Diabetes and Stroke: What Are the Connections?

Prevalence of macro-vascular complications among type 2 diabetic adults aged 50 and over: results from Ardakan cohort study on aging (ACSA)

Objective

Type 2 diabetes mellitus (T2DM) is a common condition that can lead to adverse macrovascular complications. This study aims to determine the prevalence of macrovascular complications in adults aged ≥ 50 with T2DM in Ardakan city, using data from the Ardakan Cohort Study on Aging (ACSA).

Methods

A cross-sectional investigation involved 5933 participants from the ACSA; of those assessed, 2340 had T2DM. Macrovascular complications, specifically coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral artery disease(PAD) were identified through medical records and physician assessment. Logistic regression was used to identify risk factors for these complications.

Results

The prevalence of CAD and CVD were 16.9% (95% CI:16.0-19.0) and 4% (95% CI:3.3-5.0), respectively. risk factors for CAD included age over 60 (OR = 1.47, 95% CI: 1.08-2.01, p = 0.01), male gender (OR = 1.87, 95% CI: 1.33-2.62, p < 0.001), former smoking (OR = 1.96, 95% CI: 1.30-2.95, p = 0.001), hypertension (OR = 3.16, 95% CI: 2.23-4.46, p < 0.001), and over ten years of diabetes duration(OR = 2.04, 95% CI: 1.39-2.99, p < 0.001) and For CVD, significant risk factors included male gender (OR = 2.61, 95% CI: 1.52-4.51, p = 0.001) and hypertension (OR = 2.36, 95% CI: 1.27-4.39, p = 0.006).

Conclusion

This study highlights the high prevalence of macrovascular complications in adults over 50 with T2DM in Ardakan. It emphasizes the importance of managing key risk factors such as hypertension and quitting smoking, especially in older adults and males.

Effect of metabolic disorders on reactive gliosis and glial scarring at the early subacute phase of stroke in a mouse model of diabetes and obesity

It is well recognized that type II Diabetes (T2D) and overweight/obesity are established risk factors for stroke, worsening also their consequences. However, the underlying mechanisms by which these disorders aggravate outcomes are not yet clear limiting the therapeutic opportunities. To fill this gap, we characterized, for the first time, the effects of T2D and obesity on the brain repair mechanisms occurring 7 days after stroke, notably glial scarring. In the present study, by performing a 30-minute middle cerebral artery occlusion (MCAO) on db/db (obese diabetics mice) and db/+ (controls) mice, we demonstrated that obese and diabetic mice displayed larger lesions (i.e. increased infarct volume, ischemic core, apoptotic cell number) and worsened neurological outcomes compared to their control littermates. We then investigated the formation of the glial scar in control and db/db mice 7 days post-stroke. Our observations argue in favor of a stronger and more persistent activation of astrocytes and microglia in db/db mice. Furthermore, an increased deposition of extracellular matrix (ECM) was observed in db/db vs control mice (i.e. chondroitin sulfate proteoglycan and collagen type IV). Consequently, we demonstrated for the first time that the db/db status is associated with increased astrocytic and microglial activation 7 days after stroke and resulted in higher deposition of ECM within the damaged area. Interestingly, the injury-induced neurogenesis appeared stronger in db/db as shown by the labeling of migrating neuroblast. This increase appeared correlated to the larger size of lesion. It nevertheless raises the question of the functional integration of the new neurons in db/db mice given the observed dense ECM, known to be repulsive for neuronal migration. Carefully limiting glial scar formation after stroke represents a promising area of research for reducing neuronal loss and limiting disability in diabetic/obese patients.

Signaling Pathways and Promising Small-Molecule Therapeutic Agents for Ischemic Stroke

Stroke is the second highest cause of death and leading cause of disability with high economic burden worldwide. The incidence of stroke is increasing faster and more prevalent for the global population over age 65. Ischemic stroke (IS) has a higher incidence than hemorrhagic stroke, accounting over 80 % of the total incidence of stroke. The rate of ischemic stroke is increasing in all age groups and both sexes. In present era, hypertension, high blood pressure and modern lifestyle are considered as the causes of the disease. The treatment options for stroke is still limited, mainly thrombolytic and thrombectomy therapy are available options. In the past decade, a number of therapeutic agents have been studied for the acute ischemic stroke to protect the brain from ischemic injury. Several study methods focus to improve neurons functions around the ischemic core and protect from the shock. Many signalling pathways including NF-kB, NrF, Nrf2-Keap1, PI3K/AKT, JAK/STAT signalling pathways are strongly associated for the indication. Controlling the signalling pathways by small molecules potentially improve the neuronal functions. In this article, we review the recent advancement of the drug discovery, controlling the signalling pathways by small molecules, and kinase inhibitors in ischemic stroke.

Scientometric analysis and historical review of diabetic encephalopathy research: Trends and hotspots (2004-2023)

BACKGROUND

Diabetic encephalopathy (DE) is a common and serious complication of diabetes that can cause death in many patients and significantly affects the lives of individuals and society. Multiple studies investigating the pathogenesis of DE have been reported. However, few studies have focused on scientometric analysis of DE.

AIM

To analyze literature on DE using scientometrics to provide a comprehensive picture of research directions and progress in this field.

METHODS

We reviewed studies on DE or cognitive impairment published between 2004 and 2023. The latter were used to identify the most frequent keywords in the keyword analysis and explore the hotspots and trends of DE.

RESULTS

Scientometric analysis revealed 1308 research papers on DE, a number that increased annually over the past 20 years, and that the primary topics explored were domain distribution, knowledge structure, evolution, and emergence of research topics related to DE. The inducing factors, comorbidities, pathogenesis, treatment, and animal models of DE help clarify its occurrence, development, and treatment. An increasing number of studies on DE may be a result of the recent increase in patients with diabetes, unhealthy lifestyles, and unhealthy eating habits, which have aggravated the incidence of this disease.

CONCLUSION

We identified the main inducing factors and comorbidities of DE, though other complex factors undoubtedly increase social and economic burdens. These findings provide vital references for future studies.

Role of Residual Inflammation as a Risk Factor Across Cardiovascular-Kidney-Metabolic (CKM) Syndrome: Unpacking the Burden in People with Type 2 Diabetes

Type 2 diabetes mellitus (T2DM) is a global health crisis, with cardiovascular disease (CVD) accounting for 75% of mortality in this population. Despite advances in managing traditional risk factors, such as low-density lipoprotein cholesterol (LDL) cholesterol reduction (IMPROVE-IT, FOURIER), antithrombotic therapies (PEGASUS, COMPASS), and triglyceride-lowering agents (REDUCE-IT), a substantial residual cardiovascular risk persists, driven in part by chronic low-grade systemic inflammation. Chronic low-grade inflammation is a central driver of cardiovascular-kidney-metabolic (CKM) syndrome in T2DM, perpetuating residual cardiovascular risk despite optimal management of traditional risk factors. This narrative review synthesizes evidence on how inflammation accelerates coronary heart disease (CHD), heart failure (HF), stroke, diabetic kidney disease (DKD), and peripheral artery disease (PAD). We evaluate the anti-inflammatory mechanisms of current therapies such as statins, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide 1 (GLP-1) receptor agonists, as well as emerging agents like colchicine and interleukin (IL)-1β/IL-6 inhibitors, emphasizing their differential efficacy across CKM traits. By integrating pathophysiological insights with clinical trial data, we propose biomarker-guided strategies to target inflammation as a modifiable risk factor, offering a roadmap to bridge the gap in diabetes-related cardiovascular care.

Risk factors for cardiovascular disease among Saudi students: Association with BMI, current smoking, level of physical activity, and dietary habits

Cardiovascular disease (CVD) risk factors, including poor diet, lack of physical activity (PA), smoking, and obesity, are associated with unhealthy lifestyle choices and contribute significantly to the global disease burden. This study aims to investigate the prevalence of behavioral risk factors associated with overweight/obesity, PA, smoking, and eating habits among Saudi students and explores how these vary by region, age, gender, relationship status, and income. A total of 968 participants (285 males and 681 females), aged 18-50, were recruited from bachelor's, master's, doctoral, and other university programs across the Eastern, Riyadh, and Western provinces. Each participant completed the Saudi Food Frequency Questionnaire (SFFQ). The risk of CVD was assessed by summing individual risk factors related to BMI, tobacco use, PA level, glycemic load (GL) of ingested foods, and consumption of saturated fats (SF), processed meats, oily fish, nuts, and cereal fiber (CF). Participants were classified into minimal, medium, or high-risk categories based on their total scores. A high prevalence of CVD risk factors was observed, with 93.6% of participants having three or more risk factors. After adjusting for demographic variables, living in Riyadh was associated with a 12% lower probability of CVD risk. Conversely, students aged 46-50 showed a five- to nine-fold increase in CVD risk. Significant factors influencing CVD risk included BMI (Exp(β) = 11.70), smoking status (Exp(β) = 6.54), PA (Exp(β) = 7.61), SF intake (Exp(β) = 4.79), GL (Exp(β) = 7.00), CF intake (Exp(β) = 24.58), and oily fish consumption (Exp(β) = 2.99). Low CF intake and high BMI were the most prominent risk factors. Lifestyle interventions targeting overweight/obesity, physical inactivity, smoking, high GL and SF intake, and promoting CF and oily fish consumption could improve CV health among participants. Addressing these modifiable risk factors is essential for effective prevention.

Advancing atherosclerosis treatment: Drug encapsulation nanosystems and synthetic HDL nanoparticles

Atherosclerosis, characterized by plaque accumulation in arterial walls, remains a leading cause of cardiovascular disease. Current pharmacological treatments often lack efficacy in halting disease progression or addressing systemic complications. Nanotechnology offers promising solutions, including targeted drug delivery, enhanced bioavailability, and the ability to overcome biological barriers. This review explores the integration of drug-delivery nanosystems and synthetic high-density lipoprotein (HDL) nanoparticles into therapeutic strategies. Synthetic HDL nanoparticles not only serve as effective carriers for antidyslipidemic drugs but also act directly as functional HDL, improving lipid profiles and reducing systemic side effects. By enabling localized treatment and enhancing therapeutic precision, nanotechnology and synthetic HDL nanoparticles represent a paradigm shift in managing atherosclerosis, offering safer and more effective alternatives for preventing its life-threatening complications.

