Predictors of Stroke in Middle-Aged Patients With Non–Insulin-Dependent Diabetes

Lehto, Seppo; Rönnemaa, Tapani; Pyörälà, Kalevi; Laakso, Markku

doi:10.1161/01.str.27.1.63

Cited by 223 publications

(167 citation statements)

References 36 publications

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“…The magnitude of the effect of diabetes and stroke on stroke risk probably depends on the duration of the disease, and this time factor may operate differently for diabetes than for stroke. Among the patients who have survived an acute stroke, the risk of subsequent stroke event is highest immediately after the attack and the risk stabilizes over time, whereas among diabetic subjects, the stroke risk increases with the duration of the disease [15]. As in the baseline cohort analyses of our study, most previous studies have not paid attention to the time of stroke event or duration of diabetes in their data analyses.…”

Section: Discussionmentioning

confidence: 86%

“…Several studies have recently assessed the relationship between type 2 diabetes and the risk of stroke. Type 2 diabetes has been shown to be an independent risk factor for stroke morbidity [15,[18][19][20][21][22] and mortality [14,16,17,22,40]. The Renfrew and Paisley Study found that type 2 diabetes was a predictor of stroke incidence among women but not among men [41].…”

Section: Discussionmentioning

confidence: 99%

“…Several prospective studies have assessed the independent effect of type 2 diabetes on stroke risk, with inconsistent results. Some [14][15][16][17][18][19][20][21][22], but not all studies [23,24], have identified type 2 diabetes as an independent risk factor for stroke. Moreover, it is not fully understood whether the risk of stroke death associated with incident diabetes is similar to that associated with incident stroke.…”

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confidence: 99%

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The effect of diabetes and stroke at baseline and during follow-up on stroke mortality

Jousilahti

Sarti

et al. 2006

Diabetologia

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Aims/hypothesis The aim of this study was to compare the magnitude of the effect of diabetes and stroke at baseline and during follow-up on risk of stroke mortality. Materials and methods Study cohorts included 25,155 Finnish men and 26,423 women aged 25-74 years. Data on diabetes and stroke history at baseline, their incidence during follow-up, and stroke death were obtained from national registers. Results During a mean follow-up of 18.9 years, 838 stroke deaths were recorded. In the baseline study, hazard ratios (HRs) for stroke mortality were 5.26 for men with prior diabetes only, 4.76 for men with prior stroke only, and 13.4 for men with both prior diabetes and stroke compared with men without diabetes and stroke at baseline and during follow-up. In women, the corresponding hazard ratios were 7.29, 5.27 and 5.52, respectively. When only diabetes and stroke status during the follow-up were considered, the hazard ratios for stroke mortality were 1.41 for men and 1.56 for women with incident diabetes only, 5.62 for men and 5.58 for women with incident stroke only, and 5.59 for men and 4.48 for women with both incident diabetes and stroke compared with men and women without diabetes and stroke at baseline and during follow-up. Conclusions/interpretation Diabetes and stroke, present either at baseline or during follow-up, markedly increase the risk of stroke death. Prior stroke at baseline carries a similar risk of stroke mortality as prior diabetes. There is a greater risk of stroke mortality associated with incident stroke during follow-up than with incident diabetes.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The effect of diabetes and stroke at baseline and during follow-up on stroke mortality

Jousilahti

Sarti

et al. 2006

Diabetologia

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“…Indeed, Wong et al showed that after the age of 75 years, patients with diabetes had the same risk of stroke as those without diabetes [2]. The evidence for an increase in risk with smoking and obesity in people with diabetes is conflicting [3,[7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Part of the variation in the published risk estimates for stroke in people with diabetes may be explained by the composition of the study populations [2,3,9,14]. Many studies excluded older patients, did not differentiate between diabetes type, selected from a population that had a different underlying risk of stroke from that of the UK or used the general population containing diabetes as the comparison group [9,10,13,14].…”

Section: Introductionmentioning

confidence: 99%

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

et al. 2006

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Aims/hypothesis Risk estimates for stroke in patients with diabetes vary. We sought to obtain reliable risk estimates for stroke and the association with diabetes, comorbidity and lifestyle in a large cohort of type 2 diabetic patients in the UK. Materials and methods Using the General Practice Research Database, we identified all patients who had type 2 diabetes and were aged 35 to 89 years on 1 January 1992. We also identified five comparison subjects without diabetes and of the same age and sex. Hazard ratios (HRs) for stroke between January 1992 and October 1999 were calculated, and the association with age, sex, body mass index, smoking, hypertension, atrial fibrillation and duration of diabetes was investigated. Results The absolute rate of stroke was 11.91 per 1,000 person-years (95% CI 11.41-12.43) in people with diabetes (n=41,799) and 5.55 per 1,000 person-years (95% CI 5.40-5.70) in the comparison group (n=202,733). The ageadjusted HR for stroke in type 2 diabetic compared with non-diabetic subjects was 2.19 (95% CI 2.09-2.32) overall, 2.08 (95% CI 1.94-2.24) in men and 2.32 (95% CI 2.16-2.49) in women. The increase in risk attributable to diabetes was highest among young women (HR 8.18; 95% CI 4.31-15.51) and decreased with age. No investigated comorbidity or lifestyle characteristic emerged as a major contributor to risk of stroke. Conclusions/interpretation This study provides risk estimates for stroke for an unselected population from UK general practice. Patients with type 2 diabetes were at an increased risk of stroke, which decreased with age and was higher in women. Additional risk factors for stroke in type 2 diabetic patients included duration of diabetes, smoking, obesity, atrial fibrillation and hypertension.

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Risk Factors for Stroke in Type 2 Diabetes Mellitus

Davis¹

1999

Arch Intern Med

175

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Predictors of Stroke in Middle-Aged Patients With Non–Insulin-Dependent Diabetes

Abstract: Our prospective population-based study gives evidence that previous history of stroke, hypertension, hyperglycemia, and dyslipidemia are strong predictors of stroke in middle-aged patients with NIDDM.

Cited by 223 publications

References 36 publications

The effect of diabetes and stroke at baseline and during follow-up on stroke mortality

The effect of diabetes and stroke at baseline and during follow-up on stroke mortality

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

Risk Factors for Stroke in Type 2 Diabetes Mellitus

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