Hyperglycemia, duration of diabetes, and intracranial atherosclerotic stenosis by magnetic resonance angiography: The ARIC-NCS study

Associations of hematological and biochemical markers with intracranial atherosclerotic stenosis in stroke-free populations: A systematic review and meta-analysis of observational studies

BACKGROUND AND AIMS

Intracranial atherosclerotic stenosis (ICAS) is an important cause of ischemic stroke and transient ischemic attack. We aimed to synthesize relevant evidence on the associations of hematological and biochemical markers with ICAS in stroke-free populations.

METHODS AND RESULTS

We searched MEDLINE and EMBASE for articles reporting associations of hematological and biochemical markers with ICAS presence in stroke-free populations. Weighted mean difference (WMD) and 95% confidence interval (CI) for each biomarker were pooled using fixed- or random-effects models. Among 32 studies included in the systematic review, 23 studies (48,326 subjects) with 22 biomarkers were meta-analyzed. Compared with subjects without ICAS, those with ICAS had significantly higher white blood cell (4118 subjects, WMD 0.28 per 10⁹/L, 95% CI 0.01-0.56), neutrophil (4326 subjects, WMD 0.24 per 10⁹/L, 0.10-0.38), neutrophil/lymphocyte ratio (4326 subjects, WMD 0.16, 0.07-0.26), low-density lipoprotein (28,606 subjects, WMD 0.12 mmol/L, 0.05-0.19), non-high-density lipoprotein (3671 subjects, WMD 0.17 mmol/L, 0.08-0.25), C-reactive protein (CRP; 5355 subjects, WMD 0.06 mg/dL, 0.04-0.07), high-sensitivity CRP (9383 subjects, WMD 0.07 mg/dL, 0.01-0.13), uric acid (5966 subjects, WMD 17.91 μmol/L, 11.16-24.66), creatinine (5731 subjects, WMD 4.03 μmol/L, 0.77-7.29), and homocysteine (7053 subjects, WMD 2.25 μmol/L, 1.02-3.48), but lower lymphocyte (4326 subjects, WMD -0.12 per 10⁹/L, -0.19--0.04). Sensitivity analyses showed similar results.

CONCLUSIONS

Several hematological and biochemical markers easily accessible were associated with ICAS presence in stroke-free populations. This can facilitate early identification of subjects at a high risk of ICAS, who may benefit from ICAS screening and prevention.

PROSPERO REGISTRATION NUMBER

CRD42021247990.

Association between diabetes duration and 1-year prognosis of stroke: A national registry study

BACKGROUND AND PURPOSE

Diabetes mellitus is a strong independent risk factor for stroke recurrence. However, the association between diabetes duration and the prognosis of stroke remains uncertain. We aimed to characterize whether an association exists between diabetes duration and stroke outcomes in patients with ischemic stroke or transient ischemic attack (TIA).

METHODS

Between 2015 and 2018, 14,674 patients with ischemic stroke or TIA within 7 days and older than 18 years from the Third China National Stroke Registry (CNSR-III) were included in this analysis. Diabetes duration at baseline was collected by face-to-face interviews and further categorized into groups of without diabetes, diabetes < 4, 4 to <8 and ≥8 years. The association between diabetes duration and clinical outcomes, including stroke recurrence, poor function outcome (modified Rankin Scale score of 3-6), and all-cause mortality at the 1-year follow-up after stroke onset, was evaluated by a multivariable Cox proportional hazard regression model, competing risk model and logistic regression model with adjustment for demographic and clinical features.

RESULTS

Among the 14,674 patients included, the average age was 62.0 years, and 68.5% were male. There were 1419 (9.7%) patients who had stroke recurrence, 1912 (13.0%) who had poor function outcome, and 478 (3.3%) who had all-cause mortality at the 1-year follow-up. After adjusting for potential covariates, a diabetes duration ≥8 years was associated with an increased risk of 1-year stroke recurrence (adjusted hazards ratio [HR], 1.31; 95% CI, 1.05-1.64; p = .02) in comparison to those without Diabetes mellitus. Using a competing risk regression model, a diabetes duration ≥8 years was a significant risk factor for stroke recurrence (HR, 1.31; 95% CI, 1.12-1.53). In contrast, there was no significant association between diabetes duration < 4, 4 to <8 years and clinical outcomes.

CONCLUSIONS

Long-term diabetes duration (≥8 years), but not short-term diabetes duration, was associated with an increased risk of 1-year stroke recurrence in patients with ischemic stroke or TIA.

Clinically Recognized Varicose Veins and Physical Function in Older Individuals: The ARIC Study

BACKGROUND

Although a few studies reported an association between varicose veins and physical function, this potentially bidirectional association has not been systematically evaluated in the general population.

METHOD

In 5 580 participants (aged 71-90 years) from the Atherosclerosis Risk in Communities study, varicose veins were identified in outpatient and inpatient administrative data prior to (prevalent cases) and after (incident cases) visit 5 (2011-2013). Physical function was evaluated by the Short Physical Performance Battery (SPPB, score ranging from 0 to 12). We evaluated (i) cross-sectional association between prevalent varicose veins and physical function, (ii) association of prevalent varicose veins with subsequent changes in physical function from visit 5 to visits 6 (2016-2017) and 7 (2018-2019), and (iii) association of physical function at visit 5 with incident varicose veins during a median follow-up of 3.6 years (105 incident varicose veins among 5 350 participants without prevalent cases at baseline).

RESULTS

At baseline, varicose veins were recognized in 230 (4.1%) participants and cross-sectionally associated with reduced physical function. Longitudinally, prevalent varicose veins were not significantly associated with a decline in SPPB over time. In contrast, a low SPPB ≤6 was associated with a greater incidence of varicose veins compared to SPPB ≥10 (adjusted hazard ratio 2.13 [95% confidence interval = 1.19, 3.81]).

CONCLUSION

In community-dwelling older adults, varicose veins and low physical function were associated cross-sectionally. Longitudinally, low physical function was a risk factor for incident varicose veins, but not vice versa. Our findings suggest an etiological contribution of low physical function to incident varicose veins.

Diabetes, stroke, and neuroresilience: looking beyond hyperglycemia

Ischemic stroke is a leading cause of morbidity and mortality among type 2 diabetic patients. Preclinical and translational studies have identified critical pathophysiological mediators of stroke risk, recurrence, and poor outcome in diabetic patients, including endothelial dysfunction and inflammation. Most clinical trials of diabetes and stroke have focused on treating hyperglycemia alone. Pioglitazone has shown promise in secondary stroke prevention for insulin-resistant patients; however, its use is not yet widespread. Additional research into clinical therapies directed at diabetic pathophysiological processes to prevent stroke and improve outcome for diabetic stroke survivors is necessary. Resilience is the process of active adaptation to a stressor. In patients with diabetes, stroke recovery is impaired by insulin resistance, endothelial dysfunction, and inflammation, which impair key neuroresilience pathways maintaining cerebrovascular integrity, resolving poststroke inflammation, stimulating neural plasticity, and preventing neurodegeneration. Our review summarizes the underpinnings of stroke risk in diabetes, the clinical consequences of stroke in diabetic patients, and proposes hypotheses and new avenues of research for therapeutics to stimulate neuroresilience pathways and improve stroke outcome in diabetic patients.