Role of prediabetes in stroke

Comparative Effect of Glucose-Lowering Drugs for Type 2 Diabetes Mellitus on Stroke Prevention: A Systematic Review and Network Meta-Analysis

BACKGRUOUND

There is still a lack of research on which diabetic drugs are more effective in preventing stroke. Our network metaanalysis aimed to compare cerebrovascular benefits among glucose-lowering treatments.

METHODS

We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the ClinicalTrials.gov registry for clinical trials from inception through May 25, 2021. We included both prespecified cerebrovascular outcomes and cerebrovascular events reported as severe adverse events. Subgroup analyses were conducted by stroke subtype, publication type, age of patients, baseline glycosylated hemoglobin (HbA1c), duration of type 2 diabetes mellitus, and cardiovascular risks.

RESULTS

Of 2,861 reports and 1,779 trials screened, 79 randomized controlled trials comprising 206,387 patients fulfilled the inclusion criteria. In the pairwise meta-analysis, the use of glucagon-like peptide-1 (GLP-1) agonist was associated with a lower risk of total stroke compared with placebo (relative risk [RR], -0.17; 95% confidence interval [CI], -0.27 to -0.07). In the network meta- analysis, only the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitor was associated with a reduction of total stroke, compared with placebo (RR, 0.81; 95% CI, 0.67 to 0.98). In the subgroup analyses, the use of SGLT-2 inhibitor and GLP-1 agonist was associated with a lower risk of stroke in those with high HbA1c (≥8.0) and low-risk of cardiovascular disease, respectively.

CONCLUSION

SGLT-2 inhibitors and GLP-1 agonists were shown to be beneficial for stroke prevention in patients with type 2 diabetes mellitus.

Prediabetes: An overlooked risk factor for major adverse cardiac and cerebrovascular events in atrial fibrillation patients

BACKGROUND

Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events (MACCE). However, the relationship between prediabetes and MACCE in atrial fibrillation (AF) patients has not been extensively studied. Therefore, this study aimed to establish a link between prediabetes and MACCE in AF patients.

AIM

To investigate a link between prediabetes and MACCE in AF patients.

METHODS

We used the National Inpatient Sample (2019) and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes, excluding diabetics. The primary outcome was MACCE (all-cause inpatient mortality, cardiac arrest including ventricular fibrillation, and stroke) in AF-related hospitalizations.

RESULTS

Of the 2965875 AF-related hospitalizations for MACCE, 47505 (1.6%) were among patients with prediabetes. The prediabetes cohort was relatively younger (median 75 vs 78 years), and often consisted of males (56.3% vs 51.4%), blacks (9.8% vs 7.9%), Hispanics (7.3% vs 4.3%), and Asians (4.7% vs 1.6%) than the non-prediabetic cohort (P < 0.001). The prediabetes group had significantly higher rates of hypertension, hyperlipidemia, smoking, obesity, drug abuse, prior myocardial infarction, peripheral vascular disease, and hyperthyroidism (all P < 0.05). The prediabetes cohort was often discharged routinely (51.1% vs 41.1%), but more frequently required home health care (23.6% vs 21.0%) and had higher costs. After adjusting for baseline characteristics or comorbidities, the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort [18.6% vs 14.7%, odds ratio (OR) 1.34, 95% confidence interval 1.26-1.42, P < 0.001]. On subgroup analyses, males had a stronger association (aOR 1.43) compared to females (aOR 1.22), whereas on the race-wise comparison, Hispanics (aOR 1.43) and Asians (aOR 1.36) had a stronger association with MACCE with prediabetes vs whites (aOR 1.33) and blacks (aOR 1.21).

CONCLUSION

This population-based study found a significant association between prediabetes and MACCE in AF patients. Therefore, there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.

