title: Elevated levels of hemoglobin A1c are associated with cerebral white matter disease in patients with stroke.
abstract: OBJECTIVE
  This study was conducted to investigate the association of cerebral white matter disease (WMD) on MRI with vascular risk factors and laboratory findings in consecutive first acute ischemic stroke patients.
  
  
  METHODS
  Acute ischemic stroke patients underwent MRI ≤24 hours after stroke onset and follow-up on day 2. WMD was scored on fluid attenuated inversion recovery MRI according to the Wahlund score. Vascular risk factors and laboratory parameters were assessed during hospital stay. Univariate and multiple logistic regression analyses were performed.
  
  
  RESULTS
  We included 512 patients with first acute ischemic stroke (mean age, 68.5 [SD, 13.2] years; 192 women (37.5%); median National Institutes of Health Stroke Scale on admission, 3 [interquartile range, 1-6]; and median Wahlund score, 4 [interquartile range, 2-9]). WMD was present in 460 (89.8%) patients. In univariate analysis, age, arterial hypertension, reduced estimated glomerular filtration rate, hemoglobin A1c (HbA1c) levels, diabetes mellitus, and female sex were associated with the presence of WMD (P<0.05). In multiple regression analysis, age, arterial hypertension, and elevated levels of HbA1c (P<0.05) remained independently associated with the extent of WMD.
  
  
  CONCLUSIONS
  Among known risk factors, higher levels of HbA1c were associated with cerebral WMD in stroke patients. This may suggest that chronic disturbance of glycemia measured by HbA1c plays a role in the pathophysiology of WMD.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00715533.
authors.affiliation: From the Center for Stroke Research Berlin (M.R., T.B.R., U.G., M.E., J.B.F., G.J.J.), Department of Neurology (M.R., M.E.), ExcellenceCluster NeuroCure (M.E.), German Center for Neurodegenerative Diseases (M.E.), and German Center for Cardiovascular Research (M.E.), and Department for Biostatistics and Clinical Epidemiology (U.G.), Charité-Universitätsmedizin, Berlin; and Department of Neurology, The Jewish Hospital, Berlin (G.J.J.).
authors.forename: Michal
authors.initials: M
authors.lastname: Rozanski
authors.forename: Tobias B
authors.initials: TB
authors.lastname: Richter
authors.forename: Ulrike
authors.initials: U
authors.lastname: Grittner
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
authors.forename: Gerhard J
authors.initials: GJ
authors.lastname: Jungehulsing
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology* / Q000378:metabolism / Q000473:pathology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology* / Q000378:metabolism; D006973:Hypertension / Q000453:epidemiology; D056784:Leukoencephalopathies / Q000453:epidemiology* / Q000378:metabolism / Q000473:pathology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000453:epidemiology / Q000378:metabolism; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000453:epidemiology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000378:metabolism / Q000473:pathology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: ischemia; leukoencephalopathies; magnetic resonance imaging