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

Abstract

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.

Risk of myocardial infarction in men and women with type 2 diabetes in the UK: a cohort study using the General Practice Research Database

“…This increased relative risk in women remained even when adjusted for risk factors and corroborates the findings of Huxley et al, which showed women to be at a greater relative risk than men [5]. This finding is consistent with our previous work on all-cause mortality and stroke in type 2 diabetes [31,32]. We consider that the data presented here are consistent and that this pattern of increased relative risk in women is likely to be real.…”

Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: an observational study in 13,087 patients

“…Overweight and obesity are associated with increased risks of cardiovascular morbidity and mortality in the general population [8][9][10][11][12][24][25][26][27], but only a few previous studies of type 2 diabetic patients have addressed the topic, and with somewhat conflicting results [13][14][15][16][28][29][30][31]. Our large observational study clearly shows an increased risk of fatal/non-fatal CHD (15%), stroke (11%), CVD (13%) and total mortality (27%) with a 5 unit increase in BMI at baseline after adjustment for age, sex, diabetes duration, type of hypoglycaemic treatment and smoking (model 1), and the risks were attenuated, but remained significant (except for stroke), when also adjusted for additional cardiovascular risk factors (e.g.…”

“…The UK GPRD study (N= 41,799, age 35-89 years, followed from 1992 to 1999) found a significantly increased risk of stroke (36%) only with BMI >35 kg/m 2 compared with BMI 20-24 kg/m 2 (adjustment as in model 1 and for hypertension) [29], whereas in a UKPDS report, obesity was not independently associated with an increased risk of fatal or non-fatal stroke [30].…”

The Role of Triglyceride in Cardiovascular Disease in Asian Patients with Type 2 Diabetes - A Systematic Review

“…In patients with stroke, the role of TG is equivocal. Systolic blood pressure is a leading predictor of stroke in Western or Asian populations [15,31,41]. Thus, when compared with blood pressure, the influence of TG may be concealed.…”