Astrocytes and microglia-targeted Danshensu liposomes enhance the therapeutic effects on cerebral ischemia-reperfusion injury

Cerebral ischemia-reperfusion injury (CI/RI) is the main cause of disability and death in stroke without satisfactory therapeutic effect. Inflammation mediated by activation of astrocytes and microglia is the main pathological mechanism of CI/RI. Danshensu (DSS) has been shown to exert anti-inflammatory effects against brain injury. However, limited by its poor cellular permeability and low bioavailability, it is still needed the new DSS preparations with the ability to cross the blood-brain barrier (BBB) and target inflammatory glial cells. In this study, we developed phosphatidylserine (PS) and transferrin (TF) modified liposomes carrying DSS (TF/PS/DSS-LPs) to improve the therapeutic efficacy against ischemic stroke. First, TF molecules targeted transferrin receptor (TfR) that is overexpressed in the BBB. Following the liposomes enter the brain, PS modification allowed the liposomes to target and bind to the overexpressed phosphatidylserine-specific receptors (PSRs) on the surface of astrocytes and microglia. Furthermore, it enhanced the uptake of TF/PS/DSS-LPs by astrocytes and microglia, while polarizing astrocytes from A1 to A2 and microglia from M1 to M2, reducing neuronal inflammation, and ultimately ameliorating cerebral ischemic injury. Thus, TF/PS/DSS-LPs could potentially serve as a promising strategy for the CI/RI treatment.

Association of Glycosylated Hemoglobin with Long-Term Adverse Cardiac Events after Percutaneous Coronary Intervention in Non Diabetes and Controlled Diabetes Patients: An Observational Study from the Korean COACT Registry

Glycosylated hemoglobin (HbA1c) is an established marker associated with cardiovascular risk, even if it is below the diagnostic threshold for diabetes mellitus (DM). However, whether or not prediabetic and controlled diabetic levels of HbA1c are associated with increased major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) remains unclear. This observational study included a total of 9128 patients who underwent PCI in the COACT registry from eight centers in Korea. A total of 2517 non-DM patients were divided into three groups (Groups I, II, III) according to their HbA1c levels and compared with 965 controlled DM patients (HbA1c < 7.0%, Group IV). During 22 months of median follow-up, there was no significant differences in MACE (p = 0.294) and cardiac death (p = 0.105) among the four groups. In addition, there were also no significant differences in MACE (p = 0.058) between Group III and Group IV. Although patients were diagnosed as DM, they had a similar prognosis in the same range of newly diagnosed DM patients in HbA1c, if they were treated well. The results of this study suggest that intensive treatment is required to reach the Hba1c target in diabetic patients with PCI in order to have a similar prognosis to patients not previously diagnosed with diabetes.

Diabetic Retinopathy May Covariate With Stroke in Diabetes Mellitus

Diabetes mellitus is a chronic metabolic disorder with increasing prevalence per hour. Cataracts are one of the most common eye complications, and they affect all structures of the eye. The incidence of cataracts is increasing in patients with diabetes by several mechanisms. With the advancement of technology, cataract surgery is now a necessary procedure for diabetic patients. High-risk complications, like diabetic macular oedema, diabetic retinopathy (DR), phakic, postoperative cyst, and postoperative macular oedema, and macular oedema and endophthalmitis following surgery for a pseudocyst, could result in blindness. The importance of preoperative, intraoperative, and postoperative factors cannot be overestimated in managing complications and improving visual outcomes. DR can be a severe problem if it worsens and causes non-proliferative or proliferative DR or if fluid accumulation in the eye is diagnosed as macular oedema. A woman progressing to sight-threatening DR during childbearing age experiences distress and often requires ocular treatment. Diabetes that has been present for a more extended period, as well as more significant hyperglycaemia, hypertension, cardiovascular diseases, and elevated blood pressure, substantially predict the development of DR. Oxidative stress can be caused by hyperglycaemia, irregular metabolic processes, and people with DR developing neurodegeneration. Therefore, controlling postprandial hyperglycaemia is crucial for preventing DR. Femtosecond laser technology, multifocal intraocular lenses, and other surgical innovations are popularly referred to as surgical management; it will be engaged in the coming era to determine whether there will be a continued reduction in the complication of cataract surgery. This article aims to review the correlation of DR with stroke and its screening and to outline the critical management strategies. 

Prevalence and predictors of stroke among individuals with prediabetes and diabetes in Florida

BACKGROUND

The prevalence of both prediabetes and diabetes have been increasing in Florida. These increasing trends will likely result in increases of stroke burden since both conditions are major risk factors of stroke. However, not much is known about the prevalence and predictors of stroke among adults with prediabetes and diabetes and yet this information is critical for guiding health programs aimed at reducing stroke burden. Therefore, the objectives of this study were to estimate the prevalence and identify predictors of stroke among persons with either prediabetes or diabetes in Florida.

