Longitudinal Average Glucose Levels and Variance and Risk of Stroke: A Chinese Cohort Study

Abstract

Background. Diabetes is a known independent risk factor for stroke. However, whether higher glucose levels (126–139.9 mg/dl) can increase the risk of stroke in people without diabetes is still unknown. Moreover, as a fluctuating parameter, long-term glucose levels may also be related to the risk of stroke outcome. It is important to explore the correlation between long-term average blood glucose, as well as its variability, and stroke. Methods. We used 40,975 clinical measurements of glucose levels and 367 measurements of glycated hemoglobin A1c levels from 12,321 participants without stroke to examine the relationship between glucose levels and the risk of stroke. Participants were from the Weitang Geriatric Diseases study, including 5,707 men and 6,614 women whose mean age at baseline was 60.8 years; 1,011 participants had diabetes, and 11,310 did not. We estimated the long-term average blood glucose level based on the multilevel Bayesian model and fit in Cox regression models, stratified according to diabetes status. Results. Over a median follow-up period of 5 years, stroke developed in 279 of the 12,321 participants (244 without diabetes and 35 with). For people with an average glucose level of 126–139.9 mg per deciliter, compared with 90–99.9 mg per deciliter, the adjusted hazard ratio (HR) for total stroke was 1.78 (95% confidence interval (CI), 1.16–2.75), and the HR for levels higher than 140 mg per deciliter was 1.89 (95% CI, 1.09–3.29). Among those without diabetes whose glucose level was higher than 140 mg per deciliter, compared with 90–99.9 mg per deciliter, the adjusted HRs for total stroke and fatal stroke were 3.66 (95% CI, 1.47–9.08) and 5 (95% CI, 1.77–14.15), respectively. For a glucose standard deviation level higher than 13.83 mg per deciliter, compared with that lower than 5.91 mg per deciliter, the adjusted HR for total stroke was 2.31 (95% CI, 1.19–4.48). Conclusions. Our results suggest that higher average glucose levels (126–139.9 mg/dl) and variance may be risk factors for stroke, even among people without diabetes diagnosis.

Metabolic syndrome parameters' variability and stroke incidence in hypertensive patients: evidence from a functional community cohort

“…Our findings did not reveal a substantial correlation between WC variability and heightened risk of stroke; it is possible that being overweight or even obese in elderly individuals may confer a protective effect on health [ 40 ]. The enduring fluctuation in glucose levels has garnered increasing attention, and earlier studies corroborate our findings regarding variability in FBG [ 11 , 12 ]. There is an exact mechanism by which the fluctuations in glucose levels adversely affect endothelial function and oxidative stress compared to average glucose levels [ 41 ], ultimately exacerbating the progression of the atherosclerotic process, a crucial factor in the development of stroke [ 42 ].…”

Admission Glucose Levels May Increase the Risk for Early Neurological Deterioration in Females With Acute Ischemic Stroke

“…It was reported that GV within the initial 3 hospital days was associated with increased risk for END in diabetic patients with AIS (44). Although the mechanism for the occurrence of GV in patients with AIS is not clear, GV was strongly associated with infarct volume, severity of symptoms, and stroke outcomes (45,46). It could be important clinically to determine if the patients with elevated blood glucose levels at admission could have increased risk for GV in diabetic patients and to determine if a combined approach of optimal glycemic control and minimizing glucose fluctuations in diabetic patients could improve the outcome for stroke patients in the future studies.…”

Enriching the Study Population for Ischemic Stroke Therapeutic Trials Using a Machine Learning Algorithm

“…Additionally, both systolic and diastolic blood pressure were ranked among the most important features (top 20), with higher values indicating a higher risk of stroke onset. While diabetes is a known independent risk factor for stroke onset, recent studies have shown that elevated glucose levels and glucose fluctuations (variance) can increase stroke risk, even among individuals without diabetes ( 40 ). Similarly, we found that a high variance in glucose level correlated positively with stroke onset.…”