5.3 years. Ischemic stroke rates were 0.83 per 100 person-years for nonDM, 1.19 for noninsulin-treated DM and 1.40 for insulin-treated DM. Insulin-treated DM (adjusted hazard ratio (HRadj) 1.48, 95% CI 1.15-1.91) and noninsulin-treated DM patients (HRadj 1.30, 95% CI 1.09-1.54) had higher risks of ischemic stroke than nonDM patients. There was no difference between insulin-treated DM and noninsulin-treated DM (HRadj 1.09, 95% CI 0.82-1.46). Stratification by coronary artery disease yielded comparable risk estimates.CONCLUSION: In patients with AF, DM increases the risk of ischemic stroke, regardless of treatment.",

keywords = "CHA DS -VASc score, Diabetes mellitus, Insulin, Ischemic stroke, Thromboembolism",

author = "Thomas Jensen and Olesen, {Kevin Kris Warnakula} and {De Caterina}, Raffaele and Morten W{\"u}rtz and Kristensen, {Steen Dalby} and Michael Maeng",

note = "Copyright {\textcopyright} 2020. Published by Elsevier Inc.",

year = "2021",

month = feb,

doi = "10.1016/j.vph.2020.106809",

language = "English",

volume = "136",

journal = "Vascular Pharmacology",

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Insulin-treated versus noninsulin-treated diabetes and risk of ischemic stroke in patients with atrial fibrillation. / Jensen, Thomas ; Olesen, Kevin Kris Warnakula; De Caterina, Raffaele et al.
In: Vascular Pharmacology, Vol. 136, 106809, 02.2021.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Insulin-treated versus noninsulin-treated diabetes and risk of ischemic stroke in patients with atrial fibrillation

AU - Jensen, Thomas

AU - Olesen, Kevin Kris Warnakula

AU - De Caterina, Raffaele

AU - Würtz, Morten

AU - Kristensen, Steen Dalby

AU - Maeng, Michael

PY - 2021/2

Y1 - 2021/2

N2 - BACKGROUND: Diabetes mellitus (DM) and atrial fibrillation (AF) are known risk factors for ischemic stroke. Recent data, however, suggest that only insulin-treated DM is a risk factor for ischemic stroke among AF patients.OBJECTIVES: To evaluate the risk of stroke in patients with insulin and noninsulin treated DM.METHODS: We included AF patients undergoing coronary angiography in Western Denmark between 2003 and 2016. Patients were categorized as 1) insulin treated DM, 2) noninsulin treated DM, or 3) nonDM patients. The main outcome was ischemic stroke >30 days after CAG.RESULTS: AF patients (n = 21,223) were included, of whom 17,181 (81%) did not have DM, 2890 (14%) had noninsulin-treated DM and 1152 (5%) had insulin-treated DM. Median follow-up was 5.3 years. Ischemic stroke rates were 0.83 per 100 person-years for nonDM, 1.19 for noninsulin-treated DM and 1.40 for insulin-treated DM. Insulin-treated DM (adjusted hazard ratio (HRadj) 1.48, 95% CI 1.15-1.91) and noninsulin-treated DM patients (HRadj 1.30, 95% CI 1.09-1.54) had higher risks of ischemic stroke than nonDM patients. There was no difference between insulin-treated DM and noninsulin-treated DM (HRadj 1.09, 95% CI 0.82-1.46). Stratification by coronary artery disease yielded comparable risk estimates.CONCLUSION: In patients with AF, DM increases the risk of ischemic stroke, regardless of treatment.

AB - BACKGROUND: Diabetes mellitus (DM) and atrial fibrillation (AF) are known risk factors for ischemic stroke. Recent data, however, suggest that only insulin-treated DM is a risk factor for ischemic stroke among AF patients.OBJECTIVES: To evaluate the risk of stroke in patients with insulin and noninsulin treated DM.METHODS: We included AF patients undergoing coronary angiography in Western Denmark between 2003 and 2016. Patients were categorized as 1) insulin treated DM, 2) noninsulin treated DM, or 3) nonDM patients. The main outcome was ischemic stroke >30 days after CAG.RESULTS: AF patients (n = 21,223) were included, of whom 17,181 (81%) did not have DM, 2890 (14%) had noninsulin-treated DM and 1152 (5%) had insulin-treated DM. Median follow-up was 5.3 years. Ischemic stroke rates were 0.83 per 100 person-years for nonDM, 1.19 for noninsulin-treated DM and 1.40 for insulin-treated DM. Insulin-treated DM (adjusted hazard ratio (HRadj) 1.48, 95% CI 1.15-1.91) and noninsulin-treated DM patients (HRadj 1.30, 95% CI 1.09-1.54) had higher risks of ischemic stroke than nonDM patients. There was no difference between insulin-treated DM and noninsulin-treated DM (HRadj 1.09, 95% CI 0.82-1.46). Stratification by coronary artery disease yielded comparable risk estimates.CONCLUSION: In patients with AF, DM increases the risk of ischemic stroke, regardless of treatment.

KW - CHA DS -VASc score

KW - Diabetes mellitus

KW - Insulin

KW - Ischemic stroke

KW - Thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=85095756017&partnerID=8YFLogxK

U2 - 10.1016/j.vph.2020.106809

DO - 10.1016/j.vph.2020.106809

M3 - Journal article

C2 - 33130017

SN - 1537-1891

VL - 136

JO - Vascular Pharmacology

JF - Vascular Pharmacology

M1 - 106809

ER -

Insulin-treated versus noninsulin-treated diabetes and risk of ischemic stroke in patients with atrial fibrillation

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Keywords

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