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Cardiovascular prognosis poor with type 1 diabetes, incident stroke
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Adults with type 1 diabetes and incident stroke are at risk for all-cause mortality and have a poor cardiovascular prognosis, especially if they experience hemorrhagic stroke and progression of diabetic kidney disease, study data show.
Per-Henrik Groop, MD, DMSc, professor of nephrology at Folkhälsan Research Center in Helsinki, and colleagues evaluated data from the FinnDiane study on 144 adults with type 1 diabetes who experienced an incident stroke between 1997 and 2010 to assess the prognosis of the patients and to identify predictors of survival after a stroke.
The primary endpoint was hard CV events and death as a result of CV or diabetes-related cause collectively referred to as a vascular composite endpoint. Follow-up time to the composite endpoint was 3.4 years.
During follow-up, 72% of participants experienced a vascular composite endpoint, whereas the remaining 28% were free of the event. Among participants who had a composite endpoint, 32% experienced a hard CV event, 32% experienced a recurrent stroke and 8% experienced multiple strokes.
There was a steady decrease in overall survival from 76% at 1 year to 58% at 5 years. The 1-year survival was higher with ischemic stroke (87%) compared with hemorrhagic stroke (52%; P < .001), and survival decreased for both at 5 years (46% for hemorrhagic stroke vs. 64% for ischemic stroke; P = .038). Survival among participants also decreased with increasing chronic kidney disease stage with the 1-year survival: 87% for stage 1, 88% for stage 2, 81% for stage 3, 64% for stage 4 and 50% for stage 5. Survival further decreased at 5 years: 87% for stage 1, 63% for stage 2, 53% for stage 3, 57% for stage 4 and 30% for stage 5.
“For the first time, predictors of survival and prognosis after an incident stroke in type 1 diabetes could be elucidated, and hemorrhagic stroke, ESRD and CKD stages 2-5 all independently increase the risk of a recurrent stroke, hard cardiovascular event, or death by cardiovascular or diabetes-related cause,” the researchers wrote. “Prevention of stroke, and especially of diabetes-related kidney disease, is therefore of great importance to improve the prognosis of patients with type 1 diabetes.” – by Amber Cox
Disclosures: Groop reports receiving lecture honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Elo Water, Genzyme, Merck Sharp & Dohme, Novartis, Novo Nordisk and Sanofi, and is an advisory board member of AbbVie, AstraZeneca, Boehringer Ingelheim, Cebix, Eli Lilly, Jansson, Novartis, Novo Nordisk and Sanofi. Please see the study for all other authors’ relevant financial disclosures.
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