In Vitro and in vivo characterization of nasal pH-Responsive in-situ hydrogel of Candesartan-loaded invasomes as a potential stroke treatment

Candesartan (CDN) is a useful anti-stroke medication because it lowers blood pressure, inflammation, oxidative stress, angiogenesis and apoptosis. However, CDN has limited efficacy due to its low solubility and poor bioavailability. This study set out to develop nasal pH-responsive in situ hydrogel of CDN-loaded invasomes a (PRHCLI) for enhancing CDN's release, penetration, bioavailability, and effectiveness as a possible treatment for stroke. Based on the results of the pre-formulation investigation, the optimum CLI formulation for intravasomal delivery of CDN was determined to be 3% of phospholipid, 0.16% of cholesterol, 3% of ethanol, and 1% of cineole. The optimum formulation significantly enhanced CDN permeation and release by 2.06-fold and 59.06%, respectively. The CLI formulation was added to a mixture of chitosan (0.67%w/v) and glyceryl monooleate (0.27%v/v) to develop PRHCLI. The PRHCLI formulation enhanced the release and permeation of CDN relative to free CDN by 2.15 and 2.76 folds, respectively. An experimental rat stroke model was utilized for in vivo studies to evaluate the bioavailability, effectiveness, and toxicity of the PRHCLI formulation. The nasal PRHCLI drops increased the CDN's bioavailability by 3.20-fold compared to oral free CDN. Increased grip strength and decreased flexion, spontaneous motor activity, and Morris Water Maze scores in comparison to oral free CDN showed that nasal PRHCLI drops have better anti-stroke activity. The toxicity evaluation revealed the safety of nasal PRHCLI. Hence, nasal PRHCLI drops may represent a promising avenue as a stroke therapy.

Safety of concomitant use of oral anticoagulants and antidiabetic drugs: a systematic review of observational studies

INTRODUCTION

We systematically reviewed observational studies assessing the safety of concomitant use of oral anticoagulants (OACs) and antidiabetic drugs (ADs).

METHODS

We systematically searched MEDLINE/PubMed and EMBASE up to 10/2024 for cohort, case-control, and case-only studies on concomitant use of OACs and ADs and the risk of adverse outcomes (hypoglycemia, bleeding). Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool.

RESULTS

We identified five cohort studies and two self-controlled case-series (n = 1,370,036). Concomitant use of sulfonylureas and warfarin was mostly associated with increased risks of hypoglycemia versus sulfonylurea use alone (five studies); results were heterogeneous when comparing concomitant use of sulfonylureas and warfarin versus concomitant use of sulfonylureas and DOACs (two studies) and concomitant use of non-sulfonylurea ADs and warfarin versus non-sulfonylurea AD use alone (two studies). Concomitant use of warfarin and sulfonylureas was not associated with the risk of bleeding versus warfarin use alone (one study). Via ROBINS-I, four studies were at moderate, one at serious, and two at critical risk of bias.

CONCLUSIONS

Given inconsistent findings and a non-negligible risk of bias, observational studies do not suggest major clinical hazards due to concomitant use of OACs and ADs. (PROSPERO registration: CRD42024505475).

Changing the triglyceride diagnostic criteria of metabolic syndrome for African Americans

The incidence and prevalence of metabolic syndrome has been increasing globally with no signs of abating. Individuals with metabolic syndrome are at increased risk of multiple comorbidities, including cardiovascular disease and type 2 diabetes mellitus. Studies show that there is a paradoxical relationship in African Americans however, as they experience a higher rate of cardiovascular disease and type 2 diabetes mellitus despite having a lower prevalence of metabolic syndrome when compared to whites. The triglyceride paradox, an unusual phenomenon in which African Americans consistently express a more normal triglyceride status even when having conditions known to be characterized by high triglyceride levels, is believed to account for this paradoxical relationship. In this manuscript, we review the history and pathophysiology of metabolic syndrome while also discussing the importance of the triglyceride paradox in explaining the inverse relationship that exists between metabolic syndrome, cardiovascular disease, and type 2 diabetes mellitus in African Americans. In addition, we advocate for decreasing the triglyceride cutoff value when diagnosing metabolic syndrome in this population to more precisely determine who is at risk for developing type 2 diabetes mellitus and cardiovascular disease.

Risk of Ischemic and Hemorrhagic Stroke in Individuals With Type 1 and Type 2 Diabetes: A Nationwide Cohort Study in Sweden

BACKGROUND AND OBJECTIVES

Diabetes significantly increases the risk of cardiovascular events, including stroke. Although the association with ischemic stroke is well established, the relationship with hemorrhagic stroke remains unclear. This study aimed to evaluate the risk of ischemic and hemorrhagic stroke in individuals with type 1 and type 2 diabetes compared with diabetes-free controls from the general population.

METHODS

This cohort study included individuals with type 1 or type 2 diabetes from the Swedish National Diabetes Register between 2005 and 2019, matched to diabetes-free controls by age and sex. Data on baseline characteristics, comorbidities, medications, and outcomes were collected from multiple national registers. Stroke incidence rates and adjusted hazard ratios were estimated using Cox proportional hazard models, stratified by diabetes type, for ischemic and hemorrhagic stroke.

RESULTS

The study included 47,720 individuals with type 1 diabetes (mean age 34.4, 44.8% female) and 686,158 with type 2 diabetes (mean age 65.3, 43.3% female), matched to 143,160 and 2,058,474 controls, respectively. In individuals with type 1 diabetes, the ischemic stroke risk was 2.54 times higher (95% CI 2.36-2.73) and the hemorrhagic stroke risk was 1.88 times higher (95% CI 1.57-2.26) compared with controls. In individuals with type 2 diabetes, the ischemic stroke risk was 1.37 times higher (95% CI 1.35-1.38) while the hemorrhagic stroke risk was not significantly increased (HR: 0.99, 95% CI 0.96-1.02). Higher HbA1c levels were associated with increased ischemic stroke risk for both diabetes types. For hemorrhagic stroke, individuals with type 1 diabetes had significantly higher risk starting at HbA1c > 52 mmol/mol while in those with type 2 diabetes, a modest risk increase was observed only at HbA1c > 72 mmol/mol.

DISCUSSION

The risk of ischemic stroke was higher for both diabetes types. Individuals with type 1 diabetes also exhibited a higher risk of hemorrhagic stroke compared with diabetes-free controls while type 2 diabetes was significantly associated with risk of hemorrhagic stroke only when HbA1c was higher than 72 mmol/mol. These findings highlight the increased stroke risk in diabetes, with distinct patterns by stroke subtype and diabetes type. Tailored prevention strategies are essential to address these differences.

Factors associated with newly diagnosed ischemic stroke among people with type 2 diabetes mellitus in Thailand: A population- based case-control study

Stroke is a leading cause of mortality and disability-adjusted life years. Its incidence is rising across Asia, with ischemic stroke accounting for approximately 80% of total stroke cases in Thailand. Stroke often leads to long-term disabilities, including impairments in speech, communication, and cognitive function. The aim of this study was to investigate risk factors associated with newly diagnosed ischemic stroke. A matched case-control study was conducted, including 154 newly diagnosed ischemic stroke cases and 183 non-stroke controls, all with type 2 diabetes mellitus (T2DM). Data were collected between February and September 2022 (post-COVID-19 period) using a structured questionnaire covering socio-demographics, lifestyle factors, perceived social support, and self-care management (SCM). Multivariable logistic regression models were used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI). The majority of participants were female (60.8%), Buddhist (92.9%), and agriculturists (66.5%), with a mean age of 58.9 (±9.9) years. Factors associated with ischemic stroke included male (aOR: 3.53; 95%CI: 1.73-7.21), Buddhism (aOR: 3.53, 95%CI: 1.11-11.25), sedentary occupation (aOR: 5.78; 95%CI: 2.61-12.81), and T2DM duration >10 years (aOR: 6.19, 95%CI: 3.55-10.80). Protective factors included age >60 years (aOR = 0.55, 95%CI: 0.31-98) and moderate SCM levels (aOR=0.45, 95%CI: 0.26-0.80). This study highlighted that prolonged T2DM and sedentary occupations significantly contributed to ischemic stroke risk. Targeted prevention strategies, including lifestyle modifications and enhanced diabetes self-care management, may help reduce the burden of ischemic stroke.

A Home-Based Behaviour Change Intervention With Sedentary Behaviour and Physical Activity in People With Stroke and Diabetes-A Feasibility and Safety Study

BACKGROUND AND PURPOSE

Stroke survivors with type 2 diabetes mellitus (DM) face heightened cardiovascular risks, which are exacerbated by sedentary behaviour (SB). Despite existing interventions, there remains a gap in the literature regarding effective strategies to reduce SB and increase physical activity (PA). The purpose of this study was to explore the feasibility and safety of the 12-week 'Everyday Life is Rehabilitation' (ELiR) intervention comprising recruitment, adherence, practicality, and implementation into everyday life.

METHODS

Single-group longitudinal intervention study with 1-week baseline, motivational interviews at weeks 1 and 6, and 12-week follow-up. Stroke survivors with DM (N = 14) were recruited from Neurovascular Center at Zealand University Hospital, Roskilde. The ELiR intervention is a theory-based intervention that focuses on healthcare professionals (HCP) consultations with stroke survivors with DM to address SB and PA. Primary outcomes were recruitment, adherence, completion of physical tests (accelerometer measurements), cognitive tests, and safety. Secondary outcomes were sedentary time and steps collected using an accelerometer and glycated haemoglobin (HbA1c) measurements.

RESULTS

23 participants were recruited, of whom two were readmitted, one withdrew consent before the baseline test, and six were not discharged with a physiotherapy rehabilitation plan within 1-7 hospitalisation days. The remaining 14 were included and completed the study with a median modified Rankin scale (mRS) score of 1. The ELiR intervention revealed high adherence. Three participants experienced falls, and two were hospitalised. These incidents were not related to the intervention. Future adjustments include modified inclusion criteria, SMS-reminders, and point-of-care HbA1c measurements.

DISCUSSION

The ELiR intervention was feasible and safe. Falls and serious adverse events are in line with previously reported risks. Self-reported questionnaires and clinical tests had low and moderate adherence, whereas accelerometers had high adherence. However, the small sample size limits generalisability, and adjustments to the ELiR intervention are suggested to improve usability in physiotherapy practice before testing in RCT studies to confirm these findings.