METHODS

The 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey data were obtained from the Florida Department of Health and used for the study. Weighted prevalence estimates of stroke and potential predictor variables as well as their 95% confidence intervals were computed for adults with prediabetes and diabetes. A conceptual model of predictors of stroke among adults with prediabetes and diabetes was constructed to guide statistical model building. Two multivariable logistic models were built to investigate predictors of stroke among adults with prediabetes and diabetes.

RESULTS

The prevalence of stroke among respondents with prediabetes and diabetes were 7.8% and 11.2%, respectively. The odds of stroke were significantly (p ≤ 0.05) higher among respondents with prediabetes that were ≥ 45 years old (Odds ratio [OR] = 2.82; 95% Confidence Interval [CI] = 0.74, 10.69), had hypertension (OR = 5.86; CI = 2.90, 11.84) and hypercholesterolemia (OR = 3.93; CI = 1.84, 8.40). On the other hand, the odds of stroke among respondents with diabetes were significantly (p ≤ 0.05) higher if respondents were non-Hispanic Black (OR = 1.79; CI = 1.01, 3.19), hypertensive (OR = 3.56; CI = 1.87, 6.78) and had depression (OR = 2.02; CI = 1.14, 3.59).

CONCLUSIONS

Stroke prevalence in Florida is higher among adults with prediabetes and diabetes than the general population of the state. There is evidence of differences in the importance of predictors of stroke among populations with prediabetes and those with diabetes. These findings are useful for guiding health programs geared towards reducing stroke burden among populations with prediabetes and diabetes.

Time to Development of Overt Diabetes and Macrovascular and Microvascular Complications Among Patients With Prediabetes: A Retrospective Cohort Study

Objective In this study, we aimed to determine the effect of age, gender, race, and obesity on the development of overt diabetes and macro/microvascular events among patients with prediabetes. Methods This was a retrospective cohort study of patient records available through a national electronic health record (EHR) database from 2012 to 2017. Patients with prediabetes in the baseline year of 2012 were identified. Macro/microvascular events were defined as the diagnosis of myocardial infarction (MI), stroke, or chronic kidney disease (CKD). The effects of age, gender, race, and obesity on the incidence of diabetes and macro/microvascular events between 2013-2017 were assessed using the multivariate Cox proportional-hazards model. Results Among the total 5,230 patients with prediabetes in 2012, 16.7% developed overt diabetes, and 19.7% developed a macro/microvascular event. Elderly patients (HR: 2.96, 95% CI: 2.12-4.13), males (HR: 1.38, 95% CI: 1.20-1.59), and African-Americans (HR: 1.47, 95% CI: 1.26-1.73) were at a higher risk of experiencing a macro/microvascular event. Additionally, male gender (HR: 1.27, 95% CI: 1.11-1.46) and obesity (HR: 1.24, 95% CI: 1.08-1.43) were significant factors associated with the development of overt diabetes. Furthermore, when diabetes status was added as an interaction term to the Cox proportional-hazards model, no statistical difference was found with respect to any of the other independent variables. It can therefore be inferred that those with prediabetes and overt diabetes had a similar risk of developing macro/microvascular events. Conclusions Based on our findings, factors including advanced age, obesity, male gender, and African race significantly impact the progression to diabetes and associated macro/microvascular events.

Investigation of the role of sleep quality and sleep duration on fasting blood glucose level in acute ischemic stroke patients: A preliminary study

The aim of this study was to evaluate the association between the sleep quality and sleep duration with the level of fasting blood glucose in patients with acute ischemic stroke. A cross-sectional study was conducted among acute ischemic stroke patients admitted to Dr. Soetomo Hospital and Universitas Airlangga Hospital from May to October 2021. Patients who met the inclusion were enrolled. To assess the sleep quality, Pittsburgh Sleeps Quality Index (PSQI) was applied. To determine sleep duration during the nocturnal period, Fitbit Charge 2 HR device was used. Evaluation of plausible confounders was assessed through physical examination, interviews, and a set of validated questionnaires. A total of 30 acute ischemic stroke patients were included in this study. The mean age of the participants was 56.40±9.77 years and 60% were males. There were 63.3% patients classified as mild stroke and 36.7% moderate-severe stroke. The average PQSI score was 5.57±2.59, while the average sleep duration was 319.8±108.7 minutes. The average fasting blood glucose level was 89.03±14.71 mg/dL. Significant positive correlation was obtained between sleep duration and fasting blood glucose level (r=0.533; p=0.002). Similarly, there was no statistically significant correlation between sleep quality with the level of fasting blood glucose (r=-0.167; p=0.377). To the best of our knowledge, this is the first study assessing the correlation between sleep quality and sleep duration with the level of fasting blood glucose levels in patients with acute ischemic stroke. This study therefore might be of great interest to provide insights on the importance of sleep management in acute ischemic stroke patients.

