Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention

Xu, Richard; Kong, Xiangyi; Xu, Benjamin; Song, Yun; Ji, Meng; Zhao, Min; Huang, Xiao; Li, Ping; Cheng, Xiaoshu; Chen, Fang; Zhang, Yan; Tang, Genfu; Zhang, Yuanyuan; Hou, Fan Fan; Dong, Qiang; Chen, Yundai; Yang, Tianlun; Sun, Ning; Li, Xiaoying; Zhao, Lina; Ge, Junbo; Ji, Linong; Huo, Yong; Li, Jianping

doi:10.3945/ajcn.116.145656

Cited by 20 publications

(17 citation statements)

References 25 publications

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“…The result of the present study agreed with previous cohort analyses among adults with hypertension. 12,16 Our study did not find a clear threshold for the relationship between FBG and ischemic stroke among older adults with hypertension. Our results might suggest a J-curve nor a U-curve relationship, which was also suggested in some other studies.…”

Section: Discussioncontrasting

confidence: 65%

<p>The Relationship Between Fasting Blood Glucose Levels and First Ischemic Stroke in Elderly Hypertensive Patients</p>

Huang¹,

Lo²,

Liu³

et al. 2020

RMHP

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The relationship between fasting blood glucose and first ischemic stroke in older adults was unclear, so we explored this association among older patients with hypertension in China. Methods: We recruited hypertensive participants with 60 or more of age. Fasting blood glucose concentrations were categorized into quartiles. Hazard ratio (HR) and 95% confidence interval (CI) for ischemic stroke were estimated using multivariate Cox regression analysis and subgroup analysis. Results: A total of 3310 (1474 (44.53%) male) patients with mean age of 71.41±7.20 years were included. During the mean follow-up period of 5.5 years, 206 cases of ischemic stroke occurred. After adjusting for potential confounding variables, multivariate adjusted HRs for each standard deviation increment of fasting blood glucose, the risk of ischemic stroke increased by 11% (95% CI: 1.03, 1.21; P= 0.008). In addition, when using the lowest group (Q1) as reference, the multivariate adjusted HRs for first ischemic stroke were 1.76 (95% CI: 1.08, 2.86; P=0.023), 1.73 (95% CI: 1.06, 2.81; P=0.027) and 2.42 (95% CI: 1.49, 3.93; P<0.001) (P for trend<0.001). Subgroup analysis revealed that the association between fasting blood glucose and the risk of ischemic stroke was higher in male (

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Section: Discussioncontrasting

confidence: 65%

<p>The Relationship Between Fasting Blood Glucose Levels and First Ischemic Stroke in Elderly Hypertensive Patients</p>

Huang¹,

Lo²,

Liu³

et al. 2020

RMHP

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“…Furthermore, glycemia levels have been proved to be positively associated with the development progression of CVD [ 3 ], the involvement of information on glycemia measures might contribute to the improvements in CVD prediction capability [ 4 – 5 ]. In adults with hypertension of our country, patients with a fasting blood glucose (FBG) concentration ≥7.0mmol/l or diabetes always accompanied with higher risk of first stroke, which can be reduced by 34% with the application of folic acid treatment [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Observation of elevated fasting blood glucose and functional outcome after ischemic stroke in patients with and without diabetes

