Diabetes Mellitus Is Associated With Increased Risk of Ischemic Stroke in Patients With and Without Coronary Artery Disease

Abstract

Background and Purpose— Diabetes mellitus (DM) and non-DM patients without coronary artery disease (CAD) have a similar low risk of myocardial infarction after coronary angiography. The risk of ischemic stroke in DM patients dependent on CAD status is less explored. We examined whether DM patients without CAD have a risk of ischemic stroke similar to that in patients with neither DM nor CAD. Methods— We conducted a cohort study of patients who underwent coronary angiography between 2004 and 2012 in Western Denmark. Patients diagnosed with previous ischemic stroke or transient ischemic attack were excluded. Patients were stratified according to the presence of DM and CAD. Follow-up started 30 days after coronary angiography. We computed event rates and adjusted incidence rate ratios using patients without DM or CAD as reference. We examined the trend between CAD extent and ischemic stroke in patients with DM. Results— A total of 81 909 patients were included. Median follow-up was 3.8 years. Patients with both DM and CAD were at the highest risk of ischemic stroke (1.32 events per 100 person-years; adjusted incidence rate ratio, 2.00 [95% CI, 1.72–2.32]). Patients with CAD alone (0.77 events per 100 person-years; adjusted incidence rate ratio, 1.27 [95% CI, 1.12–1.44]) or DM alone (0.95 events per 100 person-years; adjusted incidence rate ratio, 1.74 [95% CI, 1.42–2.15]) were at intermediate risk, whereas patients with neither DM nor CAD (0.52 events per 100 person-years) were at the lowest risk. Among patients with DM, extent of CAD was further predictive of risk ( P trend <0.001). Conclusions— Not only CAD but also DM are associated with the risk of ischemic stroke after coronary angiography. Their combination further increases the risk of ischemic stroke depending on the extent of CAD.

Diabetes is not a risk factor for myocardial infarction in patients without coronary artery disease: A study from the Western Denmark Heart Registry

“…Hence, we have previously reported that diabetes patients without CAD had increased risk of ischemic stroke compared to patients with neither CAD nor diabetes (adjusted IRR 1.74, 95% CI, 1.42-2.15), although the risk was lower risk than in patients with CAD and diabetes combined. 19 In addition, diabetes also adversely affects the microvasculature in multiple organs leading to complications such as kidney failure and peripheral neuropathy. 20 Thus, the absence of CAD by CAG ensures an 11-year low risk of MI for diabetes patients, but it only provides moderate protection against macrovascular complications, such as stroke 19 and possibly PAD, which could explain the observed increased mortality in diabetes patients.…”

“…19 In addition, diabetes also adversely affects the microvasculature in multiple organs leading to complications such as kidney failure and peripheral neuropathy. 20 Thus, the absence of CAD by CAG ensures an 11-year low risk of MI for diabetes patients, but it only provides moderate protection against macrovascular complications, such as stroke 19 and possibly PAD, which could explain the observed increased mortality in diabetes patients. Furthermore, microvascular complications, particularly kidney failure, are strongly associated with mortality.…”

COVID-19 and diabetes mellitus: from pathophysiology to clinical management

“…Diabetes mellitus was also found to be associated with an increase of more than twofold in the risk of ulcer formation after DVT 155 . Thus, patients with diabetes mellitus are already in a high-risk category for a thromboembolic event or stroke 156,157 .…”

“…Considering an increased thromboembolic risk among patients with diabetes mellitus [153][154][155][156][157] , we propose that physicians should consider prescribing antiplatelet or anticoagulating agents more actively in patients with diabetes mellitus to prevent thromboembolic events and their complications during the COVID-19 pandemic.…”

Application of Concomitant Disease Scoring in Acute Cerebral Infarction

“…A previous study revealed that there are certain synergic factors in the process of progressive cerebral infarction caused by hypertension, such as high homocysteine and diabetes (7). The incidence of hypertension is significantly higher in diabetic patients with cerebral infarction than in patients with cerebral infarction alone (8). Hyperglycemia can promote cerebral infarction in hypertensive patients, and promote the progression of cerebral infarction (9).…”