Diabetes and glucose intolerance as risk factors for stroke

Journal of Cardiovascular Risk

Volumn 6, Issue 4, 1999, Pages 241-249

  Tuomilehto, Jaakko ^a   Rastenyte, Daiva ^b  

^a NATIONAL PUBLIC HEALTH INSTITUTE   (Finland)

^b Institute of Cardiology   (Lithuania)

Author keywords

Cerebrovascular disease; Diabetes; Glucose intolerance; Stroke

Indexed keywords

GLUCOSE; ANTIHYPERTENSIVE AGENT; CHOLESTEROL; GLYCOSYLATED HEMOGLOBIN; HIGH DENSITY LIPOPROTEIN CHOLESTEROL; INSULIN; LOW DENSITY LIPOPROTEIN CHOLESTEROL;

BLOOD PRESSURE MEASUREMENT; DIABETES MELLITUS; DIABETIC NEPHROPATHY; GLUCOSE BLOOD LEVEL; GLUCOSE INTOLERANCE; HUMAN; HUMAN TISSUE; PRIORITY JOURNAL; PROGNOSIS; REVIEW; RISK FACTOR; STROKE; ANTIHYPERTENSIVE THERAPY; ARTERY LESION; BLOOD PRESSURE; BODY MASS; CEREBROVASCULAR ACCIDENT; CHOLESTEROL BLOOD LEVEL; DIABETIC PATIENT; DIABETIC RETINOPATHY; DISEASE COURSE; FOLLOW UP; IMPAIRED GLUCOSE TOLERANCE; INCIDENCE; INSULIN DEPENDENT DIABETES MELLITUS; INSULIN TREATMENT; KETOACIDOSIS; NON INSULIN DEPENDENT DIABETES MELLITUS; ORAL GLUCOSE TOLERANCE TEST; PREVALENCE;

EID: 0032853987     PISSN: 13506277     EISSN: None     Source Type: Journal    
DOI: 10.1177/204748739900600409     Document Type: Review

References (84)

