Effects of chronic hyperglycaemia on incident stroke in Hong Kong Chinese patients with type 2 diabetes

Yang, Xilin; Kong, Alice P.S.; So, Wing Yee; Ma, Rong; Ho, Chung Shun; Lam, Christopher Wai‐Kei; Chow, Chun Chung; Cockram, Clive S.; Tong, Peter C.Y.; Chan, Juliana C.N.

doi:10.1002/dmrr.675

Cited by 11 publications

(9 citation statements)

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“…We have reported a 1.49-fold increased risk of ischemic stroke per 1% increase in A1C in Chinese patients with type 2 diabetes (20). These increased risks may be attributable to the high prevalence of albuminuria in our populationestimated at 50 -60%-that has also been reported in other Asian populations (21).…”

Section: Characteristics Of Study Patientssupporting

confidence: 67%

Additive Interaction of Hyperglycemia and Albuminuria on Risk of Ischemic Stroke in Type 2 Diabetes

Yang

et al. 2008

Diabetes Care

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OBJECTIVE -The study aims to test whether biological interaction between hyperglycemia and albuminuria can explain the inconsistent findings from epidemiological studies and clinical trials about effects of hyperglycemia on stroke in type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 6,445 Hong Kong Chinese patients with type 2 diabetes and free of stroke at enrollment were followed up for a median of 5.37 years. Spline Cox proportional hazard regression was used to obtain hazard ratio curves, which were used to identify cutoff points of A1C and spot urinary albumin-to-creatinine ratio for increased ischemic stroke risk. The identified cutoff point of A1C was used to check biological interaction between A1C and albuminuria (micro-and macroalbuminuria). The biological interaction was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index.RESULTS -During the follow-up period, 4.45% (n ϭ 287) of patients developed ischemic stroke. A1C was associated with increased hazard ratios of ischemic stroke in a near-linear manner except for two points-6.2 and 8.0%-where the slope between these two points accelerated. For A1C values Ͻ6.2%, the presence of micro/macroalbuminuria did not confer additional risk, while significant biological interaction between A1C and micro/ macroalbuminuria for values Ն6.2% was observed (RERI 0.92, 95% CI 0.16 -1.68, and AP 0.40, 0.01-0.78).CONCLUSIONS -A1C Ն6.2% and micro/macroalbuminuria interact to markedly increase the ischemic stroke risk, which explains a large proportion of risk in patients with type 2 diabetes harboring both risk factors.

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Section: Characteristics Of Study Patientssupporting

confidence: 67%

Additive Interaction of Hyperglycemia and Albuminuria on Risk of Ischemic Stroke in Type 2 Diabetes

Yang

et al. 2008

Diabetes Care

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“…A total of 56 studies were assessed for inclusion in meta‐analyses performed, of which 20 were excluded for the following reasons: 7 studies did not provide HR or RR data; 3 studies provided only effect sizes adjusted for hypoglycemic medication use; 5 studies provided effect sizes which compared diabetes mellitus to non‐diabetes mellitus participants; 1 study provided HR which compared intensively treated to non‐intensively treated cohorts; 1 study had effect size covariate adjustment and stratification limitations; 1 study used a duplicate study population with incomplete HbA 1c strata use in effect size calculation; 1 study used a conditional HR that compared stroke and non‐stroke patient cohorts; and 1 study used a pooled cardiovascular disease outcome without stratifying for a stroke outcome. A detailed overview of the study review process is presented in Figure …”

Section: Resultsmentioning

confidence: 99%

“…Of the 36 studies deemed suitable for meta‐analysis, 7 reported recurrent stroke outcome data and were included only in narrative synthesis because of concerns regarding underpowering of meta‐analyses following outcome stratification (Tables ). A total of 29 studies comprising 532 779 participants were used in meta‐analyses and sensitivity analyses (Figure ). A narrative summary of baseline participant characteristics within all 36 articles identified for potential inclusion is provided in Tables through .…”

Section: Resultsmentioning

confidence: 99%

Relationship Between Glycated Hemoglobin and Stroke Risk: A Systematic Review and Meta‐Analysis

