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Jeong J, Park JK, Koh YH, Park JM, Bae HJ, Yun SM. Association of HbA1c with functional outcome by ischemic stroke subtypes and age. Front Neurol 2023; 14:1247693. [PMID: 37840925 PMCID: PMC10568315 DOI: 10.3389/fneur.2023.1247693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Objectives To determine whether high HbA1c levels are related to short-and long-term functional outcomes in patients with ischemic stroke (IS) and whether this association differs according to the IS subtype and the patient's age. Methods The data of 7,380 IS patients admitted to 16 hospitals or regional stroke centers in South-Korea, between May 2017 and December 2019, were obtained from the Clinical Research Collaboration for Stroke-Korea-National Institute of Health database and retrospectively analyzed. Among these patients, 4,598 were followed-up for one-year. The HbA1c levels were classified into three groups (<5.7, 5.7 to <6.5%, ≥6.5%). Short-and long-term poor functional outcomes were defined using the modified Rankin Scale score of 2 to 6 at three-months and one-year, respectively. IS subtypes were categorized according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Results There was an association between higher HbA1c (≥6.5%) and poor functional outcomes at three-months in all patients (three-months; OR, 1.299, 95% CI 1.098, 1.535, one-year; OR, 1.181, 95% CI 0.952, 1.465). When grouped by age, the associations after both 3 months and 1 year observed in younger adult group (<65 years), but not in group aged 65 years and older (three-months; <65 years OR, 1.467, 95% CI 1.112, 1.936, ≥65 years OR, 1.220, 95% CI 0.987, 1.507, p for interaction = 0.038, one-year; <65 years OR, 1.622, 95% CI 1.101, 2.388, ≥65 years OR, 1.010, 95% CI 0.778, 1.312, p for interaction = 0.018). Among younger adult group, the higher HbA1c level was related to short-and long-term functional loss in patients with the small vessel occlusion subtype (three-months; OR, 2.337, 95%CI 1.334, 4.095, one-year; OR, 3.004, 95% CI 1.301, 6.938). However, in patients with other TOAST subtypes, a high HbA1c level did not increase the risk of poor outcomes, regardless of the age of onset. Conclusion High HbA1c levels increase the risk of short-and long-term poor functional outcomes after IS onset. However, this association differs according to stroke subtype and age. Thus, pre-stroke hyperglycemia, reflected by HbA1c, may be a significant predictor for a poor prognosis after ischemic stroke, particular in young- and middle-aged adults.
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Affiliation(s)
- Jihyun Jeong
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
- Division of Injury Prevention and Control, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju-si, Republic of Korea
| | - Jae Kyung Park
- Division of Brain Diseases Research, Department of Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju-si, Republic of Korea
| | - Young Ho Koh
- Division of Brain Diseases Research, Department of Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju-si, Republic of Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang-Moon Yun
- Division of Cardiovascular Disease Research, Department of Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju-si, Republic of Korea
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Amin HP, Madsen TE, Bravata DM, Wira CR, Johnston SC, Ashcraft S, Burrus TM, Panagos PD, Wintermark M, Esenwa C. Diagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association. Stroke 2023; 54:e109-e121. [PMID: 36655570 DOI: 10.1161/str.0000000000000418] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
At least 240 000 individuals experience a transient ischemic attack each year in the United States. Transient ischemic attack is a strong predictor of subsequent stroke. The 90-day stroke risk after transient ischemic attack can be as high as 17.8%, with almost half occurring within 2 days of the index event. Diagnosing transient ischemic attack can also be challenging given the transitory nature of symptoms, often reassuring neurological examination at the time of evaluation, and lack of confirmatory testing. Limited resources, such as imaging availability and access to specialists, can further exacerbate this challenge. This scientific statement focuses on the correct clinical diagnosis, risk assessment, and management decisions of patients with suspected transient ischemic attack. Identification of high-risk patients can be achieved through use of comprehensive protocols incorporating acute phase imaging of both the brain and cerebral vasculature, thoughtful use of risk stratification scales, and ancillary testing with the ultimate goal of determining who can be safely discharged home from the emergency department versus admitted to the hospital. We discuss various methods for rapid yet comprehensive evaluations, keeping resource-limited sites in mind. In addition, we discuss strategies for secondary prevention of future cerebrovascular events using maximal medical therapy and patient education.
