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García-Casares N, González-González G, de la Cruz-Cosme C, Garzón-Maldonado FJ, de Rojas-Leal C, Ariza MJ, Narváez M, Barbancho MÁ, García-Arnés JA, Tinahones FJ. Effects of GLP-1 receptor agonists on neurological complications of diabetes. Rev Endocr Metab Disord 2023; 24:655-672. [PMID: 37231200 PMCID: PMC10404567 DOI: 10.1007/s11154-023-09807-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/27/2023]
Abstract
Emerging evidence suggests that treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) could be an interesting treatment strategy to reduce neurological complications such as stroke, cognitive impairment, and peripheral neuropathy. We performed a systematic review to examine the evidence concerning the effects of GLP-1 RAs on neurological complications of diabetes. The databases used were Pubmed, Scopus and Cochrane. We selected clinical trials which analysed the effect of GLP-1 RAs on stroke, cognitive impairment, and peripheral neuropathy. We found a total of 19 studies: 8 studies include stroke or major cardiovascular events, 7 involve cognitive impairment and 4 include peripheral neuropathy. Semaglutide subcutaneous and dulaglutide reduced stroke cases. Liraglutide, albiglutide, oral semaglutide and efpeglenatide, were not shown to reduce the number of strokes but did reduce major cardiovascular events. Exenatide, dulaglutide and liraglutide improved general cognition but no significant effect on diabetic peripheral neuropathy has been reported with GLP-1 RAs. GLP-1 RAs are promising drugs that seem to be useful in the reduction of some neurological complications of diabetes. However, more studies are needed.
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Affiliation(s)
- Natalia García-Casares
- Facultad de Medicina, Departamento de Medicina, Universidad de Málaga, Málaga, Spain.
- Instituto de Investigación Biomédica de Málaga (I.B.I.M.A), Málaga, Spain.
- Centro de Investigaciones Médico-Sanitarias (C.I.M.ES), Málaga, Spain.
- Departamento de Medicina, Facultad de Medicina, Universidad de Málaga, Centro de Investigaciones Médico Sanitarias (C.I.M.E.S), Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Campus Universitario de Teatinos s/n., Málaga, 29010, España.
| | | | - Carlos de la Cruz-Cosme
- Instituto de Investigación Biomédica de Málaga (I.B.I.M.A), Málaga, Spain
- Hospital Universitario Virgen de la Victoria de Málaga, Málaga, Spain
| | - Francisco J Garzón-Maldonado
- Instituto de Investigación Biomédica de Málaga (I.B.I.M.A), Málaga, Spain
- Hospital Universitario Virgen de la Victoria de Málaga, Málaga, Spain
| | - Carmen de Rojas-Leal
- Facultad de Medicina, Departamento de Medicina, Universidad de Málaga, Málaga, Spain
| | - María J Ariza
- Facultad de Medicina, Departamento de Medicina, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (I.B.I.M.A), Málaga, Spain
- Centro de Investigaciones Médico-Sanitarias (C.I.M.ES), Málaga, Spain
| | - Manuel Narváez
- Facultad de Medicina, Departamento de Medicina, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (I.B.I.M.A), Málaga, Spain
| | - Miguel Ángel Barbancho
- Facultad de Medicina, Departamento de Medicina, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (I.B.I.M.A), Málaga, Spain
- Centro de Investigaciones Médico-Sanitarias (C.I.M.ES), Málaga, Spain
| | | | - Francisco J Tinahones
- Facultad de Medicina, Departamento de Medicina, Universidad de Málaga, Málaga, Spain.
- Instituto de Investigación Biomédica de Málaga (I.B.I.M.A), Málaga, Spain.
- Hospital Universitario Virgen de la Victoria de Málaga, Málaga, Spain.
- Departamento de Medicina, Facultad de Medicina, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Campus Universitario de Teatinos s/n., Málaga, 29010, España.
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2
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Del Cuore A, Pipitone RM, Casuccio A, Mazzola MM, Puleo MG, Pacinella G, Riolo R, Maida C, Di Chiara T, Di Raimondo D, Zito R, Lupo G, Agnello L, Di Maria G, Ciaccio M, Grimaudo S, Tuttolomondo A. Metabolic memory in diabetic foot syndrome (DFS): MICRO-RNAS, single nucleotide polymorphisms (SNPs) frequency and their relationship with indices of endothelial function and adipo-inflammatory dysfunction. Cardiovasc Diabetol 2023; 22:148. [PMID: 37365645 DOI: 10.1186/s12933-023-01880-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Diabetic foot is a significant cause of morbidity in diabetic patients, with a rate that is approximately twice that of patients without foot ulcers. "Metabolic memory" represents the epigenetic changes induced by chronic hyperglycaemia, despite the correction of the glucose levels themselves. These epigenetic modifications appear to perpetuate the damage caused by persistently elevated glucose levels even in their absence, acting at various levels, mostly affecting the molecular processes of diabetic ulcer healing. METHODS The aim of our cross-sectional study was to analyse a cohort of patients with diabetes with and without lower limb ulcers. We examined the effects of epigenetic changes on miRNA 126, 305, and 217 expression and the frequency of the SNPs of genes encoding inflammatory molecules (e.g., IL-6 and TNF-alpha) and their correlations with serum levels of proangiogenic molecules (e.g., ENOS, VEGF and HIF-1alpha) and several adipokines as well as with endothelial dysfunction, assessed noninvasively by reactive hyperaemia peripheral artery tonometry. Between March 2021 and June 2022, 110 patients were enrolled into the study: 50 diabetic patients with diabetic foot injuries, 40 diabetic patients without ulcerative complications and 20 nondiabetic patients as the control group. RESULTS Diabetic subjects with lower limb ulcerative lesions exhibited higher levels of inflammatory cytokines, such as VEGF (191.40 ± 200 pg/mL vs. 98.27 ± 56.92 pg/mL vs. 71.01 ± 52.96 pg/mL; p = 0.22), HIF-1alpha (40.18 ± 10.80 ng/mL vs. 33.50 ± 6.16 ng/mL vs. 33.85 ± 6.84 ng/mL; p = 0.10), and Gremlin-1 (1.72 ± 0.512 ng/mL vs. 1.31 ± 0.21 ng/mL vs. 1.11 ± 0.19 ng/mL; p < 0.0005), than those without lower limb ulcers and healthy controls. Furthermore, we observed that miR-217-5p and miR-503-5p were 2.19-fold (p < 0.05) and 6.21-fold (p = 0.001) more highly expressed in diabetic foot patients than in healthy controls, respectively. Additionally, diabetic patients without lower limb ulcerative complications showed 2.41-fold (p = 0) and 2.24-fold (p = 0.029) higher expression of miR-217-5p and miR-503-5p, respectively, than healthy controls. Finally, diabetic patients with and without ulcerative complications of the lower limbs showed higher expression of the VEGFC2578A CC polymorphism (p = 0.001) and lower expression of the VEGFC2578A AC polymorphism (p < 0.005) than the healthy control population. We observed a significant increase in Gremlin-1 levels in patients with diabetic foot, suggesting that this inflammatory adipokine may serve as a predictive marker for the diagnosis of diabetic foot. CONCLUSIONS Our results highlighted that patients with diabetic foot showed predominant expression of the VEGF C2578A CC polymorphism and reduced expression of the AC allele. Additionally, we found an overexpression of miR-217-5p and miR-503-5p in diabetic patients with and without diabetic foot syndrome compared with healthy controls. These results align with those reported in the literature, in which the overexpression of miR-217-5p and miR-503-5p in the context of diabetic foot is reported. The identification of these epigenetic modifications could therefore be helpful in the early diagnosis of diabetic foot and the treatment of risk factors. However, further studies are necessary to confirm this hypothesis.
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Affiliation(s)
- Alessandro Del Cuore
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
- Internal Medicine and Stroke Care Ward, Policlinico "P. Giaccone", Palermo, Italy
| | - Rosaria Maria Pipitone
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
| | - Alessandra Casuccio
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
| | - Marco Maria Mazzola
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
- Internal Medicine and Stroke Care Ward, Policlinico "P. Giaccone", Palermo, Italy
| | - Maria Grazia Puleo
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
- Internal Medicine and Stroke Care Ward, Policlinico "P. Giaccone", Palermo, Italy
| | - Gaetano Pacinella
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
- Internal Medicine and Stroke Care Ward, Policlinico "P. Giaccone", Palermo, Italy
| | - Renata Riolo
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
- Internal Medicine and Stroke Care Ward, Policlinico "P. Giaccone", Palermo, Italy
| | - Carlo Maida
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
- Internal Medicine and Stroke Care Ward, Policlinico "P. Giaccone", Palermo, Italy
| | - Tiziana Di Chiara
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
- Internal Medicine and Stroke Care Ward, Policlinico "P. Giaccone", Palermo, Italy
| | - Domenico Di Raimondo
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
- Internal Medicine and Stroke Care Ward, Policlinico "P. Giaccone", Palermo, Italy
| | - Rossella Zito
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
| | - Giulia Lupo
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
| | - Luisa Agnello
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Gabriele Di Maria
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
| | - Marcello Ciaccio
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Stefania Grimaudo
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
| | - Antonino Tuttolomondo
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (PROMISE) G. D'Alessandro, University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy.
- Internal Medicine and Stroke Care Ward, Policlinico "P. Giaccone", Palermo, Italy.
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Wei M, Huang Q, Yu F, Feng X, Luo Y, Zhao T, Tu R, Liao D, Du Y, Huang Q, Gu W, Liu Y, Jiang Y, Gu H, Li Z, Xia J. Stroke-associated infection in patients with co-morbid diabetes mellitus is associated with in-hospital mortality. Front Aging Neurosci 2022; 14:1024496. [PMID: 36533168 PMCID: PMC9751873 DOI: 10.3389/fnagi.2022.1024496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/02/2022] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The association between infection and acute ischemic stroke (AIS) with diabetes mellitus (DM) remains unknown. Therefore, this study aimed to explore the effect of infection on AIS with DM. MATERIALS AND METHODS The data of patients with AIS and DM were extracted from the Chinese Stroke Center Alliance (CSCA) database from August 2015 to July 2019. The association between infections [pneumonia or urinary tract infection (UTI)] and in-hospital mortality was analyzed. Logistic regression models were used to identify the risk factors for in-hospital mortality of patients with infection. RESULTS In total, 1,77,923 AIS patients with DM were included in the study. The infection rate during hospitalization was 10.5%, and the mortality rate of infected patients was 3.4%. Stroke-associated infection was an independent risk factor for an early poor functional outcome [odds ratio (OR) = 2.26, 95% confidence interval (CI): 1.97-2.34, P < 0.0001] and in-hospital mortality in AIS patients with DM. The in-hospital mortality after infection was associated with age (OR = 1.02, 95% CI: 1.01-1.03, P < 0.0001), male (OR = 1.39, 95% CI: 1.13-1.71, P = 0.0018), reperfusion therapy (OR = 2.00, 95% CI: 1.56-2.56, P < 0.0001), and fasting plasma glucose at admission (OR = 1.05, 95% CI: 1.03-1.08, P < 0.0001). In contrast, antiplatelet drug therapy (OR = 0.63, 95% CI: 0.50-0.78, P < 0.0001) and hospital stay (OR = 0.96, 95% CI: 0.94-0.97, P < 0.0001) were independent protecting factors against in-hospital mortality of patients with infection. CONCLUSION Infection is an independent risk factor of in-hospital mortality for patients with AIS and DM, and those patients require strengthening nursing management to prevent infection.
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Affiliation(s)
- Minping Wei
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qin Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Fang Yu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xianjing Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yunfang Luo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Tingting Zhao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Ruxin Tu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Di Liao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Du
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wenping Gu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yunhai Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yingyu Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Chandrasekera D, Katare R. Exosomal microRNAs in diabetic heart disease. Cardiovasc Diabetol 2022; 21:122. [PMID: 35778763 PMCID: PMC9250231 DOI: 10.1186/s12933-022-01544-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/27/2022] [Indexed: 02/08/2023] Open
Abstract
Diabetes is a metabolic disorder that affects millions of people worldwide. Diabetic heart disease (DHD) comprises coronary artery disease, heart failure, cardiac autonomic neuropathy, peripheral arterial disease, and diabetic cardiomyopathy. The onset and progression of DHD have been attributed to molecular alterations in response to hyperglycemia in diabetes. In this context, microRNAs (miRNAs) have been demonstrated to have a significant role in the development and progression of DHD. In addition to their effects on the host cells, miRNAs can be released into circulation after encapsulation within the exosomes. Exosomes are extracellular nanovesicles ranging from 30 to 180 nm in diameter secreted by all cell types. They carry diverse cargos that are altered in response to various conditions in their parent cells. Exosomal miRNAs have been extensively studied in recent years due to their role and therapeutic potential in DHD. This review will first provide an overview of exosomes, their biogenesis and function, followed by the role of exosomes in cardiovascular disease and then focuses on the known role of exosomes and associated miRNAs in DHD.
