Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy.
Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic.
Clin Res Cardiol. 2023 Nov;112(11):1517-1528. doi: 10.1007/s00392-022-02080-5. Epub 2022 Aug 17.
Recent data have suggested that insulin-requiring diabetes mostly contributes to the overall increase of thromboembolic risk in patients with atrial fibrillation (AF) on warfarin. We evaluated the prognostic role of a different diabetes status on clinical outcome in a large cohort of AF patients treated with edoxaban.
We accessed individual patients' data from the prospective, multicenter, ETNA-AF Europe Registry. We compared the rates of ischemic stroke/transient ischemic attack (TIA)/systemic embolism, myocardial infarction (MI), major bleeding and all-cause death at 2 years according to diabetes status.
Out of an overall population of 13,133 patients, 2885 had diabetes (22.0%), 605 of whom (21.0%) were on insulin. The yearly incidence of ischemic stroke/TIA/systemic embolism was 0.86% in patients without diabetes, 0.87% in diabetic patients not receiving insulin (p = 0.92 vs no diabetes) and 1.81% in those on insulin (p = 0.002 vs no diabetes; p = 0.014 vs diabetes not on insulin). The annual rates of MI and major bleeding were 0.40%, 0.43%, 1.04% and 0.90%, 1.10% and 1.71%, respectively. All-cause yearly mortality was 3.36%, 5.02% and 8.91%. At multivariate analysis, diabetes on insulin was associated with a higher rate of ischemic stroke/TIA/systemic embolism [adjusted HR 2.20, 95% CI 1.37-3.54, p = 0.0011 vs no diabetes + diabetes not on insulin] and all-cause death [aHR 2.13 (95% CI 1.68-2.68, p < 0.0001 vs no diabetes]. Diabetic patients not on insulin had a higher mortality [aHR 1.32 (1.11-1.57), p = 0.0015], but similar incidence of stroke/TIA/systemic embolism, MI and major bleeding, vs those without diabetes.
In a real-world cohort of AF patients on edoxaban, diabetes requiring insulin therapy, rather than the presence of diabetes per se, appears to be an independent factor affecting the occurrence of thromboembolic events during follow-up. Regardless of the diabetes type, diabetic patients had a lower survival compared with those without diabetes.
最近的数据表明，在华法林治疗的心房颤动（AF）患者中，需要胰岛素的糖尿病主要导致血栓栓塞风险的整体增加。我们评估了不同糖尿病状态对依度沙班治疗的大型 AF 患者临床结局的预后作用。
我们从前瞻性、多中心的 ETNA-AF Europe 注册中心获取了个体患者的数据。我们根据糖尿病状态比较了 2 年内缺血性卒中和短暂性脑缺血发作（TIA）/系统性栓塞、心肌梗死（MI）、大出血和全因死亡的发生率。
在总共 13133 例患者中，2885 例（22.0%）患有糖尿病，其中 605 例（21.0%）正在接受胰岛素治疗。无糖尿病患者的缺血性卒中和 TIA/系统性栓塞的年发生率为 0.86%，未接受胰岛素治疗的糖尿病患者为 0.87%（p=0.92 与无糖尿病），接受胰岛素治疗的患者为 1.81%（p=0.002 与无糖尿病；p=0.014 与未接受胰岛素的糖尿病）。MI 和大出血的年发生率分别为 0.40%、0.43%、1.04%和 0.90%、1.10%和 1.71%。全因年死亡率为 3.36%、5.02%和 8.91%。多变量分析显示，接受胰岛素治疗的糖尿病与更高的缺血性卒中和 TIA/系统性栓塞发生率相关[调整后的 HR 2.20，95%CI 1.37-3.54，p=0.0011 与无糖尿病+未接受胰岛素的糖尿病]和全因死亡[aHR 2.13（95%CI 1.68-2.68，p<0.0001 与无糖尿病]。未接受胰岛素治疗的糖尿病患者死亡率更高[aHR 1.32（1.11-1.57），p=0.0015]，但与无糖尿病患者相比，卒中/TIA/系统性栓塞、MI 和大出血的发生率相似。
在接受依度沙班治疗的 AF 患者的真实世界队列中，需要胰岛素治疗的糖尿病而不是糖尿病本身似乎是影响随访期间血栓栓塞事件发生的独立因素。无论糖尿病类型如何，与无糖尿病患者相比，糖尿病患者的生存率均较低。