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Mosenzon O, Cheng AYY, Rabinstein AA, Sacco S. Diabetes and Stroke: What Are the Connections? J Stroke 2023; 25:26-38. [PMID: 36592968 PMCID: PMC9911852 DOI: 10.5853/jos.2022.02306] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/07/2022] [Indexed: 01/04/2023] Open
Abstract
Stroke is a major cause of death and long-term disability worldwide. Diabetes is associated with an increased risk of cardiovascular complications, including stroke. People with diabetes have a 1.5-2 times higher risk of stroke compared with people without diabetes, with risk increasing with diabetes duration. These risks may also differ according to sex, with a greater risk observed among women versus men. Several mechanisms associated with diabetes lead to stroke, including large artery atherosclerosis, cerebral small vessel disease, and cardiac embolism. Hyperglycemia confers increased risk for worse outcomes in people presenting with acute ischemic stroke, compared with people with normal glycemia. Moreover, people with diabetes may have poorer post-stroke outcomes and higher risk of stroke recurrence than those without diabetes. Appropriate management of diabetes and other vascular risk factors may improve stroke outcomes and reduce the risk for recurrent stroke. Secondary stroke prevention guidelines recommend screening for diabetes following a stroke. The diabetes medications pioglitazone and glucagon-like peptide-1 receptor agonists have demonstrated protection against stroke in randomized controlled trials; this protective effect is believed to be independent of glycemic control. Neurologists are often involved in the management of modifiable risk factors for stroke (including hypertension, hyperlipidemia, and atrial fibrillation), but less often in the direct management of diabetes. This review provides an overview of the relationships between diabetes and stroke, including epidemiology, pathophysiology, post-stroke outcomes, and treatments for people with stroke and diabetes. This should aid neurologists in diabetes-related decision-making when treating people with acute or recurrent stroke.
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Affiliation(s)
- Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel,Correspondence: Ofri Mosenzon Diabetes Unit, Hadassah Medical Center, P.O.B 12000, Jerusalem 9112001, Israel Tel: +1-972-505172464 Fax: +1-972-26424514 E-mail:
| | - Alice YY Cheng
- Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, Toronto, ON, Canada
| | | | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
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Nath M, Swarnkar P, Sharma R, Kumar A, Misra S, Kumar P. Association of modifiable risk factors with ischaemic stroke subtypes in Asian versus Caucasian populations: A systematic review and meta-analysis. Eur J Clin Invest 2022; 52:e13849. [PMID: 35906805 DOI: 10.1111/eci.13849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ischaemic stroke (IS) is associated with various modifiable risk factors but the association of these risk factors based on TOAST classification, which characterises IS into five subtypes: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolic disease (CE), other determined aetiology (ODE) and undetermined aetiology (UDE), is unknown. We aimed to summarise the published evidence for the association of modifiable risk factors with IS subtypes based on TOAST classification, specifically focussing on the Asian versus Caucasian population. METHOD A comprehensive search for all the published articles was performed in electronic databases including PubMed, EMBASE, Cochrane Library, and Google Scholar from 01st January 1950 to 10th April 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Odds ratio (OR) with 95% confidence interval (CIs) along with random-effect models was used to calculate summary estimates. RESULTS In our meta-analysis, 32 studies with a total of 23,404 IS (14,364 in Asian vs. 9040 in Caucasian population), 7121 LAA (5219 in Asian vs. 1902 in Caucasian), 5532 SVO (3604 in Asian vs. 1928 in Caucasian), 3498 CE (1634 in Asian vs. 1864 in Caucasian), 1131 ODE (546 in Asian vs. 585 in Caucasian) and 4519 UDE (2076 in Asian vs. 2443 in Caucasian) were included. Our findings suggest a significant association between LAA and hypertension (OR = 1.07, 95% CI = 1.02-1.12), smoking (OR = 1.11, 95% CI = 1.04-1.17), dyslipidemia (OR = 1.13, 95% CI = 1.06-1.21), diabetes mellitus (OR = 1.18, 95% CI = 1.11-1.25) and atrial fibrillation (OR = 0.55, 95% CI = 0.40-0.75). Significantly strong association of hypertension, smoking, dyslipidemia, diabetes mellitus and atrial fibrillation was observed with SVO and CE stroke subtypes. Subgroup analysis based on ethnicity revealed a significant association for dyslipidemia, diabetes mellitus and atrial fibrillation in LAA for both Asians and Caucasians. Hypertension was significantly associated with SVO and ODE subtypes in both Asians and Caucasians; however, only Asian population showed significant association of hypertension in LAA and CE subtypes. The other risk factors did not show any statistical difference between the ethnic groups for the different stroke subtypes. The majority of the risk factors depicted positive association with LAA and SVO, negative with CE and neutral with ODE and UDE. CONCLUSION Our findings suggest strong association of smoking, dyslipidemia and diabetes mellitus with LAA and SVO subtypes in the Caucasian population. However, only diabetes mellitus showed significant association with both LAA and SVO subtypes in Asian population as well. Thus, a majority of the traditional modifiable risk factors had a positive association in LAA and SVO, while a negative protective association was observed in CE subtype, among both the Asian and the Caucasian subgroups.
