Thromboembolic Risk in AF and Diabetes May Be Insulin Related

JANUARY 27, 2017
Jennifer Barrett, Assistant Editor

Individuals with diabetes and atrial fibrillation (AF) are often at risk for thromboembolic events, but a new study explores the role that insulin plays in elevating rates of thromboembolic incidents. The study, published in the Journal of the American College of Cardiology, compares the impact that taking insulin has on thromboembolic events.
In other studies, it has been shown that patients with diabetes are at an increased risk for a number of diseases, including  systemic hypertension, congestive heart failure, and prior transient ischemic attack/stroke/thromboembolism vascular disease. The primary end point of the study was stroke/systemic embolism incidence at the 1-year follow up, according to diabetes and insulin status.
After 1 year, stroke/systemic embolism incidence was 2 per 100 patients/year overall. Patients with diabetes requiring insulin therapy were associated with a higher risk for thromboembolic events compared to those patients who had diabetes and did not require insulin, or those patients who did not have diabetes. Patients receiving insulin also had an increased prevalence of sustained AF.
The results demonstrated a link between insulin-requiring diabetes and higher rates of thromboembolic events, especially in patients with congestive heart failure and patients who were receiving antithrombotic therapy.
Elevated rates of stroke/systemic embolism remained present in patients receiving insulin who had also received anticoagulation.
AF-related stroke/systemic embolism rates seem to be affected by insulin therapy rather than diabetes alone, the researchers concluded. The results indicated that insulin-requiring diabetes contributed the most to increases in thromboembolic risk, and could help health care providers assess thromboembolic risk in patients with both diabetes and AF.
Patti G, Lucerna M, Cavallari I, et al. Insulin-requiring vs noninsulin-requiring diabetes and thromboembolic risk in patients with atrial fibrillation: PREFER in AF. J Am Coll Cardiol. 2017;69(4):409-419. doi:10.1016/j.jacc.2016.10.069