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Original Research: Cardiovascular Disease |

The Impact of Associated Diabetic Retinopathy on Stroke and Severe Bleeding Risk in Diabetic Patients With Atrial FibrillationDiabetic Retinopathy and Atrial Fibrillation: The Loire Valley Atrial Fibrillation Project

Gregory Y. H. Lip, MD; Nicolas Clementy, MD; Bertrand Pierre, MD; Mathieu Boyer, MSc; Laurent Fauchier, MD, PhD
Author and Funding Information

From the University of Birmingham Centre for Cardiovascular Sciences (Prof Lip), City Hospital, Birmingham, England; Thrombosis Research Unit (Prof Lip), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; and Service de Cardiologie, Pôle Coeur Thorax Vasculaire (Drs Clementy, Pierre, and Fauchier and Mr Boyer), Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.

CORRESPONDENCE TO: Gregory Y. H. Lip, MD, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Rd, Birmingham, B18 7QH, England; e-mail: g.y.h.lip@bham.ac.uk


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(4):1103-1110. doi:10.1378/chest.14-2096
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BACKGROUND:  Diabetes mellitus is recognized as a stroke risk factor in atrial fibrillation (AF). Patients with diabetes with retinopathy have an increased risk for systemic cardiovascular complications, and severe diabetic retinopathy predisposes to ocular bleeding. We hypothesized that patients with diabetes, retinopathy, and AF have increased stroke/thromboembolism (TE) and severe bleeding risks when compared with patients with diabetes and AF who do not have retinopathy or to patients with AF and without diabetes.

METHODS:  We tested our hypothesis in a large “real-world” cohort of individuals with AF from the Loire Valley Atrial Fibrillation project.

RESULTS:  Of 8,962 patients with AF in our dataset, 1,409 (16%) had documented diabetes mellitus. Of these, 163 (1.8% of the whole cohort) were patients with diabetic retinopathy. After a follow-up of 31 ± 36 months, when compared with patients without diabetes, the risk of stroke/TE in patients with diabetes with no retinopathy increased 1.3-fold (relative risk [RR], 1.30; 95% CI, 1.07-1.59; P = .01); in patients with diabetes with retinopathy, the risk of stroke/TE was increased 1.58-fold (RR, 1.58; 95% CI, 1.07-2.32; P = .02). There was no significant difference when patients with diabetes with no retinopathy were compared with patients with diabetes with retinopathy (RR, 1.21; 95% CI, 0.80-1.84; P = .37). A similar pattern was seen for mortality and severe bleeding. On multivariate analysis, the presence of diabetic retinopathy did not emerge as an independent predictor for stroke/TE or severe bleeding.

CONCLUSIONS:  Crude rates of stroke/TE increased in a stepwise fashion when patients without diabetes and with AF were compared with patients with diabetes with no retinopathy and patients with diabetes with retinopathy. However, we have shown for the first time, to our knowledge, that the presence of diabetic retinopathy did not emerge as an independent predictor for stroke/TE or severe bleeding on multivariate analysis.

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