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Affiliation(s)
- Manabesh Nath
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Swarnkar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakhee Sharma
- Department of Paediatrics, Army Hospital Research & Referral, New Delhi, India
| | - Amit Kumar
- Department of Paediatrics, Army Hospital Research & Referral, New Delhi, India
| | - Shubham Misra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Onset and Recurrence Characteristics of Chinese Patients with Noncardiogenic Ischemic Stroke in Chinese Medicine Hospital. Chin J Integr Med 2022; 28:492-500. [PMID: 35258782 DOI: 10.1007/s11655-022-3306-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To delineate the onset and recurrence characteristics of noncardiogenic ischemic stroke patients in China. METHODS A prospective, multicenter and registry study was carried out in 2,558 patients at 7 representative clinical sub-centers during November 3, 2016 to February 17, 2019. A questionnaire was used to collect information of patients regarding CM syndromes and constitutions and associated risk factors. Additionally, stroke recurrence was defined as a primary outcome indicator. RESULTS A total of 327 (12.78 %) patients endured recurrence events, 1,681 (65.72%) were men, and the average age was 63.33 ± 9.45 years. Totally 1,741 (68.06%) patients suffered first-ever ischemic stroke, 1,772 (69.27%) patients reported to have hypertension, and 1,640 (64.11%) of them reported dyslipidemia, 1,595 (62.35%) patients exhibited small-artery occlusion by The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Specifically, 1,271 (49.69%) patients were considered as qi-deficient constitution, and 1,227 (47.97%) patients were determined as stagnant blood constitution. There were 1,303 (50.94%) patients diagnosed as blood stasis syndrome, 1,280 (50.04%) patients exhibited phlegm and dampness syndrome and 1,012 (39.56%) patients demonstrated qi deficiency syndrome. And 1,033 (40.38%) patients declared intracranial artery stenosis, and 478 (18.69%) patients reported carotid artery stenosis. The plaque in 1,508 (41.36%) patients were of mixed. Particularly, 41.09% of them demonstrated abnormal levels of glycated hemoglobin levels. CONCLUSIONS Recurrence in minor and small-artery stroke cannot be ignored. Hypertension, dyslipidemia, abnormal HbA1c, intracranial artery stenosis and carotid plaque were more common in stroke patients. Particularly, phlegm-dampness and blood stasis syndromes, as well as qi deficiency and blood stasis constitutions, were still the main manifestations of stroke. (Trial registration at ClinicalTrials.gov No. NCT03174535).
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Wolf V, Abdul Y, Ergul A. Novel Targets and Interventions for Cognitive Complications of Diabetes. Front Physiol 2022; 12:815758. [PMID: 35058808 PMCID: PMC8764363 DOI: 10.3389/fphys.2021.815758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/08/2021] [Indexed: 01/16/2023] Open
Abstract
Diabetes and cognitive dysfunction, ranging from mild cognitive impairment to dementia, often coexist in individuals over 65 years of age. Vascular contributions to cognitive impairment/dementia (VCID) are the second leading cause of dementias under the umbrella of Alzheimer's disease and related dementias (ADRD). Over half of dementia patients have VCID either as a single pathology or a mixed dementia with AD. While the prevalence of type 2 diabetes in individuals with dementia can be as high as 39% and diabetes increases the risk of cerebrovascular disease and stroke, VCID remains to be one of the less understood and less studied complications of diabetes. We have identified cerebrovascular dysfunction and compromised endothelial integrity leading to decreased cerebral blood flow and iron deposition into the brain, respectively, as targets for intervention for the prevention of VCID in diabetes. This review will focus on targeted therapies that improve endothelial function or remove iron without systemic effects, such as agents delivered intranasally, that may result in actionable and disease-modifying novel treatments in the high-risk diabetic population.
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Affiliation(s)
- Victoria Wolf
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Yasir Abdul
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States,*Correspondence: Yasir Abdul,
| | - Adviye Ergul
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
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Dabilgou AA, Dravé A, Kyelem JMA, Zoungrana R, Napon C, Millogo A, Kaboré J. Frequency of recurrent stroke in Burkina Faso: an observational hospital based study of 6 months. Pan Afr Med J 2021; 40:108. [PMID: 34887982 PMCID: PMC8627149 DOI: 10.11604/pamj.2021.40.108.23098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/08/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction studies on stroke recurrence are rare in sub-Sahara Africa. The aim to this study is to determine the prevalence and risk factors for recurrent stroke in two University Teaching Hospital in Burkina Faso. Methods this prospective cross-sectional study was carried on 266 stroke patients admitted in two hospitals in the city of Ouagadougou from September 1, 2017 to February 28, 2018. Patients with stroke recurrence (ischemic or hemorrhagic) were included. Results of 266 acute stroke patients included, 44 (16.4%) had recurrent stroke. The mean age of patients was 66.5 ± 11.49 years with male predominance. Hypertension was the most vascular risk factors (81.8%). Previous stroke was ischemic in 61.4%, hemorrhagic in 22.7% and unknown in 15.9% of cases. Poor compliance (< 60%) was determined in patients taking antiagregant (43.6%) and statins (50%). At admission, the most neurological disorders was motor deficit (100%), aphasia (84.1%), and deglutition disorders (15.9%). CT scan showed ischemic in 82% and hemorrhagic stroke in 18% of cases. With the analysis of second stroke, recurrent stroke after intracerebral hemorrhage was hemorrhagic in 77.8% and ischemic in 22.2%. Recurrent stroke after ischemic stroke was ischemic in 100%. Conclusion stroke recurrence is common in our context. Hypertension was the most common vascular risk factor in recurrent stroke. Poor compliance was determined in patients taking antiagregant agents and statins in previous stroke.
