Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus

Abstract

BackgroundWe aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High‐risk patients with Acute Non‐disabling Cerebrovascular Events) trial.Methods and ResultsIn total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of METS and DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS, 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither, METS only, DM only, and both, respectively. After 90 days of follow‐up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89–3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95% CI 1.98–3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different METS or DM status for the risk of recurrent stroke (P=0.82 for interaction in the fully adjusted model of CDS) was observed. Using the METS (IDF) criteria demonstrated similar results.ConclusionsConcurrent METS and DM was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack.

Corneal confocal microscopy identifies greater corneal nerve damage in patients with a recurrent compared to first ischemic stroke

“…A recent study from China has shown that the incidence of recurrent stroke has increased 3-fold between 1992 and 2012 [3]. Age [4], dyslipidemia [5], smoking [6], diabetes, hypertension, homocysteine levels, atrial fibrillation [1], metabolic syndrome [7] and other risk factors [8][9][10] are associated with recurrent stroke. Indeed, a recent study has shown that hypertension, prior symptomatic stroke and chronic infarcts on MRI were independently associated with recurrent stroke and this also doubled the all-cause mortality [11].…”

Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

“…Minor stroke and transient ischemic attack (TIA) are usually regarded as a whole to study because of the similar pathophysiological mechanism and epidemical characteristics . It is reported that minor ischemic stroke and TIA account for ≈65% of all acute ischemic cerebrovascular events . Although minor stroke and TIA seem to be benign, recent studies have shown that a significant proportion of patients with steno‐occlusive arterial disease is in unstable clinical state and has high risks of recurrent cerebrovascular events or early neurological deterioration (END) in the hospital, resulting in major physical disability .…”

Blood Pressure and Heat Shock Protein 70 Levels Related to Acute Ischemic Stroke Severity

“…Liu et al found that there was a significant difference between systolic blood pressure and the NIHSS value of acute stroke patients, where patients with higher systolic blood pressure had higher NIHSS values, but different results found in diastolic blood pressure. 5,11 Kvistad et al reported that elevated admission blood pressure was associated with mild stroke and severe stroke. 12 We also found no significant difference in HSP 70 levels in the mild stroke group as compared to that of a moderate stroke group.…”