Stress Hyperglycemia Is Associated with Unfavorable Outcomes After Mechanical Thrombectomy in Patients with Acute Ischemic Stroke

Background: Stress hyperglycemia may deteriorate stroke outcomes, but its impact on the prognosis following mechanical thrombectomy remains unclear. This study aimed to evaluate the effects of stress hyperglycemia on in-hospital and 3-month outcomes in stroke patients with anterior circulation occlusion undergoing mechanical thrombectomy. Methods: A total of 415 patients who had mechanical thrombectomy in the anterior circulation were enrolled. The stress hyperglycemia ratio (SHR) was calculated as the fasting glucose to glycated hemoglobin ratio and was categorized into tertiles (i.e., SHR1-3). In-hospital and 3-month outcomes were compared using multivariable regression models. The impact of SHR stratified by diabetes status was evaluated and the predictive accuracy of the Totaled Health Risks in Vascular Events (THRIVE)-c risk score was explored with the inclusion of SHR. Results: Compared to the SHR1-2 groups, the SHR3 group exhibited significantly higher rates of 24 h symptomatic intracranial hemorrhage (adjusted odds ratio [aOR], 4.088; 95% confidence interval [CI], 1.551-10.772; p = 0.004) and 72 h early neurological deterioration (aOR, 3.505; 95% CI, 1.984-6.192; p < 0.001), while the incidence of post-stroke pneumonia did not differ significantly between the groups (aOR, 1.379; 95% CI, 0.838-2.268; p = 0.206). At three months, the SHR3 group had a worse distribution of modified Rankin scale (aOR, 2.261; 95% CI, 1.495-3.421; p < 0.001) and faced a higher risk of functional dependence (adjusted hazard ratio [aHR], 1.629; 95% CI, 1.230-2.158; p = 0.001) as well as all-cause mortality (aHR, 1.986; 95% CI, 1.235-3.194; p = 0.005). The adverse effects of an elevated SHR were more pronounced in non-diabetic patients, and incorporating SHR significantly enhanced the predictive accuracy of the THRIVE-c score for poor stroke outcomes. Conclusions: Stress hyperglycemia could be related to the risks of in-hospital complications and 3-month poor outcomes following mechanical thrombectomy in the anterior circulation.

Total bilirubin modified the association between diabetes and stroke: a cross-sectional study from NHANES 2011-2016

BACKGROUND

Total bilirubin (TBIL) has antioxidant and anti-inflammatory properties. This study aimed to determine whether elevated TBIL could modify the association between diabetes and stroke.

METHOD

Data were obtained from the National Health and Nutrition Examination Survey 2011-2016. TBIL was stratified by median (10.3 µmol/L). The association between diabetes and stroke was quantified using multivariable logistic regression models. The cut-off concentration for the presence of TBIL modification effects was identified by Johnson-Neyman analyses. Mediation analyses were performed to determine the influence of TBIL on mediating factors that mediate the relationship between diabetes and stroke.

RESULTS

This cross-sectional study included 16 130 participants, with the mean age of 46.8±0.4 years and 48.5% of men. Diabetes was associated with the presence of stroke at TBIL <10.3 µmol/L (OR=2.19, 95% CI 1.58 to 3.05) but not at TBIL ≥10.3 µmol/L (OR=1.27, 95% CI 0.85 to 1.88) after adjustment for confounders. Above associations were significantly different between the two TBIL concentrations (P for interaction=0.03). Moreover, the modification effect of TBIL specifically occurred in men (P for interaction=0.02) rather than in women (P for interaction=0.08). The cut-off concentration for the presence of TBIL modification effects was 17.05 µmol/L. Additionally, the TBIL of ≥10.3 µmol/L inhibited mediating effects of hypersensitive C reactive protein (mediating effect=0.03, 95% CI -0.15 to 0.22, P=0.72) and systemic immune-inflammation index (mediating effect=0.01, 95% CI -0.01 to 0.04, P=0.29) as compared with the TBIL of <10.3 µmol/L.

CONCLUSIONS

Elevated TBIL modified the association between diabetes and stroke through inhibiting mediating effects of inflammatory factors.

Multi-omics approaches for biomarker discovery and precision diagnosis of prediabetes

Recent advancements in multi-omics technologies have provided unprecedented opportunities to identify biomarkers associated with prediabetes, offering novel insights into its diagnosis and management. This review synthesizes the latest findings on prediabetes from multiple omics domains, including genomics, epigenomics, transcriptomics, proteomics, metabolomics, microbiomics, and radiomics. We explore how these technologies elucidate the molecular and cellular mechanisms underlying prediabetes and analyze potential biomarkers with predictive value in disease progression. Integrating multi-omics data helps address the limitations of traditional diagnostic methods, enabling early detection, personalized interventions, and improved patient outcomes. However, challenges such as data integration, standardization, and clinical validation and translation remain to be resolved. Future research leveraging artificial intelligence and machine learning is expected to further enhance the predictive power of multi-omics technologies, contributing to the precision diagnosis and tailored management of prediabetes.

How Can Podiatrists and Other Health Care Professionals Support the Detection of Atrial Fibrillation?

Atrial fibrillation (AF) is a global health crisis affecting 33.5 million people, with costs projected to reach £75 billion by 2035. A significant concern is that 43-48% of cases are asymptomatic, increasing the risk of stroke and heart failure. While general population screening lacks strong support, targeted screening shows promise in reducing stroke occurrence and healthcare costs. Podiatrists, who frequently treat adults of advancing age, are uniquely positioned to detect AF in high-risk, asymptomatic individuals. This commentary advocates for opportunistic AF screening by podiatrists and other healthcare professionals, offering guidance for implementation. Early detection through defined referral pathways is crucial for timely diagnosis and management, potentially reducing AF-related strokes that can lead to early mortality. Further high-quality podiatry-led studies are recommended to build on this commentary paper.

Observations of teamworking in a multidisciplinary diabetic foot clinic: Bridging roles of podiatry and technology

Diabetic foot ulcer (DFU) is arguably the gravest complication of type 2 diabetes with high disease burden and mortality. Its complexity as a chronic disease with acute presentation necessitates rapid access to a multidisciplinary team (MDT), typically comprising vascular surgeons, endocrinologists and podiatrists. We conducted a focused ethnography of 55 (82.5 h) observations, 10 interviews with patients and several opportunistic in-situ conversations with patients and members of the care team at the multidisciplinary foot clinic of a tertiary public hospital in Singapore. In the clinic, the patient sat in the centre of the treatment room to be attended to by various members of the MDT who entered and exited the room singly, then collectively, to diagnose and recommend treatments. This led us to adopt a dramaturgical model as our theoretical framework to explore the movements and interactions composing what can be recognised as teamworking. The clinicians' teamworking could be organized into front-stage planned activities of history-taking and diagnosing and treating the foot wound; front-stage ad hoc activities of clinical deliberating and recommending; back-stage planned activities consisting of discussions on workups, interventions and appointments and coordinating these for performing teamwork in the front-stage; back-stage ad hoc activities such as interprofessional discussions away from the patient and outside the clinic; and off-stage activities in the patient's lifeworld pertaining to patients' everyday decisions and concerns. The protracted treatment work of the podiatrist places her in a bridging position between the patient and the medical members of the MDT that could plug knowledge gaps, and enrich clinical explanations and decision-making. Technology enabled backstage interaction and sustained teamwork outside the clinic even when decision-makers among the medical team members were not physically present. The occurrences from the patient's lifeworld pose an essential influence that can inform teamworking in the clinic. We discuss implications for practice.

Repurposing metformin: A potential off-label indication for ischaemic stroke?

The term 'clinical cemetery' is frequently used to characterize ischaemic stroke, one of the leading causes of mortality and long-term morbidity globally. Over the past two decades, a number of novel therapies have been investigated for ischaemic stroke. However, aside from mechanical thrombectomy, the only FDA-approved prescription for treating ischaemic stroke is tissue plasminogen activator, which has a limited therapeutic period. Although post-stroke rehabilitation therapies are helpful in improving functional recovery, their benefits cannot be yielded promptly. Nowadays, drug repurposing might be an appealing approach to expanding therapeutic options for ischaemic stroke. During the last decade, metformin has been extensively researched as a potential repurposing medicine for ischaemic stroke, with a focus on both preventive and therapeutic approaches. With regard to the idea of repurposing metformin in ischaemic stroke, this review aims to compile the available data from pre-clinical and clinical trials, address and clarify any discrepancies, and offer solutions.

Mediating factors in the association between educational attainment and stroke: A mendelian randomization study

Background

Stroke is a common cardiovascular and cerebrovascular disease with high disability and mortality. Lower educational attainment has been reported to be associated with an increased risk of stroke, but it is unclear which pathways mediate this association.

Methods

Using genome-wide association studies (GWAS) based on European ancestry, we performed two-sample Mendelian randomization (MR) analyses to investigate the causal association of genetically estimated educational attainment with stroke and its subtypes. Then, we used mediation analyses to assess the extent to which seven cardiometabolic risk factors alone and in combination explain their effects.

Results

Genetically estimated educational attainment was negatively associated with the risk of any stroke (AS), any ischemic stroke (AIS), ischemic stroke subtypes (large artery stroke [LAS], cardioembolic stroke [CES], and small vessel stroke [SVS]), and hemorrhagic stroke subtypes (cerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]). For individual mediating effects, type 2 diabetes, hypertension, hyperlipidemia, and smoking mediated the impact of education on AS, AIS, and ischemic stroke subtypes, while obesity, NAFLD, and alcohol consumption played no role. For combined mediation, the proportion of the association that cardiometabolic mediators explained ranged from 4% (95% CI: 2.72%-5.27%) for SVS to 38.73% (95% CI: 37.42%-40.05%) for LAS. Nevertheless, they did not account for any of the estimates for hemorrhagic stroke subtypes.

Conclusion

Higher educational attainment would have a protective effect on stroke and its subtypes, and cardiometabolic risk factors mediated part proportion of this association. Hence, patients with low education should pay more attention to managing cardiometabolic diseases to prevent stroke.

The burden of ischemic stroke in Eastern Europe from 1990 to 2021

BACKGROUND AND PURPOSE

Ischemic stroke is a significant public health concern, particularly in Eastern Europe, where the burden remains high. This study aims to evaluate the trends and burden of ischemic stroke in Eastern Europe from 1990 to 2021, providing insights into epidemiological changes and informing public health strategies.