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Affiliation(s)
| | - Alassane Dravé
- Department of Neurology, Regional University Hospital of Ouahigouya, Ouahigouya, Burkina Faso
| | | | - Robert Zoungrana
- Department of Neurology, University Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Christian Napon
- Department of Neurology, University Hospital of Bogodogo, Ouagadougou, Burkina Faso
| | - Athanase Millogo
- Department of Neurology, University Hospital Teaching Hospital Souro Sanon, Bobo Dioulasso, Burkina Faso
| | - Jean Kaboré
- Department of Neurology, University Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso
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Guo Z, Jia J, Tu Y, Jin C, Guo C, Song F, Wu X, Bao H, Fan W. Altered Jagged1-Notch1 Signaling in Enhanced Dysfunctional Neovascularization and Delayed Angiogenesis After Ischemic Stroke in HFD/STZ Induced Type 2 Diabetes Rats. Front Physiol 2021; 12:687947. [PMID: 34305641 PMCID: PMC8297620 DOI: 10.3389/fphys.2021.687947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
Diabetes exacerbates brain damage in cerebral ischemic stroke. Our previous study has demonstrated that after cerebral ischemia, type 2 diabetes rats displayed worse neurological outcomes, larger cerebral infarction and severer blood-brain barrier disruption. However, our knowledge of the mechanisms of how diabetes impacts the cerebrovascular repair process is limited. This study was aimed to characterize structural alterations and potential mechanisms in brain microvessels before and after ischemic stroke in type 2 diabetic rats treated with high-fat diet and streptozotocin (HFD/STZ). Furtherly, we tested our hypothesis that dysregulated intercellular Jagged1-Notch1 signaling was involved in the dysfunctional cerebral neovascularization both before and after ischemic stroke in HFD/STZ rats. In our study, we found increased yet dysfunctional neovascularization with activated Jagged1-Notch1 signaling in the cerebrovasculature before cerebral ischemia in HFD/STZ rats compared with non-diabetic rats. Furthermore, we observed delayed angiogenesis as well as suppressed Jagged1-Notch1 signaling after ischemic stroke. Our results elucidate the potential mechanisms underlying diabetes-related cerebral microvasculature dysfunction after ischemic stroke.
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Affiliation(s)
- Zhihui Guo
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jia Jia
- Department of Neurology, Shanghai Xuhui District Central Hospital, Shanghai, China
| | - Yanling Tu
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Chang Jin
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cen Guo
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Feifei Song
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xuqing Wu
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haifeng Bao
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Fan
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
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Chen M, Luo W, Li J, Cao K, Li X, Huang H, He Y. Clinical Characteristics and Outcomes of Acute Ischemic Stroke in Patients with Type 2 Diabetes: A Single-Center, Retrospective Study in Southern China. Int J Endocrinol 2021; 2021:5517228. [PMID: 34234826 PMCID: PMC8216820 DOI: 10.1155/2021/5517228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/18/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To explore the associations between type 2 diabetes mellitus (DM) and stroke by evaluating the clinical risk factors, characteristics, and outcomes of acute ischemic stroke (AIS) patients with and without type 2 DM. METHODS A total of 1,156 AIS patients (including 410 with type 2 DM (AIS-DM group)) and 746 without type 2 DM (AIS-NDM group)) were included. Patients' demographics, auxiliary examinations, clinical manifestations, and treatment outcomes were recorded and analyzed. RESULTS Among the included AIS patients, 35.46% had type 2 DM. The AIS-DM group had less males (59.76% versus 70.64%), less smokers (33.90% versus 41.96%), more patients with hypertension (72.93% versus 63.94%; p=0.002), higher triglyceride levels (42.93% versus 25.08%; p ≤ 0.01), and lower total cholesterol (147.06 mg/dl versus 175.31 mg/dl) than the AIS-NDM group. The proportion of patients with large artery atherosclerosis (LAA) in the AIS-DM group was lower (77.56% versus 85.92%; p < 0.05) than that in the AIS-NDM group, and the proportion of patients with small arterial occlusions (SAO) in the AIS-DM group was higher (27.07% versus 13.67%; p < 0.05) than that in the AIS-NDM group. The mean National Institutes of Health Stroke Scale (NIHSS) score at admission in the AIS-DM group was lower than that in the AIS-NDM group (4.39 versus 5.00; p=0.008), but there was no significant difference in the NIHSS score or the modified Rankin Scale score between the two groups at discharge. A total of 85 AIS patients underwent intravenous thrombolysis treatment with recombinant tissue plasminogen activator (rtPA). The door-to-needle time (DNT) did not differ significantly between the groups (49.39 ± 30.40 min versus 44.25 ± 15.24 min; p=0.433). In addition, there were no significant differences in the baseline NIHSS score, 7-day NIHSS score, and mRS score at discharge between the groups. After intravenous thrombolysis with rtPA, the AIS-NDM group had better recovery (44.30% versus 29.20%; p=0.017) and a higher ratio of good treatment outcome at discharge (65.60% versus 54.20%; p=0.762). CONCLUSIONS Type 2 DM is associated with AIS and its risk factors, such as dyslipidemia and hypertension. Patients in the AIS-DM group had less LAA and smaller arterial occlusions, and DM could exacerbate the short-term clinical outcomes in AIS patients.
