Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women

Abstract

Aims/hypothesis. The aim of this study was to examine the relationship between type 2 diabetes and risk of ischaemic stroke in Asian populations. Methods. We conducted a 17-year prospective cohort study in 10,582 Japanese individuals (4287 men and 6295 women) aged 40-69 years living in five communities in Japan. All subjects were free of stroke and CHD at baseline. Diabetes was defined as a fasting glucose level of ≥7.0 mmol/l, a non-fasting glucose of ≥11.1 mmol/l, or receiving medication for diabetes.Results. The risk of non-embolic ischaemic stroke was approximately two-fold higher in diabetic subjects than in subjects with normal glucose levels. The multivariate relative risk after adjustment for age, community, hypertensive status, BMI, triceps and subscapular skinfold thickness (TSF and SSF), and other known cardiovascular risk factors was 1.8 (95% CI 1.0-3.2) for men and 2.2 (1.2-4.0) for women. This excess risk was primarily observed among non-hypertensive subjects and individuals with higher values for measures of adiposity (BMI, TSF and SSF values above the median), particularly those with higher values for SSF. The association between non-embolic ischaemic stroke and glucose abnormality was particularly strong among nonhypertensive subjects with higher SSF values: the multivariate relative risk was 1.9 (1.0-3.7) for borderline diabetes and 4.9 (2.5-9.5) for diabetes. Conclusions/interpretation. In this cohort, type 2 diabetes was a significant risk factor for non-embolic ischaemic stroke, particularly in non-hypertensive and non-lean individuals. Due to the nationwide decrease in blood pressure and increase in mean BMI among the Japanese population, with current levels approaching those observed in Western countries, the impact of glucose abnormalities on risk of ischaemic stroke represents a forthcoming public health issue in Japan.

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

“…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].…”

“…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.…”

Relationship of elevated casual blood glucose level with coronary heart disease, cardiovascular disease and all-cause mortality in a representative sample of the Japanese population. NIPPON DATA80

“…Since April 1975, this laboratory has been certified by the CDC-NHLBI Lipid Standardization Program of the Center for Disease Control and Prevention (Atlanta, GA, USA) [15]. Blood glucose levels were measured at this site using the cupric-neocuproine method [16] between 1975 and 1986 [17]. Because blood glucose levels are now widely measured with the hexokinase method, the serum glucose levels were adjusted by using a formula ([0.047×(glucose concentration in mg/dl)]−0.541) previously reported by the same laboratory, which gives levels in mmol/l [17].…”

“…Blood glucose levels were measured at this site using the cupric-neocuproine method [16] between 1975 and 1986 [17]. Because blood glucose levels are now widely measured with the hexokinase method, the serum glucose levels were adjusted by using a formula ([0.047×(glucose concentration in mg/dl)]−0.541) previously reported by the same laboratory, which gives levels in mmol/l [17]. Iso et al [17] reported that this formula was obtained from 60 random samples of blood with the regression line (r 2 =0.93).…”

Risk of hospitalization for diabetic macrovascular complications and in‐hospital mortality with irregular physician visits using propensity score matching

“…In diabetic patients, the proportion of ischemic heart disease (IHD) is two‐ to fourfold higher3, the risk of stroke is approximately twofold greater4 and the risk of peripheral arterial disease (PAD) is approximately fourfold greater5 than in non‐diabetic patients. In Japan, DM was reported as a risk factor for cardiovascular disease and coronary heart disease6, and DM is related to coronary heart disease among women and ischemic stroke among both sexes7.…”