Pre-diabetes is a predictor of short-term poor outcomes after acute ischemic stroke using IV thrombolysis

BACKGROUNDS

Pre-diabetes is an intermediate state between normal glucose metabolism and diabetes. Recent studies suggest that the presence of pre-diabetes is associated with poor outcomes after AIS. However, the results have been controversial. This study examines whether pre-diabetes influences the patients' short and long-term outcomes for AIS using IV thrombolysis.

METHODS

We enrolled 661 AIS patients with IV thrombolysis. Based on the 2010 ADA guidelines, patients were classified as pre-diabetes, with HbA1c levels of 5.7-6.4%; diabetes, with HbA1c levels more than 6.5%; and NGM (normal glucose metabolism), with HbA1c levels less than 5.7%. We investigated short-term outcomes, including early neurologic deterioration (END), in-hospital death, and poor functional outcomes (mRS > 2) at 90 days. As for long-term outcomes, poor functional outcomes were measured at 1 year.

RESULTS

Of the 661 AIS patients treated with IV thrombolysis, 197 patients (29.8%) were diagnosed with pre-diabetes, and 210 (31.8%) were diagnosed with diabetes. In a multivariate analysis, pre-diabetes was an independent predictor for END (OR = 2.02; 95% CI 1.12-3.62; p = 0.02) and in-hospital death (OR = 3.12; 95% CI 1.06-9.09; p = 0.04). On the other hand, diabetes was a significant independent factor for poor long-term outcomes (OR = 1.75; 95% CI 1.09-2.78; p = 0.02) after correcting confounding factors.

CONCLUSIONS

Unlike diabetes, pre-diabetes can be an important predictor of short-term outcomes after AIS. However, a more detailed research is needed to specify the precise mechanisms through which pre-diabetes affects the prognosis of acute ischemic stroke.

Sex disparities in cardiovascular disease outcomes among geriatric patients with prediabetes

AIMS

To analyze the sex-based differences in the prevalence of cardiovascular disease risk factors and outcomes in older patients with prediabetes using demographically matched national cohorts of hospitalized patients aged ≥65 years.

METHODS

We queried the 2007-2014 National Inpatient Database to identify older patients (>65 years) admitted with prediabetes using ICD-9 Clinical Modification codes. The older patients were then subcategorized based on sex. Comparative analyses of their baseline characteristics, the prevalence of cardiovascular(CV) disease comorbidities, hospitalization outcomes, and mortality rates were performed on propensity-matched cohorts for demographics.

RESULTS

A total of 1,197,978 older patients with prediabetes (599,223 males; mean age 75years and 598,755 females; mean age 76years) were identified. Higher admission rates were found commonly among older white males (84.1%) and females (81.7%). Prediabetic older males showed a higher frequency of cardiovascular comorbidities compared to females. Prediabetic older males had higher all-cause in-hospital mortality (4.2% vs. 3.6%, p < 0.001), acute myocardial infarction (7.0% vs. 4.7%, p < 0.001), arrhythmia (36.3% vs. 30.5%, p < 0.001), stroke (4.8% vs. 4.6%, p < 0.001), venous thromboembolism (3.3% vs. 3.0%, p < 0.001) and percutaneous coronary intervention (3.1% vs. 1.5%, p < 0.001) compared to females.

CONCLUSIONS

Our analysis revealed that among older patients hospitalized with prediabetes, males suffered worse in-hospital CV outcomes and survival rates compared to females.

