Stroke, Vol 25, 1157-1164, Copyright © 1994 by American Heart Association
J Kuusisto, L Mykkanen, K Pyorala and M Laakso
BACKGROUND AND PURPOSE: Non-insulin-dependent diabetes mellitus (NIDDM) is
a major risk factor for stroke in the middle-aged population, but few
prospective population-based studies are available in the elderly.
Moreover, the importance of metabolic control and the duration of diabetes
in diabetic subjects has remained controversial. There are no previous
studies on association of insulin with the risk of stroke. The present
study examined whether NIDDM, its metabolic control and duration, and
insulin level predict stroke. METHODS: We measured cardiovascular risk
factors including glucose tolerance, plasma insulin, and glycosylated
hemoglobin A1c in a Finnish cohort of 1298 subjects aged 65 to 74 years and
investigated the impact of these risk factors on the incidence of both
fatal and nonfatal stroke during 3.5 years of follow-up. RESULTS: Of 1298
subjects participating in the baseline study, 1069 did not have diabetes
and 229 had NIDDM. During the 3.5-year follow-up, 3.4% (n = 36) of
nondiabetic subjects and 6.1% (n = 14) of NIDDM subjects had a nonfatal or
fatal stroke. The incidence of stroke was significantly higher in diabetic
women compared with nondiabetic women (odds ratio [OR], 2.25; 95%
confidence interval [CI], 1.65 to 3.06). In contrast, the risk of stroke
was not significantly higher in diabetic men than in nondiabetic men (OR,
1.36; 95% CI, 0.44 to 4.18). In multivariate logistic regression analyses
including all study subjects, fasting and 2-hour glucose (P < .01 and P
< .05, respectively), glycosylated hemoglobin A1c (P < .01), atrial
fibrillation (P < .05), hypertension (P < .05), and previous stroke
(P < .01) predicted stroke events. In diabetic subjects, fasting and 2-
hour glucose (P < .01 and P < .05, respectively), glycosylated
hemoglobin A1c (P < .05), the duration of diabetes (P < .05), and
atrial fibrillation (P < .05) were the baseline variables predicting
stroke events. Finally, fasting insulin (P < .05), hypertension (P <
.05), and previous stroke (P < .01) were associated with stroke
incidence in nondiabetic subjects. CONCLUSIONS: Our 3.5-year follow-up
study provides evidence that NIDDM, its metabolic control, and the duration
of diabetes are important predictors of stroke in elderly subjects,
particularly in women. Moreover, fasting insulin level appears to be a risk
factor for stroke in elderly nondiabetic subjects.
ARTICLES
Non-insulin-dependent diabetes and its metabolic control are important predictors of stroke in elderly subjects
Department of Medicine, Kuopio University Hospital, Finland.
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