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Affiliation(s)
- Dhananjie Chandrasekera
- Department of Physiology, School of Biomedical Sciences, HeartOtago, University of Otago, 270, Great King Street, Dunedin, New Zealand.
| | - Rajesh Katare
- Department of Physiology, School of Biomedical Sciences, HeartOtago, University of Otago, 270, Great King Street, Dunedin, New Zealand.
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Kim S, Park ES, Chen PR, Kim E. Dysregulated Hypothalamic–Pituitary–Adrenal Axis Is Associated With Increased Inflammation and Worse Outcomes After Ischemic Stroke in Diabetic Mice. Front Immunol 2022; 13:864858. [PMID: 35784349 PMCID: PMC9243263 DOI: 10.3389/fimmu.2022.864858] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/09/2022] [Indexed: 01/08/2023] Open
Abstract
Diabetic patients have larger infarcts, worse neurological deficits, and higher mortality rate after an ischemic stroke. Evidence shows that in diabetes, the hypothalamic–pituitary–adrenal (HPA) axis was dysregulated and levels of cortisol increased. Based on the role of the HPA axis in immunity, we hypothesized that diabetes-dysregulated stress response exacerbates stroke outcomes via regulation of inflammation. To test this hypothesis, we assessed the regulation of the HPA axis in diabetic mice before and after stroke and determined its relevance in the regulation of post-stroke injury and inflammation. Diabetes was induced in C57BL/6 mice by feeding a high-fat diet and intraperitoneal injection of streptozotocin (STZ), and then the mice were subjected to 30 min of middle cerebral artery occlusion (MCAO). Infarct volume and neurological scores were measured in the ischemic mice. The inflammatory cytokine and chemokine levels were also determined in the ischemic brain. To assess the effect of diabetes on the stroke-modulated HPA axis, we measured the expression of components in the HPA axis including corticotropin-releasing hormone (CRH) in the hypothalamus, proopiomelanocortin (POMC) in the pituitary, and plasma adrenocorticotropic hormone (ACTH) and corticosterone. Diabetic mice had larger infarcts and worse neurological scores after stroke. The exacerbated stroke outcomes in diabetic mice were accompanied by the upregulated expression of inflammatory factors (including IL-1β, TNF-α, IL-6, CCR2, and MCP-1) in the ischemic brain. We also confirmed increased levels of hypothalamic CRH, pituitary POMC, and plasma corticosterone in diabetic mice before and after stroke, suggesting the hyper-activated HPA axis in diabetic conditions. Finally, we confirmed that post-stroke treatment of metyrapone (an inhibitor of glucocorticoid synthesis) reduced IL-6 expression and the infarct size in the ischemic brain of diabetic mice. These results elucidate the mechanisms in which the HPA axis in diabetes exacerbates ischemic stroke. Maintaining an optimal level of the stress response by regulating the HPA axis may be an effective approach to improving stroke outcomes in patients with diabetes.
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Gao Q, Qi P, Wang J, Hu S, Yang X, Fan J, Li L, Lu Y, Lu J, Chen J, Wang D. Effects of diabetes mellitus complicated by admission hyperglycemia on clot histological composition and ultrastructure in patients with acute ischemic stroke. BMC Neurol 2022; 22:130. [PMID: 35382802 PMCID: PMC8981928 DOI: 10.1186/s12883-022-02660-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) affects the occurrence and prognosis of acute ischemic stroke (AIS). However, the impact of diabetes on thrombus characteristics is unclear. The relationship between the composition and ultrastructure of clots and DM with admission hyperglycemia was investigated. Methods Consecutive patients with AIS who underwent endovascular thrombus retrieval between June 2017 and May 2021 were recruited. The thrombus composition and ultrastructure were evaluated using Martius scarlet blue stain and scanning electron microscopy. Clot perviousness was evaluated via thrombus attenuation increase on computed tomography angiography (CTA) versus non-contrast CT. Patients with admission hyperglycemia DM (ahDM) and those without DM (nonDM) were compared in terms of thrombus composition, ultrastructure, and perviousness. Results On admission, higher NIHSS scores (17 vs. 12, respectively, p = 0.015) was evident in ahDM patients. After the 90-day follow-up, the rates of excellent outcomes (mRS 0–1) were lower in patients with ahDM (16.6%, p = 0.038), but functional independence (mRS 0–2) and handicapped (mRS 3–5) were comparable between patients with ahDM and nonDM. The outcome of mortality was higher in patients with ahDM (33.3%, p = 0.046) than in nonDM patients. Clots in patients with ahDM had more fibrin (39.4% vs. 25.0%, respectively, p = 0.007), fewer erythrocyte components (21.2% vs. 41.5%, respectively, p = 0.043), equivalent platelet fraction (27.7% vs. 24.6%, respectively, p = 0.587), and higher WBC counts (4.6% vs. 3.3%, respectively, p = 0.004) than in nonDM patients. The percentage of polyhedral erythrocytes in thrombi was significantly higher in ahDM patients than in nonDM patients (68.9% vs. 45.6%, respectively, p = 0.007). The proportion of pervious clots was higher in patients nonDM than in patients with ahDM (82.61% vs. 40%, respectively, p = 0.026). Conclusion Patients with ahDM presented with greater stroke severity on admission and poorer functional outcomes after 3 months. Clots in patients with ahDM had more fibrin, leucocytes, and fewer erythrocyte components than in patients nonDM. The content of polyhedral erythrocytes and impervious clots proportion were significantly higher in thrombi of patients with AIS and ahDM. Further research is required to validate these findings.
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Affiliation(s)
- Qun Gao
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Junjie Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Shen Hu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Ximeng Yang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Jingwen Fan
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.,Peking University Fifth School of Clinical Medicine, Beijing Hospital, Beijing, China
| | - Ling Li
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China.,Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yao Lu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China.,Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China. .,Graduate School of Peking Union Medical College, Beijing, China.
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China. .,Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, China.
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China. .,Graduate School of Peking Union Medical College, Beijing, China.
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7
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Maida CD, Daidone M, Pacinella G, Norrito RL, Pinto A, Tuttolomondo A. Diabetes and Ischemic Stroke: An Old and New Relationship an Overview of the Close Interaction between These Diseases. Int J Mol Sci 2022; 23:ijms23042397. [PMID: 35216512 PMCID: PMC8877605 DOI: 10.3390/ijms23042397] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus is a comprehensive expression to identify a condition of chronic hyperglycemia whose causes derive from different metabolic disorders characterized by altered insulin secretion or faulty insulin effect on its targets or often both mechanisms. Diabetes and atherosclerosis are, from the point of view of cardio- and cerebrovascular risk, two complementary diseases. Beyond shared aspects such as inflammation and oxidative stress, there are multiple molecular mechanisms by which they feed off each other: chronic hyperglycemia and advanced glycosylation end-products (AGE) promote ‘accelerated atherosclerosis’ through the induction of endothelial damage and cellular dysfunction. These diseases impact the vascular system and, therefore, the risk of developing cardio- and cerebrovascular events is now evident, but the observation of this significant correlation has its roots in past decades. Cerebrovascular complications make diabetic patients 2–6 times more susceptible to a stroke event and this risk is magnified in younger individuals and in patients with hypertension and complications in other vascular beds. In addition, when patients with diabetes and hyperglycemia experience an acute ischemic stroke, they are more likely to die or be severely disabled and less likely to benefit from the one FDA-approved therapy, intravenous tissue plasminogen activator. Experimental stroke models have revealed that chronic hyperglycemia leads to deficits in cerebrovascular structure and function that may explain some of the clinical observations. Increased edema, neovascularization, and protease expression as well as altered vascular reactivity and tone may be involved and point to potential therapeutic targets. Further study is needed to fully understand this complex disease state and the breadth of its manifestation in the cerebrovasculature.
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Affiliation(s)
- Carlo Domenico Maida
- Molecular and Clinical Medicine PhD Programme, University of Palermo, 90127 Palermo, Italy; (C.D.M.); (A.T.)
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Mario Daidone
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
- Correspondence:
| | - Gaetano Pacinella
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Rosario Luca Norrito
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Antonio Pinto
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Antonino Tuttolomondo
- Molecular and Clinical Medicine PhD Programme, University of Palermo, 90127 Palermo, Italy; (C.D.M.); (A.T.)
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
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Bradley SA, Spring KJ, Beran RG, Chatzis D, Killingsworth MC, Bhaskar SMM. Role of diabetes in stroke: Recent advances in pathophysiology and clinical management. Diabetes Metab Res Rev 2022; 38:e3495. [PMID: 34530485 DOI: 10.1002/dmrr.3495] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 02/05/2023]
Abstract
The increasing prevalence of diabetes and stroke is a major global public health concern. Specifically, acute stroke patients, with pre-existing diabetes, pose a clinical challenge. It is established that diabetes is associated with a worse prognosis after acute stroke and the various biological factors that mediate poor recovery profiles in diabetic patients is unknown. The level of association and impact of diabetes, in the setting of reperfusion therapy, is yet to be determined. This article presents a comprehensive overview of the current knowledge of the role of diabetes in stroke, therapeutic strategies for primary and secondary prevention of cardiovascular disease and/or stroke in diabetes, and various therapeutic considerations that may apply during pre-stroke, acute, sub-acute and post-stroke stages. The early diagnosis of diabetes as a comorbidity for stroke, as well as tailored post-stroke management of diabetes, is pivotal to our efforts to limit the burden. Increasing awareness and involvement of neurologists in the management of diabetes and other cardiovascular risk factors is desirable towards improving stroke prevention and efficacy of reperfusion therapy in acute stroke patients with diabetes.
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Affiliation(s)
- Sian A Bradley
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Kevin J Spring
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Medical Oncology Group, Liverpool Clinical School, Western Sydney University & Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Roy G Beran
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Medical School, Griffith University, Southport, Queensland, Australia
- Sechenov Moscow First State University, Moscow, Russia
| | | | - Murray C Killingsworth
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Department of Anatomical Pathology, Correlatively Microscopy Facility, NSW Health Pathctology, Sydney, New South Wales, Australia
| | - Sonu M M Bhaskar
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, New South Wales, Australia
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Yang S, Boudier-Revéret M, Kwon S, Lee MY, Chang MC. Effect of Diabetes on Post-stroke Recovery: A Systematic Narrative Review. Front Neurol 2021; 12:747878. [PMID: 34970205 PMCID: PMC8712454 DOI: 10.3389/fneur.2021.747878] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/19/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Patients with stroke often have comorbid diabetes. Considering its detrimental effects on brain function, diabetes may increase the risk of poor recovery.Methods: The aim of this review was to investigate the effect of diabetes on post-stroke recovery by a systematic review. Several specific aspects of post-stroke recovery, including activities of daily living (ADL), motor, cognitive, and quality of life (QOL) recovery, were examined. We searched the PubMed, SCOPUS, Embase, and Cochrane Library databases for relevant studies on the effect of diabetes on post-stroke recovery, published until May 26, 2021. A total of 52,051 potentially relevant articles were identified. After reading the titles and abstracts and assessing their eligibility based on full-text articles, 34 publications were included in this review.Results: Of 29 studies that assessed ADL recovery after stroke, 22 studies suggested that diabetes had a negative effect on recovery of ADL after stroke. Regarding motor recovery, only one out of four studies showed that diabetes had some effect on motor recovery after stroke. Of the two studies on cognitive recovery, one reported that diabetes was an independent predictor of poor cognitive recovery after stroke. Three studies on QOL reported that a poor QOL after stroke was associated with the presence of diabetes.Conclusions: The current review suggests that the post-stroke recovery of ADL seems to be poorer in patients with diabetes than patients without diabetes. Further, there are insufficient data to conclude the effect of diabetes on motor and cognitive recovery, but it may have some influence on the quality of life after stroke.Systematic Review Registration: doi: 10.37766/inplasy2021.11.0032, identifier: INPLASY2021110032.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - SuYeon Kwon
- Department of Rehabilitation Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Min Yong Lee
- Department of Dermatology, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Gyeongsan, South Korea
- *Correspondence: Min Cheol Chang
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Maksimova MY, Ivanov AV, Nikiforova KA, Virus ED, Suanova ET, Ochtova FR, Piradov MA, Kubatiev AA. Plasma low molecular weight aminothiols in ischemic stroke patients with type 2 diabetes mellitus. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2021. [DOI: 10.24075/brsmu.2021.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It was found that ischemic stroke (IS) results in decreased levels of a number of reduced forms of low molecular weight aminothiols (LMWTs). The study was aimed to assess the impact of type 2 diabetes mellitus (Т2D) on the total content, reduced forms and redox status of LMWTs in patients with IS. A total of 175 patients with IS in the internal carotid artery basin (the average age was 62 (55–69)) years) were assessed, who were admitted to the Center within the first 10–24 h since the onset of neurological disorder. The index group included 68 patients with IS and T2D (males made up 41.2%). The comparison group consisted of 107 patients with IS and stress hyperglycemia (males made up 57%), and the control group included 31 non-diabetic patients with chronic cerebrovascular disease (CCVD) (males made up 54.8%). The admission plasma levels of LMWTs were assessed by liquid chromatography in all patients. It was found, that IS in patients with T2D was associated with the rapid decrease in total cysteine (tCys), total glutathione (tGSH), total homocysteine (tHcy), reduced glutathione (rGSH), and glutathione redox status (GSH RS), along with the increase in cysteine redox status (Cys RS) and homocysteine redox status (Hcy RS). In contrast to patients with stress hyperglycemia developing during the acute period of IS, patients with T2D had lower tCys, tGSH, and tHcy levels. Thus, GSH RS of 4.06% or lower in the first 24 hours after the IS in patients with T2D was a predictor of poor functional outcome (mRS score was 3 or more 3 weeks after IS).
