Non-insulin-dependent diabetes and its metabolic control are important predictors of stroke in elderly subjects.

Kuusisto, Johanna; Mykkänen, Leena; Pyörälà, Kalevi; Laakso, Markku

doi:10.1161/01.str.25.6.1157

Cited by 179 publications

(107 citation statements)

References 31 publications

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“…[13][14][15][16][17] The lesions arise because of prolonged hyperglycemia and the excessive production of LDLs (with a predominance of small dense particles). This adverse milieu induces circulating monocytes to pass through the carotid vessel's intact endothelial layer (at gap junctions) and lodge in the intimal wall, where they mature into macrophages.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus

Friedlander¹,

Garrett²,

Norman³

et al. 2002

The Journal of the American Dental Association

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Type 2 diabetes mellitus (previously known as noninsulin-dependent diabetes mellitus) afflicts approximately 15 million Americans. 1 These people are at heightened risk of stroke because hyperglycemia, hyperlipidemia, and a hypertension often associated with the disorder have been implicated as the cause of atherosclerosis of the cervical portion of the carotid artery. 2 Panoramic radiography is capable of discern-ing calcified atherosclerotic lesions (atheromas) in the cervical carotid artery and is frequently used to assess the maxillofacial 420 complex of people with type 2 diabetes because of their known propensity to have oral infections. [3][4][5][6] The scientific literature is silent, how-ever, as to the prevalence of atheromas on the radiographs of this high-risk group of patients. Therefore, we undertook a study to determine the prevalence of calcified atherosclerotic lesions among a group of patients with type 2 diabetes. MATERIAL AND METHODS Patients studiedThe members of the study group were gleaned from 94 consecutively treated outpatients attending the Diabetes Clinic at the Veterans Affairs Los Angeles Ambulatory Care Center. Inclusion criteria for the patients were (1) a diagnosis of type 2 diabetes (ie, in the unmedicated state, having a fasting plasma glucose [FPG] level > 126 mg/dL on 2 separate occasions 7 ), (2) daily insulin administration, (3) an age of 55 years or greater, and (4) the ability to sustain a panoramic radiograph. Exclusion criteria for the patients were (1) a history of a transient ischemic attack, (2) a history of a cerebrovascular acci- Results. The radiographs of the diabetics (mean age, 66.9 years) revealed that 20.4% had atheromas whereas those of the controls (mean age, 68.1 years) demonstrated that 4% had atheromas (a statistically significant difference; P = .0275). Also statistically significant was the prevalence of atherogenic risk factors (plasma glucose, Iow density lipoproteins, and serum triglycerides) identified in the diabetic group. The radiographic appearance of the atheromas manifested by both groups of individuals, however, was similar, with the lesions located 1.5-2.5 cm inferior-posterior to angle of the mandible. Conclusions.People with type 2 diabetes have a greater prevalence of calcified atheromas on their panoramic radiographs than do nondiabetics.

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Section: Discussionmentioning

confidence: 99%

The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus

Friedlander¹,

Garrett²,

Norman³

et al. 2002

The Journal of the American Dental Association

View full text Add to dashboard Cite

show abstract

“…However, as HbA 1 c is a function of both FPG and PPG, a specific deleterious effect of postprandial hyperglycaemia might not be detectable when using HbA 1 c as a parameter of glucose control. In the same cohort it was observed that FPG was a stronger predictor of stroke than 2-h OGTT plasma glucose [49]. In the already mentioned DECODE Study, it was observed that within diabetic subjects (known and previously undiagnosed with FPG ³ 7 mmol/l) those with the higher glucose concentrations following OGTT had the highest risk of CVD mortality [44].…”

Section: Postprandial Glucose and Cardiovascular Risk In Diabetes Melmentioning

confidence: 99%

Postprandial blood glucose as a risk factor for cardiovascular disease in Type II diabetes: the epidemiological evidence

2001

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“…Indeed, Wong et al showed that after the age of 75 years, patients with diabetes had the same risk of stroke as those without diabetes [2]. The evidence for an increase in risk with smoking and obesity in people with diabetes is conflicting [3,[7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

et al. 2006

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Aims/hypothesis Risk estimates for stroke in patients with diabetes vary. We sought to obtain reliable risk estimates for stroke and the association with diabetes, comorbidity and lifestyle in a large cohort of type 2 diabetic patients in the UK. Materials and methods Using the General Practice Research Database, we identified all patients who had type 2 diabetes and were aged 35 to 89 years on 1 January 1992. We also identified five comparison subjects without diabetes and of the same age and sex. Hazard ratios (HRs) for stroke between January 1992 and October 1999 were calculated, and the association with age, sex, body mass index, smoking, hypertension, atrial fibrillation and duration of diabetes was investigated. Results The absolute rate of stroke was 11.91 per 1,000 person-years (95% CI 11.41-12.43) in people with diabetes (n=41,799) and 5.55 per 1,000 person-years (95% CI 5.40-5.70) in the comparison group (n=202,733). The ageadjusted HR for stroke in type 2 diabetic compared with non-diabetic subjects was 2.19 (95% CI 2.09-2.32) overall, 2.08 (95% CI 1.94-2.24) in men and 2.32 (95% CI 2.16-2.49) in women. The increase in risk attributable to diabetes was highest among young women (HR 8.18; 95% CI 4.31-15.51) and decreased with age. No investigated comorbidity or lifestyle characteristic emerged as a major contributor to risk of stroke. Conclusions/interpretation This study provides risk estimates for stroke for an unselected population from UK general practice. Patients with type 2 diabetes were at an increased risk of stroke, which decreased with age and was higher in women. Additional risk factors for stroke in type 2 diabetic patients included duration of diabetes, smoking, obesity, atrial fibrillation and hypertension.

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Non-insulin-dependent diabetes and its metabolic control are important predictors of stroke in elderly subjects.

Cited by 179 publications

References 31 publications

The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus

The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus

Postprandial blood glucose as a risk factor for cardiovascular disease in Type II diabetes: the epidemiological evidence

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

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