Impaired Glucose Tolerance Increases Stroke Risk in Nondiabetic Patients With Transient Ischemic Attack or Minor Ischemic Stroke

Abstract

on behalf of the Dutch TIA Trial Study Group Background and Purpose-Impaired glucose tolerance, an intermediate metabolic state between normal glucose and diabetes characterized by nonfasting glucose levels between 7.8 to 11.0 mmol/L, is associated with an increased stroke risk in patients with coronary heart disease. Whether impaired glucose tolerance increases the risk of stroke in patients with transient ischemic attack (TIA) or minor ischemic stroke is unknown. Methods-In total, 3127 patients with a TIA or minor ischemic stroke participated in the Dutch TIA Trial, testing 2 different doses of aspirin and atenolol versus placebo. We estimated the risk of stroke and the risk of myocardial infarction or cardiac death in relation to baseline nonfasting glucose levels (mean 6.0, SD 2.2 mmol/L) with Cox proportional hazards regression analysis, adjusted for cardiovascular risk factors. Results-During 2.6 years follow-up, 272 patients (9%) experienced a stroke and 200 (6%) a myocardial infarction or cardiac death. We found a J-shaped relationship between baseline nonfasting glucose levels and stroke risk. Stroke risk was nearly doubled in patients with impaired glucose tolerance (glucose 7.8 to 11.0 mmol/L) compared with those with normal glucose levels (hazard ratio [HR] 1.8, 95% CI, 1.1 to 3.0) and nearly tripled in diabetic patients (glucose Ն11.1 mmol/L; HR 2.8, 95% CI, 1.9 to 4.1). Patients with low glucose levels (Ͻ4.6 mmol/L) had a 50% increased stroke risk (HR 1.5, 95% CI, 1.0 to 2.2) compared with those with normal glucose levels. There was no association between glucose levels and risk of myocardial infarction or cardiac death. Conclusion-Impaired glucose tolerance is an independent risk factor for future stroke in nondiabetic patients with TIA or minor ischemic stroke.

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

“…Previous data showed a higher recurrence rate of stroke, and 12% of patients with IGT and 18% of patients with DM had a recurrence of stroke during the 2.6-year study period 19) . Recent Asian data also showed that the recurrence rate after a 1-year followup period to be 8.2% in cases with impaired glucose regulation 18) .…”

“…A high incidence of these types of prediabetic conditions among symptomatic stroke patients has been reported from both Asian and Western populations [14][15][16][17] . These prediabetic conditions were also correlated with a poor outcome after stroke 7,18) and increased the risk of reccurence 19) . Thus, prediabetes is an important target to prevent the recurrence of stroke and to decrease the incidence of cardiovascular events.…”

Task-oriented treadmill exercise training in chronic hemiparetic stroke

“…We and others report that insulin resistance is highly prevalent after stroke [18] and that the combined prevalence of impaired glucose tolerance (IGT) and T2DM may exceed 80 percent in individuals with chronic stroke [19]. Since IGT and T2DM prospectively predict two-and threefold increased risk for recurrent cerebrovascular events, respectively [20], this finding may constitute an important modifiable risk factor in secondary stroke prevention.…”

Human genome comparison of paretic and nonparetic vastus lateralis muscle in patients with hemiparetic stroke

“…The level of contribution from alterations in the neural activation pattern and from deconditioning remains to be elucidated. SCI results in an increased incidence of insulin resistance and diabetes, similar to the high prevalence of these conditions after stroke [5,7,[44][45]. These results suggest that paresis resulting from an upper motor neuron lesion of stroke and a spinal cord lesion both induce similar changes in paretic muscles.…”

“…Hemiparesis is the most common neurological sequela. Skeletal muscle has recently been recognized as a site of secondary biological change after stroke that may propagate the functional decline and contribute to the increased risk of insulin resistance, cardiovascular disease, and recurrent stroke [2][3][4][5][6][7]. A number of pathophysiological mechanisms underlie the biological changes in muscle in stroke survivors.…”