ArticleCardiovascular diabetology2020
Glycemic status and risks of thromboembolism and major bleeding in patients with atrial fibrillation.
Article in Cardiovascular diabetology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed, 28 citations in OpenAlex.
- Atrial fibrillation and metabolic syndrome: an updated review of mechanisms, risk factors, and therapeutic strategies.Frontiers in cardiovascular medicine · 2026Review
- Review
- Cardiovascular and venous thromboembolism risks in cancer patients treated with immune checkpoint inhibitors compared to non-users- a multi-center retrospective study.Cardio-oncology (London, England) · 2024Article
- Impact of glycated hemoglobin on 2-year clinical outcomes in elderly patients with atrial fibrillation: sub-analysis of ANAFIE Registry, a large observational study.Cardiovascular diabetology · 2023Observational
- Discharge status validation of the Chang Gung Research database in Taiwan.Biomedical journal · 2022Observational
- Impact of mental disorders on the risk of atrial fibrillation in patients with diabetes mellitus: a nationwide population-based study.Cardiovascular diabetology · 2022Article
- Benzodiazepines in Patients with Heart Failure and Reduced Ejection Fraction.Acta Cardiologica Sinica · 2022Article
- Lifestyle Modification and Atrial Fibrillation: Critical Care for Successful Ablation.Journal of clinical medicine · 2022Review
- Early anticoagulation in atrial fibrillation-related acute ischaemic stroke: efficacy and safety profile.Journal of neurology · 2022Article
- Glycemic control and atrial fibrillation: an intricate relationship, yet under investigation.Cardiovascular diabetology · 2022Review
- Association of Diabetes Duration and Glycemic Control With Stroke Rate in Patients With Atrial Fibrillation and Diabetes: A Population-Based Cohort Study.Journal of the American Heart Association · 2022Article
- Prognostic significance of diabetes mellitus in patients with atrial fibrillation.Cardiovascular diabetology · 2021Article
- Cardiovascular risks and bleeding with non-vitamin K antagonist oral anticoagulant versus warfarin in patients with type 2 diabetes: a tapered matching cohort study.Cardiovascular diabetology · 2020Article
- Association of HbA1c and comorbidities on stroke severity: insights from a cross-sectional analysis in a tertiary hospital.Frontiers in neurologyArticle
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Authors and funding
12 authors at 4 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundStudies specifically examining the association between glycated hemoglobin A1c (HbA1c) levels and ischemic stroke/systemic thromboembolism (IS/SE) risk in atrial fibrillation (AF) patients are limited. Here, we investigated the association between HbA1c levels and the risk of IS/SE, as well as major bleeding, among AF patients with or without oral anticoagulants (OACs). We also compared the effectiveness and safety of warfarin and direct oral anticoagulants (DOACs) in different HbA1c categories.
methodsWe utilized medical data from a multi-center healthcare provider in Taiwan, which included 34,036 AF patients with serum HbA1c data available within 3 months after AF being diagnosed. Patients were divided into seven study groups according to their HbA1c levels: < 5.4%, 5.4%-5.6%, 5.7%-5.9%, 6.0%-6.4%, 6.5%-6.9%, 7.0%-7.9%, and ≥ 8.0%. The risks of IS/SE and major bleeding were compared among the groups after adjusting for baseline stroke and bleeding risk factors.
resultsCompared with the patients with HbA1c level < 5.4%, IS/SE risk significantly increased at HbA1c levels higher than 6.5% [adjusted hazard ratio (HR): 1.20, 95% confidence interval (CI): 1.00-1.43 for HbA1c level 6.5%-6.9%; 1.32, (95% CI 1.11-1.57) for HbA1c level 7.0%-7.9%; and 1.48 (95% CI 1.25-1.76) for HbA1c level ≥ 8.0%]. These results were generally consistent in AF patients without OACs (n = 24,931). However, among 9105 patients receiving OACs, IS/SE risk was not higher for patients having higher HbA1c levels. The risk of major bleeding was comparable across all HbA1c categories. Compared with warfarin, DOACs were associated with lower risks of IS/SE (adjusted HR: 0.61, 95% CI 0.49-0.75) and major bleeding (adjusted HR: 0.30, 95% CI 0.21-0.42) without interactions across different HbA1c categories (all P interactions > 0.05).
conclusionFor AF patients, IS/SE risk significantly increased once HbA1c levels exceeded 6.5%, and OACs may attenuate these associations. Compared with warfarin, DOACs were more effective and safer across broad HbA1c categories. Therefore, in addition to prescribing DOACs when indicated, more aggressive glycemic control to achieve an HbA1c level < 6.5% may be considered for eligible AF patients and should be tested in further prospective studies.
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