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Affiliation(s)
- Minrui Chen
- Department of the First Clinical Medicine, Guangdong Medical University, Zhanjiang 524023, Guangdong, China
| | - Weiliang Luo
- Department of Neurology, Huizhou Hospital Affiliated to Guangdong Medical University Huizhou Municipal Central Hospital, Huizhou 516001, Guangdong, China
| | - Jiming Li
- Department of Neurology, Huizhou Hospital Affiliated to Guangdong Medical University Huizhou Municipal Central Hospital, Huizhou 516001, Guangdong, China
| | - Kaiyi Cao
- Department of Neurology, Huizhou Hospital Affiliated to Guangdong Medical University Huizhou Municipal Central Hospital, Huizhou 516001, Guangdong, China
| | - Xiaohui Li
- Department of Neurology, Huizhou Hospital Affiliated to Guangdong Medical University Huizhou Municipal Central Hospital, Huizhou 516001, Guangdong, China
| | - Huihong Huang
- Department of Neurology, Huizhou Hospital Affiliated to Guangdong Medical University Huizhou Municipal Central Hospital, Huizhou 516001, Guangdong, China
| | - Yan He
- Department of Neurology, Huizhou Hospital Affiliated to Guangdong Medical University Huizhou Municipal Central Hospital, Huizhou 516001, Guangdong, China
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Zhu N, Shu H, Jiang W, Wang Y, Zhang S. Mean platelet volume and mean platelet volume/platelet count ratio in nonvalvular atrial fibrillation stroke and large artery atherosclerosis stroke. Medicine (Baltimore) 2020; 99:e21044. [PMID: 32664115 PMCID: PMC7360237 DOI: 10.1097/md.0000000000021044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ischemic stroke subtypes such as patients with large artery atherosclerosis, cardioembolism, and embolic stroke of undetermined source were investigated. This study was performed aimed to determine mean platelet volume (MPV) and mean platelet volume/platelet count (MPV/Plt) ratio in nonvalvular atrial fibrillation (AF) stroke and large artery atherosclerosis (LAA) stroke.We conducted a retrospective study of consecutive patients for treatment of acute ischemic stroke at Ruian People's Hospital from March 2017 to October 2018. The patients with ischemic stroke caused by AF and LAA were recruited to this study. Ischemic stroke was confirmed by magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), ischemic lesions on diffusion-weighted imaging were measured in terms of size, composition, and pattern. MPV and platelet count were examined and (MPV/Plt) ratio was calculated.Three hundred seventy one patients were enrolled composing of 177 (47.7%) nonvalvular AF and 194 (52.2%) with LAA. The MPV (11.3 ± 1.3 vs 10.8 ± 1.0, P < .001) and MPV/Plt ratio (0.066 ± 0.025 vs 0.055 ± 0.20, P < .001) were much higher in AF group than LAA group. Receiver-operating characteristic (ROC) analysis showed MPV (AUC: 0.624, confidence interval: 0.567-0.68, P < .001) and MPV/Plt (AUC: 0.657, confidence interval: 0.601-0.713, P < .001) predicted AF between the 2 groups. MPV/Plt ratio was negatively associated with lesion volume (r = -0.161, P = .033) in AF. The analyses of subtypes of composition of infarcts and infarct pattern showed that MPV/Plt ratio was almost higher in AF than LAA except for subcortical-only pattern. Multivariable regression analyses demonstrated National Institutes of Health Stroke Scale (NIHSS) score (r = 2.74; P < .001), LAD (r = -1.15; P = .025) and MPV/Plt ratio (r = -180.64; P = .021) were correlated with lesion volume.Our results indicated elevated MPV and MPV/Plt ratio for the identification of difference between AF and LAA in patients with ischemic stroke.
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Affiliation(s)
- Ning Zhu
- Department of Cardiology, The Wenzhou Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou
| | - Hao Shu
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Ruian People's Hospital, Ruian, Zhejiang Province, P.R. China
| | - Wenbing Jiang
- Department of Cardiology, The Wenzhou Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou
| | - Yi Wang
- Department of Cardiology, The Wenzhou Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou
| | - Shunkai Zhang
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Ruian People's Hospital, Ruian, Zhejiang Province, P.R. China
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Finch E, Foster M, Fleming J, Cruwys T, Williams I, Shah D, Jaques K, Aitken P, Worrall L. Exploring changing needs following minor stroke. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:347-356. [PMID: 31568627 DOI: 10.1111/hsc.12866] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/19/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
Medical advances have led to many of the severe consequences of stroke being averted. Consequently, more people are being discharged from hospital following treatment for what is classed as minor stroke. The needs of people with minor stroke have received little research attention. The aim of the current study was to conduct an exploratory prospective needs analysis to document the unmet health, rehabilitation and psychosocial needs of a recently hospitalised minor stroke cohort approximately 2 weeks (T1) and 2 months (T2) post-hospital discharge. An exploratory cohort design was used to explore the unmet health, service and social needs of 20 patients with minor stroke. Participants completed questionnaires (Survey of Unmet Needs and Service Use, Mayo-Portland Adaptability Inventory-4, Exeter Identity Transition Scales, RAND 36-Item Health Survey 1.0) at T1 and T2. Nine participants reported unmet needs at T1 and seven participants reported unmet needs at T2. Between T1 and T2, there was a significant improvement in perceived role limitations due to physical health. Participation in society was significantly better at T2. In conclusion, patients with minor stroke report health, service and social needs that are unmet by existing services. This patient cohort urgently requires co-ordinated services to detect and manage these unmet needs.
