Ugowe Francis E, Hellkamp Anne S, Wang Allen, Becker Richard C, Berkowitz Scott D, Breithardt Günter, Fox Keith A A, Halperin Jonathan L, Hankey Graeme J, Mahaffey Kenneth W, Nessel Christopher C, Singer Daniel E, Patel Manesh R, Piccini Jonathan P
Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
Heart Rhythm O2. 2021 Apr 20;2(3):215-222. doi: 10.1016/j.hroo.2021.04.001. eCollection 2021 Jun.
Insulin use may be a better predictor of stroke risk and morbidity and mortality than diabetes in patients with atrial fibrillation (AF).
Determine if the increased risk of stroke observed in patients with AF and diabetes is restricted to those treated with insulin.
We analyzed the association between diabetes and treatment and the occurrence of stroke/systemic embolism, myocardial infarction (MI), all-cause death, vascular death, composite outcomes, and bleeding risk in the ROCKET AF trial.
In a cohort of 14,264 patients, there were 40.3% (n = 5746) with diabetes, 5.9% (n = 842) on insulin, 18.9% (n = 2697) on oral medications, and 11.9% (n = 1703) diet-controlled. Compared to those without diabetes, patients with non-insulin-treated diabetes had increased risks of stroke (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.06-1.68), MI (HR 1.64, 95% CI 1.17-2.30), all-cause death (HR 1.26, 95% CI 1.08-1.46), vascular death (HR 1.33, 95% CI 1.11-1.60), and composite outcomes (HR 1.37, 95% CI 1.18-1.157). Patients with insulin-treated diabetes had a significantly higher risk of MI (HR 2.31, 95% CI 1.33-4.01) and composite outcomes (HR 1.57, 95% CI 1.19-2.08) compared to those without diabetes. There were no significant differences between insulin-treated and non-insulin-treated diabetes for any outcome.
Among patients with AF and diabetes, there were no significant differences in outcomes in insulin-treated diabetes compared to non-insulin-treated diabetes.
在心房颤动（AF）患者中，胰岛素使用情况可能比糖尿病更能预测中风风险、发病率和死亡率。
确定在AF合并糖尿病患者中观察到的中风风险增加是否仅限于接受胰岛素治疗的患者。
我们在ROCKET AF试验中分析了糖尿病与治疗方法和中风/全身性栓塞、心肌梗死（MI）、全因死亡、血管性死亡、复合结局及出血风险之间的关联。
在14264例患者队列中，40.3%（n = 5746）患有糖尿病，5.9%（n = 842）接受胰岛素治疗，18.9%（n = 2697）接受口服药物治疗，11.9%（n = 1703）通过饮食控制。与无糖尿病患者相比，非胰岛素治疗的糖尿病患者中风风险增加（风险比[HR] 1.33，95%置信区间[CI] 1.06 - 1.68）、MI风险增加（HR 1.64，95% CI 1.17 - 2.30）、全因死亡风险增加（HR 1.26，95% CI 1.08 - 1.46）、血管性死亡风险增加（HR 1.33，95% CI 1.11 - 1.60）以及复合结局风险增加（HR 1.37，95% CI 1.18 - 1.57）。与无糖尿病患者相比，胰岛素治疗的糖尿病患者MI风险显著更高（HR 2.31，95% CI 1.33 - 4.01）以及复合结局风险更高（HR 1.57，95% CI 1.19 - 2.08）。胰岛素治疗组和非胰岛素治疗组在任何结局方面均无显著差异。
在AF合并糖尿病患者中，胰岛素治疗的糖尿病患者与非胰岛素治疗的糖尿病患者在结局方面无显著差异。
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