Yonsei Med J.  2015 Jan;56(1):62-71. 10.3349/ymj.2015.56.1.62.

Clinical Characteristics and Impact of Diabetes Mellitus on Outcomes in Patients with Nonvalvular Atrial Fibrillation

• Huang B
• Yang Y
• Zhu J
• Liang Y
• Zhang H
• Tian L
• Shao X
• Wang J

• KMID: 2352790
• DOI: http://doi.org/10.3349/ymj.2015.56.1.62

Abstract

PURPOSE
Studies have shown that diabetes mellitus (DM) is a risk factor for cardiovascular disease, including atrial fibrillation (AF); however, the clinical characteristics and prognostic impact of DM in patients with nonvalvular AF have not been well understood in China.
MATERIALS AND METHODS
Included were 1644 consecutive patients with nonvalvular AF. Endpoints included all-cause mortality, cardiovascular mortality, stroke, major bleeding, and combined endpoint events (CEE) during a 1-year follow-up.
RESULTS
The prevalence of DM was 16.8% in nonvalvular AF patients. Compared with non-diabetic AF patients, diabetic AF patients were older and tended to coexist with other cardiovascular diseases. Most patients with DM (93.5%) were eligible for anticoagulation, as determined by CHADS2 scores. However, only 11.2% of patients received anticoagulation. During a 1-year follow-up, the all-cause mortality and CEE rate in the DM group were significantly higher than those of the non-DM group, while the incidence of stroke was comparable. After multivariate adjustments, DM was still an independent risk factor for 1-year all-cause mortality [hazard ratio (HR)=1.558; 95% confidence interval (CI) 1.126-2.156; p=0.007], cardiovascular mortality (HR=1.615; 95% CI 1.052-2.479; p=0.028), and CEE (HR=1.523; 95% CI 1.098-2.112; p=0.012), yet not for stroke (HR=1.119; 95% CI 0.724-1.728; p=0.614).
CONCLUSION
DM is a common morbidity coexisting with nonvalvular AF and is associated with an increased risk of 1-year all-cause mortality, cardiovascular mortality, and CEE. However, no increased risk of stroke was found during a 1-year follow-up in patients with AF and DM.

Keyword

Nonvalvular atrial fibrillation; diabetes mellitus; anticoagulation; outcomes

MeSH Terms

Aged
Atrial Fibrillation/*etiology
Cause of Death
China
Diabetes Complications/*pathology
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Multivariate Analysis
Proportional Hazards Models
Risk Factors
Treatment Outcome

Figure

• 

  Fig. 1 1-year outcomes of nonvalvular AF patients with and without DM. AF, atrial fibrillation; DM, diabetes mellitus; CEE, combined endpoint events (including all-cause mortality, stroke, non-CNS embolism, and major bleeding); CNS, central nervous system.

• 

  Fig. 2 The Kaplan-Meier event rates of nonvalvular AF patients with and without DM. (A) Survival curves of all-cause mortality. (B) Survival curves of cardiovascular mortality. (C) Cumulative incidence of stroke. (D) Cumulative incidence of CEE (including all-cause mortality, stroke, non-CNS embolism, and major bleeding). AF, atrial fibrillation; DM, diabetes mellitus; CEE, combined endpoint events; CNS, central nervous system.

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