Pre-Stroke Glycemic Variability Estimated by Glycated Albumin Is Associated with Early Neurological Deterioration and Poor Functional Outcome in Prediabetic Patients with Acute Ischemic Stroke

<b><i>Introduction:</i></b> Whether glycemic variability prior to stroke increases the risk of stroke outcomes in prediabetic patients presenting with acute ischemic stroke is still unclear. We evaluated whether pre-stroke glycemic variability, estimated by glycated albumin (GA), increased early neurological deterioration (END) and functional outcomes in prediabetic patients with acute ischemic stroke. <b><i>Methods:</i></b> A total of 215 acute ischemic stroke patients with prediabetes were evaluated. The primary outcome was END, defined as an incremental increase in the National Institutes of Health Stroke Scale score by ≥1 point in motor power or ≥2 points in the total score within the 7 days after admission. The secondary outcome was poor functional status defined by a modified Rankin Scale at 3 months. Higher GA (≥16.0%) was determined to reflect glycemic fluctuation prior to ischemic stroke. <b><i>Results:</i></b> Of the 215 prediabetic patients, 77 (35.8%) were in the higher GA group. In prediabetic patients, END occurrence and poor functional status were higher in the higher GA group than in the lower GA group. The multivariate analysis showed that a higher GA was associated with an increased risk of END occurrence and poor functional outcomes at 3 months (adjusted odds ratio [95% confidence interval], 4.58 [1.64–12.81], <i>p</i> = 0.004 and 2.50 [1.19–5.25], <i>p</i> = 0.02, respectively). <b><i>Conclusion:</i></b> Pre-stroke glycemic variability estimated by GA was associated with END occurrence and poor functional outcome after ischemic stroke in patients with prediabetes.

Prediabetes Deserves More Attention: A Review

Evidence increasingly demonstrates that prediabetes is a toxic state, as well as a risk factor for diabetes, and is associated with pathophysiological changes in several tissues and organs. Unfortunately, use of available evidence-based treatments for prediabetes is low. This review seeks to explain why prediabetes must be viewed and treated as a serious pathological entity in its own right. It offers an overview of the pathophysiology and complications of prediabetes and describes how this condition can be reversed if all treatment avenues are deployed early in its course.

The Probability of Ischaemic Stroke Prediction with a Multi-Neural-Network Model

As is known, cerebral stroke has become one of the main diseases endangering people’s health; ischaemic strokes accounts for approximately 85% of cerebral strokes. According to research, early prediction and prevention can effectively reduce the incidence rate of the disease. However, it is difficult to predict the ischaemic stroke because the data related to the disease are multi-modal. To achieve high accuracy of prediction and combine the stroke risk predictors obtained by previous researchers, a method for predicting the probability of stroke occurrence based on a multi-model fusion convolutional neural network structure is proposed. In such a way, the accuracy of ischaemic stroke prediction is improved by processing multi-modal data through multiple end-to-end neural networks. In this method, the feature extraction of structured data (age, gender, history of hypertension, etc.) and streaming data (heart rate, blood pressure, etc.) based on a convolutional neural network is first realized. A neural network model for feature fusion is then constructed to realize the feature fusion of structured data and streaming data. Finally, a predictive model for predicting the probability of stroke is obtained by training. As shown in the experimental results, the accuracy of ischaemic stroke prediction reached 98.53%. Such a high prediction accuracy will be helpful for preventing the occurrence of stroke.

Prediabetes is associated with poor functional outcome in patients with intracerebral hemorrhage

INTRODUCTION

The association between prediabetes and functional outcome in cerebrovascular diseases is controversial. No study has explored the relationship between prediabetes and functional outcome in intracerebral hemorrhage patients. Our study aimed to explore the association between prediabetes and functional outcome in intracerebral hemorrhage patients 1 month poststroke.

METHODS

One hundred and fifty intracerebral hemorrhage patients were consecutively recruited within the first 24 hr after admission and were followed up for 1 month. Patients were divided into a diabetes mellitus group, a prediabetes group, and a nondiabetic group by fasting glucose levels, 2-hr postprandial blood glucose levels, and glycosylated hemoglobin levels. Patients with modified Rankin Scale scores >2 at 1 month were defined as having a poor functional outcome.

RESULTS

The prediabetes group had a higher risk of poor functional outcome than the nondiabetic group in intracerebral hemorrhage patients (37.9% vs. 9.8%, χ²  = 11.521, p = .001). According to the logistic regression analyses, prediabetes was associated with a poor functional outcome in intracerebral hemorrhage patients after adjusting for confounding factors (odds ratio = 6.167, 95% confidence interval = 1.403-27.102, p = .016).

