Diabetes mellitus and ischemic stroke in the young

Putaala, Jukka; Liebkind, Ron; Gordin, Daniel; Thorn, Lena M.; Haapaniemi, Elena; Forsblom, Carol; Groop, Per‐Henrik; Kaste, Markku; Tatlısumak, Turgut

doi:10.1212/wnl.0b013e31821cccc2

Cited by 97 publications

(76 citation statements)

References 25 publications

(39 reference statements)

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“…Type 1 diabetes mellitus was distinguished from type 2 diabetes mellitus based on insulin dependency within 1 year from diabetes mellitus diagnosis. 17 History of transient ischemic attack, coronary heart disease, atrial fibrillation, congestive heart failure, and active malignancy was recorded. Cigarette smoking was defined as a patient smoking ≥1 cigarette per day within 1 year before stroke.…”

Section: Baseline Datamentioning

confidence: 99%

Long-Term Mortality After First-Ever and Recurrent Stroke in Young Adults

Aarnio

Haapaniemi

Melkas

et al. 2014

Stroke

116

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Background and Purpose-Mortality after first-ever stroke, and particularly after recurrent stroke, and predictors of longterm mortality among young and middle-aged stroke patients are not well-known. We assessed 17-year risk of mortality with focus on the effect of recurrence on the risk of death of young and middle-aged patients with stroke. Methods-Mortality and recurrent stroke rate of 970 consecutive 30-day survivors of first-ever ischemic stroke aged 15 to 49 years (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) were studied. Prospective follow-up data came from the Finnish Care Register for Health Care and Statistics Finland. Mean follow-up was 10.2±4.3 years. We compared survival between clinical subgroups and identified factors associated with mortality. Standardized mortality ratio was calculated for demographic and pathogenetic subgroups using mortality data of the general population matched with age, sex, calendar year, and geographical area. Results-At the end of follow-up, 152 (15.7%) patients had died (cumulative risk, 23.0%; 95% confidence interval, 19.1%-26.9%) and 132 (13.6%) had experienced a recurrent stroke. After adjusting for baseline characteristics, recurrent stroke was statistically the most important risk factor for mortality after first-ever ischemic stroke (hazard ratio, 16.68; 95% confidence interval, 2.33-119.56; P=0.005). Observed mortality was 7-fold higher than the expected mortality (standardized mortality ratio, 6.94; 95% confidence interval, 5.84-8.04) and particularly high among patients who experienced a recurrent stroke (standardized mortality ratio, 14.43; 95% confidence interval, 10.11-18.74). Conclusions-The high mortality rates and the striking impact of recurrent stroke on the risk of death should lead to development of more robust primary and secondary prevention strategies for young patients with stroke. (Stroke. 2014;45:2670-2676.)

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Section: Baseline Datamentioning

confidence: 99%

Long-Term Mortality After First-Ever and Recurrent Stroke in Young Adults

Aarnio

Haapaniemi

Melkas

et al. 2014

Stroke

116

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“…Patients with diabetes have a two-to-three-fold increased risk of cerebrovascular events compared with those without diabetes [3][4][5] . Moreover, the short-term prognosis of stroke patients with diabetes is significantly worse compared with that of patients without diabetes 6,7) , and the long-term prognosis of stroke survivors with diabetes is also poor 8) . In addition to the increasing ethics committee of Juntendo University Hospital.…”

Section: Introductionmentioning

confidence: 99%

Effects of Pioglitazone for Secondary Stroke Prevention in Patients with Impaired Glucose Tolerance and Newly Diagnosed Diabetes: The J-SPIRIT Study