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Affiliation(s)
| | - AV Ivanov
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - KA Nikiforova
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - ED Virus
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - ET Suanova
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - FR Ochtova
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - MA Piradov
- Research Center of Neurology, Moscow, Russia
| | - AA Kubatiev
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
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11
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Prevalence and Clinical Characteristics of Lacunar Stroke: A Hospital-Based Study. Brain Sci 2021; 11:brainsci11111466. [PMID: 34827465 PMCID: PMC8615713 DOI: 10.3390/brainsci11111466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022] Open
Abstract
Lacunar stroke (LS) is responsible for one-quarter of the overall number of ischemic strokes with long-term complications and carries health and economic issues for patients and health care systems. Therefore, we aimed to investigate lacunar versus non-lacunar strokes in a tertiary academic center. From February 2016 to July 2019, all patients admitted to the stroke unit were retrospectively reviewed. We included LS patients and compared them to other TOAST subtypes. Hemorrhagic stroke and conditions mimicking stroke were excluded. Regression analysis was done to determine LS predictors and outcomes. A 35.5% rate of LS among 989 ischemic stroke patients was found. Most patients (71.9%) were males. Lower National Institutes of Health Stroke Scale (NIHSS) scores at admission and negative history for cardiac diseases were predictors for LS in our population. At discharge, LS patients had low NIHSS scores and shorter hospitalization periods compared to non-LS patients. In conclusion, LS was prevalent among ischemic stroke patients in our cohort. Future studies are highly needed with long follow-up intervals to identify the stroke recurrence, complications, and outcomes.
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12
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Scavasine VC, Chamma JF, Bazan R, Braga GP, Lange MC, Zétola VDHF. Comparison of right-to-left shunt characteristics in cryptogenic embolic ischemic stroke and non-cardioembolic ischemic stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:859-863. [PMID: 34706014 DOI: 10.1590/0004-282x-anp-2020-0430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/07/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patent foramen ovale (PFO) has been considered a potential mechanism of embolic stroke of undetermined origin. OBJECTIVE The aim of the present study was to identify the features of the right-to-left shunt (RLS) in patients with undetermined embolic ischemic stroke and compare them with those of patients with non-cardioembolic ischemic stroke. METHODS A retrospective study was conducted with 168 patients with stroke and RLS separated into the following two groups: the undetermined embolic stroke group (UES group) and non-cardioembolic stroke group (NCES group). All patients were assessed by transcranial Doppler to evaluate the presence and quantification of microembolic signals (MES) at rest and under Valsalva maneuver. RESULTS Of all patients evaluated in the current study, 96 were included in the UES group and 72 in the NCES group. In the UES group, 65 patients had RLS with ≥10 MES (67.7%), which was higher than that observed in the NCES group (51.4%, p=0.038). According to the moment of the cardiac cycle, 75 patients (78.1%) in the UES group had a positive test at rest compared to 42 (58.3%) in the NCES group (p=0.007). CONCLUSIONS The current study demonstrated that almost 70% of patients with undetermined embolic stroke and PFO presented a large RLS and more than 75% had RLS at rest. These findings suggest that the size of the shunt should be taken into account when evaluating whether PFO could be a possible mechanism underlying cryptogenic stroke.
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Affiliation(s)
| | - Jamileh Ferreira Chamma
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Departamento de Neurologia, Botucatu SP, Brazil
| | - Gabriel Pereira Braga
- Universidade Federal de Mato Grosso do Sul, Departamento de Neurologia, Campo Grande MS, Brazil
| | - Marcos Christiano Lange
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brazil
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Cirillo L, Romano DG, Vornetti G, Frauenfelder G, Tamburrano C, Taglialatela F, Isceri S, Saponiero R, Napoletano R, Gentile M, Romoli M, Princiotta C, Simonetti L, Zini A. Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches. BMC Neurol 2021; 21:362. [PMID: 34535118 PMCID: PMC8447719 DOI: 10.1186/s12883-021-02393-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Occlusion of the internal carotid artery (ICA), whether isolated or in the setting of a tandem lesion (TL) have a poor response to treatment with intravenous thrombolysis. Previous studies have demonstrated the superiority of mechanical thrombectomy in the treatment of acute ischemic stroke (AIS) following large vessel occlusion, compared to standard intravenous fibrinolysis. The aim of our study was to describe endovascular treatment (EVT) in AIS due to isolated ICA occlusion or TL. METHODS We assessed the association between 90-day outcome and clinical, demographic, imaging, and procedure data in 51 consecutive patients with acute isolated ICA occlusion or TL who underwent EVT. We evaluated baseline NIHSS and mRS, ASPECTS, type of occlusion, stent placement, use of stent retrievers and/or thromboaspiration, duration of the procedure, mTICI, postprocedural therapy and complications. RESULTS A favorable 90-day outcome (mRS 0-2) was achieved in 34 patients (67 %) and was significantly associated with the use of dual antiplatelet therapy after the procedure (p = 0.008), shorter procedure duration (p = 0.031), TICI 2b-3 (p < 0.001) and lack of post-procedural hemorrhagic transformation (p = 0.001). Four patients did not survive, resulting in a mortality rate of 8 %. CONCLUSIONS Our study has shown that EVT in the treatment of AIS due to ICA occlusion is safe, and effective in determining a good functional outcome. ICA stenting led to good angiographic results and therapy with a glycoprotein IIb / IIIa inhibitor immediately after stent release did not result in a greater risk of hemorrhage. The use of post-procedural dual antiplatelet therapy was associated with favorable outcome, without a significant increase in hemorrhagic transformation.
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Affiliation(s)
- Luigi Cirillo
- Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy. .,UOSI Neuroradiologia Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di Bologna, Bologna, Italy.
| | | | - Gianfranco Vornetti
- Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy
| | - Giulia Frauenfelder
- UOC Neuroradiologia AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Chiara Tamburrano
- Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy
| | - Francesco Taglialatela
- UOSI Neuroradiologia Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di Bologna, Bologna, Italy
| | - Salvatore Isceri
- UOSI Neuroradiologia Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di Bologna, Bologna, Italy
| | - Renato Saponiero
- UOC Neuroradiologia AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Rosa Napoletano
- UOC Neurologia AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Mauro Gentile
- UOC Neurologia e Rete Stroke metropolitana Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di Bologna, Bologna, Italy
| | - Michele Romoli
- UOC Neurologia e Rete Stroke metropolitana Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di Bologna, Bologna, Italy
| | - Ciro Princiotta
- UOSI Neuroradiologia Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di Bologna, Bologna, Italy
| | - Luigi Simonetti
- UOSI Neuroradiologia Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di Bologna, Bologna, Italy
| | - Andrea Zini
- UOC Neurologia e Rete Stroke metropolitana Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di Bologna, Bologna, Italy
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14
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Bao Y, Gu D. Glycated Hemoglobin as a Marker for Predicting Outcomes of Patients With Stroke (Ischemic and Hemorrhagic): A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:642899. [PMID: 33868148 PMCID: PMC8044393 DOI: 10.3389/fneur.2021.642899] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/16/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Glycated hemoglobin (HbA1c) has emerged as a useful biochemical marker reflecting the average glycemic control over the last 3 months, and the values are not affected by short-term transient changes in blood glucose levels. However, its prognostic value in the acute neurological conditions such as stroke is still not well-established. The present meta-analysis was conducted to assess the relationship of HbA1c with outcomes such as mortality, early neurological complications, and functional dependence in stroke patients. Methods: A systematic search was conducted for the PubMed, Scopus, and Google Scholar databases. Studies, either retrospective or prospective in design that examined the relationship between HbA1c with outcomes of interest and presented the strength of association in the form of adjusted odds ratio/hazard ratios were included in the review. Statistical analysis was done using STATA version 13.0. Results: A total of 22 studies (15 studies on acute ischemic stroke and seven studies on hemorrhagic stroke) were included in the meta-analysis. For patients with acute ischemic stroke, each unit increase in HbA1c was found to be associated with an increased risk of mortality within 1 year, increased risk of poor functional outcome at 3 months, and an increased risk of symptomatic intracranial hemorrhage (sICH) within 24 h of admission. In those with HbA1c ≥ 6.5%, there was an increased risk of mortality within 1 year of admission, increased risk of poor functional outcomes at 3 and 12 months as well as an increased risk of symptomatic intracranial hemorrhage (sICH) within 24 h of admission. In patients with hemorrhagic stroke, each unit increase in HbA1c was found to be associated with increased risk of poor functional outcome within the first 3 months from the time of admission for stroke. In those with HbA1c ≥ 6.5%, there was an increased risk of poor functional outcome at 12 months. Conclusions: The findings indicate that glycated hemoglobin (HbA1c) could serve as a useful marker to predict the outcomes in patients with stroke and aid in the implementation of adequate preventive management strategies at the earliest.
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Affiliation(s)
- Yaya Bao
- Shaoxing University Medical College, Shaoxing, China
| | - Dadong Gu
- Department of Neurology, Zhuji Affiliated Hospital of Shaoxing University, Zhuji, China
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Hadwen J, Kim W, Dewar B, Ramsay T, Davis A, Dowlatshahi D, Shamy M. Association between insulin resistance and post-ischaemic stroke outcome in patients without diabetes: protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e044771. [PMID: 33771829 PMCID: PMC8006852 DOI: 10.1136/bmjopen-2020-044771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Insulin resistance is an independent risk factor for atherosclerosis, coronary artery disease and ischaemic stroke. Currently, insulin resistance is not usually included in post-stroke risk stratification. This systematic review and meta-analysis intends to determine if available scientific knowledge supports an association between insulin resistance and post-stroke outcomes in patients without diabetes. METHODS AND ANALYSIS The authors will conduct a literature search in Medline, Embase, Web of Science and Cochrane Central. The review will include studies that assess the association between elevated insulin homeostasis model of insulin resistance (HOMA-IR) and post-stroke outcome (functional outcome and recurrent stroke). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines will be used. The primary outcome will be post-stroke functional outcome (Modified Rankin Scale), and the secondary outcome will be recurrent ischaemic stroke. Comparison of outcome will be made between highest and lowest HOMA-IR range (as defined in each article included in this systematic review). Risk of bias will be assessed qualitatively. Meta-analysis will be performed if sufficient homogeneity exists between studies. Heterogeneity of outcomes will be assessed by I². ETHICS AND DISSEMINATION No human or animal subjects or samples were/will be used. The results will be published in a peer-reviewed journal, and will be disseminated at local and international neurology conferences. PROSPERO REGISTRATION NUMBER CRD42020173608.
