Microvascular Parameters Help to Predict Stroke Risk in the Asian Diabetic Population in Taiwan: A Population Based Case-Control Study

Abstract

Intensive glycemic control has not shown consistent findings in stroke prevention for diabetes patients, particularly for those with microvascular complications. This case-control study evaluates the risks of stroke in Asian diabetic population with microvascular complications. From the insurance claims of Taiwan, we identified 67,426 type 2 diabetic mellitus (DM) patients with newly diagnosed stroke in 2000–2011 and 134,852 randomly selected controls with DM but without stroke, matched by sex, age, and number of years since diagnosis of DM. Conditional logistic regression analysis measured crude odds ratios (OR) and adjusted odds ratio (aOR) of stroke and 95% confidence intervals (CI) for associations with demographic status, comorbidities, and microvascular complications: retinopathy (RetP), neuropathy (NeuP) or nephropathy (NepP). The aOR of stroke increased significantly associated with each complication: 1.47 with RetP, 1.73 with NeuP and 1.23 with NepP. The risk increased further when there was a combination of complications. The overall aOR of stroke was 2.83 (95% CI 2.58–3.09) for stroke patients with 3 microvascular complications. The corresponding aOR of ischemic stroke was 2.64 (95% CI 2.39–2.91) and that of hemorrhagic stroke was 4.12 (95% CI 3.25–5.22). The number of microvascular complications positively correlated to the prevalence of comorbidity (p < 0.01). This study suggests that microvascular complications are significant stroke predictors, with a greater involvement for ischemic stroke than for hemorrhagic stroke. Multiple microvascular complications interactively increase the stroke risk. Our study contributes to the identification of high-risk subjects for stroke prevention and adequate glycemic control.

Effects of colchicine use on ischemic and hemorrhagic stroke risk in diabetic patients with and without gout

“…Wicke et al reported that higher aDSCI levels are correlated with a higher risk of stroke, supporting our assumption 22 . Moreover, Lo et al reported that the three variables in the aDSCI—neuropathy, nephropathy, and retinopathy—indicate a higher risk of hemorrhagic stroke (adjusted hazard ratio [aHR] = 4.12) and ischemic stroke (aHR = 2.64) 23 . In our study, patients with hypoglycemia were more likely to have a aDSCI score of 2 (27.10% vs 24.58%) and had higher frequencies of ischemic stroke (11.43% vs 6.75%) and hemorrhagic stroke (2.11% vs 1.84%) among the colchicine users (Appendix Tables 1 and 2 ).…”

Impact of individual microvascular disease on the risks of macrovascular complications in type 2 diabetes: a nationwide population-based cohort study

“…Patients with retinopathy had a 1.11–7.35 times higher risk of stroke [ 21 ]. Patients with cardiac autonomic neuropathy exhibited a 1.7–2.7 folds higher risk of stroke than those without cardiac autonomic neuropathy [ 8 , 10 , 27 , 28 ]. Our study showed that patients with microvascular disease demonstrated a significantly higher risk of stroke development than those without microvascular disease.…”

“…Diabetic neuropathy is a syndrome that includes somatic and autonomic neuropathy of the peripheral nervous system [ 4 , 29 ]. The plausible mechanisms to explain the intense association of neuropathy and stroke development are as follows: first, diabetic neuropathy may lead to the dysfunction of the parasympathetic and sympathetic innervation of cerebral vasculatures, resulting in the defective autoregulation of cerebral blood flow and render the brain vessels more vulnerable to injury and occlusion [ 10 , 27 , 28 ]. Second, neuropathy may cause unstable baroreflex and heart rhythms and favor atrial fibrillation with subsequent stroke development [ 28 ].…”