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Affiliation(s)
- Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health
| | - Michele Foster
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tegan Cruwys
- Research School of Psychology, Australian National University, Canberra, Australia
| | | | - Darshan Shah
- Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Katherine Jaques
- Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Philip Aitken
- Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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You W, Li Y, Ouyang J, Li H, Yang S, Hu Q, Zhong J. Predictors of Poor Outcome in Patients with Minor Ischemic Stroke by Using Magnetic Resonance Imaging. J Mol Neurosci 2019; 69:478-484. [PMID: 31325109 DOI: 10.1007/s12031-019-01379-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/09/2019] [Indexed: 02/06/2023]
Abstract
Although the symptoms of minor ischemic stroke are mild, poor prognosis may occur if left untreated. Therefore, it is particularly important to identify the predictors that associated with poor outcome in patients presenting minor ischemic stroke. The aim of this study was to elucidate the predictors of progression by using magnetic resonance imaging (MRI). A total of 516 patients diagnosed with minor ischemic stroke were enrolled in this study. They were divided into two groups, the progressive group and non-progressive group, according to the modified Rankin Scale (mRS) with the cutoff value of 2 points on day 90 after the stroke onset. We compared the results of MRI scan between the two groups to investigate the potential independent determinants of progression using multivariate logistic regression analysis. Ninety of 516 patients (17.44%) underwent progression. There were 9 factors that were independently associated with poor outcome, including age (OR = 1.045, 95% CI 1.017-1.074), heart disease (OR = 2.021, 95% CI 1.063-3.841), baseline NIHSS score (OR = 1.662, 95% CI 1.177-2.347), limb motor disturbance (OR = 2.430, 95% CI 1.010-5.850), ataxia (OR = 2.929, 95% CI 1.188-7.221), early neurological deterioration (OR = 50.994, 95% CI 17.659-147.258), diameter of infarction (OR = 1.279, 95% CI 1.075-1.521), non-responsible vessel size (OR = 2.518, 95% CI 1.145-5.536), and large-artery atherosclerosis (OR = 2.010, 95% CI 1.009-4.003). This study indicated that age, heart disease, motor disturbance of limb, ataxia, early neurological deterioration, diameter of infarction, size of non-responsible vessels, and large-artery atherosclerosis can be used to assess the prognosis of patients with minor ischemic stroke.
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Affiliation(s)
- Wenxia You
- Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China
| | - Yongxin Li
- Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China
| | - Jipeng Ouyang
- Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China
| | - Hongzhuang Li
- Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China
| | - Shaomin Yang
- Department of Radiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China
| | - Qiugen Hu
- Department of Radiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China
| | - Jianping Zhong
- Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China.
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Ling X, Shen B, Li K, Si L, Yang X. Development of a prediction model for 1-year poor prognosis in patients with acute ischemic stroke. J Investig Med 2019; 67:957-963. [PMID: 30728175 DOI: 10.1136/jim-2018-000883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2019] [Indexed: 11/03/2022]
Abstract
The goals of this study were to develop a new prediction model to predict 1-year poor prognosis (death or modified Rankin scale score of ≥3) in patients with acute ischemic stroke (AIS) and to compare the performance of the new prediction model with other prediction scales. Baseline data of 772 patients with AIS were collected, and univariate and multivariate logistic regression analyses were performed to identify independent risk factors for 1-year poor prognosis in patients with AIS. The area under the receiver operating characteristics curve (AUC) value of the new prediction model and the THRIVE, iScore and ASTRAL scores was compared. The Hosmer-Lemeshow test was used to assess the goodness of fit of the model. We identified 196 (25.4%) patients with poor prognosis at 1-year follow-up, and of these 68 (68/196, 34.7%) had died. Multivariate logistic regression and receiver operating characteristic curve analyses showed that age ≥70 years, consciousness (lethargy or coma), history of stroke or transient ischemic attack, cancer, abnormal fasting blood glucose levels ≥7.0 mmol/L, and National Institutes of Health Stroke Scale score were independent risk factors for 1-year poor prognosis in patients with AIS. Scores were assigned for each variable by rounding off β coefficient to the integer score, and a new prediction model with a maximum total score of 9 points was developed. The AUC value of the new prediction model was higher than the THRIVE score (p<0.05). The χ2 value for the Hosmer-Lemeshow test was 7.337 (p>0.05), suggesting that the prediction model had a good fit. The new prediction model can accurately predict 1-year poor prognosis in Chinese patients with AIS.