METHODS

We used data from the Global Burden of Disease 2021 database to comprehensively assess regional and national ischemic stroke indicators in Eastern Europe. These indicators included the number of cases, incidence, number of deaths, mortality, disability-adjusted life years (DALYs), DALY rates, and estimated annual percentage change (EAPC). Joinpoint analysis was employed to examine sex-specific time trends in the burden of ischemic stroke across Eastern European countries. These estimates incorporated the Socio-Demographic Index (SDI).

RESULTS

In 2021, Eastern Europe reported 490,197 cases of ischemic stroke, with an age-standardized incidence rate (ASIR) of 142.57 (95% UI: 122.12 to 164.67), exceeding the global level. The region recorded 329,291 deaths, with an age-standardized mortality rate (ASMR) of 90.99 (95% UI: 82.79 to 98.48), significantly higher than the global rate. Disability-adjusted life years (DALYs) totaled 5,713,718, with an age-standardized DALYs rate (ASDR) of 1601.20 (95% UI: 1483.51 to 1723.12). Our joinpoint regression analysis indicates that the disease burden remains notably high in Eastern Europe, despite an overall declining trend from 1990 to 2021 in ASIR and ASMR across most countries, with estimated annual percentage changes (EAPC) of -1.13 (95% CI: -1.24 to -1.02) and - 2.78 (95% CI: -3.24 to -2.32), respectively. Lithuania reported the highest incidence rate, while the Russian Federation had the highest mortality and DALY rate. Conversely, Estonia showed significant improvements in stroke indicators. Key risk factors included low temperature and smoking, contributing notably to environmental and behavioral risks.

CONCLUSION

Ischemic stroke continues to be a significant global health issue. Our temporal trends study results indicate that the disease burden remains notably high in Eastern Europe, particularly in Lithuania and the Russian Federation.

Glial Cell Reprogramming in Ischemic Stroke: A Review of Recent Advancements and Translational Challenges

Ischemic stroke, the second leading cause of death worldwide and the leading cause of long-term disabilities, presents a significant global health challenge, particularly in aging populations where the risk and severity of cerebrovascular events are significantly increased. The aftermath of stroke involves neuronal loss in the infarct core and reactive astrocyte proliferation, disrupting the neurovascular unit, especially in aged brains. Restoring the balance between neurons and non-neuronal cells within the perilesional area is crucial for post-stroke recovery. The aged post-stroke brain mounts a fulminant proliferative astroglial response, leading to gliotic scarring that prevents neural regeneration. While countless therapeutic techniques have been attempted for decades with limited success, alternative strategies aim to transform inhibitory gliotic tissue into an environment conducive to neuronal regeneration and axonal growth through genetic conversion of astrocytes into neurons. This concept gained momentum following discoveries that in vivo direct lineage reprogramming in the adult mammalian brain is a feasible strategy for reprogramming non-neuronal cells into neurons, circumventing the need for cell transplantation. Recent advancements in glial cell reprogramming, including transcription factor-based methods with factors like NeuroD1, Ascl1, and Neurogenin2, as well as small molecule-induced reprogramming and chemical induction, show promise in converting glial cells into functional neurons. These approaches leverage the brain's intrinsic plasticity for neuronal replacement and circuit restoration. However, applying these genetic conversion therapies in the aged, post-stroke brain faces significant challenges, such as the hostile inflammatory environment and compromised regenerative capacity. There is a critical need for safe and efficient delivery methods, including viral and non-viral vectors, to ensure targeted and sustained expression of reprogramming factors. Moreover, addressing the translational gap between preclinical successes and clinical applications is essential, emphasizing the necessity for robust stroke models that replicate human pathophysiology. Ethical considerations and biosafety concerns are critically evaluated, particularly regarding the long-term effects and potential risks of genetic reprogramming. By integrating recent research findings, this comprehensive review provides an in-depth understanding of the current landscape and future prospects of genetic conversion therapy for ischemic stroke rehabilitation, highlighting the potential to enhance personalized stroke management and regenerative strategies through innovative approaches.

Prevalence of stroke and associated risk factors among elderly patients in a primary care setting: A retrospective cohort study

Background

Stroke is a major health concern worldwide, with significant morbidity and mortality. This study aims to retrospectively analyze the prevalence and risk factors associated with stroke in a primary care setting in Riyadh, Saudi Arabia.

Methods

A retrospective cohort study was conducted at the Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre in Riyadh. Data were collected from patients aged 50 years and older who visited the clinic between January 1, 2021, and December 31, 2022. Stroke diagnoses were determined using ICD-10 codes, and data on demographic variables and stroke risk factors were extracted from medical records. Statistical analyses included Chi-square or Fisher's Exact tests, Mann-Whitney U test, and logistic regression analysis.

Results

Out of 2034 patients, 36 (1.8%) were diagnosed with stroke, predominantly ischemic (91.7%). Significant correlations with stroke occurrence included advanced age, male gender, family history of stroke, and comorbidities such as hypertension, transient ischemic attack, ischemic heart disease, brain aneurysm, and carotid artery disease. Multivariable analysis identified older age (≥80 years, OR = 8.949, P = 0.013), male gender (OR = 5.980, P = 0.010), underweight status (OR = 50.873, P = 0.005), family history of stroke (OR = 12.603, P = 0.040), and hypertension (OR = 7.984, P = 0.009) as significant risk factors for stroke.

Conclusion

Stroke prevalence in the sampled population was 18 per 100,000 individuals, with advanced age, male gender, and hypertension identified as significant risk factors. These findings highlight the need for targeted preventive strategies and further prospective research to establish causal relationships and improve stroke management in Saudi Arabia.

Development and validation of a risk stratification model for stroke recurrence after acute ischemic stroke in young adults: A nomogram-based, multicenter retrospective study

OBJECTIVE

The prevalence of ischemic stroke in young adults has increased dramatically. However, factors associated with prognosis in this cohort have not been well studied. This study primary aimed to construct and validate a nomogram for predicting stroke recurrence and to achieve risk stratification of young adults after acute ischemic stroke (AIS).

METHODS

In this retrospective, multicenter study, we identified AIS patients aged 18-50 years in Tianjin Huanhu Hospital (training cohort) and The Affiliated Hospital of Chengde Medical College (validation cohort) from September 2019 to September 2021, respectively. Demographics and clinical characteristics data were systematically collected. A stepwise Cox proportional hazards regression analysis was used to identify the independent predictors of stroke recurrence in the training cohort and employed to construct the best-fit nomogram. Patients were stratified into low-, medium-, and high-risk groups based on the total points. Receiver operating characteristic (ROC) analysis and calibration curves were used to assess the discrimination and calibration of the nomogram. The discriminate value of risk stratification was verified using Kaplan-Meier curves, and external validation was performed with the validation cohort.

RESULTS

A total of 467 young adult AIS patients were enrolled in this study. The overall prevalence of young adults in AIS patients was 13.3 % (95 % confidence interval, 12.2 %-14.5 %). Hyperlipidemia (Hazard ratio, 2.4 [1.2-4.9]), current smoking (5.9 [2.7-12.8]), stroke subtype (small-vessel occlusion, 3.7 [1.8-7.6]; stroke of undetermined cause/ others, 14.5 [3.0-70.2]), and stenosis (11.4 [4.5-28.9]) were significant independent predictors of stroke recurrence. A nomogram was constructed with the above predictors and achieved a satisfactory prediction in the validation cohort. Patients were classified into low-, medium-, and high-risk groups based on the total points with the cutoff value of 110.8 and 185.2. The log-rank test showed significant discrimination among the Kaplan-Meier curves of different risk groups (P < 0.001).

CONCLUSION

The nomogram can satisfactory prediction of stroke recurrence-free rate in young adult patients and achieved risk stratification, may help to personalize management of patients.

Type 2 Diabetes Mellitus: New Pathogenetic Mechanisms, Treatment and the Most Important Complications

Type 2 diabetes mellitus (T2DM), a prevalent chronic disease affecting over 400 million people globally, is driven by genetic and environmental factors. The pathogenesis involves insulin resistance and β-cell dysfunction, mediated by mechanisms such as the dedifferentiation of β-cells, mitochondrial dysfunction, and oxidative stress. Treatment should be based on non-pharmacological therapy. Strategies such as increased physical activity, dietary modifications, cognitive-behavioral therapy are important in maintaining normal glycemia. Advanced therapies, including SGLT2 inhibitors and GLP-1 receptor agonists, complement these treatments and offer solid glycemic control, weight control, and reduced cardiovascular risk. Complications of T2DM, such as diabetic kidney disease, retinopathy, and neuropathy, underscore the need for early diagnosis and comprehensive management to improve patient outcomes and quality of life.

The effects of admission hyperglycemia and diabetes mellitus on mechanical thrombectomy outcomes: A systematic review and meta-analysis

BACKGROUND

The impact of certain comorbidities on mechanical thrombectomy (MT) outcomes remains largely unexplored. Diabetes mellitus (DM) and admission hyperglycemia have been associated with poor clinical outcomes for patients treated with MT. In this study, we sought to investigate the effects of DM and admission hyperglycemia on MT outcomes.

METHODS

Following PRISMA guidelines, a systematic literature search was conducted in Medline, Embase, Scopus, and Web of Science databases. Data regarding successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b), functional independence (modified Rankin Scale [mRS] 0-2), excellent outcomes (mRS 0-1), symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. The pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated using random effects model.

RESULTS

Twenty-one studies comprising 9708 patients were included. A total of 2311 patients (24%) had a history of DM, and 2026 patients (21%) had admission hyperglycemia. Admission hyperglycemia was associated with significantly lower odds of mTICI ≥2b (OR = 0.7, 95% CI = 0.55-0.89), mRS 0-2 (OR = 0.47, 95% CI = 0.41-0.53), and mRS 0-1 (OR = 0.43, 95% CI = 0.34-0.55) as compared to normoglycemic state. Patients with hyperglycemia had significantly higher rates of sICH (OR = 2.05, 95% CI = 1.66-2.54) and mortality (OR = 1.99, 95% CI = 1.58-2.52) than normoglycemic patients. Diabetes mellitus was associated with significantly high rates of mortality (OR = 1.74, 95% CI = 1.31-2.3) and lower rates of mRS 0-2 (OR = 0.60, 95% CI = 0.48-0.76) in sensitivity analyses.

