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

ABSTRACT: Diagnosed diabetes mellitus (DM) is a consistently documented risk factor for ischemic stroke in patients with atrial fibrillation (AF).The purpose of this study was to assess the association between duration of diabetes and elevated hemoglobin A1c (HbA1c) with risk of stroke among diabetic patients with AF.We assessed this association in the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) California community-based cohort of AF patients (study years 1996 to 2003) where all events were clinician adjudicated. We used Cox proportional hazards regression to estimate the rate of ischemic stroke in diabetic patients according to time-varying measures of estimated duration of diabetes (?3 years compared with <3 years) and HbA1c values (?9.0% and 7.0% to 8.9% compared with <7.0%), focusing on periods where patients were not anticoagulated.There were 2,101 diabetic patients included in the duration analysis: 40% with duration <3 years and 60% with duration ?3 years at baseline. Among 1,933 diabetic patients included in the HbA1c analysis, 46% had HbA1c <7.0%, 36% between 7.0% and 8.9%, and 19% ?9.0% at baseline. Duration of diabetes ?3 years was associated with an increased rate of ischemic stroke compared with duration <3 years (adjusted hazard ratio [HR]: 1.74, 95% confidence interval [CI]: 1.10 to 2.76). The increased stroke rate was observed in older (age ?75 years) and younger (age <75 years) individuals. Neither poor glycemic control (HbA1c ?9.0%, adjusted HR: 1.04, 95% CI: 0.57 to 1.92) nor moderately increased HbA1c (7.0% to 8.9%, adjusted HR: 1.21, 95% CI: 0.77 to 1.91) were significantly associated with an increased rate of ischemic stroke compared with patients who had HbA1c <7.0%.Duration of diabetes is a more important predictor of ischemic stroke than glycemic control in patients who have diabetes and AF.

SUBMITTER: Ashburner JM

PROVIDER: S-EPMC4724056 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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

Ashburner Jeffrey M JM Go Alan S AS Chang Yuchiao Y Fang Margaret C MC Fredman Lisa L Applebaum Katie M KM Singer Daniel E DE

Journal of the American College of Cardiology 20160101 3

<h4>Background</h4>Diagnosed diabetes mellitus (DM) is a consistently documented risk factor for ischemic stroke in patients with atrial fibrillation (AF).<h4>Objectives</h4>The purpose of this study was to assess the association between duration of diabetes and elevated hemoglobin A1c (HbA1c) with risk of stroke among diabetic patients with AF.<h4>Methods</h4>We assessed this association in the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) California community-based cohort of ...[more]

PMID: 26796386

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Project description:Medical nutrition therapy is recognized as an important treatment option in type 2 diabetes. Most guidelines recommend eating a diet with a high intake of fiber-rich food including fruit. This is based on the many positive effects of fruit on human health. However some health professionals have concerns that fruit intake has a negative impact on glycemic control and therefore recommend restricting the fruit intake. We found no studies addressing this important clinical question. The objective was to investigate whether an advice to reduce the intake of fruit to patients with type 2 diabetes affects HbA1c, bodyweight, waist circumference and fruit intake.This was an open randomized controlled trial with two parallel groups. The primary outcome was a change in HbA1c during 12 weeks of intervention. Participants were randomized to one of two interventions; medical nutrition therapy + advice to consume at least two pieces of fruit a day (high-fruit) or medical nutrition therapy + advice to consume no more than two pieces of fruit a day (low-fruit). All participants had two consultations with a registered dietitian. Fruit intake was self-reported using 3-day fruit records and dietary recalls. All assessments were made by the "intention to treat" principle.The study population consisted of 63 men and women with newly diagnosed type 2 diabetes. All patients completed the trial. The high-fruit group increased fruit intake with 125 grams (CI 95%; 78 to 172) and the low-fruit group reduced intake with 51 grams (CI 95%; -18 to -83). HbA1c decreased in both groups with no difference between the groups (diff.: 0.19%, CI 95%; -0.23 to 0.62). Both groups reduced body weight and waist circumference, however there was no difference between the groups.A recommendation to reduce fruit intake as part of standard medical nutrition therapy in overweight patients with newly diagnosed type 2 diabetes resulted in eating less fruit. It had however no effect on HbA1c, weight loss or waist circumference. We recommend that the intake of fruit should not be restricted in patients with type 2 diabetes.http://www.clinicaltrials.gov; Identifier: NCT01010594.

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

Publications

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

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