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Affiliation(s)
- Xia Ling
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Bo Shen
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Kangzhi Li
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Lihong Si
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
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Lou H, Dong Z, Zhang P, Shao X, Li T, Zhao C, Zhang X, Lou P. Interaction of diabetes and smoking on stroke: a population-based cross-sectional survey in China. BMJ Open 2018; 8:e017706. [PMID: 29622573 PMCID: PMC5892748 DOI: 10.1136/bmjopen-2017-017706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Diabetes and smoking are known independent risk factors for stroke; however, their interaction concerning stroke is less clear. We aimed to explore such interaction and its influence on stroke in Chinese adults. DESIGN Cross-sectional study. SETTING Community-based investigation in Xuzhou, China. PARTICIPANTS A total of 39 887 Chinese adults who fulfilled the inclusion criteria were included. METHODS Participants were selected using a multistage stratified cluster method, and completed self-reported questionnaires on stroke and smoking. Type 2 diabetes mellitus (DM2) was assessed by fasting blood glucose or use of antidiabetic medication. Interaction, relative excess risk owing to interaction (RERI), attributable proportion (AP) and synergy index (S) were evaluated using a logistic regression model. RESULTS After adjustment for age, sex, marital status, educational level, occupation, physical activity, body mass index, hypertension, family history of stroke, alcohol use and blood lipids, the relationships between DM2 and stroke, and between smoking and stroke, were still significant: ORs were 2.75 (95% CI 2.03 to 3.73) and 1.70 (95% CI 1.38 to 2.10), respectively. In subjects with DM2 who smoked, the RERI, AP and S values (and 95% CIs) were 1.80 (1.24 to 3.83), 0.52 (0.37 to 0.73) and 1.50 (1.18 to 1.84), respectively. CONCLUSIONS The results suggest there are additive interactions between DM2 and smoking and that these affect stroke in Chinese adults.
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Affiliation(s)
- Heqing Lou
- The School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Zongmei Dong
- The School of Public Health, Xuzhou Medical University, Xuzhou, China
- Department of Non-communicable Disease Control, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Pan Zhang
- Department of Non-communicable Disease Control, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Xiaoping Shao
- The School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Ting Li
- Department of Non-communicable Disease Control, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Chunyan Zhao
- The School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Xunbao Zhang
- The School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Peian Lou
- The School of Public Health, Xuzhou Medical University, Xuzhou, China
- Department of Non-communicable Disease Control, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
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15
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Eberhardt O, Topka H. Neurological outcomes of antidiabetic therapy: What the neurologist should know. Clin Neurol Neurosurg 2017; 158:60-66. [PMID: 28477558 DOI: 10.1016/j.clineuro.2017.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/05/2017] [Accepted: 04/15/2017] [Indexed: 02/09/2023]
Abstract
Considering the causative or contributory effects of diabetes mellitus on common neurological diseases such as polyneuropathy, stroke and dementia, modern antidiabetic drugs may be expected to reduce incidence or progression of these conditions. Nevertheless, most observed benefits have been small, except in the context of therapy for diabetes mellitus type I and new-onset polyneuropathy. Recently, semaglutide, a GLP-1 analog, has been shown to significantly reduce stroke incidence in a randomized controlled trial. Beneficial effects of antidiabetic drugs on stroke severity or outcome have been controversial, though. The level of risk conferred by diabetes mellitus, the complex pathophysiology of neurological diseases, issues of trial design, side-effects of antidiabetic drugs as well as co-medication might be interacting factors that determine the performance of antidiabetic therapy with respect to neurological outcomes. It might be speculated that early treatment of prediabetes might prevent cerebral arteriosclerosis, cognitive decline or polyneuropathy more effectively, but this remains to be demonstrated.
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Affiliation(s)
- Olaf Eberhardt
- Department for Neurology, Clinical Neurophysiology, Clinical Neuropsychology and Stroke Unit, Klinikum Bogenhausen Englschalkinger Str. 77, München, 81925, Germany.
| | - Helge Topka
- Department for Neurology, Clinical Neurophysiology, Clinical Neuropsychology and Stroke Unit, Klinikum Bogenhausen Englschalkinger Str. 77, München, 81925, Germany
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Lin Y, Wang A, Li J, Lin J, Wang D, Meng X, Ou L, Chen W, Zhao X, Liu L, Wang Y, Wang Y. Impact of Glycemic Control on Efficacy of Clopidogrel in Transient Ischemic Attack or Minor Stroke Patients With CYP2C19 Genetic Variants. Stroke 2017; 48:998-1004. [PMID: 28289237 DOI: 10.1161/strokeaha.116.016463] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/26/2017] [Accepted: 02/01/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Dysglycemia may influence the predictive value of CYP2C19 loss-of-function allele for clinical efficacy of antiplatelet drug, but the role of glycated albumin (GA) remains unclear in patients with stroke on antiplatelet drugs. METHODS The CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) included 2933 patients who had GA levels and CYP2C19 genotyping. Cox proportional hazards model was used to assess the interaction between CYP2C19 loss-of-function allele (*2, *3) carrier status and the effect of antiplatelet therapy based on their GA levels. RESULTS There was significant interaction between carrier status and antiplatelet therapy regimen on the risk of recurrent stroke (P=0.03) in patients with GA levels of ≤15.5%, but not in those with GA levels of >15.5% (P=0.48). Only in noncarriers with low GA levels, dual-antiplatelet therapy reduced stroke recurrence (3.5%) compared with those on aspirin alone (14.7%; hazard ratio, 0.23; 95% confidence interval, 0.10-0.49; P<0.001). Similar effects were observed when examined the combined vascular event or ischemic stroke. No significant difference in bleeding was found among groups. CONCLUSIONS In patients with minor stroke or high-risk transient ischemic attack, clopidogrel-aspirin when compared with aspirin alone reduced stroke recurrence only in noncarriers of CYP2C19 loss-of-function allele and normal GA levels. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589.
