title: Presence of diabetic microvascular complications does not incrementally increase risk of ischemic stroke in diabetic patients with atrial fibrillation: A nationwide cohort study.
abstract: Conventional stroke risk prediction tools used in atrial fibrillation (AF) incorporate the presence of diabetes mellitus (DM) as a risk factor. However, it is unknown whether this risk is homogenous or dependent on the presence of diabetic microvascular complications, such as diabetic retinopathy, nephropathy, and neuropathy. The present study examined the risk of ischemic stroke in diabetic patients with and without microvascular complications. The present study used the National Health Insurance Research Database in Taiwan with detailed healthcare data on all-comers to the Taiwanese medical system from January 1, 1996 to December 31, 2011. AF and DM were identified when listed as discharge diagnoses or confirmed more than twice in the outpatient department. Patients on antithrombotic agents were excluded. The clinical endpoint was ischemic stroke. Among the 50,180 AF patients with DM, the majority had no microvascular complications (72.7%), while 2.6% had diabetic retinopathy, 8.4% had diabetic nephropathy, and 16.1% had diabetic neuropathy. Ischemic stroke occurred in 6003 patients, with a 4.74% annual risk of ischemic stroke. When compared with DM patients without microvascular complications, those with diabetic retinopathy, nephropathy, or neuropathy had higher incidences of ischemic stroke (4.65 vs 5.07, 4.77, or 5.20 per 100 person-years, respectively). However, after adjusting for confounding factors, the differences were no longer significant. In a large nationwide AF cohort with DM, risk of ischemic stroke was similar between patients with and without microvascular complications, suggesting that risk stratification of these patients does not require inclusion of diabetic retinopathy, nephropathy, and neuropathy.
authors.affiliation: Division of Cardiology, Department of Medicine, Lions Gate Hospital, North Vancouver, British Columbia, Canada Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital Institute of Public Health and School of Medicine, National Yang-Ming University Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Annie Y
authors.initials: AY
authors.lastname: Chou
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
authors.forename: Tze-Fan
authors.initials: TF
authors.lastname: Chao
authors.forename: Kang-Ling
authors.initials: KL
authors.lastname: Wang
authors.forename: Ta-Chuan
authors.initials: TC
authors.lastname: Tuan
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Shih-Ann
authors.initials: SA
authors.lastname: Chen
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D015331:Cohort Studies; D003925:Diabetic Angiopathies / Q000150:complications*; D003928:Diabetic Nephropathies / Q000150:complications; D003929:Diabetic Neuropathies / Q000150:complications; D003930:Diabetic Retinopathy / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013624:Taiwan