Predictors of Stroke in Type 2 Diabetics Identified

Researchers have identified several risk factors for stroke in type 2 diabetic patients, with the two strongest being older age and a prior stroke. Numerous reports have shown type 2 diabetes to be a strong risk factor for cerebrovascular disease, but few studies have looked at the occurrence of stroke and associated predictors in unselected populations of patients with the disease.

As reported in the April issue of Stroke, Dr. Carol Bruno Giorda, from the Metabolism and Diabetes Unit in Chieri, and colleagues assessed the incidence of stroke in 14,432 diabetic patients, between 40 and 97 years of age, with and without a history of cardiovascular disease.

Over a 4-year period, a total of 296 strokes were logged, the report indicates. The rates of stroke in men and women without a history of cardiovascular disease were 5.5 and 6.3 cases per 1000 person-years, respectively. The corresponding rates in patients with a history of cardiovascular disease were 13.7 and 10.8 per 1000 person-years.

For each 10-year increase in age, the risk of stroke increased by 1.94- and 2.25-fold in men and women, respectively, without a history of cardiovascular disease. Similar risks were seen in patients with a history of such disease. In both sexes, a prior history of stroke more than doubled the risk of stroke, the report indicates.

Predictors of stroke in men without a history of cardiovascular disease included HbA1c and smoking, whereas in men with a history, use of insulin therapy plus oral agents, treatment for high cholesterol, and low HDL cholesterol were identified as risk factors. In women, microvascular complications were an important predictor of stroke.

"What emerges from our results in practical terms is that a diabetes specialist with ~2000 patients will probably have to face ~15 new cases of stroke each year, consisting mostly of older patients and those with a more complex clinical history of diabetes," the authors conclude.

Stroke 2007;38:1154-1160.

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