Prospective Evaluation of Carotid Bruit as a Predictor of First Stroke in Type 2 Diabetes

Abstract

Background and Purpose-We sought to examine prospectively the relationship between asymptomatic carotid bruit and stroke in type 2 diabetes. Methods-We studied 1181 (91.3%) of a community-based sample of 1294 patients with type 2 diabetes. These patients had no history of cerebrovascular disease at recruitment during 1993-1996 and were followed until the end of January 2002. Hospital morbidity and death register data relating to cerebrovascular events were also available. Cox proportional hazards models were used to determine whether carotid bruit status was an independent predictor of stroke and to identify other significant cerebrovascular risk factors. Results-One hundred thirty-four patients (11.3%) suffered a first stroke during 6.5Ϯ2.2 (meanϮSD) years of follow-up.In the first 2 years after study entry, first stroke (nϭ45/1181; 3.8%) was strongly predicted by the presence of carotid bruit(s) after adjustment for known cardiovascular risk factors and other potentially confounding variables (hazard ratio, 6.7; 95% CI, 3.0 to 14.9; PϽ0.001). Between 2 years and census, first stroke (nϭ89/1083; 8.2%) was not associated with carotid bruit(s) (Pϭ0.97). Age and diastolic blood pressure were other determinants of stroke in the first 2 years, while age, atrial fibrillation/flutter, and microalbuminuria were independent predictors of subsequent stroke. Conclusions-Type 2 diabetic patients found to have incidental carotid bruits have Ͼ6 times the risk of first stroke in the first 2 years than patients without a bruit and should receive intensified management of vascular risk factors. Carotid imaging with a view to surgical intervention in these patients remains controversial.

Asymptomatic bacteriuria as a predictor of subsequent hospitalisation with urinary tract infection in diabetic adults: The Fremantle Diabetes Study

“…Details of hospitalisations between MSU screening and the end of June 2003 were obtained from the WA Data Linkage System [6], which includes details of all WA hospital separations and deaths. Hospitalisations with urosepsis were identified from the International Classification of Diseases (ICD) 9th revision (ICD-9-CM) or 10th revision (ICD-10-AM) codes for UTI, cystitis, pyelonephritis, orchitis, epididymitis and prostatitis, as either principal diagnosis (that immediately responsible for admission) or secondary diagnosis (contributing to, but not the major cause of, hospitalisation).…”

Effect of a Pharmaceutical Care Program on Vascular Risk Factors in Type 2 Diabetes

“…Patients were classified as having coronary heart disease (CHD) if there was a self-reported history of myocardial infarction, angina, coronary artery bypass grafting or angioplasty, or if pathological Q waves were present on the electrocardiograph (20). Stroke was determined from self-report and hospital discharge data (21).…”

Bone mineral density and its determinants in diabetes: the Fremantle Diabetes Study

“…All patients completed a supplementary questionnaire which contained questions relating to (1) conditions predisposing to osteoporosis (family history, hepatic and renal disease, thyroid and parathyroid disease, inflammatory conditions including rheumatoid arthritis, malabsorption, glucocorticoid use, menopausal status and use of hormone replacement therapy [HRT]); (2) details of past fractures; (3) prior use of any treatment for osteoporosis or any medication influencing bone metabolism; and (4) details of previous bone density measurements. Additional data on fractures were obtained from hospitalisations recorded in the Western Australian Data Linkage System [23].…”

“…A subject was considered as having retinopathy if any grade of retinopathy, including maculopathy, was detected by direct and/or indirect ophthalmoscopy in one or both eyes and/or on more detailed assessment by an ophthalmologist. Self-reported stroke and transient ischaemic attack were amalgamated with prior hospitalisations to define baseline cerebrovascular disease status [23]. Patients were classified as having CHD if there was a self-reported history of, or hospitalisation for, myocardial infarction, angina, coronary artery bypass grafting, angioplasty, and/or definite myocardial infarction on a Minnesota-coded electrocardiogram [25].…”