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Ugowe FE, Hellkamp AS, Wang A, et al. Pharmacotherapy for diabetes and stroke risk: Results from ROCKET AF. Heart Rhythm O2. 2021;2(3):215-222doi: 10.1016/j.hroo.2021.04.001.
Ugowe, F. E., Hellkamp, A. S., Wang, A., Becker, R. C., Berkowitz, S. D., Breithardt, G., Fox, K. A. A., Halperin, J. L., Hankey, G. J., Mahaffey, K. W., Nessel, C. C., Singer, D. E., Patel, M. R., Piccini, J. P. (2021). Pharmacotherapy for diabetes and stroke risk: Results from ROCKET AF. Heart rhythm O2, 2(3), 215-222. https://doi.org/10.1016/j.hroo.2021.04.001
Ugowe, Francis E, et al. "Pharmacotherapy for diabetes and stroke risk: Results from ROCKET AF." Heart rhythm O2 vol. 2,3 (2021): 215-222. doi: https://doi.org/10.1016/j.hroo.2021.04.001
Ugowe FE, Hellkamp AS, Wang A, Becker RC, Berkowitz SD, Breithardt G, Fox KAA, Halperin JL, Hankey GJ, Mahaffey KW, Nessel CC, Singer DE, Patel MR, Piccini JP. Pharmacotherapy for diabetes and stroke risk: Results from ROCKET AF. Heart Rhythm O2. 2021 Apr 20;2(3):215-222. doi: 10.1016/j.hroo.2021.04.001. eCollection 2021 Jun. PMID: 34337571; PMCID: PMC8322824.
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Heart Rhythm O2. 2021 Apr 20;2(3):215-222. doi: 10.1016/j.hroo.2021.04.001. eCollection 2021 Jun.

Pharmacotherapy for diabetes and stroke risk: Results from ROCKET AF.

Heart rhythm O2

Francis E Ugowe, Anne S Hellkamp, Allen Wang, Richard C Becker, Scott D Berkowitz, Günter Breithardt, Keith A A Fox, Jonathan L Halperin, Graeme J Hankey, Kenneth W Mahaffey, Christopher C Nessel, Daniel E Singer, Manesh R Patel, Jonathan P Piccini,

Affiliations

  1. Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina.
  2. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
  3. Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
  4. University of Cincinnati College of Medicine, Cincinnati, Ohio.
  5. Bayer U.S. LLC, Parsippany, New Jersey.
  6. Hospital of the University of Münster, Münster, Germany.
  7. University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
  8. Mount Sinai School of Medicine, New York, New York.
  9. School of Medicine and Pharmacology, The University of Western Australia, Crawley, Australia.
  10. Stanford Center for Clinical Research, Stanford University, School of Medicine, Stanford, California.
  11. Janssen Research & Development, Raritan, New Jersey.
  12. Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

PMID: 34337571 PMCID: PMC8322824 DOI: 10.1016/j.hroo.2021.04.001

Abstract

BACKGROUND: Insulin use may be a better predictor of stroke risk and morbidity and mortality than diabetes in patients with atrial fibrillation (AF).

OBJECTIVES: Determine if the increased risk of stroke observed in patients with AF and diabetes is restricted to those treated with insulin.

METHODS: 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.

RESULTS: 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.

CONCLUSION: Among patients with AF and diabetes, there were no significant differences in outcomes in insulin-treated diabetes compared to non-insulin-treated diabetes.

© 2021 Published by Elsevier Inc. on behalf of Heart Rhythm Society.

Keywords: Atrial fibrillation; Diabetes; Rivaroxaban; Stroke; Warfarin

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