CONCLUSIONS

Our findings show that prediabetes is associated with a poor functional outcome in intracerebral hemorrhage patients 1 month poststroke.

Age-specific rate of undiagnosed diabetes and prediabetes in acute stroke

AIMS

We investigated age-specific rates of undiagnosed diabetes and prediabetes among patients with acute stroke.

METHODS

We used data from 2223 patients with acute stroke consecutively admitted to an Italian Stroke Unit (SU) between 2010 and 2015. Information from medical records and glycated hemoglobin (HbA1c) measured on admission was retrospectively used to screen for diabetes and prediabetes defined according to standard criteria.

RESULTS

Overall rate of diabetes undiagnosed at admission and diabetes still undiagnosed at SU discharge were 9.7% and 6.7% but age-specific prevalence peaked up to 12.0% and 9.0% after age 80. At admission, the proportion of all undiagnosed diabetes on total diabetes cases was one out of every two cases before age 60 and three out of every four cases after age 80. In these same age intervals, one out of every three diabetes cases was still undiagnosed at SU discharge. Regardless of age, about three out of ten patients with acute stroke had prediabetes. Less than 2% of these patients had a prediabetes diagnosis before or after SU admission.

CONCLUSIONS

In patients with acute stroke, diabetes is substantially underdiagnosed before age 60 and after age 80. Prediabetes is highly prevalent but mostly undiagnosed at all ages.

Impaired glucose tolerance predicts all-cause mortality among older men at high risk for cardiovascular disease in China

AIMS

To investigate the potential association between impaired glucose tolerance (IGT) and all-cause mortality among older men at high risk for cardiovascular disease (CVD) in China.

METHODS

In this prospective observational study, 460 older men aged ≥60 years were determined to have either IGT or normal glucose tolerance (NGT) based on an oral glucose tolerance test conducted between May 2005 and May 2007. IGT and NGT were diagnosed according to the 1999 WHO diagnostic criteria. All subjects were followed until March 2017. The primary outcome studied was all-cause mortality. Multivariate Cox models were used to estimate relative risk for all-cause mortality.

RESULTS

During a mean follow-up of 11.2 years, forty-three (21.4%) subjects in the IGT group and twenty-nine (11.2%) subjects in the NGT group died (HR 2.05, 95% CI 1.28-3.28, P=0.003). Multivariate Cox proportional-hazards analysis demonstated that IGT was significantly associated with increased risk for all-cause mortality, composite cardiovascular outcome, nonfatal stroke and heart failure after adjusting for potential confounding factors. Logistic regression analysis showed that IGT at baseline (P<0.05) rather than incident type 2 diabetes was a risk factor of all-cause mortality.

CONCLUSIONS

IGT was significantly associated with all-cause mortality in older Chinese men at high risk for CVD.

Pediatric stroke as the presenting symptom of new-onset type 1 diabetes mellitus without DKA: case report and literature review

Background Stroke and other neurologic complications are rare in pediatric type 1 diabetes mellitus (T1DM) without severe diabetic ketoacidosis (DKA) or poor glycemic control. Case presentation A previously healthy, 10-year-old female presented with acute thalamic stroke, non-acidotic new T1DM diagnosis and negative hypercoagulopathy workup. She received routine insulin therapy and aspirin, and returned to neurologic baseline within a year without stroke recurrence. Conclusions The contribution of non-acidotic hyperglycemia to stroke risk is better described in adults. Even though unable to prove causality, this case should at least raise awareness of the possible association of pediatric new-onset diabetes and stroke for optimal outcomes.

Isosteviol Sodium Protects against Ischemic Stroke by Modulating Microglia/Macrophage Polarization via Disruption of GAS5/miR-146a-5p sponge

