Newly diagnosed diabetes has high risk for cardiovascular outcome in ischemic stroke patients

Kyung-Hee Cho, Sun U Kwon, Ji Sung Lee, Sungwook Yu, A-Hyun Cho, Kyung-Hee Cho, Sun U Kwon, Ji Sung Lee, Sungwook Yu, A-Hyun Cho

Abstract

We investigated cardiovascular outcomes in ischemic stroke patients with newly diagnosed diabetes mellitus (DM) compared with those of patients with previously known DM and no DM using the glycosylated hemoglobin (HbA1c) criteria. The relationship between new DM diagnosis and cardiovascular risk remains unclear to date. We performed post hoc analysis using the data of participants from the Prevention of Cardiovascular events in iSchemic Stroke patients with high risk of cerebral hemOrrhage (PICASSO) trial. Newly diagnosed DM was defined as HbA1c of ≥ 6.5% without known DM history. The outcome was the incidence of composite cardiovascular events, including stroke (ischemic and hemorrhagic), myocardial infarction, and cardiovascular death. In total, 1306 patients were included; 38 patients (2.9%) had newly diagnosed DM; 438 patients (33.5%), known DM; and 830 patients (63.6%), no DM. In patients with newly diagnosed DM, known DM, and no DM, the incidence of ischemic stroke was 8.93, 3.79, and 2.64 per 100 person-years (log-rank test; p = 0.0092), while that of composite cardiovascular events was 8.93, 5.92, and 3.87 per 100 person-years (p = 0.025), respectively. Newly diagnosed DM was an important risk factor for ischemic stroke and composite cardiovascular events after ischemic stroke.Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01013532.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Kaplan–Meier estimates of event probability expressed as diabetes status.

References

    1. Rao Kondapally Seshasai S, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N. Engl. J. Med. 2011;364:829–841. doi: 10.1056/NEJMoa1008862.
    1. Reeves MJ, et al. Quality of care and outcomes in patients with diabetes hospitalized with ischemic stroke: Findings from Get With the Guidelines-Stroke. Stroke. 2010;41:e409–e417. doi: 10.1161/strokeaha.109.572693.
    1. Arboix A, et al. Cerebral infarction in diabetes: Clinical pattern, stroke subtypes, and predictors of in-hospital mortality. BMC Neurol. 2005;5:9. doi: 10.1186/1471-2377-5-9.
    1. Megherbi SE, et al. Association between diabetes and stroke subtype on survival and functional outcome 3 months after stroke: Data from the European BIOMED Stroke Project. Stroke. 2003;34:688–694. doi: 10.1161/01.Str.0000057975.15221.40.
    1. Mapoure YN, et al. Acute stroke patients with newly diagnosed diabetes mellitus have poorer outcomes than those with previously diagnosed diabetes mellitus. J. Stroke Cerebrovasc. Dis. 2018;27:2327–2335. doi: 10.1016/j.jstrokecerebrovasdis.2018.04.017.
    1. Jing J, et al. Prognosis of ischemic stroke with newly diagnosed diabetes mellitus according to hemoglobin A1c criteria in Chinese population. Stroke. 2016;47:2038–2044. doi: 10.1161/strokeaha.116.013606.
    1. Mbanya VN, Kengne AP, Mbanya JC, Akhtar H. Body mass index, waist circumference, hip circumference, waist-hip-ratio and waist-height-ratio: Which is the better discriminator of prevalent screen-detected diabetes in a Cameroonian population? Diabetes Res. Clin. Pract. 2015;108:23–30. doi: 10.1016/j.diabres.2015.01.032.
    1. Rhee EJ, et al. Relation between baseline height and new diabetes development: A nationwide population-based study. Diabetes Metab. J. 2019;43:794–803. doi: 10.4093/dmj.2018.0184.
    1. Timmer JR, et al. Prognostic value of admission glycosylated hemoglobin and glucose in nondiabetic patients with ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention. Circulation. 2011;124:704–711. doi: 10.1161/circulationaha.110.985911.
    1. Stolar M. Glycemic control and complications in type 2 diabetes mellitus. Am. J. Med. 2010;123:S3–S11. doi: 10.1016/j.amjmed.2009.12.004.
    1. Selvin E, et al. Cardiovascular outcomes in trials of oral diabetes medications: A systematic review. Arch. Intern. Med. 2008;168:2070–2080. doi: 10.1001/archinte.168.19.2070.
    1. Matz K, et al. Disorders of glucose metabolism in acute stroke patients: An underrecognized problem. Diabetes Care. 2006;29:792–797. doi: 10.2337/diacare.29.04.06.dc05-1818.
    1. Di Bonito P, et al. Impact of known and unknown diabetes on in-hospital mortality from ischemic stroke. Nutr. Metab. Cardiovasc. Dis. 2003;13:148–153. doi: 10.1016/s0939-4753(03)80174-6.
    1. Song SO, et al. Background and data configuration process of a nationwide population-based study using the korean national health insurance system. Diabetes Metab. J. 2014;38:395–403. doi: 10.4093/dmj.2014.38.5.395.
    1. Kim BJ, et al. Prevention of cardiovascular events in Asian patients with ischaemic stroke at high risk of cerebral haemorrhage (PICASSO): A multicentre, randomised controlled trial. Lancet Neurol. 2018;17:509–518. doi: 10.1016/s1474-4422(18)30128-5.
    1. Hong KS, Kim BJ, Lee JY, Kwon SU, Investigators PICASSO. Rationale and design of the PreventIon of CArdiovascular events in iSchemic Stroke patients with high risk of cerebral hemOrrhage (PICASSO) study: A randomized controlled trial. Int. J. Stroke. 2015;10:1153–1158. doi: 10.1111/ijs.12519.
    1. Lin DY, Wei LJ, Ying Z. Checking the Cox model with cumulative sums of martingale-based residuals. Biometrika. 1993;80:557–572. doi: 10.1093/biomet/80.3.557.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit