(Stroke. 1999;30:1780-1786.)
© 1999 American Heart Association, Inc.
Original Contributions |
Nonfasting Serum Glucose and Insulin Concentrations and the Risk of Stroke
From the Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, England (S.G.W., A.G.S.), and the Department of Epidemiology and Public Health, University College Cork, Republic of Ireland (I.J.P.).
Correspondence to Dr S. Goya Wannamethee, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Rowland Hill St, London NW3 2PF, England. E-mail goya{at}rfhsm.ac.uk
Background and Purpose—Type 2 diabetes is an established risk factor for stroke, but the relations between asymptomatic hyperglycemia, hyperinsulinemia, and stroke incidence remain uncertain. We have examined the relationship between established diabetes, nonfasting serum glucose and serum insulin concentrations, and subsequent risk of stroke.
Methods—We performed a prospective study of 7735 men aged 40 to 59 years drawn from general practices in 24 British towns. Men with missing serum glucose values (n=50) and men on insulin injection (n=36) were excluded, leaving 7649 men available for analysis. Baseline nonfasting serum was analyzed for insulin with a specific enzyme-linked immunosorbent assay method in 18 of the 24 towns (n=5663 men).
Results—During the mean follow-up period of 16.8 years, there
were 347 stroke cases (fatal and nonfatal) in the 7649 men. Men who
developed diabetes during follow-up (n=320) and men with established
type 2 diabetes at screening (n=98) both showed significantly increased
risk of stroke, even after adjustment for
cardiovascular risk factors, including blood pressure
(adjusted relative risk [RR], 2.27; 95% CI, 1.23 to 4.20; RR, 2.07;
95% CI, 1.44 to 2.98, respectively). In men with no diagnosed
diabetes at screening (n=7551), risk of stroke was increased
significantly only in the top 2.5% of the nonfasting glucose
distribution (
8.2 mmol/L), and this persisted even after
adjustment for cardiovascular risk factors, including
hypertension (RR, 1.86; 95% CI, 1.11 to 3.13). Exclusion of the
320 men who developed diabetes during follow-up attenuated this risk so
that it was no longer significant (RR, 1.56; 95% CI, 0.83 to 2.91). In
the 5567 men with insulin measurements and no diagnosis of diabetes at
screening, a J-shaped relationship was seen between nonfasting insulin
and risk of stroke. Risk was significantly raised in the first quintile
and in the fourth quintile and above compared with the second quintile,
with all findings of marginal significance. Part of the increased risk
at higher levels of insulin was due to men who developed diabetes in
the follow-up period.
Conclusions—This study confirms the importance of established type 2 diabetes as an independent risk factor for stroke. The increased risk of stroke seen in hyperglycemic subjects and those with elevated serum insulin levels at screening reflected to some extent the high proportion of men who subsequently developed diabetes.
Key Words: diabetes mellitus • glucose • insulin • stroke
This article has been cited by other articles:
 |
|
 |
|
  A. K. Harris, M. M. Elgebaly, W. Li, K. Sachidanandam, and A. Ergul Effect of chronic endothelin receptor antagonism on cerebrovascular function in type 2 diabetes Am J Physiol Regulatory Integrative Comp Physiol, April 1, 2008; 294(4): R1213 - R1219. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Myint, S. Sinha, N. J. Wareham, S. A. Bingham, R. N. Luben, A. A. Welch, and K.-T. Khaw Glycated Hemoglobin and Risk of Stroke in People Without Known Diabetes in the European Prospective Investigation Into Cancer (EPIC)-Norfolk Prospective Population Study: A Threshold Relationship? Stroke, February 1, 2007; 38(2): 271 - 275. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Circulation, June 20, 2006; 113(24): e873 - e923. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Stroke, June 1, 2006; 37(6): 1583 - 1633. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. B. Levitan, Y. Song, E. S. Ford, and S. Liu Is Nondiabetic Hyperglycemia a Risk Factor for Cardiovascular Disease?: A Meta-analysis of Prospective Studies Arch Intern Med, October 25, 2004; 164(19): 2147 - 2155. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Tanne, N. Koren-Morag, and U. Goldbourt Fasting Plasma Glucose and Risk of Incident Ischemic Stroke or Transient Ischemic Attacks: A Prospective Cohort Study Stroke, October 1, 2004; 35(10): 2351 - 2355. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Almdal, H. Scharling, J. S. Jensen, and H. Vestergaard The Independent Effect of Type 2 Diabetes Mellitus on Ischemic Heart Disease, Stroke, and Death: A Population-Based Study of 13 000 Men and Women With 20 Years of Follow-up Arch Intern Med, July 12, 2004; 164(13): 1422 - 1426. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. H. FRIEDLANDER, N. R. GARRETT, and D. C. NORMAN The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus J Am Dent Assoc, November 1, 2002; 133(11): 1516 - 1523. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. N. Kernan, S. E. Inzucchi, C. M. Viscoli, L. M. Brass, D. M. Bravata, and R. I. Horwitz Insulin resistance and risk for stroke Neurology, September 24, 2002; 59(6): 809 - 815. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J.G. Hanley, K. Williams, M. P. Stern, and S. M. Haffner Homeostasis Model Assessment of Insulin Resistance in Relation to the Incidence of Cardiovascular Disease: The San Antonio Heart Study Diabetes Care, July 1, 2002; 25(7): 1177 - 1184. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Lindahl, B. Dinesen, M. Eliasson, M. Roder, G. Hallmans, and B. Stegmayr High Proinsulin Levels Precede First-Ever Stroke in a Nondiabetic Population Stroke, December 1, 2000; 31(12): 2936 - 2941. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. J. Tegos, E. Kalodiki, S.-S. Daskalopoulou, and A. N. Nicolaides Stroke: Epidemiology, Clinical Picture, and Risk Factors: Part I of III Angiology, October 1, 2000; 51(10): 793 - 808. [Abstract] [PDF]
|
|