Recent studies have shown that transforming microglia phenotype from pro-inflammation of M1 phenotype to anti-inflammation and tissue-repairing M2 phenotype may be an effective therapeutic strategy for preventing ischemic stroke brain injury. Isosteviol Sodium (STV-Na) has shown promise as a neuroprotective agent in cerebral ischemia model, although its effect on microglial polarization and chronic recovery after stroke is not clear. Here, we demonstrated that STV-Na treatment significantly reduced cerebral ischemic damage at both acute and chronic time points. STV-Na has a profound regulatory effect on microglia response after stroke. It can promote M2 polarization and inhibit microglia-mediated inflammation (M1) response following stroke in vivo and in vitro. Furthermore, we also found that Growth Arrest-Specific 5 (GAS5) altered OGD/R-induced microglial activation by increasing Notch1 expression via miR-146a-5p, the mRNA level of GAS5 and the protein level of Notch1 in vivo and in vitro, were discovered that both downgraded with STV-Na. Taken together, the present study demonstrated that STV-Na exerted neuroprotective effects by modulating microglia/macrophage polarization in ischemic stroke via the GAS5/miR-146a-5p sponge. These findings provide new evidence that targeting STV-Na could be a treatment for the prevention of stroke-related brain damage.

A Case-Control Study on Risk Factors and Their Interactions with Prediabetes among the Elderly in Rural Communities of Yiyang City, Hunan Province

BACKGROUND

The prevalence of prediabetes has been increasing significantly in recent years. Individuals with prediabetes have an increased risk of developing diabetes and cardiovascular diseases. The objectives of this study were to identify risk factors for prediabetes and their interactions among the elderly in rural communities of Hunan Province and to provide a scientific basis for prediabetes prevention.

METHODS

A case-control study was conducted to explore risk factors for prediabetes among the elderly in rural areas. The general sociodemographic information, lifestyle behaviours, and physiological results of elderly individuals with prediabetes and controls were collected by a questionnaire and laboratory testing. Conditional logistic regression was performed to identify the risk factors for prediabetes among the elderly, and additive interactions were used to analyse the interactions between risk factors.

RESULTS

A total of 425 elderly subjects with prediabetes were included in the case group, and 425 elderly subjects with normal plasma glucose levels were included in the control group. The main risk factors for prediabetes among the elderly in rural communities of Hunan Province were a family history of diabetes (OR = 2.48; 95% CI: 1.13, 5.46), physical inactivity (OR = 3.27; 95% CI: 1.95, 5.49), a lack of health literacy on diabetes prevention and control (OR = 3.26; 95% CI: 1.62, 6.55), hypertension (OR = 2.01; 95% CI: 1.38, 2.93), overweight (OR = 2.53; 95% CI: 1.67, 3.81), obesity (OR = 3.08; 95% CI: 1.48, 6.40), and a high waist-to-hip ratio (WHR) (OR = 2.26; 95% CI: 1.45, 3.51). Additive interactions for prediabetes were detected between a high WHR and physical inactivity, with a relative excess risk due to interaction (RERI) of 6.30 (95% CI: 0.42, 12.18), and between a high WHR and overweight or obesity, with an RERI of 2.92 (95% CI: 0.56, 5.29).

CONCLUSION

The independent risk factors for prediabetes are a family history of diabetes, physical inactivity, a lack of health literacy on diabetes prevention and control, hypertension, overweight or obesity, and a high WHR. A high WHR has additive interactions with physical inactivity and overweight or obesity for the risk of prediabetes. These findings have significant implications for prediabetes prevention among the elderly in rural areas.

Association between the Hypertriglyceridemic Waist Phenotype and Prediabetes in Chinese Adults Aged 40 Years and Older

OBJECTIVE

To investigate the association between the hypertriglyceridemic waist (HTGW) phenotype and prediabetes in Chinese adults aged 40 years and older.

METHODS

12757 adults (4101 men and 8656 women) without diabetes or cardiovascular and cerebrovascular diseases, free of using lipid-modified agents, were enrolled in this cross-sectional study. The HTGW phenotype was defined as elevated serum triglyceride concentrations and enlarged waist circumference. A two-hour post 75 g oral glucose tolerance test was performed in all participants. Multiple logistic regression analysis was used to evaluate the relationship of the HTGW phenotype with prediabetes.

RESULTS

Individuals with the HTGW phenotype had a higher adjusted odds ratio (OR: 1.70; 95% CI: 1.48-1.95) of prediabetes than those without the phenotype. There existed a strong relationship of the HTGW phenotype with impaired glucose tolerance (IGT) (OR: 1.83; 95% CI: 1.57-2.13), but not with impaired fasting glucose (IFG) (OR: 0.87; 95% CI: 0.65-1.17). Only women with the HTGW phenotype are significantly associated with the combined IFG and IGT (OR: 1.83; 95% CI: 1.28-2.62).