Tanaka

Yamashiro

Okuma

et al. 2015

JAT

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Aim:Prediabetes is an independent risk factor for future stroke. However, no effective treatment has yet been established for the recurrence of stroke in patients with prediabetes. Here we investigated the effects of pioglitazone, a potent peroxisome proliferator-activated receptor-gamma agonist, for the reduction of recurrent stroke in patients with prediabetes. Methods: Participants were patients who had a symptomatic ischemic stroke or transient ischemic attack (TIA) without a history of type 2 diabetes mellitus and who were diagnosed to have IGT or newly diagnosed diabetes by a 75-g oral glucose tolerance test. These patients were randomized to either receive or not receive pioglitazone. The primary endpoint was a recurrence of ischemic stroke. Results: A total of 120 patients were enrolled in the study. Sixty-three patients received pioglitazone and 57 were enrolled in the control group that did not receive pioglitazone. The majority of patients (68.3%) were prescribed 15 mg of pioglitazone, while the remaining patients (31.7%) were treated with 30 mg of pioglitazone. Over a median follow-up period of 2.8 years, treatment with pioglitazone was found to be associated with a lower rate of the primary endpoint (recurrence of stroke) than that observed in the control group [event rate 4.8% pioglitazone vs 10.5% control, hazard ratio 0.62, 95% confidence interval 0.13 -2.35, p 0.49]. However, differences were not statistically significant. Conclusions: While this study was too underpowered to determine the effect of pioglitazone, the result failed to show beneficial effects in patients of ischemic stroke or TIA with impaired glucose tolerance and newly diagnosed diabetes. J Atheroscler Thromb, 2015; 22: 1305-1316.

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“…DM is an important risk factor for ischemic stroke; the reported hazard ratio (HR) for ischemic stroke was 2.3 (95% confidence interval [CI] 2.0-2.7) in individuals with DM versus those without DM. 1 Furthermore, ischemic stroke patients with DM have a poor prognosis, [2][3][4] and DM has been widely used to predict outcome after acute ischemic stroke or transient ischemic attack as an important risk factor. [5][6][7] The traditional glucose-based criteria of DM are based on a fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) (FPG ≥7.0 mmol/L and/or 2-hour OGTT ≥11.1 mmol/L).…”

mentioning

confidence: 99%

Prognosis of Ischemic Stroke With Newly Diagnosed Diabetes Mellitus According to Hemoglobin A1c Criteria in Chinese Population

Jing

Pan

Zhao

et al. 2016

Stroke

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Background and Purpose-Hemoglobin A1c (HbA1c) was recommended to diagnose diabetes mellitus, but whether newly diagnosed diabetes mellitus (NDDM) according to the new criteria was associated with stroke prognosis was unclear. We aimed to investigate the prognosis of ischemic stroke with NDDM according to the new criteria. Methods-Ischemic stroke without a diabetes mellitus history in the survey on Abnormal Glucose Regulation in Patients With Acute Stroke Across China were included in the analysis. NDDM was defined as fasting plasma glucose ≥7.0 mmol/L, 2-hour oral glucose tolerance test ≥11.1 mmol/L, or HbA1c ≥6.5%, and NDDM was divided into group 1, diagnosed by glucose criteria (fasting plasma glucose ≥7.0 mmol/L or 2-hour oral glucose tolerance test ≥11.1 mmol/L with/without HbA1c ≥6.5%), or group 2, diagnosed by single high HbA1c (fasting plasma glucose <7.0 mmol/L, 2-hour oral glucose tolerance test <11.1 mmol/L, and HbA1c ≥6.5%). The association between NDDM and 1-year prognosis (mortality, stroke recurrence, and poor functional outcome [modified Rankin scale score 3-6]) was estimated. Results-Among 1251 ischemic stroke patients, 539 were NDDM and 141 of NDDM with single high HbA1c. NDDM was an independent risk factor for 1-year mortality (hazard ratio, 1.12; 95% confidence interval, 1.001-1.26), stroke recurrence (hazard ratio, 1.14; 95% confidence interval, 1.01-1.28), and poor functional outcome (odds ratio, 2.58; 95% confidence interval, 1.95-3.43) compared with non-diabetes mellitus. Nevertheless, NDDM with single high HbA1c was not significantly associated with 1-year prognosis for all end points (P>0.05 for all). Conclusions-NDDM by new criteria was associated with poor prognosis at 1 year after ischemic stroke; however, NDDM with single high HbA1c did not predict a poor prognosis.

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Diabetes mellitus and ischemic stroke in the young

Abstract: Our findings suggest that ischemic stroke patients with T1D or T2D exhibit a distinct risk-factor and etiologic profile and a worse vascular prognosis than do nondiabetic patients.

Cited by 97 publications

References 25 publications

Long-Term Mortality After First-Ever and Recurrent Stroke in Young Adults

Long-Term Mortality After First-Ever and Recurrent Stroke in Young Adults

Effects of Pioglitazone for Secondary Stroke Prevention in Patients with Impaired Glucose Tolerance and Newly Diagnosed Diabetes: The J-SPIRIT Study

Prognosis of Ischemic Stroke With Newly Diagnosed Diabetes Mellitus According to Hemoglobin A1c Criteria in Chinese Population

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