Diabetes had a greater impact on risk of post-stroke death in younger patients
than in older patients in recent research.
San Diego—With a conclusion that initially may seem counterintuitive, a
study presented at the 2005 annual meeting of the American Neurological
Association suggests that the risk of death from a first ischemic stroke is
greater in younger patients than in older ones.
In fact, younger patients with diabetes and ischemic stroke were nearly
twice as likely to die as patients without diabetes, according to the
retrospective study led by Yong-Jin Cho, MD, assistant professor of neurology
at
"In general, older people have more comorbidities than younger people.
If patients already have several diseases, such as hypertension, atrial
fibrillation, myocardial infarction or hypercholesterolemia, than adding
diabetes onto the list may not make a big difference in mortality," Dr.
Cho said. "However, we can speculate that the impact of diabetes would be
greater in patients who have fewer comorbidities—in
other words, younger patients."
Dr. Cho and his team examined the records of all patients aged 18 years and
older (n=1,543) who were hospitalized for a first ischemic stroke in the
greater Cincinnati/Northern Kentucky region between July 1993 and June 1994.
Subjects were followed for an average of eight years; 192 (12.4%) were excluded
from the study because they died within 30 days of the stroke.
Of the 1,351 remaining patients, 442 (32.7%) had diabetes.
The analysis showed that long-term mortality was increased for patients with
diabetes in all age groups. The risk was greatest for the youngest age group
(1.76; 18-64 years) compared with the middle age group, (1.58; 65-74 years) and
the oldest age group (1.46; >75 years).
Rebecca Gottesman, MD, a stroke specialist and chief resident at
The researchers are planning further study of their findings, including a
comparison of the impact of diabetes on short- and long-term mortality after
ischemic stroke.
—Andrew N. Wilner, MD, FAAN, FACP
The major risk factors for stroke are hypertension, dyslipidemia and poorly
controlled diabetes. The younger patients may have had a significant difference
in these risk factors to account for their increased susceptibility to
mortality. What is more likely, however, is that older people have generalized
ischemia that has been present for a long time and have developed collaterals
sparing brain destruction. In addition, we need to differentiate ischemic from
hemorrhagic stroke, the latter having graver consequences than the former.
—
Professor of Medicine, Pathology and Neurobiology, and Director of
Research at the Strelitz Diabetes Institutes at
Eastern