Abnormal glucose regulation increases stroke risk in minor ischemic stroke or TIA.
OBJECTIVE
To investigate whether abnormal glucose regulation contributes to a new stroke in patients with a minor ischemic stroke or TIA.


METHODS
We derived data from the Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events trial. Patients with a minor stroke or TIA were categorized into 3 groups: patients with diabetes mellitus (DM), impaired fasting glucose (IFG), and normal fasting plasma glucose. The primary outcome was a new stroke (ischemic or hemorrhagic) at 90 days. We assessed the association between glucose regulation status and risk of stroke by multivariable Cox regression models adjusted for potential covariates.


RESULTS
Among 5,135 included patients, 1,587 (30.9%), 409 (8.0%), and 3,139 (61.1%) patients were identified as DM, IFG, and normal glucose, respectively. Compared with normal glucose, IFG (11.0% vs 6.9%; adjusted hazard ratio [adj HR] 1.57, 95% confidence interval [CI] 1.13-2.19) and DM (15.8% vs 6.9%; adj HR 2.38, 95% CI 1.97-2.88) were associated with increased risk of stroke at 3 months after a minor stroke or TIA after adjusted for potential covariates. We found a weak J-shaped association between fasting plasma glucose and risk of stroke with a nadir of 4.9 mmol/L.


CONCLUSIONS
Both IFG and DM were associated with an increased risk of stroke in patients with a minor stroke or TIA.


BACKGROUND
NCT00979589.
From the Department of Epidemiology and Health Statistics, School of Public Health (Y.P., Y.H.), and Department of Neurology, Beijing Tiantan Hospital (Y.P., J.J., H.L., Yongjun Wang, Yilong Wang), Capital Medical University; Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P., Y.H.); China National Clinical Research Center for Neurological Diseases (J.J., H.L., Yongjun Wang, Yilong Wang); Center of Stroke (J.J., H.L., Yongjun Wang, Yilong Wang), Beijing Institute for Brain Disorders; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J.J., H.L., Yongjun Wang, Yilong Wang), China.
Yuesong
Y
Pan
From the Department of Epidemiology and Health Statistics, School of Public Health (Y.P., Y.H.), and Department of Neurology, Beijing Tiantan Hospital (Y.P., J.J., H.L., Yongjun Wang, Yilong Wang), Capital Medical University; Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P., Y.H.); China National Clinical Research Center for Neurological Diseases (J.J., H.L., Yongjun Wang, Yilong Wang); Center of Stroke (J.J., H.L., Yongjun Wang, Yilong Wang), Beijing Institute for Brain Disorders; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J.J., H.L., Yongjun Wang, Yilong Wang), China.
Jing
J
Jing
From the Department of Epidemiology and Health Statistics, School of Public Health (Y.P., Y.H.), and Department of Neurology, Beijing Tiantan Hospital (Y.P., J.J., H.L., Yongjun Wang, Yilong Wang), Capital Medical University; Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P., Y.H.); China National Clinical Research Center for Neurological Diseases (J.J., H.L., Yongjun Wang, Yilong Wang); Center of Stroke (J.J., H.L., Yongjun Wang, Yilong Wang), Beijing Institute for Brain Disorders; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J.J., H.L., Yongjun Wang, Yilong Wang), China.
Hao
H
Li
From the Department of Epidemiology and Health Statistics, School of Public Health (Y.P., Y.H.), and Department of Neurology, Beijing Tiantan Hospital (Y.P., J.J., H.L., Yongjun Wang, Yilong Wang), Capital Medical University; Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P., Y.H.); China National Clinical Research Center for Neurological Diseases (J.J., H.L., Yongjun Wang, Yilong Wang); Center of Stroke (J.J., H.L., Yongjun Wang, Yilong Wang), Beijing Institute for Brain Disorders; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J.J., H.L., Yongjun Wang, Yilong Wang), China.
Yongjun
Y
Wang
From the Department of Epidemiology and Health Statistics, School of Public Health (Y.P., Y.H.), and Department of Neurology, Beijing Tiantan Hospital (Y.P., J.J., H.L., Yongjun Wang, Yilong Wang), Capital Medical University; Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P., Y.H.); China National Clinical Research Center for Neurological Diseases (J.J., H.L., Yongjun Wang, Yilong Wang); Center of Stroke (J.J., H.L., Yongjun Wang, Yilong Wang), Beijing Institute for Brain Disorders; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J.J., H.L., Yongjun Wang, Yilong Wang), China. yanhe118@sina.com yilong528@gmail.com.
Yilong
Y
Wang
From the Department of Epidemiology and Health Statistics, School of Public Health (Y.P., Y.H.), and Department of Neurology, Beijing Tiantan Hospital (Y.P., J.J., H.L., Yongjun Wang, Yilong Wang), Capital Medical University; Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P., Y.H.); China National Clinical Research Center for Neurological Diseases (J.J., H.L., Yongjun Wang, Yilong Wang); Center of Stroke (J.J., H.L., Yongjun Wang, Yilong Wang), Beijing Institute for Brain Disorders; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J.J., H.L., Yongjun Wang, Yilong Wang), China. yanhe118@sina.com yilong528@gmail.com.
Yan
Y
He
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism*; D002545:Brain Ischemia / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D000077144:Clopidogrel; D048909:Diabetes Complications / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012306:Risk; D020521:Stroke / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
D001786:Blood Glucose; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin