Gender Differences and Risk Factors of Recurrent Stroke in Type 2 Diabetic Malaysian Population with History of Stroke: The Observation from Malaysian National Neurology Registry

Abstract

Background and Purpose Diabetes mellitus has been reported as a strong independent risk factor for stroke recurrence. Data on the modifiable factors contributing to the recurrence of stroke in type 2 diabetic Malaysian population with a history of stroke stratified by genders are lacking, and this supports the importance of this study. Method The data of 4622 patients with T2DM who had a history of stroke was obtained from the Malaysian National Stroke Registry. Univariate analysis was performed to differentiate between genders with and without stroke recurrence in terms of demographics, first stroke attack presentations, and other clinical characteristics. The significant factors determined from the univariate analysis were further investigated using logistic regression. Results Ischemic heart diseases were found significantly associated with the stroke recurrence in males (OR = 1.738; 95% CI: 1.071-2.818) as well as female (OR = 5.859; 95% CI: 2.469-13.752) diabetic patients. The duration of hypertension, as well as the duration of diabetes, has been associated with the recurrence in both male and female subjects (p value < 0.05). Smoking status has an impact on the stroke recurrence in male subjects, while no significant association was observed among their peers. Conclusions Most of the predictive factors contributing to the recurrence of stroke in type 2 diabetic Malaysian population with a history of stroke are modifiable, in which IHD was the most prominent risk factor in both genders. The impact of optimizing the management of IHD as well as blood glucose control on stroke recurrence may need to be elucidated. No major differences in recurrent stroke predictors were seen between genders among the Malaysian population with type 2 diabetes mellitus who had a previous history of stroke.

Population-based Study Comparing Predictors of Ischemic Stroke Recurrence After Index Ischemic Stroke in Non-elderly Adults with or without Diabetes

“… 24 Regardless of DM status, IHD was found to be an independent predictor of recurrent IS in the current study whereby patients with history of IHD have three times the risk of IS recurrence. This finding is consistent with data reported previously 21 , 25–29 which illustrates that IHD should be considered as the main indicator of recurrent IS regardless of age and DM status. IS shares a similar pathophysiology with IHD, mainly because atherosclerosis is manifested in both conditions.…”

“…The details on the National Stroke Registry of Malaysia were published previously. 21 The stroke was diagnosed according to the World Health Organization’s criteria. 22 All diagnoses were confirmed using brain computed tomography or magnetic resonance imaging.…”

Diabetes, Vascular Aging and Stroke: Old Dogs, New Tricks?

“…Various factors are implicated in this risk. These are related to lifestyle, comorbidities, hypertension and lipid profile, but also anthropometric data, such as body weight [ 12 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 51 ] ( Figure 2 ).…”

“…Very interesting and noteworthy is the fact that women with type 1 diabetes have a relative risk of all-cause death of 40% and double the excess risk of fatal and non-fatal vascular events compared to men with type 1 diabetes, according to data obtained in a meta-analysis that included 26 studies and 214,114 individuals [ 24 ]. On the other hand, data from the Malaysian National Stroke Registry, which included 4622 individuals with type 2 DM, showed no differences between genders regarding stroke recurrence with a previous history of stroke [ 25 ].…”

Determinan Kejadian Stroke pada Pasien Hipertensi (Analisis Data Sekunder IFLS 5)

“…Uji regresi logisitik univariabel menunjukkan adanya signifikansi hubungan antara lama menderita hipertensi dengan kekambuhan stroke baik pada laki-laki (p = 0,005) maupun perempuan (p=0,006) penderita diabetes. Namun hasil uji regresi logistik multivariabel menunjukkan baik pada laki-laki maupun perempuan, keduanya menunjukkan bahwa lama menderita hipertensi tidak memiliki hubungan yang signifikan dengan kekambuhan stroke baik pada laki-laki maupun perempuan penderita diabetes (21).…”