title: Poststroke glycemic variability increased recurrent cardiovascular events in diabetic patients.
abstract: OBJECTIVE
  The association between blood glucose fluctuation and poststroke cardiovascular outcome has been largely unknown. This study attempted to evaluate whether initial glycemic variability increases cardiovascular events and mortality in diabetic patients with acute ischemic stroke.
  
  
  METHODS
  We recruited consecutive patients with acute ischemic stroke or transient ischemic attack from March 2005 to December 2014. A total of 674 patients with diabetes within 72 hours from stroke onset were included. The serum glucose levels were checked 4 times per day during the initial 3 hospital days. J-index, coefficients of variation and standard deviation were calculated for glycemic variability. Composite outcome (nonfatal stroke, nonfatal myocardial infarction, cardiovascular death) and all-cause mortality at 3 months were prospectively captured. Multivariable logistic regression analyses were done adjusting for covariates which can influence on cardiovascular outcomes.
  
  
  RESULTS
  Cardiovascular composite outcomes at 3 months were identified in 71 (10.5%): 11 (6.5%), 15 (8.9%), 18 (10.7%) and 27 (16.0%) in each J-index quartiles (P = .035). The highest quartile of J-index had significantly higher cardiovascular death (4.2%, 3.6%, 6.5% and 11.8%; P = .008). In multivariable logistic regression, age (odds ratio [OR] 1.045; 95% confidence interval [CI] 1.006-1.084), P = .021), NIH stroke scale (OR 1.078; 95% CI 1.024-1.134, P = .004), and the highest J-index (OR 12.058; 95% 1.890-76.912, P = .008) were significantly associated with 3-month cardiovascular composite outcome. Increased cardiovascular outcomes in highest J-index quartile were similar in both euglycemic and hyperglycemic groups.
  
  
  CONCLUSIONS
  The initial glycemic variability might increase cardiovascular events in acute ischemic stroke patients with diabetes.
authors.affiliation: Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jee-Eun
authors.initials: JE
authors.lastname: Yoon
authors.affiliation: Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jun-Sang
authors.initials: JS
authors.lastname: Sunwoo
authors.affiliation: Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea.
authors.forename: Ji Sun
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hakjae
authors.initials: H
authors.lastname: Roh
authors.affiliation: Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea.
authors.forename: Moo-Young
authors.initials: MY
authors.lastname: Ahn
authors.affiliation: Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hee-Yeon
authors.initials: HY
authors.lastname: Woo
authors.affiliation: Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea. Electronic address: kblee@schmc.ac.kr.
authors.forename: Kyung Bok
authors.initials: KB
authors.lastname: Lee
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000628:therapy; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D058065:Diabetic Cardiomyopathies / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control
chemical_list: D001786:Blood Glucose
keywords: Acute ischemic stroke; Cardiovascular outcomes; Glycemic variability; J-index