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Affiliation(s)
- Jeremiah Hadwen
- Neurology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Neurology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Woojin Kim
- Neurology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Neurology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Brian Dewar
- Neurology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Dar Dowlatshahi
- Neurology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Neurology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michel Shamy
- Neurology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Neurology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Agazhe M, Eshetu D, Arsicha A, Hamato A, Petros A, Dabaro D, Yohanis N, Getahun B, Hirigo AT. Incidence and pattern of stroke among patients admitted to medical ward at Yirgalem General Hospital, Sidama Regional State, Southern-Ethiopia. SAGE Open Med 2021; 9:20503121211001154. [PMID: 33796298 PMCID: PMC7968040 DOI: 10.1177/20503121211001154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/15/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: In the current days, stroke has become one of the common reasons for admission in many health care setups and becoming an alarming public health problem in Ethiopia. Hence, this study aimed to assess the incidence and associated factors of stroke among patients admitted to the medical wards in Yirgalem hospital. Methods: An institution-based retrospective cross-sectional study design was carried out from 01 January 2017, to 30 December 2019. Admitted adult patients’ medical charts were used to collect all required information using structured checklists. Data were analyzed using statistical package for social sciences (SPSS) version 20 software, and a p value < 0.05 was accepted as statistically significant. Result: From a total of 3016 admitted patients, the incidence of stroke was 3.15% (n = 95). Of the 95 stroke cases, 58.9% were males and 69.5% of them were urban dwellers. 62.1% (59/95) of the stroke patients had an ischemic stroke, whereas 37.9% (36/95) had a hemorrhagic stroke. Patients with age ⩾ 65 years, smokers, hypertension, and type-II diabetes had significantly higher ischemic stroke when compared to patients with hemorrhagic stroke (62.7% vs 30.5%, p = 0.008), (49.1% vs 11.1%, p ⩽ 0.0001), and (71.2%vs 13.9%, p < 0.0001), respectively. While patients with hypertension had a significantly higher rate of hemorrhagic stroke when compared to patients with ischemic stroke (88.9% vs 61%, p = 0.003). Conclusion: The majority of stroke patients had cardiovascular problems and hypertension. More than 44% and 34.7% of them had a history of alcoholism and smoking. Therefore, proper management of hypertension, lifestyle modification, early screening and management of strok risks and avoiding risk-full personal behaviors like smoking and alcoholism are important tools to limit or prevent stroke-related morbidity and mortality.
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Affiliation(s)
| | - Daniel Eshetu
- Department of Microbiology, Yirgalem Hospital Medical College, Yirgalem, Southern-Ethiopia
| | - Admasu Arsicha
- Yirgalem Hospital Medical College, Yirgalem, Southern-Ethiopia
| | - Assefa Hamato
- Department of Microbiology, Yirgalem Hospital Medical College, Yirgalem, Southern-Ethiopia
| | - Assefa Petros
- Yirgalem Hospital Medical College, Yirgalem, Southern-Ethiopia
| | - Desalegn Dabaro
- Yirgalem Hospital Medical College, Yirgalem, Southern-Ethiopia
| | | | - Bekalu Getahun
- Department of Ophthalmology & Optometry, College of Medicine and Health Science, Hawassa University, Hawassa, Southern-Ethiopia
| | - Agete Tadewos Hirigo
- School of Medical Laboratory Sciences, Faculty of Medicine, College of Medicine and Health Science, Hawassa University, Hawassa, Southern-Ethiopia
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Krinock MJ, Singhal NS. Diabetes, stroke, and neuroresilience: looking beyond hyperglycemia. Ann N Y Acad Sci 2021; 1495:78-98. [PMID: 33638222 DOI: 10.1111/nyas.14583] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Matthew J Krinock
- Department of Neurology, University of California - San Francisco, San Francisco, California
| | - Neel S Singhal
- Department of Neurology, University of California - San Francisco, San Francisco, California
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Hu CC, Low A, O'Connor E, Siriratnam P, Hair C, Kraemer T, Sahathevan R. Diabetes in ischaemic stroke in a regional Australian hospital - uncharted territory. Intern Med J 2020; 52:574-580. [PMID: 32985758 DOI: 10.1111/imj.15073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/05/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stroke and diabetes (DM) are significant interrelated healthcare issues but there is a dearth of data on the prevalence of DM among Australia's regional stroke population. AIMS We aimed to determine the prevalence of DM in stroke patients at a large regional centre, including sub-analyses on stroke subtypes, glycaemic control and renal function in ischaemic stroke (IS). METHODS We conducted a retrospective analysis of all patients (n = 323) with IS or transient ischaemic attack (TIA) admitted to Ballarat Base Hospital from January 2015 to December 2016. Demographic data, cardiovascular risk factors, aetiology/territory of IS, pre-morbid DM status, indicators of glycaemic control and renal impairment were recorded. RESULTS DM was present in 28.5% of IS and TIA patients including 4% being newly diagnosed. Among diabetic IS patients, 45.3% had poor glycaemic control (HbA1c ≥7.0%) while 16% had moderate to severe renal impairment (eGFR of <30). The majority of IS were partial anterior circulation stroke (53.4%) and cardioembolism was the commonest mechanism (43.5%). We found no significant association between DM and a specific stroke location or mechanism. CONCLUSION Almost a third of IS/TIA patients had DM with a significant proportion showing poor glycaemic control. The DM prevalence in our cohort was comparable to reported rates from other developed countries. While we found no association between DM and a particular stroke type or mechanism, it is likely a reflection of our cohort size. Our study demonstrated that DM, as a significant risk factor in IS, warrants early detection and better management strategies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Chih-Chiang Hu
- Faculty of Medicine, Ballarat Health Services (Hospital Medical Officer), Australia
| | - Ashlea Low
- Faculty of Medicine, Ballarat Health Services (Hospital Medical Officer), Australia
| | - Ellie O'Connor
- Faculty of Medicine, Ballarat Health Services (Hospital Medical Officer), Australia
| | - Pakeeran Siriratnam
- Faculty of Medicine, Ballarat Health Services (Hospital Medical Officer), Australia
| | - Casey Hair
- Faculty of Medicine, Ballarat Health Services (Clinical Nurse Specialist), Australia
| | - Thomas Kraemer
- Faculty of Medicine, Ballarat Health Services (Consultant Neurologist). School of Medicine, Deakin University, Geelong, Australia
| | - Ramesh Sahathevan
- Faculty of Medicine, Ballarat Health Services (Consultant Neurologist). Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne (Senior Fellow). Florey Institute of Neuroscience and Mental Health (Principal Research Fellow)
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Biose IJ, Dewar D, Macrae IM, McCabe C. Impact of stroke co-morbidities on cortical collateral flow following ischaemic stroke. J Cereb Blood Flow Metab 2020; 40:978-990. [PMID: 31234703 PMCID: PMC7181095 DOI: 10.1177/0271678x19858532] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Acute hyperglycaemia and chronic hypertension worsen stroke outcome but their impact on collateral perfusion, a determinant of penumbral life span, is poorly understood. Laser-speckle contrast imaging (LSCI) was used to determine the influence of these stroke comorbidities on cortical perfusion after permanent middle cerebral artery occlusion (pMCAO) in spontaneously hypertensive stroke prone rats (SHRSP) and normotensive Wistar rats. Four independent studies were conducted. In animals without pMCAO, cortical perfusion remained stable over 180 min. Following pMCAO, cortical perfusion was markedly reduced at 30 min then gradually increased, via cortical collaterals, over the subsequent 3.5 h. In the contralateral non-ischaemic hemisphere, perfusion did not change over time. Acute hyperglycaemia (in normotensive Wistar) and chronic hypertension (SHRSP) attenuated the restoration of cortical perfusion after pMCAO. Inhaled nitric oxide did not influence cortical perfusion in SHRSP following pMCAO. Thus, hyperglycaemia at the time of arterial occlusion or pre-existing hypertension impaired the dynamic recruitment of cortical collaterals after pMCAO. The impairment of collateral recruitment may contribute to the detrimental effects these comorbidities have on stroke outcome.
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Affiliation(s)
- Ifechukwude J Biose
- Stroke and Brain Imaging, Institute of Neuroscience and Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Department of Anatomy and Forensic Anthropology, Cross River University of Technology, Calabar, Nigeria
| | - Deborah Dewar
- Stroke and Brain Imaging, Institute of Neuroscience and Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - I Mhairi Macrae
- Stroke and Brain Imaging, Institute of Neuroscience and Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Christopher McCabe
- Stroke and Brain Imaging, Institute of Neuroscience and Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Paul B, Jain D, Chawala M, Mittal N, Jain A, Puri S. Profile of cerebrovascular accidents in subjects with or without type 2 diabetes mellitus in intensive care units of tertiary care centre. J Anaesthesiol Clin Pharmacol 2020; 36:251-254. [PMID: 33013043 PMCID: PMC7480310 DOI: 10.4103/joacp.joacp_181_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 12/03/2019] [Accepted: 12/11/2019] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: Diabetes Mellitus (DM) is a modifiable and independent risk factor for stroke. As the clinical features, radiological profile, outcome and prognosis of the stroke in type 2 diabetic and non diabetic patients are significantly variable, we proposed to evaluate these variations of stroke in patients with or without Type 2 DM. Material and Methods: A prospective study was conducted from January, 2011 to June, 2012 on in-hospital admitted diabetic and non diabetic patients presenting with stroke. Data was recorded on a predesigned Performa. Results: A total of 150 cases were enrolled into the study. Out of these, 66% of patients had ischemic stroke and 34% of patients had hemorrhagic stroke. Type 2 diabetes mellitus was present in 52% patients. Ischemic stroke was significantly higher in diabetics than non diabetics (P = 0.007); however, hemorrhagic stroke was more in non diabetics. Mean age was significantly higher in diabetics (P = 0.04). CAD (P = 0.04), recurrent stroke (P = 0.006) had significant association with diabetes. Large vessel stroke was more common than small vessel stroke. Anterior circulation stroke was more common than posterior circulation stroke. There was significant improvement in morbidity and disability of the patients on follow up with treatment. Conclusions: A greater incidence of anterior circulation ischemic stroke, and recurrent strokes occur in patients with DM.
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Surkova EV, Tanashyan MM, Bespalov AI, Naminov AV. [Diabetes mellitus and cognitive impairment]. TERAPEVT ARKH 2019; 91:112-118. [PMID: 32598641 DOI: 10.26442/00403660.2019.10.000362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
The review discusses literature data and the results of our own studies on the effect of diabetes on cognitive functions and cerebrovascular pathology, as well as possible ptogenetic mechanisms for the implementation of this effect. The results of studies on the effects of antidiabetic drugs on cognitive function are presented.
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Lau L, Lew J, Borschmann K, Thijs V, Ekinci EI. Prevalence of diabetes and its effects on stroke outcomes: A meta-analysis and literature review. J Diabetes Investig 2019; 10:780-792. [PMID: 30220102 PMCID: PMC6497593 DOI: 10.1111/jdi.12932] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 08/29/2018] [Accepted: 09/03/2018] [Indexed: 12/15/2022] Open
Abstract
AIMS/INTRODUCTION Diabetes mellitus is an established risk factor for stroke and maybe associated with poorer outcomes after stroke. The aims of the present literature review were to determine: (i) the prevalence of diabetes in acute stroke patients through a meta-analysis; (ii) the association between diabetes and outcomes after ischemic and hemorrhagic stroke; and (iii) to review the value of glycated hemoglobin and admission glucose-based tests in predicting stroke outcomes. MATERIALS AND METHODS Ovid MEDLINE and EMBASE searches were carried out to find studies relating to diabetes and inpatient stroke populations published between January 2004 and April 2017. A meta-analysis of the prevalence of diabetes from included studies was undertaken. A narrative review on the associations of diabetes and different diagnostic methods on stroke outcomes was carried out. RESULTS A total of 66 eligible articles met inclusion criteria. A meta-analysis of 39 studies (n = 359,783) estimated the prevalence of diabetes to be 28% (95% confidence interval 26-31). The rate was higher in ischemic (33%, 95% confidence interval 28-38) compared with hemorrhagic stroke (26%, 95% confidence interval 19-33) inpatients. Most, but not all, studies found that acute hyperglycemia and diabetes were associated with poorer outcomes after ischemic or hemorrhagic strokes: including higher mortality, poorer neurological and functional outcomes, longer hospital stay, higher readmission rates, and stroke recurrence. Diagnostic methods for establishing diagnosis were heterogeneous between the reviewed studies. CONCLUSIONS Approximately one-third of all stroke patients have diabetes. Uniform methods to screen for diabetes after stroke are required to identify individuals with diabetes to design interventions aimed at reducing poor outcomes in this high-risk population.