Mitsios

Ekinci

Mitsios

et al. 2018

JAHA

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BackgroundDiabetes mellitus is a major risk factor for ischemic stroke. Rising hemoglobin A1c (HbA1c) levels are associated with microvascular diabetes mellitus complication development; however, this relationship has not been established for stroke risk, a macrovascular complication.Methods and ResultsWe conducted a systematic review and meta‐analysis of observational cohort and nested case‐control cohort studies assessing the association between rising HbA1c levels and stroke risk in adults (≥18 years old) with and without type 1 or type 2 diabetes mellitus. Random‐effects model meta‐analyses were used to calculate pooled adjusted hazard ratios (HRs) and their precision. The systematic review yielded 36 articles, of which 29 articles (comprising n=532 779 participants) were included in our meta‐analysis. Compared to non–diabetes mellitus range HbA1c (<5.7%), diabetes mellitus range HbA1c (≥6.5%) was associated with an increased risk of first‐ever stroke with average HR (95% confidence interval) of 2.15 (1.76, 2.63), whereas pre–diabetes mellitus range HbA1c (5.7–6.5%) was not (average HR [95% confidence interval], 1.19 [0.87, 1.62]). For every 1% HbA1c increment (or equivalent), the average HR (95% confidence interval) for first‐ever stroke was 1.12 (0.91, 1.39) in non–diabetes mellitus cohorts and 1.17 (1.09, 1.25) in diabetes mellitus cohorts. For every 1% HbA1c increment, both non–diabetes mellitus and diabetes mellitus cohorts had a higher associated risk of first‐ever ischemic stroke with average HR (95% confidence interval) of 1.49 (1.32, 1.69) and 1.24 (1.11, 1.39), respectively.ConclusionsA rising HbA1c level is associated with increased first‐ever stroke risk in cohorts with a diabetes mellitus diagnosis and increased risk of first‐ever ischemic stroke in non–diabetes mellitus cohorts. These findings suggest that more intensive HbA1c glycemic control targets may be required for optimal ischemic stroke prevention.

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“…Of these 43 articles, we excluded two that were not conducted in patients with type 2 diabetes [33], [34], two with follow-up time less than 1 year [35], [36], seven that were duplicated reports [5], [26], [37]–[41], one that had type 2 diabetes patients with heart failure at baseline [42], one with hemodialysis [43], and one with disable older women [44]. In addition, we excluded two nest case-control studies because of we were unable to perform the pooled analysis with other studies [45], [46]. Finally, 27 articles [16]–[25], [27]–[30], [32], [47]–[58] that reported 26 independent prospective cohorts were included in the present meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Glycosylated Hemoglobin in Relationship to Cardiovascular Outcomes and Death in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

et al. 2012

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BackgroundChronic hyperglycemia in type 2 diabetes increases the risk of microvascular events. However, there is continuing uncertainty about its effect on macrovascular outcomes and death. We conducted a meta-analysis of prospective studies to estimate the association of glycosylated hemoglobin level with the risk of all-cause mortality and cardiovascular outcomes among patients with type 2 diabetes.Methodology/Principal FindingsWe systematically searched the MEDLINE database through April 2011 by using Medical Subject Heading search terms and a standardized protocol. We included prospective cohort studies that reported data of glycosylated hemoglobin level on the risk of incident cardiovascular events and all-cause mortality. Relative risk estimates (continuous and categorical variables) were derived or abstracted from each cohort study. Twenty six studies were included in this analysis with a mean follow-up rang of 2.2–16 years. The pooled relative risk associated with a 1% increase in glycosylated hemoglobin level among patients with type 2 diabetes was 1.15 (95% CI, 1.11 to 1.20) for all-cause mortality, 1.17 (95% CI, 1.12 to 1.23) for cardiovascular disease, 1.15 (95% CI, 1.10 to 1.20) for coronary heart disease, 1.11 (95% CI, 1.05 to 1.18) for heart failure, 1.11 (95% CI, 1.06 to 1.17) for stroke, and 1.29 (95% CI, 1.18 to 1.40) for peripheral arterial disease, respectively. In addition, a positive dose-response trend existed between glycosylated hemoglobin level and cardiovascular outcomes.Conclusions/SignificanceChronic hyperglycemia is associated with an increased risk for cardiovascular outcomes and all-cause mortality among patients with type 2 diabetes, likely independently from other conventional risk factors.

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Effects of chronic hyperglycaemia on incident stroke in Hong Kong Chinese patients with type 2 diabetes

Abstract: Chronic hyperglycaemia is a risk factor of stroke in Chinese patients with T2DM.

Cited by 11 publications

References 48 publications

Additive Interaction of Hyperglycemia and Albuminuria on Risk of Ischemic Stroke in Type 2 Diabetes

Additive Interaction of Hyperglycemia and Albuminuria on Risk of Ischemic Stroke in Type 2 Diabetes

Relationship Between Glycated Hemoglobin and Stroke Risk: A Systematic Review and Meta‐Analysis

Glycosylated Hemoglobin in Relationship to Cardiovascular Outcomes and Death in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

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