Xue

et al. 2017

Oncotarget

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During May 2015 to October 2016, this prospective study enrolled a total of 438 patients with acute ischemic stroke(AIS), meanwhile, records regarding the severity of initial stroke and neurological outcomes at three months, as well as other examination were completed in patients on admission, as well as the measurement and evaluation of fasting blood glucose(FBG) levels. At admission, the median FBG levels in patients with a minor stroke (n=124), [P<0.001]) was significantly lower than that observed in patients with other degrees of stroke. The poor functional outcome distribution across the FBG quartiles ranged from 13.8 % (first quartile) to 59.6% (fourth quartile), with P <0.001. Compared with the reference category (first quartile), patients in the highest quartile had a relative risk of 3.12 (95% confidence interval [CI], 1.88-6.15; P<0.001) while those in the second and third quartiles had relative risks of 1.76 (95% CI, 1.21-3.03; P=0.035) and 2.23 (95% CI, 1.50-3.69; P=0.010), respectively. Furthermore, in the patients without diabetes, FBG level was observed to be increased and indicated an increased risk of disability (odds ratio [OR]: 1.30 (95%CI 1.13-1.61), P=0.002), however, similar result was not detected in patients with prior diabetes (P=0.089). In conclusion, elevated FBG levels after stroke may suggest poor functional outcome at 3-month in patients without a previous history of diabetes.

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“…Study participants were divided into four groups, based on serum WBC count and fasting glucose levels at admission: normal WBC count and normal glucose, NWNG (WBC count < 10 × 10 9 /L and fasting glucose < 7.0 mmol/L), normal WBC count and higher glucose, NWHG (WBC count < 10 × 10 9 /L and fasting glucose ≥ 7.0 mmol/L), higher WBC count and normal glucose, HWNG (WBC count ≥ 10 × 10 9 /L and fasting glucose < 7.0 mmol/L), and higher WBC count and higher glucose, HWHG (WBC count ≥ 10 × 10 9 /L and fasting glucose ≥ 7.0 mmol/L) [18, 19]. Continuous variables were expressed as mean ± standard deviation (SD) or median (interquartile range [IQR]) and were compared using the analysis of variance or Wilcoxon rank-sum test.…”

Section: Methodsmentioning

confidence: 99%

Combined utility of white blood cell count and blood glucose for predicting in-hospital outcomes in acute ischemic stroke

You

Zhang

et al. 2019

J Neuroinflammation

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Background High white blood cell (WBC) count and high blood glucose level are risk factors for mortality and pneumonia after acute ischemic stroke (AIS). We investigated the combined effect of high WBC count and high blood glucose level on hospital admission and in-hospital mortality and pneumonia in acute AIS patients. Methods A total of 3124 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into four groups according to their level of WBC count and blood glucose: NWNG (normal WBC count and normal glucose), NWHG (normal WBC count and higher glucose), HWNG (higher WBC count and normal glucose), and HWHG (higher WBC count and higher glucose). Cox proportional hazard model and logistic regression model were used to estimate the combined effect of WBC count and blood glucose on all-cause in-hospital mortality and pneumonia in AIS patients. Results HWHG was associated with a 2.22-fold increase in the risk of in-hospital mortality in comparison to NWNG (adjusted hazard ratio [HR] 2.22; 95% confidence interval [CI], 1.21–4.07; P trend = 0.003). The risk of pneumonia was significantly higher in patients with HWHG compared to those with NWNG (adjusted odds ratio [OR] 2.61; 95% CI, 1.66–4.10; P trend < 0.001). The C-statistic for the combined WBC count and blood glucose was higher than WBC count or blood glucose alone for prediction of in-hospital mortality and pneumonia (all p < 0.01). Conclusions High WBC count combined with high blood glucose level at admission was independently associated with in-hospital mortality and pneumonia in AIS patients. Moreover, the combination of WBC count and blood glucose level appeared to be a better predictor than WBC count or blood glucose alone. Electronic supplementary material The online version of this article (10.1186/s12974-019-1422-7) contains supplementary material, which is available to authorized users.

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Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention

Cited by 20 publications

References 25 publications

<p>The Relationship Between Fasting Blood Glucose Levels and First Ischemic Stroke in Elderly Hypertensive Patients</p>

<p>The Relationship Between Fasting Blood Glucose Levels and First Ischemic Stroke in Elderly Hypertensive Patients</p>

Observation of elevated fasting blood glucose and functional outcome after ischemic stroke in patients with and without diabetes

Combined utility of white blood cell count and blood glucose for predicting in-hospital outcomes in acute ischemic stroke

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