Diabetes Duration, Glycemic Control and Stroke Risk in Patients With Atrial Fibrillation

3D Illustration Concept of Human Circulatory System
3D Illustration Concept of Human Circulatory System Heart Anatomy
Investigators evaluated the effect of diabetes duration and hemoglobin A1c concentration on risk for stroke in patients with new onset atrial fibrillation.

A population-based cohort study found that longer duration of diabetes and poor glycemic control increased risk for stroke during the first year after atrial fibrillation (AF) diagnosis among patients with diabetes. These findings were published in the Journal of the American Heart Association.

Data for this study were sourced from Ontario’s Health Insurance Plan and Ontario Laboratories Information System. Patients (N=37,209) who had diabetes and were newly diagnosed with AF between 2009 and 2019 were assessed for stroke risk on the basis of diabetes duration and glycemic control.

Patients were aged median 77 years (IQR, 72-83), 42.0% were women, the median diabetes duration was 8 years (IQR, 5-12), and median hemoglobin A1C was 7% (IQR, 6%-7%). Most baseline characteristics differed significantly between patients who had been diagnosed with diabetes for less than 5 years (n=9,204), between 5 and 10 years (n=13,753), and 10 years or longer (n=14,252).

In the 365 days after an AF diagnosis, 14.7% of patients died and 1.6% had a stroke.

Stroke risk was increased among patients with a history of stroke or transient ischemic attack (hazard ratio [HR], 2.73; 95% CI, 2.07-3.61; P <.001), diabetes duration of 10 years or longer (HR, 1.45; 95% CI, 1.16-1.82; P =.001), hemoglobin A1C of 8% or more (HR, 1.44; 95% CI, 1.12-1.84; P =.004), patients who were women (HR, 1.23; 95% CI, 1.04-1.44; P =.01), and older patients (HR, 1.03; 95% CI, 1.02-1.04 per year; P <.001).

Stroke risk was decreased among patients using anticoagulants (HR, 0.67; 95% CI, 0.57-0.80; P <.001) and statins (HR, 0.68; 95% CI, 0.57-0.82; P <.001).

A subgroup analysis found that patients with a diabetes duration of less than 5 years who had hemoglobin A1c of less than 6% were at lower risk for stroke (HR, 0.47; 95% CI, 0.25-0.89; P =.02).

This study was limited by not having access to data about BMI, blood pressure, or smoking status.

“Among individuals with newly diagnosed AF and prevalent diabetes, longer duration of diabetes, and higher [hemoglobin A1c] were associated with higher rates of stroke,” the researchers noted. “This suggests that current models for stroke risk prediction in AF and strategies for risk reduction can be improved by incorporating these diabetes-specific characteristics in decision-making.”

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Abdel-Qadir H, Gunn M, Lega IC, et al. Association of diabetes duration and glycemic control with stroke rate in patients with atrial fibrillation and diabetes: A population-based cohort study. J Am Heart Assoc. Published online February 8, 2022. doi:10.1161/JAHA.121.023643