CONCLUSION

Our results indicate that admission blood glucose levels and DM can negatively affect MT outcomes. Further research should focus on optimizing MT outcomes for these patients.

Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments

Background

Diabetes-related cognitive impairment is increasingly recognized as a significant complication, profoundly impacting patients' quality of life. This review aims to examine the pathophysiological mechanisms, clinical manifestations, risk factors, assessment and diagnosis, management strategies, and future research directions of cognitive impairment in diabetes.

Methodology

A comprehensive literature search was conducted using PubMed, Medline, and other medical databases to identify, review, and evaluate published articles on cognitive impairment in diabetes. The search focused on studies examining pathophysiology, clinical presentations, risk factors, diagnostic approaches, and management strategies.

Results

The review of current literature revealed that chronic hyperglycemia, insulin resistance, and vascular factors are major contributing factors to cognitive deficits in diabetes. Clinical manifestations include impairments in attention, memory, executive function, visuospatial abilities, and language. Risk factors encompass disease duration, glycemic control, presence of complications, age, education level, and comorbidities. Assessment tools include cognitive screening instruments, neuropsychological testing, and neuroimaging techniques. Management strategies involve glycemic control optimization, lifestyle modifications, cognitive training, and pharmacological interventions.

Conclusion

This review highlights the significant prevalence and impact of cognitive impairment in diabetes, resulting from complex metabolic and vascular disturbances. Early detection and multifaceted interventions are crucial for preserving cognitive function and improving patient outcomes. Future research should focus on neuroprotective strategies, biomarker identification, and personalized approaches. Collaborative efforts between clinicians and researchers are essential to effectively address this growing healthcare challenge and enhance the quality of life for individuals with diabetes-related cognitive impairment.

Effectiveness and safety of insulin glargine 300 U/mL in insulin-naïve individuals according to diabetes duration: Results from the REALI European pooled data analysis

AIM

To evaluate the effectiveness and safety of insulin glargine 300 U/mL (Gla-300) initiation according to diabetes duration (DD).

MATERIALS AND METHODS

We analysed patient-level data from 2381 insulin-naïve individuals with type 2 diabetes (T2D), of whom 2349 (98.7%) were treated with Gla-300 for 24 weeks. Of the 2381 participants, 1048 (44.0%) had a DD of less than 8 years and 1333 (56.0%) had a DD of 8 years or longer. We further analysed the subgroups of participants having a DD of less than 4 years (N = 450), 4-8 years (N = 598), 8-12 years (N = 627) and 12 years or longer (N = 706).

RESULTS

Mean ± standard deviation age was 60.2 ± 9.0 years in participants with a DD less than 8 years and 64.2 ± 8.8 years in those with a DD of 8 years or longer. At 24 weeks of Gla-300 therapy, HbA1c improved with a least-squares (LS) mean change from baseline of -1.88% (95% confidence interval [CI], -1.95 to -1.80) and -1.71% (95% CI, -1.77 to -1.65), respectively, resulting in a LS mean difference between groups of 0.17% (95% CI, 0.07 to 0.26; P = .0005). In the subgroup analysis, LS mean HbA1c reduction from baseline to week 24 was highest in participants with a DD of less than 4 years and lowest in participants with a DD of 12 years or longer. Overall, incidences of symptomatic and severe hypoglycaemia were low, irrespective of DD, without body weight changes.

CONCLUSIONS

Gla-300 was effective and safe in insulin-naïve individuals with T2D, regardless of DD. Improvement in HbA1c was greater when Gla-300 was initiated in participants with a DD of less than 4 years, although the difference between the groups was modest.

Prevalence of diabetes and its associated factors in Cape Verde: an analysis of the 2020 WHO STEPS survey on non-communicable diseases risk factors

BACKGROUND

Type 2 diabetes mellitus (T2DM) represents a significant global health challenge, with its prevalence steadily rising across diverse populations. Understanding the factors associated with T2DM is crucial for effective prevention and management strategies. In Cape Verde, an archipelago nation off the coast of West Africa, the burden of T2DM is of particular concern, yet comprehensive studies investigating its determinants in this context remain sparse. This study aims to narrow the knowledge gap by assessing the prevalence of prediabetes, T2DM and its associated factors among the adult Cape Verdean population.

METHODS

Data from the WHO STEPs survey were used. We analyzed data from 1,936 adults aged 18-69 years. The outcome variable was diabetes status computed using the fasting blood glucose (mg/dl). The data was weighted before the analysis to account for sampling biases. Multinomial logistic regression models were computed in STATA version 18.

RESULTS

The overall prevalence of prediabetes and T2DM was 7.8% (95% CI: 6.1-9.9) and 3.9% (95% CI: 3.1-4.9), respectively. Increasing age was associated with a higher odd of prediabetes and T2DM with the highest odds observed among older adults [(prediabetes: AORs = 3.20, 95%CI: 1.88-5.54) and T2DM: AOR = 3.51, 95%CI: 1.71-7.18)]. Additionally, high total cholesterol levels were linked to increased odds of T2DM (AOR = 2.48, 95%CI: 1.64-3.76). Individuals who consumed less than four servings of vegetables daily had higher odds of T2DM (AOR = 1.74, 95%CI: 1.12-2.71) while being overweight/obese was associated with higher odds of prediabetes (AOR = 1.57, 95%CI: 1.10-2.23). Urban residents had higher odds of T2DM than rural residents (AOR = 1.92, 95%CI: 1.23-3.00). Also, higher educational attainment was associated with lower odds of T2DM only (AOR = 0.33, 95%CI: 0.12-0.88) but not statistically significant for prediabetes.

CONCLUSION

Based on the findings, we conclude that ageing, overweight/obesity, vegetable consumption and total cholesterol level are important predictors of pre-diabetes and T2DM in Cape Verde. As such, weight management and cholesterol management should be integral parts of T2DM prevention strategies. Additionally, clinicians and diabetes societies in Cape Verde must make the promotion of vegetable consumption a key component of their health advice and advocacy.

CLINICAL TRIAL NUMBER

Not applicable.

Ferroptosis-associated alterations in diabetes following ischemic stroke: Insights from RNA sequencing

OBJECTIVE

Ferroptosis is an iron-dependent form of programmed cell death associated with lipid peroxidation. Though diabetes worsens cerebral injury and clinical outcomes in stroke, it is poorly understood whether ferroptosis contributes to diabetes-exacerbated stroke. This study aimed to identify ferroptosis-associated differentially expressed genes in ischemic stroke under diabetic condition and then explore their roles using comprehensive bioinformatics analyses.

METHODS

Type 1 diabetes (T1D) model was established in male mice at 8-10 weeks of age by one intraperitoneal injection of streptozotocin (110 mg/kg). Ischemic stroke was induced by a transient 45-minute middle cerebral artery occlusion and evaluated three days thereafter. Ischemic brain cortex was dissected 24 h after the reperfusion and subjected to bulk tissue RNA sequencing followed by bioinformatics analysis and verification of key findings via quantitative real-time PCR.

RESULTS

Enlarged infarct size was seen in diabetic, as compared with non-diabetic mice, in conjunction with worsened neurological behaviors. Both body and spleen weights were reduced in diabetic as compared with non-diabetic mice. There was a trend for reduced survival rate in diabetic mice following the stroke. In RNA sequencing analysis, we identified 1299 differentially expressed genes in ischemic brain between diabetic and non-diabetic mice, with upregulation and downregulation for 732 and 567 genes, respectively. Among these genes, 27 genes were associated with ferroptosis. Further analysis reveals that solute carrier family 25 member 28(SLC25A28) and sterol carrier protein 2(SCP2) were the top genes associated with ferroptosis in diabetic mice following ischemic stroke. In several bioinformatics analyses, we found SLC25A28, one of the top ferroptosis-related genes, is involved in several metabolic and regulatory pathways as well as the regulatory complexity of microRNAs and circular RNAs, which demonstrates the potential role of SLC25A28 in diabetes-exacerbated stroke. Drug network analysis suggests SLC25A28 as a potential therapeutic target for ameliorating ischemic injury in diabetes.

CONCLUSIONS

Our bulk RNA sequencing and bioinformatics analyses show that altered ferroptosis signaling pathway was associated with the exacerbation of experimental stroke injury under diabetic condition. Especially, additional investigation into the mechanisms of SLC25A28 and SCP2 in diabetes-exacerbated stroke will be explored in the future study.

Prediction Value of High Serum Pentraxin-3 for Short-Term Recurrence of Cerebral Infarction in Patients Accompanied with Intracranial Atherosclerotic Stenosis Within One Year

Objective

Elevated serum pentraxin-3 levels are generally considered a risk factor for atherosclerosis. However, there is limited data on the relationship between pentraxin-3 and cerebral infarction (CI) accompanied by intracranial atherosclerotic stenosis (ICAS). This study aims to investigate the association between pentraxin-3 (PTX-3) and short-term recurrence in cerebral infarction caused by ICAS patients within one year.

Methods

A prospective observational study was conducted. Cerebral infarction accompanied by intracranial atherosclerotic stenosis (CI-ICAS) patients were selected from January 2020 to December 2023. Recurrent ischemic stroke (RIS) is defined as a new neurological deficit that appears after a period of clinical stabilization, lasting more than 24 hours, with an attributable new ischemic lesion that can be confirmed by CT or MRI. Serum pentraxin-3 levels were determined on admission. Multivariate logistic regression analysis was used to investigate the relationship between serum pentraxin-3 and RIS.

Results

Among 398 patients enrolled, 112 cases (28.1%) had recurrence within one year. The elevation of serum PTX-3 level in patients accompanied with ICAS was independently correlated with recurrent stroke. Therefore, it is worth considering the possibility of intervening in higher PTX-3 levels. Serum pentraxin-3 was significantly higher in patients with RIS (15.16 vs 10.21 µmol/L, P<0.001). Correlation analysis showed that PTX-3 was correlated with age, LDL, Hs-CRP, Baseline NIHSS score, and Hcy (P < 0.001). Univariate logistic regression analysis showed that pentraxin-3 remained an independent predictor of recurrent ischemic stroke after adjusting for major confounding factors (OR = 1.21, 95% CI: 1.06-1.39, P = 0.007).

Conclusion

The elevation of serum pentraxin-3 level in patients with ischemic stroke was independently correlated with the recurrence of stroke within one year. Therefore, intervention in serum pentraxin-3 levels may be worth considering.