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74. Rasmussen LM, Ledet T. Aortic collagen alterations in human diabetes mellitus: changes in basement membrane collagen content and in the susceptibility of total collagen to cyanogen bromide solubilisation. Diabetologia 1993; 36:445-453. It was found that the concentration of type IV collagen was increased in the tunica media both in plaque and non-plaque areas in the samples from the diabetic patient groups as compared with the non-diabetic groups. No consistent differences in type IV collagen concentrations were found between diabetic and non-diabetic patients in tunica intima. The type V collagen concentrations and the total collagen content were not altered in the diabetic samples. The fraction of the total collagen that was solubilized during cyanogen bromide treatment was determined, and it was found that this fraction was decreased in most tissue areas in the diabetic patient groups.
75. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977-986. Results of the study showed that in the primary-prevention cohort of patients with IDDM, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76%, as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54% and reduced the development of proliferative or severe nonproliferative retinopathy by 47%. In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria by 39%, albuminuria by 54%, and clinical neuropathy by 60%. These results confirmed that intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.
76. Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Am J Cardiol 1995; 75:894-903. The number of combined major macrovascular events was almost twice as high in the conventionally treated group as in the intensive-treatment group, although the differences were not statistically significant. There were no differences in the cumulative incidence of hypertension. Mean total serum cholesterol, calculated LDL cholesterol, and triglycerides were significantly reduced in the intensive-treatment group, as was the development of LDL cholesterol levels > 160 mg/dl. Weight gain was significantly increased in the intensive treatment group. There were no differences in cigarette smoking habits, consumption of alcohol, or aspirin use between treatment groups. The reduction in some, but not all, cardiovascular risk factors suggests a potential beneficial effect of intensive therapy on macrovascular disease in insulin-dependent diabetes mellitus.
77. Yoshinari M, Kaku R, Iwase M, Iino K, Yamamoto M, Satou Y, et al. Development of ischemic stroke in normotensive and hypertensive diabetic patients with or without antihypertensive treatment: an 8-year follow up study. J Diab Compl 1997; 11:9-14. The percentage incidence of ischemic strokes in the hypertension-treated diabetic patients was 8.9% which was similar to the 8.1% of the normotensive diabetic patients. In contrast, ischemic strokes developed in 29% of the untreated hypertensives, being significantly more frequent than in the former two groups. Multivariate analysis showed that serum total cholesterol and male sex were independent significant precursors of brain infarction in diabetic patients. It was concluded, that antihypertensive treatment decreases the incidence of ischemic stroke in diabetics. Serum total cholesterol was an independent risk factor for ischemic stroke in diabetic patients.
78. The SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265:3255-3264. This study demonstrated that in persons aged 60 years and over with isolated systolic hypertension, antihypertensive stepped-care drug treatment with low- dose chlorthalidone as step 1 medication reduced the incidence of total stroke by 36%, with 5-year absolute benefit of 30 events per 1000 participants. Major cardiovascular events were reduced, with 5-year absolute benefit of 55 events per 1000. These data confirmed the effectiveness of antihypertensive treatment in elderly.
79. Curb JD, Pressel SL, Cutler JA, Savage PJ, Applegate WB, Black H, et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. JAMA 1996; 276:1886-1892. [Published erratum, JAMA 1997; 277:1356.] This study demonstrated that in persons aged 60 years and over with isolated systolic hypertension, antihypertensive stepped-care drug treatment with low- dose chlorthalidone as step 1 medication reduced the 5-year major CVD rate by 34% both for diabetic patients and non-diabetic patients. Absolute risk reduction with active treatment compared with placebo was twice as great for diabetic versus non-diabetic patients (101/1000 versus 51/1000 randomized participants at the 5-year follow-up), reflecting the higher risk for diabetic patients.
80. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhager WH, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997; 350:757-764. Among elderly patients with isolated systolic hypertension, antihypertensive drug treatment starting with nitrendipine reduced the total rate of stroke by 44%. In the active treatment group, all fatal and non-fatal cardiac endpoints, including sudden death, declined by 26%. Non-fatal cardiac endpoints decreased by 33% and all fatal and non-fatal cardiovascular endpoints by 31%. The conclusion was made, that treatment of 1000 patients for 5 years with this type of regimen may prevent 29 strokes or 53 major cardiovascular endpoints.
81. Tuomilehto J, Rastenyte D, Birkenhänger WH, Thijs L, Antikainen R, Bulpitt CJ, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. New Engl J Med 1999; 340:677-684. This study demonstrated that in diabetic patients active treatment starting with nitrendipine reduced all-cause mortality by 55%, cardiovascular mortality by 76%, all cardiovascular endpoints by 69%, fatal and non-fatal stroke by 73% and all cardiac endpoints by 63%. In the non-diabetic patients, active treatment decreased all cardiovascular endpoints by 26% and fatal and non-fatal stroke by 38%. The conclusion was made that nitrendipine-based antihypertensive treatment is particularly beneficial in older diabetic patients with isolated systolic hypertension.
82. Sivenius J, Laakso M, Riekkinen P Sr, Smets P, Lowenthal A. European stroke prevention study: effectiveness of antiplatelet therapy in diabetic patients in secondary prevention of stroke. Stroke 1992; 23:851-854. The risk of end-point events was greater in diabetic than in non-diabetic subjects. Total end-point reduction in individuals receiving the combination of dipyridamole and acetylsalicylic acid was 39% in non-diabetic subjects and 23% in diabetic subjects in the explanatory analysis, and the reduction in the risk of stroke was 48% and 32%, respectively. However, a statistically significant reduction of risk was obtained only in non-diabetic subjects. The conclusion was made that the combination of dipyridamole and acetylsalicylic acid appeared to be more effective in non-diabetic subjects than in diabetic subjects in the prevention of death and stroke although the low number of diabetic patients may at least in part explain this result.
83. United Kingdom Prospective Diabetes Study Group. UK prospective diabetes study 33: intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998; 352:837-853.
84. United Kingdom Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317:703-713. Reductions in risk in the group of patients with type 2 diabetes assigned to tight blood pressure control (< 150/85 mmHg) compared with those assigned to less tight blood pressure control (< 180/105 mmHg) were 24% in diabetes related end-points, 32% in deaths related to diabetes, 44% in strokes, and 37% in microvascular end-points, predominantly owing to a reduced risk of retinal photocoagulation. This study provides the support for the importance of strict hypertension control in patients with type 2 diabetes when aiming to reduce the risk of deaths related to diabetes, complications related to diabetes, progression of diabetic retinopathy, and deterioration in visual acuity.