Relation of the stress hyperglycaemia ratio to residual risk in anticoagulated patients with atrial fibrillation: A report from the prospective Murcia atrial fibrillation (AF) Project III cohort
Authors' conclusion
In anticoagulated AF patients, low SHR was independently associated with higher residual thromboembolic and cardiovascular risk.
Study context
- Population
- Consecutive AF outpatients initiating oral anticoagulation, January 2016–November 2021 (Murcia AF Project III); 53.1% female, median age 76 years (IQR 69–82)
- Participants
- 1,479 outpatients
- Exposure
- Low vs high stress hyperglycaemia ratio
- Outcome
- Thromboembolic events (ischaemic stroke, TIA or systemic embolism) and MACE (MI, ischaemic stroke, TIA or cardiovascular death)
- Follow-up
- 1.87 years
Methodological detailsconsecutive outpatients, restricted cubic splines and multivariable Cox models
- Consecutive outpatients
- Restricted cubic splines and multivariable Cox models
Main finding
As reported in the abstract
Each group vs high SHREstimate (95% CI)P value
Low SHR
aHR (thromboembolic events) 1.73(1.08–2.76)
P = 0.022Low SHR
aHR (MACE) 1.58(1.06–2.37)
P = 0.025- Thromboembolic incidence rate, low vs high stress hyperglycaemia ratio (SHR)
- 4.26 vs 2.50 per 100 person-years
- MACE incidence rate, low vs high SHR
- 5.64 vs 3.34 per 100 person-years
- Thromboembolic events, overall
- 80 (5.4%)
- MACE, overall
- 107 (7.2%)
- SHR association with thromboembolic risk (splines)
- p-overall = 0.005; non-linear p = 0.015
- SHR association with MACE (splines)
- p-overall <0.001; linear p = 0.053
Observational data: associations, not effects.
Secondary outcomes
Cardiovascular and all-cause death
- No significant associations observed for secondary outcomes
Original publication
Relation of the stress hyperglycaemia ratio to residual risk in anticoagulated patients with atrial fibrillation: A report from the prospective Murcia AF Project III cohort. Diabetes Obes Metab. Published 4 December 2025. doi:10.
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