SGLT-2 Inhibitors' and GLP-1 Receptor Agonists' Influence on Neuronal and Glial Damage in Experimental Stroke

Background: SGLT-2 inhibitors (SGLT-2i) and GLP-1 receptor agonists (GLP-1RA) have demonstrated nephro- and cardioprotective effects, but their neuroprotective properties, especially concerning stroke severity, and mechanisms are not unambiguous. We aimed to study the influence of SGLT-2i with different selectivity and GLP-1RA on brain damage volume and neurological status in non-diabetic and diabetic rats and to investigate the underlying mechanisms. Methods: Non-diabetic Wistar rats were divided into five groups (n = 10 each) and received empagliflozin, canagliflozin, or dulaglutide as study drugs and metformin as comparison drug. Control animals were administered 0.9% NaCl for 7 days before stroke. At 48 h after stroke, we assessed neurological deficit, neuronal and astroglial damage markers, and brain damage volume. We also modeled type 2 DM in Wistar rats using the high-fat diet+nicotinamide/streptozotocin method and established similar treatment groups. After 8 weeks, rats were subjected to stroke with further neurological deficit, neuroglial damage markers, and brain necrosis volume measurement. Results: In non-diabetic rats, all the drugs showed an infarct-limiting effect; SGLT-2i and dulaglutide were more effective than metformin. DULA improved neurological status compared with MET and SGLT-2i treatment. All the drugs decreased neurofilament light chains (NLCs) level and neuronal damage markers, but none of them decreased the glial damage marker S100BB. In DM, similarly, all the drugs had infarct-limiting effects. Neurological deficit was most pronounced in the untreated diabetic rats and was reduced by all study drugs. All the drugs reduced NLC level; dulaglutide and empagliflozin, but not canagliflozin, also decreased S100BB. None of the drugs affected neuron-specific enolase. Conclusions: SGLT-2i and GLP-1RA are neuroprotective in experimental stroke. GLP-1RA might be more effective than SGLT-2i as in non-diabetic conditions it influences both brain damage volume and neurological status. All study drugs decrease neuronal damage, while GLP-1RA and highly selective SGLT-2i EMPA, but not low-selective CANA, also have an impact on neuroglia in diabetic conditions.

Antioxidant effects of a novel pioglitazone analogue (PA9) in a rat model of diabetes: Modulation of redox homeostasis and preservation of tissue architecture

Oxygen-free radicals have been implicated in the initiation of diabetic complications. Thiazolidinediones (TZDs), known for their antidiabetic properties, also demonstrate notable antioxidant and anti-inflammatory effects. Although a recently developed imidazolyl analogue of pioglitazone (PA9) has exhibited superior glucose-lowering efficacy compared to pioglitazone, its antioxidant effects remain unexplored. Thus, the objective of this study is to evaluate the antioxidant properties of PA9 in animal models with diabetes. Rats were randomly separated into the following four groups: control, diabetic, and two groups treated orally with pioglitazone as a standard drug and PA9 for ten days. Upon completion of the experiment, tissues from the liver, heart, brain, pancreas, spleen, and kidneys were collected to assess oxidant/antioxidant markers and histological alterations. The administration of PA9 resulted in a noteworthy reduction in malondialdehyde (MDA) levels compared to the diabetic group (p < 0.05). The group receiving PA9 displayed elevated levels of three antioxidant markers, catalase (CAT), superoxide dismutase (SOD), and total thiol, in pancreatic tissue compared to diabetic rats (p < 0.05). Furthermore, increased content of CAT was evident in the heart (p < 0.05), spleen (p < 0.001), brain, and kidney tissues in the PA9-treated group, along with augmented thiol content in the spleen compared to the diabetic group. Remarkably, no significant histological changes were observed in the liver, pancreas, heart, brain, spleen, and kidneys of the PA9-treated groups relative to diabetic rats. PA9 effectively mitigates oxidative stress, modulates redox homeostasis, and shows promise in preventing diabetic complications. The proven safety profile of this analogue underscores its potential, warranting comprehensive clinical evaluation to thoroughly understand its therapeutic scope and efficacy in the management of diabetes.

Knowledge, attitudes, and practices of patients with hyperlipidemia towards stroke: a cross-sectional study

OBJECTIVE

With the rising incidence and mortality rates of stroke, understanding the knowledge, attitudes, and practices (KAP) of patients with hyperlipidemia towards stroke is crucial for improving their health management and preventing stroke. This study aimed to investigate the KAP of patients with hyperlipidemia towards stroke.

METHODS

A cross-sectional study was conducted at the First Hospital of Hebei Medical University between November 2, 2023, and December 31, 2023. Demographic information and KAP scores of the participants were collected via questionnaire administration.

RESULTS

In this study, a total of 385 patients diagnosed with hyperlipidemia were included. Among them, 211 (54.8%) were male, and 214 (55.6%) had been dealing with hyperlipidemia for less than one year. Multivariate analyses showed that age greater than or equal to 55 years (OR = 4.016, 95% CI: [2.128,7.579], p < .001) and attitude score greater than or equal to 21 (OR = 5.673, 95% CI: [3.432,9.376], p < .001) were independently associated with proactive practice. Mediation analysis showed that knowledge directly affected the attitude (β = 0.637, p = .010) and attitude directly affected the practice (β = 0.721, p = .010). Meanwhile, the direct effect of knowledge on practice was not significant (β = -0.059, p = .438), however, knowledge was found to indirectly affected practice through attitude (β = 0.459, p = .010).

CONCLUSION

Our study reveals that patients with hyperlipidemia exhibit a concerning gap in their understanding of stroke, despite holding positive attitudes and displaying suboptimal preventive practices.

The association of 24-hour behavior rhythms with stroke among American adults with prediabetes/diabetes: evidence from NHANES 2011-2014

BACKGROUND

Emerging evidence suggests that circadian rhythms play a role in the regulation of cardiovascular diseases (CVDs). We aim to examine the relationship between the 24-hour behavior rhythms (activity-rest and feeding-fasting rhythms) and stroke.

METHODS

The study included 3201 adult participants with prediabetes/diabetes from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. The 24-hour behavior rhythm indices were calculated using data from accelerometer wearable device and dietary recall for two nonconsecutive days. Six indices were calculated including interdaily stability (IS), intradaily variability (IV), relative amplitude (RA), average activity during the least active continuous 5-hour period (L5), Average activity during the most active continuous 10-hour period (M10) which reflects the activity-rest rhythm, and feeding rhythm score which reflects the feeding-fasting rhythm. These continuous variables were divided into quintiles for logistic regression models.

RESULTS

Comparing participants in quintile 1, those in quintile 5 of IS and RA exhibited a lower odds of stroke. Conversely, participants in quintile 5 of IV, L5, and L5 start time demonstrated a higher odds of stroke. Furthermore, participants in quintile 5 of feeding rhythm score had a significantly lower odds of stroke. The associations of IV and feeding rhythm score with stroke were more pronounced in participants with diabetes compared to those with prediabetes/diabetes. No significant associations were observed between other 24-hour behavior rhythms and stroke.

CONCLUSIONS

Overall, this study highlights a significant association between 24-hour behavior rhythm and stroke in American adults with prediabetes/diabetes.

Impact of Diabetes on Excessive Cardiovascular Risk: Matched Analysis Based on the European Health Interview Survey

Background and Objectives: Diabetes represents a major public health challenge due to its strong link to cardiovascular risk, therefore the aim was to explore the excessive cardiovascular risk attributed to diabetes. Materials and Methods: This cross-sectional study was based on data from the European Health Interview Surveys in Hungary. Propensity score matching was used to control confounding factors including age, gender, education, marital status, income, health status, obesity, smoking, place of residence, and physical activity. Results: A total of 15,874 individuals were analyzed, of whom 1447 (9.12%) reported having diabetes. Furthermore, diabetes was significantly associated with higher prevalence rates of hypertension (by 23.4%), arrhythmia (by 3.85%), heart attack (by 3.42%), and coronary artery disease (by 6.92%) after adjusting for potential confounders. Conclusions: These findings highlight the importance of managing cardiovascular risk factors in individuals with diabetes.

Association of Body Composition Changes with the Development of Diabetes Mellitus: A Nation-Wide Population Study

BACKGRUOUND

We investigated the association between body composition changes and new-onset diabetes mellitus (DM) development according to the body mass index (BMI) in a longitudinal setting in the general Korean population.

METHODS

From 2010 to 2011 (1st) and 2012 to 2013 (2nd), we included 1,607,508 stratified random sample participants without DM from the National Health Insurance Service-Health Screening dataset of Korean. The predicted appendicular skeletal muscle mass index (pASMMI), body fat mass index (pBFMI), and lean body mass index (pLBMI) were calculated using pre-validated anthropometric prediction equations. A prediction equation was constructed by combining age, weight, height, waist circumference, serum creatinine levels, alcohol consumption status, physical activity, and smoking history as variables affecting body composition.

RESULTS

Decreased pASMMI (men: hazard ratio [HR], 0.866; 95% confidence interval [CI], 0.830 to 0.903; P<0.001; women: HR, 0.748; 95% CI, 0.635 to 0.881; P<0.001), decreased pLBMI (men: HR, 0.931; 95% CI, 0.912 to 0.952; P<0.001; women: HR, 0.906; 95% CI, 0.856 to 0.959; P=0.007), and increased pBFMI (men: HR, 1.073; 95% CI, 1.050 to 1.096; P<0.001; women: HR, 1.114; 95% CI, 1.047 to 1.186; P=0.007) correlated with the development of new-onset DM. Notably, only in the overweight and obese BMI categories, decreases in pASMMI and pLBMI and increases in pBFMI associated with new-onset DM, regardless of gender.

CONCLUSION

Decreased pASMMI and pLBMI, and increased pBFMI with excess fat accumulation may enhance the risk of newonset DM. Therefore, appropriate changes in body composition can help prevent new-onset DM.

Comparative study of the neuroprotective potential of semaglutide injectable preparations in experimental ischemic stroke

Introduction. Stroke remains one of the major causes of death in type diabetes mellitus (DM). Injectable form of glucagon-like peptide-1 receptor agonist semaglutide, Ozempic® decreases the stroke risk. In Russia there appeared a biosimilar Semavic® but its effects on the brain are not yet studied.