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Affiliation(s)
- Lik‐Hui Lau
- Department of EndocrinologyAustin HealthMelbourneVictoriaAustralia
| | - Jeremy Lew
- Department of EndocrinologyAustin HealthMelbourneVictoriaAustralia
| | - Karen Borschmann
- The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Vincent Thijs
- The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
- Department of NeurologyAustin HealthMelbourneVictoriaAustralia
| | - Elif I Ekinci
- Department of EndocrinologyAustin HealthMelbourneVictoriaAustralia
- Department of MedicineAustin HealthUniversity of MelbourneMelbourneVictoriaAustralia
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Park SJ, Yang HK, Byun SJ, Park KH, Hwang JM. Risk of ischemic stroke after third, fourth, and sixth cranial nerve palsies in type 2 diabetes. J Diabetes 2019; 11:379-385. [PMID: 30251398 DOI: 10.1111/1753-0407.12859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of this study was to define the risk of ischemic stroke among newly diagnosed type 2 diabetes (T2D) patients who developed ocular motor cranial nerve (CN) palsies. METHODS From the National Health Insurance Service - National Sample Cohort database (2002-2013) of a random sample of 1 025 340 Koreans, patients with newly diagnosed T2D aged ≥20 years were included in the study. The incidence of ocular motor CN palsies was identified using diagnostic codes for third, fourth, and sixth CN palsies. To determine the effect of incident ocular motor CN palsy on subsequent ischemic stroke, covariate Cox regression was used (Model 1 included only ocular motor CN palsy as a time-varying covariate; Model 2 included ocular motor CN palsy and demographic information; Model 3 included all variables in Model 2 as well as comorbidity, concomitant medication, and the Charlson comorbidity index score). RESULTS Of 45 820 T2D patients, 75 developed ocular motor CN palsy and 1411 had ischemic stroke. Four patients experienced ischemic stroke after the development of ocular motor CN palsy. Incident ocular motor CN palsy was associated with the subsequent risk of ischemic stroke in Models 1, 2 and 3 (hazard ratios [95% confidence intervals] 3.74 [1.40-9.98], 3.33 [1.25-8.89], and 2.96 [1.11-7.92], respectively). Male sex, older age, and lower income were associated with an increased risk of ischemic stroke. Among confounders, hypertension, atrial fibrillation, and congestive heart failure were associated with the risk of ischemic stroke. CONCLUSIONS Physicians should pay more attention to manageable risk factors of ischemic stroke when diabetic patients suffer from ocular motor CN palsies.
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Affiliation(s)
- Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Prevalence of vascular risk factors in patients with and without type 2 diabetes mellitus admitted to hospital for stroke in the 2011-2013 period. ACTA ACUST UNITED AC 2019; 66:150-156. [PMID: 30612900 DOI: 10.1016/j.endinu.2018.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/12/2018] [Accepted: 10/19/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Stroke and type 2 diabetes mellitus (T2DM) are among the leading causes of morbidity and mortality in Europe. OBJECTIVE To describe the vascular risk factors most prevalent in the Spanish population with and without type 2 diabetes mellitus admitted to hospital for a stroke during the 2011-2013 period. MATERIAL AND METHODS Using the Spanish Minimum Basic Data Set from 2011 to 2013, a descriptive, observational epidemiological study was conducted comparing the prevalence rates of vascular risk factors in Spanish patients admitted to hospital for stroke. The sample was stratified by the presence or absence of a diagnosis of type 2 diabetes mellitus. Other variables studied included in-hospital mortality, length of hospital stay, and other clinical and sociodemographic variables. RESULTS Hypertension was the most prevalent vascular risk factor in all population groups. Female sex, age, and T2DM had a statistically significant association (p<0.05) to hospital mortality in stroke. CONCLUSIONS Hypertension was the most common vascular risk factor in the study sample, followed by hypercholesterolemia. There were no differences in prevalence of hypertension between patients with and without T2DM. However, T2DM is an independent risk factor for hospital mortality in any hospitalization for stroke.
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Aziz S, Sheikh Ghadzi SM, Abidin NE, Tangiisuran B, Zainal H, Looi I, Ibrahim KA, Sidek NN, Wei LK, Keng Yee L, Abdul Aziz Z, Harun SN. Gender Differences and Risk Factors of Recurrent Stroke in Type 2 Diabetic Malaysian Population with History of Stroke: The Observation from Malaysian National Neurology Registry. J Diabetes Res 2019; 2019:1794267. [PMID: 31886276 PMCID: PMC6927021 DOI: 10.1155/2019/1794267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/25/2019] [Accepted: 11/08/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Diabetes mellitus has been reported as a strong independent risk factor for stroke recurrence. Data on the modifiable factors contributing to the recurrence of stroke in type 2 diabetic Malaysian population with a history of stroke stratified by genders are lacking, and this supports the importance of this study. METHOD The data of 4622 patients with T2DM who had a history of stroke was obtained from the Malaysian National Stroke Registry. Univariate analysis was performed to differentiate between genders with and without stroke recurrence in terms of demographics, first stroke attack presentations, and other clinical characteristics. The significant factors determined from the univariate analysis were further investigated using logistic regression. RESULTS Ischemic heart diseases were found significantly associated with the stroke recurrence in males (OR = 1.738; 95% CI: 1.071-2.818) as well as female (OR = 5.859; 95% CI: 2.469-13.752) diabetic patients. The duration of hypertension, as well as the duration of diabetes, has been associated with the recurrence in both male and female subjects (p value < 0.05). Smoking status has an impact on the stroke recurrence in male subjects, while no significant association was observed among their peers. CONCLUSIONS Most of the predictive factors contributing to the recurrence of stroke in type 2 diabetic Malaysian population with a history of stroke are modifiable, in which IHD was the most prominent risk factor in both genders. The impact of optimizing the management of IHD as well as blood glucose control on stroke recurrence may need to be elucidated. No major differences in recurrent stroke predictors were seen between genders among the Malaysian population with type 2 diabetes mellitus who had a previous history of stroke.
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Affiliation(s)
- Sohail Aziz
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | | | - Nur Ezzati Abidin
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Balamurugan Tangiisuran
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
- Pusat Racun Negara, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Hadzliana Zainal
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Irene Looi
- Clinical Research Centre, Seberang Jaya Hospital, Ministry of Health, Penang, Malaysia
| | - Khairul Azmi Ibrahim
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Ministry of Health, Terengganu, Malaysia
| | - Norsima Nazifah Sidek
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Ministry of Health, Terengganu, Malaysia
| | - Loo Keat Wei
- Department of Biological Science, Faculty of Science, Universiti Tunku Abdul Rahman, Bandar Barat, 31900 Kampar, Perak, Malaysia
| | - Lee Keng Yee
- National Institutes of Health (NIH), Ministry of Health, Malaysia, Kuala Lumpur, Malaysia
| | - Zariah Abdul Aziz
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Ministry of Health, Terengganu, Malaysia
| | - Sabariah Noor Harun
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
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Lew J, Thijs V, Churilov L, Donnan G, Park W, Robbins R, Hart GK, Bladin C, Khoo K, Lau LH, Tan A, Lam Q, Johnson D, Zajac JD, Ekinci EI. Using routine HbA1c measurements in stroke and the associations of dysglycaemia with stroke outcomes. J Diabetes Complications 2018; 32:1056-1061. [PMID: 30172697 DOI: 10.1016/j.jdiacomp.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/23/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
AIMS Diabetes is a major risk factor for stroke. We aimed to investigate the prevalence of diabetes and pre-diabetes within a stroke cohort and examine the association of glycaemia status with mortality and morbidity. METHODS Inpatients aged ≥54 who presented with a diagnosis of stroke had a routine HbA1c measurement as part of the Austin Health Diabetes Discovery Initiative. Additional data were attained from hospital databases and Australian Stroke Clinical Registry. Outcomes included diabetes and pre-diabetes prevalence, length of stay, 6-month and in-hospital mortality, 28-day readmission rates, and 3-month modified Rankin scale score. RESULTS Between July 2013 and December 2015, 610 patients were studied. Of these, 31% had diabetes while 40% had pre-diabetes. Using multivariable regression analyses, the presence of diabetes was associated with higher odds of 6-month mortality (OR = 1.90, p = 0.022) and higher expected length of stay (IRR = 1.29, p = 0.004). Similarly, a higher HbA1c was associated with higher odds of 6-month mortality (OR = 1.27, p = 0.005) and higher expected length of stay (IRR = 1.08, p = 0.010). CONCLUSIONS 71% of this cohort had diabetes or pre-diabetes. Presence of diabetes and higher HbA1c were associated with higher 6-month mortality and length of stay. Further research is necessary to determine if improved glycaemic control may improve stroke outcomes.
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Affiliation(s)
- Jeremy Lew
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia; Department of Medicine, Austin Health, The University of Melbourne, Australia
| | - Vincent Thijs
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia; Department of Neurology, Austin Health, Heidelberg, Vic., Australia
| | - Leonid Churilov
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia
| | - Geoffrey Donnan
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia; Department of Neurology, Austin Health, Heidelberg, Vic., Australia
| | - Warwick Park
- Department of Neurology, Austin Health, Heidelberg, Vic., Australia
| | - Raymond Robbins
- Department of Administrative Informatics, Austin Health, Heidelberg, Vic., Australia
| | - Graeme K Hart
- Department of Intensive Care, Austin Health, Heidelberg, Vic., Australia; Health and Biomedical Informatics Centre, University of Melbourne, Australia
| | - Christopher Bladin
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia; Department of Neurosciences, Eastern Health, Box Hill Hospital, Box Hill, Vic., Australia
| | - Kaylyn Khoo
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
| | - Lik-Hui Lau
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
| | - Alanna Tan
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
| | - Que Lam
- Department of Pathology, Austin Health, Heidelberg, Vic., Australia
| | - Douglas Johnson
- Department of Medicine, Austin Health, The University of Melbourne, Australia; Department of General Medicine, Austin Health, Heidelberg, Vic., Australia
| | - Jeffrey D Zajac
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia; Department of Medicine, Austin Health, The University of Melbourne, Australia
| | - Elif I Ekinci
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia; Department of Medicine, Austin Health, The University of Melbourne, Australia.
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Qiao Q, Hong Y, Zhao W, Zhou G, Liu Q, Ning X, Wang J, An Z. Sex differences in outcomes and associated factors among stroke patients with small artery occlusion in China. Biol Sex Differ 2018; 9:35. [PMID: 30071887 PMCID: PMC6090906 DOI: 10.1186/s13293-018-0194-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/27/2018] [Indexed: 11/26/2022] Open
Abstract
Background Sex differences in outcomes after small artery occlusion (SAO) stroke have not been well described, particularly in a Chinese population. We aimed to assess sex differences in outcomes and related risk factors among patients with SAO. Methods All consecutive patients with SAO were recruited between May 2005 and September 2014. Clinical features and risk factors were recorded. The mortality, recurrence, and dependency rates at 3 months after stroke were assessed. Results A total of 2524 patients with SAO were included in this study. There was a higher frequency of mild stroke, current smoking, and alcohol consumption in men than in women. Women were more likely than men to be older, to have diabetes and obesity, and to have higher total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels. There were worse outcomes in men than in women at 3 months after stroke (P < 0.05). There were more independent risk factors of poor outcome in men than in women. Older age was a common predictive factor of outcome both in men and in women. In men, low triglyceride levels and high fasting plasma glucose levels were independent risk factors for mortality; in addition, a high low-density lipoprotein cholesterol level was associated with recurrence. Moreover, in men, moderate and severe stroke, and high total cholesterol and fasting plasma glucose levels were risk factors for dependency. A negative association was found between low-density lipoprotein cholesterol level and risk of mortality and between total cholesterol level and risk of recurrence in women. Conclusions These findings suggest that it is crucial to control conventional risk factors and fasting plasma glucose and lipid levels among patients with SAO, especially male patients, to reduce the burden of stroke in China.
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Affiliation(s)
- Qing Qiao
- Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China
| | - Yan Hong
- Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China. .,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China.
| | - Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China
| | - Guanen Zhou
- Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China
| | - Qian Liu
- Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China
| | - Xianjia Ning
- Department of Epidemiology, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, China.,Department of Neurology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Jinghua Wang
- Department of Epidemiology, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, China.,Department of Neurology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Zhongping An
- Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China. .,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China.
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Jia X, Levine GN, Birnbaum Y. The CHA 2DS 2-VASc score: Not as simple as it seems. Int J Cardiol 2018; 257:92-96. [PMID: 29506745 DOI: 10.1016/j.ijcard.2017.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/29/2017] [Accepted: 12/11/2017] [Indexed: 01/31/2023]
Abstract
The CHA2DS2-VASc score has been widely adopted as a risk stratification tool for strokes in patients with atrial fibrillation and to help in deciding when anticoagulation therapy for stroke prophylaxis may be beneficial. The score as a whole has been well validated and has been included in the current major practice guidelines. An advantage of the CHA2DS2-VASc score is its ease of use, allowing clinicians to quickly estimate risk based on a short set of criteria. However, the benefit of simplicity may also be a weakness. Studies on individual components of the score suggest that only a subset of patients deemed to be at risk based on the current definition are actually at risk for stroke. Thus, users of the score should be aware of the nuances based on available evidence and avoid over-generalization. Accurate assessment of stroke risk has important clinical implications as it influences decision-making on initiation of anticoagulation.
