Published online before print August 2, 2007, doi: 10.1161/STROKEAHA.107.488361
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(Stroke. 2007;38:2413.)
© 2007 American Heart Association, Inc.
Editorials |
Potential Impact of Sulfonylureas in the Outcome of Type 2 Diabetic Patients With Ischemic Stroke
From the Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain.
Correspondence to Dr Adrià Arboix, Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Viladomat 288, E-08029 Barcelona, Spain. E-mail aarboix@hscor.com
Key Words: cerebral infarction • diabetes mellitus • type 2 • stroke management • stroke outcome • sulfonylurea compounds
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
See related article, pages 2526–2530.
Type 2 diabetes mellitus is a well known independent risk factor for coronary heart disease and stroke.1 Diabetes accelerates the clinical course of atherosclerosis and contributes to increased cardiovascular morbidity and mortality.2 Moreover, diabetes is the cerebrovascular risk factor associated with greater in-hospital mortality either in patients with ischemic stroke3–5 or primary intracerebral hemorrhage.6 However, the reason for an increased early mortality and worse prognosis in diabetic patients with cerebral infarction is not well understood. Diabetic patients with stroke had atrial fibrillation more often than nondiabetic patients.3 Congestive heart failure and atrial fibrillation are major aggravating factors in this population and are likely to further increase substantially the risk of stroke, cardiac events, and sudden death, indicating that diabetic stroke patients may have larger cerebral infarcts than nondiabetics.3,4 In addition, the worse prognosis may probably be related to metabolic derangement caused by hyperglycemia. Data from experimental studies show that hyperglycemia exacerbates ischemic lesions by increasing acidosis-related damage and is associated with an increase in cerebral edema and infarct volume.1,7 Cerebral edema is a complex pathophysiological process that causes brain swelling, complicates ischemic stroke, worsens neurological dysfunction, and can lead to brain herniation and death.8 Malignant cerebral edema after a large ischemic stroke in the territory of the middle cerebral artery is responsible for the high mortality (60% to 80%) of the patients.8
Recent experimental studies have shown that sulfonylureas may have a beneficial effect on cerebral edema.9 Sulfonylurea derivatives constitute the pharmacological class of
Related Article:
Stroke 2007 38: 2526-2530.