Aim. To compare neuroprotective properties of Semavic® and Ozempic® while used before ischemic stroke in rats without DM.

Materials and methods. The study was conducted in male Wistar rats that were divided into the following groups: “Control” (n = 10) – 0.9% NaCl, “MET” (n = 9) – metformin 200 mg/kg once daily per os, “Ozempic” (n = 10) – Ozempic® 0.012 mg/kg s.c. once daily, “Semavic” (n = 9) – Semavic® 0.012 mg/kg s.c. once daily. After 7 days ischemic stroke was modelled, after 48 hour of reperfusion neurological deficit and brain damage volume were evaluated. Glycemia was measured on the 3rd, 7th days as well as during and after ischemia.

Results. None of the study drugs caused hypoglycemia including in poststroke period. Neurological deficit in “MET” group did not differ from that in the “Control” (11.00 [6.50; 12.50] and 10.0 [6.25; 12.00] scores). Both semaglutide drugs caused comparable improvement in neurological status (14.00 [12.00; 18.00] and 14.00 [11.00; 18.00] scores in “Ozempic” and “Semavic” groups). Brain necrosis volume in “Control” group was 16.60 [13.40; 28.58] %. All the study drugs had infarct-limiting effect but brain damage volume in “Ozempic” (6.00 [4.32; 8.44] %) and “Semavic” (7.69 [2.99; 11.33] %) was smaller than in “MET” group (13.07 [8.67; 29.94] %). There were no differences between semaglutide drugs.

Conclusions. Biosimilar Semavic® and original Ozempic® demonstrate comparable neuroprotective effect while used in animals without DM prior to ischemic stroke modelling. This protective effect is not due to the drugs’ influence on glycemic profile.

Risk Factors of Acute Ischemic Stroke and Mortality Among Adults With Endocardial Fibroelastosis

OBJECTIVES

Endocardial fibroelastosis (EFE) is a rare form of restrictive cardiomyopathy associated with high morbidity and mortality. The literature is sparse on information pertaining to risk stratification. Thus, we sought to highlight the risk factors of acute ischemic stroke (AIS) and mortality in adults with EFE.

METHODS

The National Inpatient Sample (NIS) database was queried from 2001 to 2020 using the International Classification of Diseases 9th Revision (ICD-9) and 10th Revision (ICD-10) codes for adult patients with EFE. Factors associated with AIS and mortality were identified.

RESULTS

In all, 18495 cases of EFE fit the inclusion criteria, of which 2370 (12.82%) had AIS. The mean ages for patients with and without AIS were 62.37 and 54.24, respectively. Multivariate regression suggested greater odds of AIS in patients with hypertension (aOR 2.329, P <0.01), dyslipidemia (aOR: 1.566, P <0.01), peripheral vascular disease (PVD) (aOR: 1.736, P <0.01), alcohol abuse (aOR: 1.817, P <0.01), age >60 y (aOR: 1.646, P <0.01), females (vs. males, aOR: 1.238, P <0.01), and smokers (aOR: 1.697, P <0.01). Patients with cirrhosis (aOR: 0.174, P <0.01), CKD (aOR: 0.369, P <0.01), COPD (aOR: 0.402, P <0.01), atrial fibrillation (aOR: 0.542, P <0.01) had lower odds of AIS. 3.1% of EFE patients with AIS died. Diabetes (aOR: 11.665, P <0.01) and COPD (aOR: 3.201, P =0.017) were associated with the greatest odds of all-cause mortality. Dyslipidemia (aOR: 0.387, P =0.010) and females (vs. males, aOR: 0.432, P =0.012) had reduced odds of all-cause mortality.

CONCLUSION

Several risk factors are associated with AIS in EFE, while diabetes, COPD, and being male are associated with mortality in EFE.

Diabetes Mellitus and Risk of Future Stroke: Evidence From CHARLS and Mendelian Randomization Analyses

OBJECTIVES

This study leveraged the China Health and Retirement Longitudinal Study (CHARLS) to explore the association between diabetes and stroke in middle-aged and older adults in East Asia and assess the causality of this relationship using Mendelian randomization.

METHODS

Data from the 2011-2020 CHARLS cohort identified individuals with diabetes at baseline. Stroke incidence was self-reported through standardized questionnaires. Logistic regression and restricted cubic spline analysis examined the relationship between diabetes and stroke risk alongside nonlinear correlations between glucose levels and stroke. Mendelian randomization clarified the causal link and analyzed the mediating effect between diabetes and stroke using genetic methods.

RESULTS

In the study population aged 45 and above, stroke incidence was 5.99% in normoglycemic, 6.82% in prediabetic, and 9.93% in diabetic individuals. Over 7 years, 473 strokes occurred. Diabetes was associated with a 1.35-fold increased stroke risk compared to normoglycemia (OR = 1.35; 95% CI: 1.03-1.79). Subgroup analyses highlighted higher stroke risks in middle-aged women, nonsmokers, and nondrinkers. Mendelian randomization supports a genetic causal relationship between diabetes and stroke. Diabetes may indirectly lead to stroke through the mediating effects of hypertension and high cholesterol.

CONCLUSION

The findings confirm a significant association and causal link between diabetes and stroke risk in an East Asian population. In addition, the results indicate that controlling blood glucose in prediabetic individuals reduces stroke risk, with no similar benefits in diabetes.

Type 2 diabetes remodels collateral circulation and promotes leukocyte adhesion following ischemic stroke

Type 2 diabetes mellitus (T2DM) is associated with impaired leptomeningeal collateral compensation and poor stroke outcome. Neutrophils tethering and rolling on endothelium after stroke can also independently reduce flow velocity. However, the chronology and topological changes in collateral circulation in T2DM is not yet defined. Here, we describe the spatial and temporal blood flow dynamics and vessel remodeling in pial arteries and veins and leukocyte-endothelial adhesion following middle cerebral artery (MCA) stroke using two-photon microscopy in awake control and T2DM mice. Relative to control mice prior to stroke, T2DM mice already exhibited smaller pial vessels with reduced flow velocity. Following stroke, T2DM mice displayed persistently reduced blood flow in pial arteries and veins, resulting in a poor recovery of downstream penetrating arterial flow and a sustained deficit in microvascular flow. There was also persistent increase of leukocyte adhesion to the endothelium of veins, coincided with elevated neutrophils infiltration into brain parenchyma in T2DM mice compared to control mice after stroke. Our data suggest that T2DM-induced increase in chronic inflammation may contribute to the remodeling of leptomeningeal collateral circulation and the observed hemodynamics deficiency that potentiates poor stroke outcome.

Geriatric Pharmacotherapy Case Series: Medications for Diabetes-A Focus on Secondary Stroke Prevention

This report addresses evidence for efficacy of diabetes medications with a focus on stroke risk reduction. The cardiovascular benefits of SGLT-2 inhibitors and GLP-1 receptor agonists have been well-established; however, clinical trials to date have examined composite cardiovascular endpoints that include, but do not specifically focus on, stroke. The purpose of this case review is to examine the evidence for the various diabetes medications in reducing the risk for stroke. This literature review was inspired by a patient seen in a geriatric day hospital program with diabetes and a history of multiple strokes. Our goal was to select a diabetes management regimen that would provide both glycemic control and stroke risk reduction. As diabetes and cerebrovascular disease commonly coexist and are important contributors to morbidity and mortality in older individuals, appropriate management must incorporate both current evidence as well as consideration for patient-specific factors that may influence the treatment plan. This patient case illustrates the importance of both.

[Highly selective sodium-glucose co-transporter type 2 inhibitor empagliflozin as means of brain protection in conditions of chronic brain dyscirculation]

BACKGROUND

Chronic brain dyscirculation is one of the frequent type 2 diabetes mellitus (DM) complications and leads to patients' disability. Sodium-glucose co-transporter type 2 inhibitors (SGLT-2i) have been proven to have advantages for cardiovascular system, but their effect on the central nervous system (CNS) has not been studied enough.

AIM

To study empagliflozin effect on CNS damage functional and laboratory parameters in patients with type 2 DM and, under experimental conditions, to investigate the mechanisms of the drug neurotropic effect.

MATERIALS AND METHODS

The clinical part of the study included patients with type 2 DM on metformin monotherapy (n=39). Patients with a target glycated hemoglobin level formed the "MET" group (n=19), in patients with a non-target glycated hemoglobin level empagliflozin was co-administered for the following 6 months (the "MET+EMPA" group, n=20). Healthy volunteers comprised the control group (n=16). The cognitive status and neuron-specific enolase (NSE) and neurofilament light chains (NLC) concentration were studied. DM was modeled in rats, thereafter the rats were treated with empagliflozin for 8 weeks. Microglia activation was assessed using anti-Iba-1 antibodies and morphological changes in neurons when stained by the Nissl method.

RESULTS

Both in the "MET+EMPA" and the "MET" groups cognitive deficits were observed, according to the Montreal Cognitive Assessment (MOCA) (24.0 (23.0; 27.0) and 25.0 (21.0; 27.0) points) and the Mini-Mental State Examination (MMSE) (23.75 (23.0; 27.0) and 25.0 (21.0; 27.0) points). Empagliflozin therapy led to the cognitive status normalization after 6 months (26.5 (24.0; 27.0) points according to the MOCA scale and 27.5 (24.0; 28.0) points according to the MMSE). Initially, all patients had a significant increase of NSE (3.60 (2.66; 3.76) ng/ml in the "MET" group, 3.22 (2.94; 3.54) ng/ml in the "MET+EMPA» group, 2.72 (2.13; 2.72) ng/ml in the «Control» group) and NLC (4.50 (3.31; 5.56) ng/ml in the «MET» group, 5, 25 (3.75; 6.25) ng/ml in the «MET+EMPA» group comparing with 3.50 (2.25; 3.50) ng/ml in the «Control» group). Empagliflozin therapy led to a significant decrease in NLC already after 3 months (3.80 (3.25; 3.87) ng/ml), without significant influence on the NSE level. In the experiment, DM was characterized by an increased number of activated microgliocytes and destructured neurons and a decreased number of neurons with a normal structure. Empagliflozin therapy was accompanied by a decrease in the number of immunopositive microgliocytes in the CA1 zone of the hippocampus and an increase in the number of structured neurons.

