(Stroke. 1996;27:63-68.)
© 1996 American Heart Association, Inc.
Articles |
Predictors of Stroke in Middle-Aged Patients With Non–Insulin-Dependent Diabetes
From the Department of Medicine, Kuopio University Hospital, Kuopio (S.L., K.P., M.L.), and the Department of Medicine, Turku University Central Hospital, and The Social Insurance Institution, Turku (T.R.), Finland.
Correspondence to Markku Laakso, MD, Department of Medicine, Kuopio University Hospital, SF-70210 Kuopio, Finland.
Background and Purpose The risk of stroke is known to be markedly elevated in patients with non–insulin-dependent diabetes mellitus (NIDDM), but the information on risk factors predicting stroke events in middle-aged NIDDM patients is limited. Therefore, we evaluated the significance of different cardiovascular risk factors with respect to the incidence of stroke in middle-aged NIDDM patients.
Methods Levels of cardiovascular risk factors were determined at baseline in 1059 NIDDM patients (581 men, 478 women) and 1373 nondiabetic control subjects (638 men, 735 women), aged from 45 to 64 years, in eastern and western Finland. These patients were followed up for 7 years with respect to stroke events.
Results Altogether, 34 NIDDM patients (13 men, 21 women) and 5 nondiabetic subjects (4 men, 1 woman) died from stroke, and 125 NIDDM patients (61 men, 64 women) and 30 (18 men, 12 women) nondiabetic subjects had a fatal or nonfatal stroke. The risk of stroke in NIDDM men was about threefold and in NIDDM women fivefold higher than that in corresponding nondiabetic subjects. Previous history of stroke increased the risk of a new stroke event by threefold. Patients with hyperglycemia (plasma glucose >13.4 mmol/L) and high hemoglobin A1 (>10.7%) had about a twofold higher risk of stroke than patients with better glycemic control. Low levels of high-density lipoprotein cholesterol (<0.90 mmol/L), high levels of total triglyceride (>2.30 mmol/L), and the presence of hypertension were associated with a twofold increase in the risk of stroke mortality or morbidity.
Conclusions Our prospective population-based study gives evidence that previous history of stroke, hypertension, hyperglycemia, and dyslipidemia are strong predictors of stroke in middle-aged patients with NIDDM.
Key Words: diabetes mellitus • glucose • mortality • risk factors
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|
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