Association of Prestroke Glycemic Control With Vascular Events During 1-Year Follow-up

Jun Young Chang, Wook Joo Kim, Jee Hyun Kwon, Ji Sung Lee, Beom Joon Kim, Joon Tae Kim, Jun Lee, Jae Kwan Cha, Dae Hyun Kim, Yong Jin Cho, Keun Sik Hong, Soo Joo Lee, Jong Moo Park, Byung Chul Lee, Mi Sun Oh, Sang Hwa Lee, Chulho Kim, Dong Eog Kim, Kyung Bok Lee, Tai Hwan ParkJay Chol Choi, Dong Ick Shin, Sung Il Sohn, Jeong Ho Hong, Hee Joon Bae, Moon Ku Han

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background and ObjectivesWe evaluated the association between admission glycated hemoglobin (HbA1c) and subsequent risk of composite vascular events, including stroke, myocardial infarction (MI), and vascular death, in patients with acute ischemic stroke and diabetes.MethodsPatients who had a TIA or an acute ischemic stroke within 7 days of symptom onset and diabetes were included in a retrospective cohort design using the stroke registry of the Clinical Research Center for Stroke in Korea. The association between admission HbA1c and composite vascular events, including stroke, MI, and vascular death, during 1-year follow-up was estimated using the Fine-Gray model. The risk of composite vascular events according to the ischemic stroke subtype was explored using fractional polynomial and linear-quadratic models.ResultsOf the 18,567 patients, 1,437 developed composite vascular events during follow-up. In multivariable analysis using HbA1c as a categorical variable, the risk significantly increased at a threshold of 6.8%-7.0%. The influence of admission HbA1c level on the risk of composite vascular events was pronounced particularly among those in whom fasting glucose at admission was ≤130 mg/dL. The optimal ranges of HbA1c associated with minimal risks for composite vascular events were lowest for the small vessel occlusion subtype (6.6 [95% confidence internal [CI], 6.3-6.9]) compared to the large artery atherosclerosis (7.3 [95% CI, 6.8-7.9]) or the cardioembolic subtype (7.4 [95% CI, 6.3-8.5]).DicussionIn patients with ischemic stroke and diabetes, the risks of composite vascular events were significantly associated with admission HbA1c. The optimal range of admission HbA1c was below 6.8%-7.0% and differed according to the ischemic stroke subtype.

Original languageEnglish
Pages (from-to)E1717-E1726
JournalNeurology
Volume97
Issue number17
DOIs
StatePublished - 26 Oct 2021

Fingerprint

Dive into the research topics of 'Association of Prestroke Glycemic Control With Vascular Events During 1-Year Follow-up'. Together they form a unique fingerprint.

Cite this