Additive Interaction of Hyperglycemia and Albuminuria on Risk of Ischemic Stroke in Type 2 Diabetes

Yang, Xilin; Ko, Gary T.C.; So, Wing Yee; Ma, Rong; Kong, Alice P.S.; Lam, Christopher Wai‐Kei; Ho, Chung Shun; Chow, Chun‐Chung; Tong, Peter C.Y.; Chan, Juliana C.N.

doi:10.2337/dc08-1079

Cited by 29 publications

(24 citation statements)

References 25 publications

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“…We confirmed in our cohort the association of MA with the general cerebrovascular risk factors such as diabetes, atrial fibrillation, glucose level upon admission, age and chronic kidney disease reported in previous studies [13,14]. Interestingly, we found a significant association between MA and CRP levels.…”

Section: Discussionsupporting

confidence: 91%

Microalbuminuria

et al. 2012

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Section: Discussionsupporting

confidence: 91%

Microalbuminuria

et al. 2012

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“…There were a total 48 596 participants and 1263 stroke events in the current meta-analysis. Among 13 estimates, 6 derived from the general population, [15][16][17][18]22,23 5 from a Type 2 DM population, 13,14,16,19,20 and 2 from a population with a stroke history. 12,21 Nine studies were from a white-dominant population, [12][13][14][15][16][17][18][19]22 2 from an Asian population, 20,21 and 1 from an American Indian population.…”

Section: Resultsmentioning

confidence: 99%

“…13-15,17,18,20 -23 Eleven studies reported fatal plus nonfatal stroke as a primary end point, whereas 1 reported fatal stroke as a primary end point. 19 Three studies used ischemic stroke as a primary end point 15,18,20 and others used all reported stroke as a primary end point. [12][13][14]16,17,19,[21][22][23] Overall quality of studies was good (median, 6; range, 5 to 7).…”

Section: Resultsmentioning

confidence: 99%

Impact of Microalbuminuria on Incident Stroke

Lee

Saver²,

Chang³

et al. 2010

Stroke

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Background and Purpose-Microalbuminuria, a marker of both kidney disease and endothelial dysfunction, may be associated with global vascular risk, but the nature and magnitude of the link between microalbuminuria and incident stroke has not been clearly defined. The purpose of this study was to assess the consistency and strength of the association of microalbuminuria with risk of stroke in prospective studies using meta-analysis. Methods-We conducted a systematic search of electronic databases and bibliographies for studies reporting a multivariate-adjusted estimate, represented as relative risk with 95% CI, of the association between microalbuminuria and stroke risk. Studies were excluded if a majority of study participants had established kidney disease or pre-eclampsia. Estimates were combined using a random-effect model. Results-We identified 12 studies, with a total of 48 596 participants and 1263 stroke events. Overall, presence of microalbuminuria was associated with greater stroke risk (relative risk, 1.92; 95% CI, 1.61 to 2.28; PϽ0.001) after adjustment for established cardiovascular risk factors. There was evidence of significant heterogeneity in the magnitude of the association across studies (P for heterogeneity Ͻ0.001, I

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“…1) included five studies that compared stroke risk among subjects with baseline normoalbuminuria (UAE <30 mg/day or nearest equivalent interval), microalbuminuria (UAE 30–300 mg/day or nearest equivalent interval), and macroalbuminuria (UAE >300 mg/day) [4,5,6,7,8], generating six independent adjusted stroke risk estimates. Only two studies analyzed albuminuria level versus stroke risk as a continuous variable [9,10].…”

Section: Resultsmentioning

confidence: 99%

Level of Albuminuria and Risk of Stroke: Systematic Review and Meta-Analysis

et al. 2010

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Background: Gross albuminuria is associated with increased stroke risk, but it is unclear whether stroke incidence varies by level of albuminuria. We meta-analyzed prospective cohort studies to investigate the impact of various albuminuria levels and continuous urinary albumin excretion (UAE) change on stroke risk. Methods: Systematic search for studies reporting quantitative estimates of the multivariate-adjusted relative risk (RR) and 95% CI for stroke risk associated with microalbuminuria (UAE 30–300 mg/day or nearest equivalent interval) and macroalbuminuria (UAE >300 mg/day) and studies that analyzed the relation of stroke with UAE continuously. Estimates were combined using a random-effect model. Results: We identified seven studies comprising 46,638 participants with 1,479 stroke events. Incident stroke risk was greater for macroalbuminuria (RR 2.65, 95% CI 2.25–3.14) than microalbuminuria (RR 1.58, 95% CI 1.39–1.80), a difference that was significant (p for heterogeneity < 0.001, I² = 96%). In addition, risk of stroke increased proportionally with rising UAE (p < 0.001), even for UAE within normal range (beginning from levels as low as 2–4 mg/g). Conclusions: Higher albuminuria level confers greater stroke risk. These findings provide additional weight to evidence that albuminuria is strongly linked to stroke risk, and suggest that persons with elevated UAE levels may especially benefit from more intensive vascular risk reduction.

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Additive Interaction of Hyperglycemia and Albuminuria on Risk of Ischemic Stroke in Type 2 Diabetes

Cited by 29 publications

References 25 publications

Microalbuminuria

Microalbuminuria

Impact of Microalbuminuria on Incident Stroke

Level of Albuminuria and Risk of Stroke: Systematic Review and Meta-Analysis

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