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Affiliation(s)
- Xiaoming Jia
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
| | - Glenn N Levine
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Yochai Birnbaum
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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Antidiabéticos en prevención de ictus en pacientes con diabetes tipo 2. El punto de vista del neurólogo. Med Clin (Barc) 2018; 150:275-281. [DOI: 10.1016/j.medcli.2017.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 08/26/2017] [Accepted: 09/04/2017] [Indexed: 12/20/2022]
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Sarkar J, Dwivedi G, Chen Q, Sheu IE, Paich M, Chelini CM, D'Alessandro PM, Burns SP. A long-term mechanistic computational model of physiological factors driving the onset of type 2 diabetes in an individual. PLoS One 2018; 13:e0192472. [PMID: 29444133 PMCID: PMC5812629 DOI: 10.1371/journal.pone.0192472] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 01/24/2018] [Indexed: 12/25/2022] Open
Abstract
A computational model of the physiological mechanisms driving an individual's health towards onset of type 2 diabetes (T2D) is described, calibrated and validated using data from the Diabetes Prevention Program (DPP). The objective of this model is to quantify the factors that can be used for prevention of T2D. The model is energy and mass balanced and continuously simulates trajectories of variables including body weight components, fasting plasma glucose, insulin, and glycosylated hemoglobin among others on the time-scale of years. Modeled mechanisms include dynamic representations of intracellular insulin resistance, pancreatic beta-cell insulin production, oxidation of macronutrients, ketogenesis, effects of inflammation and reactive oxygen species, and conversion between stored and activated metabolic species, with body-weight connected to mass and energy balance. The model was calibrated to 331 placebo and 315 lifestyle-intervention DPP subjects, and one year forecasts of all individuals were generated. Predicted population mean errors were less than or of the same magnitude as clinical measurement error; mean forecast errors for weight and HbA1c were ~5%, supporting predictive capabilities of the model. Validation of lifestyle-intervention prediction is demonstrated by synthetically imposing diet and physical activity changes on DPP placebo subjects. Using subject level parameters, comparisons were made between exogenous and endogenous characteristics of subjects who progressed toward T2D (HbA1c > 6.5) over the course of the DPP study to those who did not. The comparison revealed significant differences in diets and pancreatic sensitivity to hyperglycemia but not in propensity to develop insulin resistance. A computational experiment was performed to explore relative contributions of exogenous versus endogenous factors between these groups. Translational uses to applications in public health and personalized healthcare are discussed.
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Affiliation(s)
- Joydeep Sarkar
- PricewaterhouseCoopers LLP, New York, New York, United States of America
| | - Gaurav Dwivedi
- PricewaterhouseCoopers LLP, New York, New York, United States of America
| | - Qian Chen
- PricewaterhouseCoopers LLP, New York, New York, United States of America
| | - Iris E. Sheu
- PricewaterhouseCoopers LLP, New York, New York, United States of America
| | - Mark Paich
- PricewaterhouseCoopers LLP, New York, New York, United States of America
| | - Colleen M. Chelini
- PricewaterhouseCoopers LLP, New York, New York, United States of America
| | | | - Samuel P. Burns
- PricewaterhouseCoopers LLP, New York, New York, United States of America
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31
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Tun NN, Arunagirinathan G, Munshi SK, Pappachan JM. Diabetes mellitus and stroke: A clinical update. World J Diabetes 2017; 8:235-248. [PMID: 28694925 PMCID: PMC5483423 DOI: 10.4239/wjd.v8.i6.235] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/26/2017] [Accepted: 05/05/2017] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular disease including stroke is a major complication that tremendously increases the morbidity and mortality in patients with diabetes mellitus (DM). DM poses about four times higher risk for stroke. Cardiometabolic risk factors including obesity, hypertension, and dyslipidaemia often co-exist in patients with DM that add on to stroke risk. Because of the strong association between DM and other stroke risk factors, physicians and diabetologists managing patients should have thorough understanding of these risk factors and management. This review is an evidence-based approach to the epidemiological aspects, pathophysiology, diagnostic work up and management algorithms for patients with diabetes and stroke.
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32
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A retrospective study of branch atheromatous disease: Analyses of risk factors and prognosis. ACTA ACUST UNITED AC 2017; 37:93-99. [PMID: 28224419 DOI: 10.1007/s11596-017-1700-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/20/2016] [Indexed: 02/08/2023]
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Sarfo FS, Gyamfi RA, Adamu S, Sarfo-Kantanka O, Owolabi M, Ovbiagele B. Administration of a pictorial questionnaire to screen for stroke among patients with hypertension or diabetes in rural Ghana. J Neurol Sci 2017; 373:289-294. [PMID: 28131208 DOI: 10.1016/j.jns.2017.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Stroke prevention is an important public health goal in low-and-middle income countries (LMIC) due to its high mortality and morbidity in these settings. Epidemiological data from high-income countries have demonstrated a potent predictive association between self-reported stroke symptoms and risks of future strokes, incident cognitive impairment and all-cause mortality. OBJECTIVE To utilize a pictographic version of the 8-item Questionnaire for Verifying Stroke Free Status (QVSFS) to screen for stroke symptoms and determine its predictors among hypertensive and diabetic patients in a rural hospital within a LMIC. METHODS Between July and October 2016, 500 consecutive patients with hypertension and/or diabetes mellitus encountered in clinic at the Agogo Presbyterian Hospital, a district level health institution in Ghana were enrolled. A validated pictographic version of the QVSFS was administered by trained research assistants to all study participants and demographic and clinical information on hypertension and diabetes control were collected. The neurologist/specialist physician examined all patients neurologically using a structured questionnaire and reviewed medical charts for objective documentary evidence of stroke. Predictors of stroke symptoms were assessed using a multivariate logistic regression model. RESULTS Among the cohort, median (IQR) age was 58 (51-66) years, 399 (79.8%) were women, 388 (77.6%) had hypertension, 92 (18.4%) had diabetes and hypertension, and 20 (4.0%) had just diabetes. 30 (6.0%) patients had confirmed stroke/TIA after physician evaluation, 151 (30.6%) had at least one symptom of stroke (SS) without prior diagnosis of stroke/TIA and 319 (63.8%) reported no stroke symptoms. Independent predictors of reporting stroke symptoms were increasing age - aOR: 1.38 (1.16-1.64) for each 10years older and HBA1C-OR: 1.74 (1.16-2.61) for each 2% increase. Subjects with previous stroke/TIA diagnosis had significantly higher mean±SD systolic blood pressure (148.0±21.2mmHg vs. 136.0±17.3mmHg vs. 138.3±19.7mmHg, p=0.009) and median (IQR) HBA1C (8.8% (6.7-10.2) vs. 8.2 (6.4-10.6) vs. 7.2 (6.3-8.0), p=0.05) compared with SS and asymptomatic groups. CONCLUSION One in three patients with hypertension and/diabetes in rural Ghana report stroke-like symptoms. Routine use of the pictographic version of the QVSFS could assist in identifying patients with or at high risk for stroke who may benefit from appropriate prevention treatments.
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Affiliation(s)
- Fred S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
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Murakami K, Asayama K, Satoh M, Inoue R, Tsubota-Utsugi M, Hosaka M, Matsuda A, Nomura K, Murakami T, Kikuya M, Metoki H, Imai Y, Ohkubo T. Risk Factors for Stroke among Young-Old and Old-Old Community-Dwelling Adults in Japan: The Ohasama Study. J Atheroscler Thromb 2016; 24:290-300. [PMID: 27487854 PMCID: PMC5383545 DOI: 10.5551/jat.35766] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM Few studies have addressed stroke risk factors in older populations, particularly among the old-old. We examined differences in traditional risk factors for stroke among the old-old compared with the young-old in community-dwelling Japanese adults. METHODS We followed 2,065 residents aged ≥ 60 years who had no history of stroke. Traditional risk factors for stroke were obtained from a self-administered questionnaire at baseline. We classified participants into two age categories, 60-74 years (n=1,502) and ≥ 75 years (n=563), and assessed whether traditional risk factors were differentially associated with stroke incidence according to age category. Hazard ratios were calculated by the Cox proportional hazards model, adjusting for confounding factors and competing risk of death. RESULTS During a median follow-up of 12.8 and 7.9 years, 163 and 111 participants aged 60-74 and ≥ 75 years, respectively, developed a first stroke. Hypertension was consistently associated with increased risk of stroke, regardless of age category. Diabetes mellitus was associated with increased risk of stroke in those aged 60-74 years (hazard ratio, 1.50; 95% confidence interval, 1.00-2.25), but not in those aged ≥ 75 years (hazard ratio, 0.65; 95% confidence interval, 0.33-1.29), with significant interaction by age (P=0.035). No traditional risk factor other than hypertension was associated with stroke among those aged ≥ 75 years. CONCLUSION Those with hypertension had significantly higher stroke risk among old people, while diabetes mellitus was differentially associated with stroke according to age category. Our findings indicate the importance of different prevention strategies for stroke incidence according to age category.
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Affiliation(s)
- Keiko Murakami
- Department of Hygiene and Public Health, Teikyo University School of Medicine
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Long X, Lou Y, Gu H, Guo X, Wang T, Zhu Y, Zhao W, Ning X, Li B, Wang J, An Z. Mortality, Recurrence, and Dependency Rates Are Higher after Acute Ischemic Stroke in Elderly Patients with Diabetes Compared to Younger Patients. Front Aging Neurosci 2016; 8:142. [PMID: 27378914 PMCID: PMC4909745 DOI: 10.3389/fnagi.2016.00142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/30/2016] [Indexed: 02/01/2023] Open
Abstract
Stroke has a greater effect on the elderly than on younger patients. However, the long-term outcomes associated with stroke among elderly patients with diabetes are unknown. We aimed to assess the differences in long-term outcomes between young and elderly stroke patients with diabetes. A total of 3,615 acute ischemic stroke patients with diabetes were recruited for this study between 2006 and 2014. Outcomes at 12 and 36 months after stroke (including mortality, recurrence, and dependency) were compared between younger (age <75 years) and elderly (age ≥75 years) patients. The elderly group included 692 patients (19.1%) overall. Elderly patients were more likely than younger patients to have a Trial of Org 10172 in Acute Stroke Treatment classification of stroke due to cardioembolism, moderate and severe stroke, and atrial fibrillation, but less likely to have hypertension and dyslipidemia, current smokers, and alcohol consumers. Mortality, dependency, and recurrence rates at 12 months after stroke were 19.0, 48.5, and 20.9% in the elderly group and 7.4, 30.9, and 15.4% in the younger group, respectively (all P < 0.05). Corresponding rates at 36 months after stroke were 35.4, 78.7, and 53.8% in the elderly group and 13.7, 61.7, and 43.0% in the younger group, respectively (all P < 0.001). The mortality, dependency, and recurrence rates at 12 and 36 months after stroke were significantly higher in the elderly group than in the younger group after adjusting for stroke subtypes, stroke severity, and risk factors. Odds ratios (95% confidence interval) at 12 and 36 months after stroke were 2.18 (1.64-2.89) and 3.10 (2.35-4.08), respectively, for mortality, all P < 0.001; 1.81 (1.49-2.20) and 2.04 (1.57-2.34), respectively, for dependency, all P < 0.001; and 1.37 (1.06-1.76) and 1.40 (1.07-1.85), respectively, for recurrence, P = 0.016. The findings from this study suggest that management and secondary prevention should be emphasized in elderly patients with diabetes in China to reduce mortality, recurrence, and dependency after stroke.
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Affiliation(s)
- Xue Long
- Department of Neurology, Tianjin Haibin People's HospitalTianjin, China; The Graduate School, Tianjin University of Traditional Chinese MedicineTianjin, China
| | - Yongzhong Lou
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Hongfei Gu
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Xiaofei Guo
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Tao Wang
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Yanxia Zhu
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General HospitalTianjin, China; Department of Epidemiology, Tianjin Neurological InstituteTianjin, China
| | - Bin Li
- Department of Neurology, Tianjin Haibin People's HospitalTianjin, China; The Graduate School, Tianjin University of Traditional Chinese MedicineTianjin, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General HospitalTianjin, China; Department of Epidemiology, Tianjin Neurological InstituteTianjin, China
| | - Zhongping An
- Department of Neurology, Tianjin Huanhu Hospital Tianjin, China
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Chen R, Ovbiagele B, Feng W. Diabetes and Stroke: Epidemiology, Pathophysiology, Pharmaceuticals and Outcomes. Am J Med Sci 2016; 351:380-6. [PMID: 27079344 PMCID: PMC5298897 DOI: 10.1016/j.amjms.2016.01.011] [Citation(s) in RCA: 324] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/25/2016] [Accepted: 01/25/2016] [Indexed: 01/01/2023]
Abstract
There has been a significant increase in obesity rates worldwide with the corresponding surge in diabetes. Diabetes causes various microvascular and macrovascular changes often culminating in major clinical complications, 1 of which, is stroke. Although gains have been made over the last 2 decades in reducing the burden of stroke, the recent rise in rates of diabetes threatens to reverse these advances. Of the several mechanistic stroke subtypes, individuals with diabetes are especially susceptible to the consequences of cerebral small vessel diseases. Hyperglycemia confers greater risk of stroke occurrence. This increased risk is often seen in individuals with diabetes and is associated with poorer clinical outcomes (including higher mortality), especially following ischemic stroke. Improving stroke outcomes in individuals with diabetes requires prompt and persistent implementation of evidence-based medical therapies as well as adoption of beneficial lifestyle practices.
