June 21, 2007 — Research shows individuals who develop type 2 diabetes have a 2-fold increased stroke risk within the first 5 years of diagnosis compared with the general population.
Investigators at the University of Alberta, Canada, found an almost 10% absolute risk for stroke within 5 years of diabetes diagnosis vs an approximate 4.5% absolute risk in the general population.
Previous research examining the association between diabetes and stroke risk has typically looked at long-term cardiovascular outcomes — usually after 10 years or more — where it has been shown associated with a 2- to 3-fold increased risk. However, this study is the first to investigate the short-term risk.
"These results show stroke risk is high, even very early in the course of diabetes. This study strongly supports aggressive management of cardiovascular risk factors immediately after diagnosis," principal investigator Thomas Jeerakathil, MD, MSc, told Medscape.
The study is published in the June 1, 2007, issue of Stroke.
Suboptimal Risk Factor Management
According to Dr. Jeerakathil, scientific evidence suggests management of cardiovascular risk factors leaves a lot to be desired, both in individuals with diabetes as well as the general population.
"With respect to diabetes we thought perhaps one of the reasons for this phenomenon was due to a perception that cardiovascular risk does not accumulate until a decade or more after disease onset. We thought it would be useful to see whether in fact, there was an upfront stroke risk following a new diagnosis of diabetes," he said.
Data for the large population-based cohort study were derived from linkable health databases from the province of Saskatchewan, Canada, which has a publicly funded health system and a population of 1 million. Stroke hospitalizations are documented yearly by age and sex, which allows investigators to compare stroke rates between the study group and the general population.
The diabetes cohort included 12,272 subjects aged 30 years or older who were recently diagnosed with type 2 diabetes. Outcomes for the diabetes study cohort included only the first stroke-related event, whereas all stroke hospitalizations were included in the population comparator group, including recurrent events.
Younger Individuals at Higher Risk
The average age of the diabetes cohort was 64 years, and 55% were men. One of the study's surprising findings, said Dr. Jeerakathil, was that the relative risk for stroke was much higher in younger individuals than in their older counterparts.
Those aged 30 to 44 years had a relative short-term risk of 5.6 vs 1.8 in subjects older than 75 years. "This was surprising to us and suggests the diabetic state in younger people is a major cause of stroke in this population," he said.
Dr. Jeerakathil added that a better understanding of the short-term risk for stroke in patients with type 2 diabetes may improve the motivation of clinicians and patients to adhere to proven therapies to lower stroke risk in patients with type 2 diabetes.
Furthermore, he pointed out that because of the population-based design of the study, which included an entire population covered under a universal health care system, the results are highly generalizable.
"I hope this study will outline to people there is a risk for stroke even in the first few years after diagnosis and treatment [of diabetes] and I hope it will highlight to both physicians and patients that major cardiovascular risk factors need to be aggressively managed right from the time a patient is diagnosed," said Dr. Jeerakathil.
Stroke. 2007;38:1739-1743.
No comments:
Post a Comment