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Affiliation(s)
- Yi Lin
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China (Y.L., L.O.); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); and Illinois Neurological Institute Stroke Network, OSF Healthcare Systems, University of Illinois College of Medicine at Peoria (D.W.)
| | - Anxin Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China (Y.L., L.O.); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); and Illinois Neurological Institute Stroke Network, OSF Healthcare Systems, University of Illinois College of Medicine at Peoria (D.W.)
| | - Jiejie Li
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China (Y.L., L.O.); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); and Illinois Neurological Institute Stroke Network, OSF Healthcare Systems, University of Illinois College of Medicine at Peoria (D.W.)
| | - Jinxi Lin
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China (Y.L., L.O.); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); and Illinois Neurological Institute Stroke Network, OSF Healthcare Systems, University of Illinois College of Medicine at Peoria (D.W.)
| | - David Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China (Y.L., L.O.); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); and Illinois Neurological Institute Stroke Network, OSF Healthcare Systems, University of Illinois College of Medicine at Peoria (D.W.)
| | - Xia Meng
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China (Y.L., L.O.); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); and Illinois Neurological Institute Stroke Network, OSF Healthcare Systems, University of Illinois College of Medicine at Peoria (D.W.)
| | - Lixian Ou
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China (Y.L., L.O.); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); and Illinois Neurological Institute Stroke Network, OSF Healthcare Systems, University of Illinois College of Medicine at Peoria (D.W.)
| | - Weiqi Chen
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China (Y.L., L.O.); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); and Illinois Neurological Institute Stroke Network, OSF Healthcare Systems, University of Illinois College of Medicine at Peoria (D.W.)
| | - Xingquan Zhao
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China (Y.L., L.O.); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); and Illinois Neurological Institute Stroke Network, OSF Healthcare Systems, University of Illinois College of Medicine at Peoria (D.W.)
| | - Liping Liu
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China (Y.L., L.O.); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); and Illinois Neurological Institute Stroke Network, OSF Healthcare Systems, University of Illinois College of Medicine at Peoria (D.W.)
| | - Yilong Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China (Y.L., L.O.); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); and Illinois Neurological Institute Stroke Network, OSF Healthcare Systems, University of Illinois College of Medicine at Peoria (D.W.)
| | - Yongjun Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China (Y.L., L.O.); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.L., A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (A.W., J. Li, J. Lin, X.M., W.C., X.Z., L.L., Yilong Wang, Yongjun Wang); and Illinois Neurological Institute Stroke Network, OSF Healthcare Systems, University of Illinois College of Medicine at Peoria (D.W.).
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Pan Y, Jing J, Chen W, Zheng H, Jia Q, Mi D, Li H, Zhao X, Liu L, Wang C, Gaisano HY, He Y, Wang Y, Wang Y. Post-Glucose Load Measures of Insulin Resistance and Prognosis of Nondiabetic Patients With Ischemic Stroke. J Am Heart Assoc 2017; 6:JAHA.116.004990. [PMID: 28108466 PMCID: PMC5523645 DOI: 10.1161/jaha.116.004990] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Insulin resistance is associated with an increased risk of cardiovascular events in the general population. This study aimed to estimate the association between post–glucose load measures of insulin resistance and prognosis of nondiabetic patients with ischemic stroke. Methods and Results Data were derived from the ACROSS‐China (Abnormal Glucose Regulation in Patients with Acute Stroke across China) registry. Patients with ischemic stroke without a history of diabetes mellitus were included. Two post–glucose load measures of insulin sensitivity, the insulin sensitivity indices ISI(composite) and the ISI0,120, were calculated. Outcomes included stroke recurrence, all‐cause death, and poor functional outcome at 12 months. Among 1203 patients, 63.3% were male with an average age of 62.1 years. At 12 months, 168 (14.4%) patients had recurrent stroke, 111 (9.2%) had died, and 288 (24.4%) had poor outcome. After adjustment for potential covariates, the first quartile of the ISI(composite) was associated with increased 12‐month stroke recurrence (adjusted hazard ratio 2.02, 95% CI 1.28–3.18, P=0.003), death (adjusted hazard ratio 2.78, 95% CI 1.59–4.86, P<0.001), and poor outcome (adjusted odds ratio 2.67, 95% CI 1.69–4.21, P<0.001) compared with the fourth quartile. Similar results were observed for the ISI0,120 but with a larger magnitude of association. Using a multivariable regression model with restricted cubic spline, we found an L‐shaped association between the insulin sensitivity indices and the risk of each end point. Conclusions In this large‐scale registry, post–glucose load measures of insulin resistance with the ISI(composite) and the ISI0,120 were associated with 12‐month poor outcomes of nondiabetic patients with ischemic stroke.
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Affiliation(s)
- Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Huaguang Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Qian Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Donghua Mi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Chunxue Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | | | - Yan He
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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