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Affiliation(s)
- Rong Chen
- Department of Neurology, Affiliated Hospital of Hainan Medical College, Haikou, Hainan, China; Department of Neurology, MUSC Stroke Center, Medical University of South Carolina, Charleston, South Carolina
| | - Bruce Ovbiagele
- Department of Neurology, MUSC Stroke Center, Medical University of South Carolina, Charleston, South Carolina
| | - Wuwei Feng
- Department of Neurology, MUSC Stroke Center, Medical University of South Carolina, Charleston, South Carolina.
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Spitznagel MB, Alosco M, Inge TH, Rochette A, Strain G, Devlin M, Crosby RD, Mitchell JE, Gunstad J. Adolescent weight history and adult cognition: before and after bariatric surgery. Surg Obes Relat Dis 2016; 12:1057-1064. [PMID: 27178608 DOI: 10.1016/j.soard.2016.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/26/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cognitive deficits occur in a subset of individuals with obesity. Deficits can be reversed with bariatric surgery, though cognitive recovery is not equally exhibited across patients. Recent work has found that obesity during adolescence portends medical complications in adulthood; it is unknown if obesity in adolescence predicts adult cognition or cognitive recovery after weight loss surgery. OBJECTIVES The present study examines the relationship between weight history and cognitive function in obese adults undergoing bariatric surgery. SETTING Academic medical centers with bariatric care services. METHODS Seventy-eight bariatric surgery patients (mean age = 43.2 years) enrolled in an ancillary study to the Longitudinal Assessment of Bariatric Surgery (LABS) project completed a questionnaire recalling weight history at age 18. Cognitive testing was completed preoperatively and at 12-month follow-up. RESULTS Weight status at age 18 was linked to performance in several aspects of cognition. Higher body mass index at age 18 predicted poorer preoperative verbal fluency (B = -.26, P = .045) as well as postoperative cognitive recovery in attention (B = -.30, P = .01) at 12-month follow-up. CONCLUSION Higher body mass index at age 18 predicts verbal fluency performance in adults with obesity, as well as postoperative recovery of attention after bariatric surgery. The mechanisms underlying this connection are not fully clear, though findings may reflect effects of obesity on the brain during a crucial period of neural maturation or duration of obesity and cumulative impact of co-morbidities on cognition. Future work examining possible causal factors involved in these relationships is needed.
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Affiliation(s)
| | | | - Thomas H Inge
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | - Michael Devlin
- Columbia University College of Physicians & Surgeons, New York, New York
| | - Ross D Crosby
- Neuropsychiatric Research Institute and University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - James E Mitchell
- Neuropsychiatric Research Institute and University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - John Gunstad
- Kent State University, Kent, Ohio; Summa Health System, Akron, Ohio
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Zhao W, An Z, Hong Y, Zhou G, Liu B, Guo J, Yang Y, Ning X, Wang J. Sex differences in long-term outcomes among acute ischemic stroke patients with diabetes in China. Biol Sex Differ 2015; 6:29. [PMID: 26640642 PMCID: PMC4670521 DOI: 10.1186/s13293-015-0045-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes has been shown to be significantly associated with poor outcome after stroke. However, the sex differences in stroke outcome among patients with diabetes are unknown. Therefore, we aimed to assess the sex differences in long-term prognosis among acute ischemic stroke patients with diabetes. METHODS The ischemic stroke patients with diabetes were recruited to this study between May 2005 and September 2014 in Tianjin, China. Sex differences in mortality, dependency (modified rank scale > 2), and recurrence at 3, 12, and 36 months after stroke were analyzed. RESULTS A total of 2360 patients were recruited in this study. The age of stroke onset, National Institute of Health stroke scale (NIHSS), and modified rank scale (mRS) on admission were greater in women than in men (P < 0.05). Women were more likely to have hypertension, obesity, atrial fibrillation, and dyslipidemias. In contrast, men were more likely to have artery stenosis, current smoking, and alcohol consumption (P < 0.001). There was higher mortality in women than in men at 3 months (7.9 % vs 5.2 %), 12 months (12.2 % vs 8.2 %), and 36 months (21.9 % vs 16.1 %) after stroke; but no differences were found in dependency and recurrence. Sex differences were found in associated factors of outcomes by time-point. Trial of Org 10172 in Acute Stroke Treatment (TOAST) of large artery atherothrombosis (LAA), cardioembolism (CE), and smoking were risk factors of outcomes in women at short term and medium term; but atrial fibrillation (AF), obesity, and alcohol were risk factors of outcomes in men at medium term and long term. CONCLUSIONS These findings suggest that it is crucial to establish the individual scheme of therapy for every patient by different risk factors of stroke, strengthen the rehabilitation of stroke, and carry on the health education early for the secondary prevention of stroke in patients with diabetes mellitus (DM).
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Affiliation(s)
- Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China ; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China
| | - Zhongping An
- Department of Neurology, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China ; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China
| | - Yan Hong
- Department of Neurology, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China ; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China
| | - Guanen Zhou
- Department of Neurology, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China ; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China
| | - Bin Liu
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China ; Department of Ultrasound, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China
| | - Jingjing Guo
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China ; Department of Radiology, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China
| | - Yuanju Yang
- Department of Neurology, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China ; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, 122 Qixiangtai Road, Hexi District, 300060 Tianjin China
| | - Xianjia Ning
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China ; Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinghua Wang
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China ; Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
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Abstract
Reports from recent studies suggest that diabetes confers a higher risk of cardiovascular disease in women compared to men. Larger studies, including meta-analyses, report that women with diabetes have a 44 % greater risk of incident coronary heart disease and a 27 % greater risk of incident stroke compared to men with diabetes. In this article, we summarize results from longitudinal studies that examine sex differences in risk factors for and rates of macrovascular complications from diabetes. We also discuss possible mechanisms for increased cardiovascular risk associated with diabetes in women compared to men, including the clustering of hypertension, obesity, and elevated triglycerides, the possible contribution of hormonal differences, and sex differences in the prescription of and adherence to pharmacologic treatment. In conclusion, diabetes is associated with a slightly higher risk of cardiovascular disease in women compared to men. Future studies should further explore the reasons underlying imperfect use of medications that lower cardiovascular risk in both women and men with diabetes.
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Affiliation(s)
- Amanda Lyon
- Department of Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Elizabeth A Jackson
- Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48106, USA.
| | - Rita R Kalyani
- Department of Medicine, Johns Hopkins University, 1830 E Monument St # 333, Baltimore, MD, 21287, USA.
| | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins University, 1830 E Monument St # 333, Baltimore, MD, 21287, USA.
| | - Catherine Kim
- Departments of Medicine, Obstetrics & Gynecology, and Epidemiology, University of Michigan, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109, USA.
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Xiang L, Mittwede PN, Clemmer JS. Glucose Homeostasis and Cardiovascular Alterations in Diabetes. Compr Physiol 2015; 5:1815-39. [DOI: 10.1002/cphy.c150001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Fuentes B, Cruz-Herranz A, Martínez-Sánchez P, Rodríguez-Sanz A, Ruiz Ares G, Prefasi D, Sanz-Cuesta BE, Lara-Lara M, Díez-Tejedor E. Acute ischemic stroke patients with diabetes should not be excluded from intravenous thrombolysis. J Thromb Thrombolysis 2015; 38:522-7. [PMID: 25002340 DOI: 10.1007/s11239-014-1110-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The benefit of intravenous thrombolysis (IVT) has been questioned for patients with diabetes mellitus (DM) in cases of acute ischemic stroke (IS). Our objective was to analyze the differences in outcome according to prior diagnosis of DM and the use or not of IVT. Observational study with inclusion of consecutive IS patients admitted to an stroke unit. Demographic data, vascular risk factors, comorbidity, stroke severity and 3-month follow-up outcome (modified Rankin Scale) were compared according to prior diagnosis of DM and the use or not of IVT. A total of 1,139 IS patients were admitted; 283 (24.8%) patients had a diagnosis of DM, and 261 were IVT treated (23.2% of the group without DM and 21.9% of the DM group). The IVT-treated patients with DM were older, had more comorbidities and had higher glucose levels on admission than those without DM and than IVT-treated patients. No significant differences in stroke severity, hemorrhagic transformation, in-hospital mortality or outcome at 3 months were found. The logistic regression analysis showed that stroke severity was associated with a higher risk of a poor outcome in IVT-treated patients, with no significant effect from DM after adjustment for confounders. Moreover, IVT was independently associated with a lower risk of poor outcome in DM patients (OR 0.49; 95% CI 0.31-0.76; P = .002). DM patients should not be excluded from IVT, because DM is not associated with a poor outcome after IVT and this treatment is clearly beneficial for DM patients as compared with DM patients not treated with IVT.
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Affiliation(s)
- Blanca Fuentes
- Department of Neurology and Stroke Center, IdiPAZ Health Research Institute, La Paz University Hospital, Autonomous University of Madrid, Paseo de la Castellana 261, 28046, Madrid, Spain,
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Chronic Treatment with a Water-Soluble Extract from the Culture Medium of Ganoderma lucidum Mycelia Prevents Apoptosis and Necroptosis in Hypoxia/Ischemia-Induced Injury of Type 2 Diabetic Mouse Brain. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:865986. [PMID: 25945116 PMCID: PMC4402482 DOI: 10.1155/2015/865986] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 02/03/2015] [Indexed: 12/31/2022]
Abstract
Type 2 diabetes mellitus has been known to increase systemic oxidative stress by chronic hyperglycemia and visceral obesity and aggravate cerebral ischemic injury. On the basis of our previous study regarding a water-soluble extract from the culture medium of Ganoderma lucidum mycelia (designed as MAK), which exerts antioxidative and neuroprotective effects, the present study was conducted to evaluate the preventive effects of MAK on apoptosis and necroptosis (a programmed necrosis) induced by hypoxia/ischemia (H/I) in type 2 diabetic KKAy mice. H/I was induced by a combination of unilateral common carotid artery ligation with hypoxia (8% O2 for 20 min) and subsequent reoxygenation. Pretreatment with MAK (1 g/kg, p.o.) for a week significantly reduced H/I-induced neurological deficits and brain infarction volume assessed at 24 h of reoxygenation. Histochemical analysis showed that MAK significantly suppressed superoxide production, neuronal cell death, and vacuolation in the ischemic penumbra, which was accompanied by a decrease in the numbers of TUNEL- or cleaved caspase-3-positive cells. Furthermore, MAK decreased the expression of receptor-interacting protein kinase 3 mRNA and protein, a key molecule for necroptosis. These results suggest that MAK confers resistance to apoptotic and necroptotic cell death and relieves H/I-induced cerebral ischemic injury in type 2 diabetic mice.
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Salak Djokić B, Spitznagel MB, Pavlović D, Janković N, Parojčić A, Ilić V, Nikolić Djurović M. Diabetes mellitus and cognitive functioning in a Serbian sample. J Clin Exp Neuropsychol 2014; 37:37-48. [DOI: 10.1080/13803395.2014.985190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Tziomalos K, Spanou M, Bouziana SD, Papadopoulou M, Giampatzis V, Kostaki S, Dourliou V, Tsopozidi M, Savopoulos C, Hatzitolios AI. Type 2 diabetes is associated with a worse functional outcome of ischemic stroke. World J Diabetes 2014; 5:939-944. [PMID: 25512800 PMCID: PMC4265884 DOI: 10.4239/wjd.v5.i6.939] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/02/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess whether ischemic stroke severity and outcome is more adverse in patients with type 2 diabetes mellitus (T2DM).
METHODS: Consecutive patients hospitalized for acute ischemic stroke between September 2010 and June 2013 were studied prospectively (n = 482; 40.2% males, age 78.8 ± 6.7 years). T2DM was defined as self-reported T2DM or antidiabetic treatment. Stroke severity was evaluated with the National Institutes of Health Stroke Scale (NIHSS) score at admission. The outcome was assessed with the modified Rankin scale (mRS) score at discharge and with in-hospital mortality. Adverse outcome was defined as mRS score at discharge ≥ 2 or in-hospital death. The length of hospitalization was also recorded.