CONCLUSION

Type 2 diabetes mellitus is characterized by functional and biochemical changes in the central nervous system even under satisfactory glycemic control. Therapy with empagliflozin has a neuroprotective effect, manifested in an improvement in cognitive status and a decrease in NLC level. Empagliflozin reduces neuronal damage and abnormal microglial activation.

Metformin monotherapy versus predominantly older non-metformin antidiabetic medications for cerebrovascular risk in early type 2 diabetes management

AIM

Choosing the initial treatment for type 2 diabetes (T2D) is pivotal, requiring consideration of solid clinical evidence and patient characteristics. Despite metformin's historical preference, its efficacy in preventing cerebrovascular events lacked empirical validation. This study aimed to evaluate the associations between first-line monotherapy (metformin or non-metformin antidiabetic medications) and cerebrovascular complications in patients with T2D without diabetic complications.

METHODS

We analysed 9090 patients with T2D without complications who were prescribed either metformin or non-metformin medications as initial therapy. Propensity score matching ensured group comparability. Cox regression analyses, stratified by initial metformin use, assessed cerebrovascular disease risk, adjusting for multiple covariates and using competing risk analysis. Metformin exposure was measured using cumulative defined daily doses.

RESULTS

Metformin users had a significantly lower crude incidence of cerebrovascular diseases compared with non-users (p < .0001). Adjusted hazard ratios (aHRs) consistently showed an association between metformin use and a lower risk of overall cerebrovascular diseases (aHRs: 0.67-0.69) and severe events (aHRs: 0.67-0.69). The association with reduced risk of mild cerebrovascular diseases was significant across all models (aHRs: 0.73-0.74). Higher cumulative defined daily doses of metformin correlated with reduced cerebrovascular risk (incidence rate ratio: 0.62-0.94, p < .0001), indicating a dose-dependent effect.

CONCLUSION

Metformin monotherapy is associated with a reduced risk of cerebrovascular diseases in early-stage T2D, highlighting its dose-dependent efficacy. However, the observed benefits might also be influenced by baseline differences and the increased risks associated with other medications, such as sulphonylureas. These findings emphasize the need for personalized diabetes management, particularly in mitigating cerebrovascular risk in early T2D stages.

Atrial cardiomyopathy revisited-evolution of a concept: a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS)

AIMS

The concept of "atrial cardiomyopathy" (AtCM) had been percolating through the literature since its first mention in 1972. Since then, publications using the term were sporadic until the decision was made to convene an expert working group with representation from four multinational arrhythmia organizations to prepare a consensus document on atrial cardiomyopathy in 2016 (EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication). Subsequently, publications on AtCM have increased progressively.

METHODS AND RESULTS

The present consensus document elaborates the 2016 AtCM document further to implement a simple AtCM staging system (AtCM stages 1-3) by integrating biomarkers, atrial geometry, and electrophysiological changes. However, the proposed AtCM staging needs clinical validation. Importantly, it is clearly stated that the presence of AtCM might serve as a substrate for the development of atrial fibrillation (AF) and AF may accelerates AtCM substantially, but AtCM per se needs to be viewed as a separate entity.

CONCLUSION

Thus, the present document serves as a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS) to contribute to the evolution of the AtCM concept.

Epidemiology, Pathophysiology, and Current Treatment Strategies in Stroke

Both ischemic and hemorrhagic strokes are critical health issues and the incidence is on the rise. The rapid neurological degeneration that can occur with either type of stroke warrants prompt medical attention. In the article, we critically reviewed the literature examining their incidence, pathophysiology, and present treatment strategies. Clinical trials show conflicting findings, with ischemic strokes accounting for 87% of all strokes. Brain injury following an ischemic stroke results in cell death and necrosis, immune cells being the primary actors in the process of neuroinflammation. In order to develop neuroprotective drugs against ischemic stroke, detailed investigation of glutamate production and metabolism as well as downstream pathways controlled by glutamate receptors provides significant information on the underlying mechanisms. The permeability of the blood-brain barrier and the degradation of glutamine synthase are two potential mechanisms by which peritoneal dialysis accelerates brain-to-blood glutamate clearance and thus reduces glutamate levels in the brain after a stroke. Oxidative stress in an ischemic stroke disturbs the oxidant-antioxidant balance, which is particularly problematic for brain cells that are high in polyunsaturated fatty acids. Because of demographic factors like age, sex, race/ethnicity, and socioeconomic status, the incidence and prevalence of stroke differ across people and regions. For rapid diagnosis and treatment decisions, diagnostic imaging tools such as vascular imaging, CT, and MRI are essential. To aid in the recovery and lessen neurological impairments following a stroke, novel avenues of research are under investigation on neuroprotective medications that target inflammation, oxidative stress, and neuronal death.

The nonlinear relationship between triglyceride glucose-waist circumference and stroke risk in middle-aged and elderly people: a nationwide prospective cohort study of the CHARLS

BACKGROUND AND AIMS

Numerous research have focused on the relationship of metabolic markers and stroke risk, yet limited research has focused on the triglyceride glucose-waist circumference (TyG-WC) index. This study explored the possible association of TyG-WC and stroke among moderately aged and old Chinese adults over 45 years of age.

METHODS

This observational cohort analysis involved 9054 participants from the Chinese Longitudinal Study of Health and Retirement and employed a standardized questionnaire administered via in-person interviews. Cox proportional hazard model, smoothed curve fitting, and threshold effect analysis were conducted for examining the potential nonlinear relationships among TyG-WC and stroke risk.

RESULTS

Within an average follow-up period of six years, 463 new strokes occurred, representing 5.11% of the total number of patients. After adjusting for possible confounding factors, a nonlinear association between TyG-WC and stroke risk was identified, with a significant dose-response relationship (P = 0.023 for the log-likelihood ratio test). A turning point was identified at the TyG-WC level of 554.48, beyond that the likelihood of stroke increased markedly (HR = 1.323, 95% CI = 1.098-1.594, P = 0.003).

CONCLUSION

This study revealed a specific curvilinear association with the TyG-WC score and stroke risk, identifying a key threshold value. This study focused on Chinese middle-aged and senior adults over the age of 45, emphasizing that increased stroke risk is linked to higher TyG-WC levels.

Determinants of adverse outcomes following patent foramen ovale closure in elderly patients

BACKGROUND

Limited data are available on transcatheter patent foramen ovale (PFO) closure outcomes in the elderly.

AIMS

Through this study, we aimed to determine the incidence and predictors of adverse events (recurrent cerebrovascular events [CVE] and atrial fibrillation [AF]) post-PFO closure in older patients with cryptogenic events.

METHODS

This multicentre international study included patients over 60 years undergoing PFO closure for cryptogenic thromboembolic events. A dedicated database compiled baseline, procedural, and follow-up data. Competing risk and adjusted outcome predictor analyses were conducted.

RESULTS

A total of 689 patients were included (median age 65 years, 41.2% female, mean Risk of Paradoxical Embolism [RoPE] score 4.5). The procedural success rate was 99.4%. After a median follow-up of 2 (interquartile range 1-5) years, 66 patients (9.6%) had died. CVE and stroke rates were 1.21 and 0.55 per 100 patient-years, respectively. Diabetes (hazard ratio [HR] 3.89, 95% confidence interval [CI]: 1.67-9.07; p=0.002) and atrial septal aneurysm (ASA; HR 5.25, 95% CI: 1.56-17.62; p=0.007) increased the CVE risk. New-onset AF occurred at a rate of 3.30 per 100 patient-years, with 51.3% within one month post-procedure. Older age (HR 1.05 per year, 95% CI: 1.00-1.09; p=0.023) and the absence of hypertension (HR 2.04, 95% CI: 1.19-3.57; p=0.010) were associated with an increased risk of AF.

CONCLUSIONS

Older patients undergoing PFO closure had a relatively low rate of CVE and new-onset AF after a median follow-up of 2 years. The presence of diabetes, ASA, and a more advanced age determined an increased risk of adverse clinical events. These factors may be considered in the clinical decision-making process regarding PFO closure in this challenging population.

Microglia Involvement into Acute and Chronic Brain Damage in Diabetic Rats: Impact of GLP-1RA and SGLT-2i

BACKGROUND

Acute and chronic brain damage in type 2 diabetes mellitus (DM) determines the need to investigate the neuroprotective potential of glucose-lowering drugs. The purpose was to directly compare the neuroprotective effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) with different duration of action and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) in type 2 diabetic rats with and without stroke.

METHODS

DM was modelled using high-fat diet and nicotinamide+streptozotocin protocol. The following groups (n = 15 each) were formed: DM without treatment, treatment with liraglutide, dulaglutide, canagliflozin as well as control group without DM and treatment. After 8 weeks, 10 rats from each group underwent middle cerebral artery occlusion. In the reperfusion period neurological deficit, neuroglial damage markers and brain necrosis were evaluated. Brain slices from the remaining 5 animals in each group were histologically examined for microglial activation and neuronal damage.

RESULTS

Brain damage was similar in "DM" and "Control" (17.53 [14.23; 26.58] and 15.87 [13.40; 22.68] % of total brain volume, respectively). All study drugs diminished damage volume comparing with "DM" and "Control" whereas the necrosis volume in "DM+Liraglutide" was smaller than in "DM+Canagliflozin" and did not significantly differ from "DM+Dulaglutide" (2.9 [1.83; 4.71], 6.17 [3.88; 8.88] and 4.57 [3.27; 7.90] %). The neurological deficit was more prominent in "DM" than in "Control", while all the drugs demonstrated similar positive effect. Neurofilament light chains (NLC) did not differ between "DM" and "Control". Dulaglutide and canagliflozin caused a marked decrease in NLC. Protein S100BB level was similar in "DM" and "Control". Liraglutide caused the largest S100BB decrease, while canagliflozin did not influence it. In chronic brain ischaemia, all drugs increased the number of normal neurons, but GLP-1RAs had a more pronounced effect. DM was accompanied by increased number of activated microglial cells in Cornu Ammonis (CA)1 hippocampal region. Both GLP-1RAs reduced the number of Iba-1-positive cells, with dulaglutide being more effective than liraglutide, whereas canagliflozin did not affect this parameter.

CONCLUSIONS

GLP-1RAs and SGLT-2i have neuroprotective properties against acute and chronic brain damage in diabetic rats, although the infarct-limiting effect of GLP-1RAs may be more pronounced. GLP-1RAs and SGLT-2i exert their protective effects by directly influencing neuronal survival, whereas GLP-1RAs also affect microglia.