Twenty-Year Temporal Trends in Risk of Ischemic Stroke in Incident Type 2 Diabetes: A Danish Population-Based Cohort Study

Abstract

<p> </p> <p>Objective<br> We examined temporal trends in risk of first-time ischemic stroke in patients with incident type 2 diabetes (T2DM) and no prior atherosclerotic cardiovascular disease (ASCVD). </p> <p>Research Design and Methods<br> Using nationwide health registries, we identified all patients with incident T2DM without a prior hospital diagnosis of ASCVD from 1996-2015 in Denmark. Patients were assigned to 5-year periods based on the date of T2DM diagnosis and were followed for 5 years. Each patient was matched by sex and age with up to 3 individuals from the general population. Temporal trends in ischemic stroke were examined using Cox regression to compute hazard ratios (HRs). Temporal use of prophylactic cardiovascular medications was also assessed. </p> <p>Results <br> The study comprised 288,825 patients with incident T2DM and 782,232 general population individuals. From 1996-2000 to 2011-2015, the 5-year risk of first-time ischemic stroke was approximately halved in the T2DM cohort (5.2% vs. 2.7%, sex- and age-adjusted HR 0.52 [95% CI 0.49-0.55]). Patients diagnosed in 2011-2015 had increased risk of ischemic stroke compared to general population individuals, however, the risk difference narrowed over time (5.2% vs. 2.9% in 1996-1999 [difference 2.3%]; 2.7% vs. 2.0% in 2011-2015 [difference 0.7%]). Use of prophylactic cardiovascular medications increased markedly during the overall study period, especially use of statins (5% to 50%) and multiple antihypertensive drugs (18% to 33%).</p> <p>Conclusions<br> From 1996 to 2015, the 5-year risk of first-time ischemic stroke was approximately halved in patients with incident T2DM and no prior ASCVD, coinciding with markedly increased use of prophylactic cardiovascular medications. </p>

Diabetes and Stroke: What Are the Connections?

“…53 In a recently reported Danish cohort study of patients with T2D and no prior atherosclerotic cardiovascular disease (ASCVD), the 5-year risk of first-time ischemic stroke was approximately halved in the period from 1996 to 2015. 54 This reduction in risk coincided with a marked increase in the use of prophylactic cardiovascular medications, including statins and antihypertensive drugs. 54 Neurologists who care for people who have had a stroke are typically involved in the treatment of atrial fibrillation, carotid stenosis, hypertension, and hyperlipidemia, but not as often in the management of diabetes.…”

“…54 This reduction in risk coincided with a marked increase in the use of prophylactic cardiovascular medications, including statins and antihypertensive drugs. 54 Neurologists who care for people who have had a stroke are typically involved in the treatment of atrial fibrillation, carotid stenosis, hypertension, and hyperlipidemia, but not as often in the management of diabetes. Therefore, rais-ing awareness of diabetes management among neurologists may be beneficial, particularly in the context of recent evidence to support stroke reduction with certain glucose-lowering agents.…”

Explore the value of carotid ultrasound radiomics nomogram in predicting ischemic stroke risk in patients with type 2 diabetes mellitus

“…Individuals with T2DM are at an elevated risk of developing carotid plaques. Numerous factors have been linked to the development of atherosclerosis in individuals with T2DM, including IR, inflammation, age, obesity, tobacco use, dyslipidemia, and other stress markers (7,8). Furthermore, diabetic dyslipidemia in individuals with T2DM is marked by elevated triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) levels, alongside diminished highdensity lipoprotein cholesterol (HDL-C) levels.…”