Stroke prevention in diabetes and obesity.
Stroke is an important cause of morbidity and mortality, and is an economic burden. Diabetes and obesity are two important modifiable risk factors for stroke. Patients with diabetes have a higher incidence of stroke and a poorer prognosis after stroke. Risk-factor modification is the most important aspect of prevention of stroke in diabetes and obesity. This includes lifestyle modifications and different therapeutic modalities to control conditions, such as diabetes, hypertension, dyslipidemia and arrhythmia. Recent landmark studies have shown the beneficial effects of statins in diabetic patients even with close to normal or normal low-density lipoprotein cholesterol. Obesity, which is a risk factor for diabetes, hypertension and hyperlipidemia has been shown to be an independent risk factor for stroke. Increased leptin, dysregulation of adipocyte proteins, increased insulin resistance and C-reactive protein may be factors involved in the increased incidence of cardiovascular morbidity and mortality directly related to obesity. Visceral fat is a much bigger health risk than subcutaneous fat. Lifestyle interventions and pharmacotherapeutic agents have been used to manage obesity. In morbidly obese patients, surgical intervention seems to be the best method of treatment with a long-lasting favorable metabolic outcome. In the 21st Century, with the advanced medical knowledge and the therapeutic modalities available, it should be possible to reduce the incidence of stroke associated with diabetes and obesity.
Kurukulasuriya
L Romayne
LR
University of Missouri-Columbia, Department of Internal Medicine, MA410 Health Science Center, One Hospital Drive, Columbia, MO 65212, USA. RomayneL@health.missouri.edu
Govindarajan
Gurushankar
G
Sowers
James
J
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D001786:Blood Glucose / Q000032:analysis; D002317:Cardiovascular Agents / Q000494:pharmacology / Q000627:therapeutic use; D016893:Carotid Stenosis / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control*; D003928:Diabetic Nephropathies / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology; D050171:Dyslipidemias / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007333:Insulin Resistance / Q000502:physiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D020738:Leptin / Q000097:blood; D008019:Life Style; D008074:Lipoproteins / Q000097:blood; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001786:Blood Glucose; D002317:Cardiovascular Agents; D020738:Leptin; D008074:Lipoproteins; D017395:Plasminogen Activator Inhibitor 1; D001241:Aspirin