CONCLUSIONS

The HTGW phenotype was a useful risk indicator and a practical screening tool to benefit in the early diagnosis and intervention for prediabetes, particularly for IGT and the combined IFG and IGT.

Predictive factors of developing type 2 diabetes mellitus, Acute Myocardial Infarction and stroke in a cohort with Impaired Fasting Glucose in Singapore

AIMS

This study describes the incidence and predictive factors for development of Type II Diabetes Mellitus (T2DM), Acute Myocardial Infarction (AMI) and stroke, among subjects with IFG over a five-year period.

METHODS

This is a retrospective cohort study of subjects with newly diagnosed IFG from the Singapore National Healthcare Group hospitals and primary care clinics from 1 January 2008 to 31 December 2010. Clinical data were collected over a five-year period from the date of diagnosis. Outcomes of interest were T2DM, AMI and stroke based on first occurrence of the ICD-9 diagnoses from the chronic disease registry. Demographic characteristics, laboratory tests, anthropometric measurements and medical history were adjusted for in the multivariate logistic regression.

RESULTS

Out of 2295 eligible subjects, 552(24.1%) developed at least one of the outcomes. 492(21.4%) developed T2DM, 20(0.9%) developed AMI and 62(2.7%) developed stroke. Predictive factors for development of any of the three outcomes included age 40-49 [Adjusted OR=2.25; 95% CI 1.44-3.51], blood pressure of 140/90mmHg and above [Adjusted OR=1.62, 95% CI 1.26-2.10] and BMI of 27.5kg/m² or more [Adjusted OR=2.35; 95% CI 1.61-3.41]. Females were more likely to develop T2DM [Adjusted OR=1.43; 95% CI 1.10-1.85] but less likely to develop AMI and/or stroke compared to males [Adjusted OR=0.43; 95% CI 0.24-0.76].

CONCLUSIONS

Development of T2DM/AMI/stroke within the first five years of IFG is significantly high for subjects age 40-49 and those with high BMI. Frequency of cardiovascular risk screening, which is currently once every three years, could be increased.

Curcumin Protects against Ischemic Stroke by Titrating Microglia/Macrophage Polarization

Stroke is the most common type of cerebrovascular disease and is a leading cause of disability and death. Ischemic stroke accounts for approximately 80% of all strokes. The remaining 20% of strokes are hemorrhagic in nature. To date, therapeutic options for acute ischemic stroke are very limited. Recent research suggests that shifting microglial phenotype from the pro-inflammatory M1 state toward the anti-inflammatory and tissue-reparative M2 phenotype may be an effective therapeutic strategy for ischemic stroke. The dietary phytochemical curcumin has shown promise in experimental stroke models, but its effects on microglial polarization and long-term recovery after stroke are unknown. Here we address these gaps by subjecting mice to distal middle cerebral artery occlusion (dMCAO) and administering curcumin intraperitoneally (150 mg/kg) immediately after ischemia and 24 h later. Histological studies revealed that curcumin post-treatment significantly reduced cerebral ischemic damage 3 days after dMCAO. Sensorimotor functions—as measured by the adhesive removal test and modified Garcia scores—were superior in curcumin-treated mice at 3, 5, 7 and 10 days after stroke. RT-PCR measurements revealed an elevation of M2 microglia/macrophage phenotypic markers and a reduction in M1 markers in curcumin-treated brains 3 days after dMCAO. Immunofluorescent staining further showed that curcumin treatment significantly increased the number of CD206⁺Iba1⁺ M2 microglia/macrophages and reduced the number of CD16⁺Iba1⁺ M1 cells 10 days after stroke. In vitro studies using the BV2 microglial cell line confirmed that curcumin inhibited lipopolysaccharide (LPS) and interferon-γ (IFN-γ)-induced M1 polarization. Curcumin treatment concentration-dependently reduced the expression of pro-inflammatory cytokines, including TNF-α, IL-6 and IL-12p70, in the absence of any toxic effect on microglial cell survival. In conclusion, we demonstrate that curcumin has a profound regulatory effect on microglial responses, promoting M2 microglial polarization and inhibiting microglia-mediated pro-inflammatory responses. Curcumin post-treatment reduces ischemic stroke-induced brain damage and improves functional outcomes, providing new evidence that curcumin might be a promising therapeutic strategy for stroke.