RESULTS: T2DM was present in 32.2% of the study population. Patients with T2DM had a larger waist circumference, higher serum triglyceride and glucose levels and lower serum high-density lipoprotein cholesterol levels as well as higher prevalence of hypertension, coronary heart disease and congestive heart failure than patients without T2DM. On the other hand, diabetic patients had lower low-density lipoprotein cholesterol levels and reported smaller consumption of alcohol than non-diabetic patients. At admission, the NIHSS score did not differ between patients with and without T2DM (8.7 ± 8.8 and 8.6 ± 9.2, respectively; P = NS). At discharge, the mRS score also did not differ between the two groups (2.7 ± 2.1 and 2.7 ± 2.2 in patients with and without T2DM, respectively; P = NS). Rates of adverse outcome were also similar in patients with and without T2DM (62.3% and 58.5%, respectively; P = NS). However, when we adjusted for the differences between patients with T2DM and those without T2DM in cardiovascular risk factors, T2DM was independently associated with adverse outcome [relative risk (RR) = 2.39; 95%CI: 1.21-4.72, P = 0.012]. In-hospital mortality rates did not differ between patients with T2DM and those without T2DM (9.0% and 9.8%, respectively; P = NS). In multivariate analysis adjusting for the difference in cardiovascular risk factors between the two groups, T2DM was again not associated with in-hospital death.
CONCLUSION: T2DM does not appear to affect ischemic stroke severity but is independently associated with a worse functional outcome at discharge.
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Tuttolomondo A, Pinto A. Ischemic stroke subtypes and the implications for stroke management. FUTURE NEUROLOGY 2014. [DOI: 10.2217/fnl.14.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Antonino Tuttolomondo
- Internal Medicine & Cardioangiology Ward, Dipartimento Biomedico di Medicina Interna & Specialistica, University of Palermo, Italy
| | - Antonio Pinto
- Internal Medicine & Cardioangiology Ward, Dipartimento Biomedico di Medicina Interna & Specialistica, University of Palermo, Italy
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Palacio S, McClure LA, Benavente OR, Bazan C, Pergola P, Hart RG. Lacunar strokes in patients with diabetes mellitus: risk factors, infarct location, and prognosis: the secondary prevention of small subcortical strokes study. Stroke 2014; 45:2689-94. [PMID: 25034716 DOI: 10.1161/strokeaha.114.005018] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Diabetes mellitus is an independent risk factor for lacunar strokes. Few data are available regarding patient features, infarct location, and recurrent vascular events for patients with diabetes mellitus with lacunar stroke. METHODS We compared features at study entry and prognosis during 3.6 years of follow-up of patients with diabetes mellitus versus patients without diabetes mellitus with recent lacunar stroke participating in the Secondary Prevention of Small Subcortical Strokes (SPS3) randomized trial. RESULTS Among the 3020 participants, the prevalence of diabetes mellitus was 37% with a mean duration of 11 years. Diabetes mellitus was independently associated with slightly younger age (63 versus 64 years; P<0.001), Hispanic ethnicity (36% versus 28%; P<0.0001), ischemic heart disease (11% versus 6%; P=0.002), and peripheral vascular disease (5% versus 2%; P<0.001). Patients with diabetes mellitus more frequently had intracranial stenosis ≥50% (P<0.001), infarcts involving the brain stem or cerebellum (P<0.001), and more extensive white matter abnormalities (P<0.001). Patients with diabetes mellitus were almost twice as likely to have a recurrent stroke (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.4-2.3), recurrent ischemic stroke (HR, 1.8; 95% CI, 1.4-2.4), disabling/fatal stroke (HR, 1.8; 95% CI, 1.2-2.9), myocardial infarction (HR, 1.7; 95% CI, 1.0-2.8), and death (HR, 2.1 95% CI, 1.6-2.8) compared with patients without diabetes mellitus. CONCLUSIONS Patients with diabetes mellitus with lacunar stroke have a distinctive clinical profile that includes double the prevalence of systemic and intracranial atherosclerosis, preferential involvement of the posterior circulation, and a poor prognosis for recurrent stroke and death. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00059306.
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Affiliation(s)
- Santiago Palacio
- From the Departments of Neurology (S.P.), Radiology (C.B.), and Medicine (P.P.), University of Texas Health Science Center, San Antonio, TX; University of Alabama at Birmingham (L.A.M.); Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada (O.R.B.); and Department of Medicine (Neurology), McMaster University/Population Health Research Institute Hamilton, Ontario, Canada (R.G.H.).
| | - Leslie A McClure
- From the Departments of Neurology (S.P.), Radiology (C.B.), and Medicine (P.P.), University of Texas Health Science Center, San Antonio, TX; University of Alabama at Birmingham (L.A.M.); Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada (O.R.B.); and Department of Medicine (Neurology), McMaster University/Population Health Research Institute Hamilton, Ontario, Canada (R.G.H.)
| | - Oscar R Benavente
- From the Departments of Neurology (S.P.), Radiology (C.B.), and Medicine (P.P.), University of Texas Health Science Center, San Antonio, TX; University of Alabama at Birmingham (L.A.M.); Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada (O.R.B.); and Department of Medicine (Neurology), McMaster University/Population Health Research Institute Hamilton, Ontario, Canada (R.G.H.)
| | - Carlos Bazan
- From the Departments of Neurology (S.P.), Radiology (C.B.), and Medicine (P.P.), University of Texas Health Science Center, San Antonio, TX; University of Alabama at Birmingham (L.A.M.); Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada (O.R.B.); and Department of Medicine (Neurology), McMaster University/Population Health Research Institute Hamilton, Ontario, Canada (R.G.H.)
| | - Pablo Pergola
- From the Departments of Neurology (S.P.), Radiology (C.B.), and Medicine (P.P.), University of Texas Health Science Center, San Antonio, TX; University of Alabama at Birmingham (L.A.M.); Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada (O.R.B.); and Department of Medicine (Neurology), McMaster University/Population Health Research Institute Hamilton, Ontario, Canada (R.G.H.)
| | - Robert G Hart
- From the Departments of Neurology (S.P.), Radiology (C.B.), and Medicine (P.P.), University of Texas Health Science Center, San Antonio, TX; University of Alabama at Birmingham (L.A.M.); Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada (O.R.B.); and Department of Medicine (Neurology), McMaster University/Population Health Research Institute Hamilton, Ontario, Canada (R.G.H.)
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Li MF, Ren Y, Zhao CC, Zhang R, Li LX, Liu F, Lu JX, Tu YF, Zhao WJ, Bao YQ, Jia WP. Prevalence and clinical characteristics of lower limb atherosclerotic lesions in newly diagnosed patients with ketosis-onset diabetes: a cross-sectional study. Diabetol Metab Syndr 2014; 6:71. [PMID: 24926320 PMCID: PMC4054910 DOI: 10.1186/1758-5996-6-71] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 05/26/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The clinical features of atherosclerotic lesions in ketosis-onset diabetes are largely absent. We aimed to compare the characteristics of lower limb atherosclerotic lesions among type 1, ketosis-onset and non-ketotic type 2 diabetes. METHODS A cross-sectional study was performed in newly diagnosed Chinese patients with diabetes, including 53 type 1 diabetics with positive islet-associated autoantibodies, 208 ketosis-onset diabetics without islet-associated autoantibodies, and 215 non-ketotic type 2 diabetics. Sixty-two subjects without diabetes were used as control. Femoral intima-media thickness (FIMT), lower limb atherosclerotic plaque and stenosis were evaluated and compared among the four groups based on ultrasonography. The risk factors associated with lower limb atherosclerotic plaque were evaluated via binary logistic regression in patients with diabetes. RESULTS After adjusting for age and sex, the prevalence of lower limb plaque in the patients with ketosis-onset diabetes (47.6%) was significantly higher than in the control subjects (25.8%, p = 0.013), and showed a higher trend compared with the patients with type 1 diabetes (39.6%, p = 0.072), but no difference was observed in comparison to the patients with non-ketotic type 2 diabetes (62.3%, p = 0.859). The mean FIMT in the ketosis-onset diabetics (0.73 ± 0.17 mm) was markedly greater than that in the control subjects (0.69 ± 0.13 mm, p = 0.045) after controlling for age and sex, but no significant differences were found between the ketosis-onset diabetics and the type 1 diabetics (0.71 ± 0.16 mm, p = 0.373), and the non-ketotic type 2 diabetics (0.80 ± 0.22 mm, p = 0.280), respectively. Age and FIMT were independent risk factors for the presence of lower limb plaque in both the ketosis-onset and non-ketotic type 2 diabetic patients, while sex and age in the type 1 diabetic patients. CONCLUSIONS The prevalence and risk of lower limb atherosclerotic plaque in the ketosis-onset diabetes were remarkably higher than in the control subjects without diabetes. The features and risk factors of lower limb atherosclerotic lesions in the ketosis-onset diabetes resembled those in the non-ketotic type 2 diabetes, but different from those in the type 1 diabetes. Our findings provide further evidences to support the classification of ketosis-onset diabetes as a subtype of type 2 diabetes rather than idiopathic type 1 diabetes.
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Affiliation(s)
- Mei-Fang Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Ying Ren
- Department of VIP, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Cui-Chun Zhao
- Department of VIP, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Rong Zhang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Lian-Xi Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Fang Liu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Jun-Xi Lu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Yin-Fang Tu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Wei-Jing Zhao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Yu-Qian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Wei-Ping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
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Hou Q, Zuo Z, Michel P, Zhang Y, Eskandari A, Man F, Gao Q, Johnston KC, Wintermark M. Influence of Chronic Hyperglycemia on Cerebral Microvascular Remodeling. Stroke 2013; 44:3557-60. [DOI: 10.1161/strokeaha.113.003150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Qinghua Hou
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Zhiyi Zuo
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Patrik Michel
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Yanrong Zhang
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Ashraf Eskandari
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Fengyuan Man
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Qingcun Gao
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Karen C. Johnston
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Max Wintermark
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
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Muscari A, Puddu GM, Fabbri E, Napoli C, Vizioli L, Zoli M. Factors predisposing to small lacunar versus large non-lacunar cerebral infarcts: is left ventricular mass involved? Neurol Res 2013; 35:1015-21. [DOI: 10.1179/1743132813y.0000000240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Antonio Muscari
- Stroke Unit – Department of Medical and Surgical SciencesUniversity of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni M Puddu
- Stroke Unit – Department of Medical and Surgical SciencesUniversity of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Elisa Fabbri
- Stroke Unit – Department of Medical and Surgical SciencesUniversity of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Chiara Napoli
- Stroke Unit – Department of Medical and Surgical SciencesUniversity of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luca Vizioli
- Stroke Unit – Department of Medical and Surgical SciencesUniversity of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Zoli
- Stroke Unit – Department of Medical and Surgical SciencesUniversity of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
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50
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Dragoumanos V, Tzirogiannis KN, Panoutsopoulos GI, Krikonis K, Fousteris E, Vourvou M, Elesnitsalis G, Melas N, Kourentzi KT, Melidonis A. Evaluation of IScore validity in a Greek cohort of patients with type 2 diabetes. BMC Neurol 2013; 13:121. [PMID: 24041109 PMCID: PMC3852226 DOI: 10.1186/1471-2377-13-121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 08/28/2013] [Indexed: 11/19/2022] Open
Abstract
Background Diabetes constitutes a risk factor for stroke that also aggravates stroke prognosis. Several prognostic models have been developed for the evaluation of neurologic status, severity, short-term functional outcome and mortality of stroke patients. IScore is a novel tool recently developed in order to predict mortality rates within 30 days and 1 year after ischemic stroke and diabetes is not included in the scoring scale of IScore. The aim of the present study was to evaluate and compare IScore validity in ischemic stroke patients with and without diabetes. Methods This prospective study included 312 consecutive Caucasian patients with type 2 diabetes and 222 Caucasian patients without diabetes admitted for ischemic stroke in a tertiary Greek hospital. Thirty-day and 1-year IScores were individually calculated for each patient and actual mortality was monitored at the same time intervals. IScore’s predictive ability and calibration was evaluated and compared for ischemic stroke patients with and without diabetes. The performance of IScore for predicting 30 and 1-year mortality between patients with and without diabetes was assessed by determining the calibration and discrimination of the score. The area under the receiver operating characteristic curve was used to evaluate the discriminative ability of IScore for patients with and without diabetes, whereas the calibration of IScore was assessed by the Hosmer–Lemeshow goodness-of fit statistic. Results Baseline population characteristics and mortality rates did not differ significantly for both cohorts. IScore values were significantly higher for patients with diabetes at 30 days and 1 year after ischemic stroke and patients with diabetes presented more frequently with lacunar strokes. Based on ROC curves analysis IScore’s predictive ability for 30 day mortality was excellent, without statistically significant difference, for both cohorts. Predictive ability for 1 year mortality was also excellent for both groups with significantly better ability for patients with diabetes especially at high score values. Calibration of the model was good for both groups of patients. Conclusions IScore accurately predicts mortality in acute ischemic stroke Caucasian patients with and without diabetes with higher efficacy in predicting 1 year mortality in patients with diabetes especially with high scores.
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Affiliation(s)
- Vasileios Dragoumanos
- Department of Nursing, Faculty of Human Movement and Quality of Life Science, University of Peloponnese, Sparta, Lakonia, Greece.
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