Mortality risk after ischemic stroke increases with time, younger age in diabetes
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The risk for mortality after an ischemic stroke increased with longer follow-up time and younger age for adults with diabetes, according to findings published in the Journal of Diabetes and Its Complications.
“Our findings suggest that younger diabetic patients after the first event of ischemic stroke might profit more from tighter risk factor control interventions while patients [older than] 90 years might enjoy a loose-control approach, since the diabetes-associated risk for mortality was found insignificant,” Efrat Zamir, BSc, a medical student at the Sackler Faculty of Medicine at Tel Aviv University in Israel, told Healio.
Zamir and colleagues conducted a retrospective observational study of adults aged at least 18 years who had an acute ischemic stroke recorded in the Israeli National Stroke Registry between 2014 and 2018. Demographic and clinical data were obtained through electronic medical records. Registry data were crosslinked with Israel’s population death registry through March 2020. Mortality within 1 month or 1 year after a stroke and mortality through the end of follow-up were outcomes in the study.
There were 41,639 adults with a first ischemic stroke between 2014 and 2018, of whom 18,526 had diabetes. Adults with diabetes were more likely to be aged 60 to 79 years, be of Arab ethnicity, have a lower socioeconomic status and were more likely to have hypertension, hyperlipidemia, congestive heart failure, ischemic heart disease, obesity and transient ischemic attack than those without diabetes. People with diabetes were also less likely to be smokers and more likely to have anemia, leukocytosis and abnormal kidney function at admission.
During the follow-up period, 13,925 of the full study cohort died. One month after a stroke, 90.9% of patients were alive, 79.9% were alive after 1 year and 66.5% were alive at the end of the follow-up. Adults with diabetes did not have an increased risk for mortality 1 month following a stroke after adjusting for comorbidities and laboratory test values. The risk for mortality among people with diabetes after having a stroke was increased with younger age and a longer follow-up time. Adults who were aged 20 years in the fifth year of follow-up after a stroke had the highest increased mortality risk compared with those without diabetes (HR = 13.9; 95% CI, 7.6-25.4), whereas those aged 90 years with diabetes did not have an increased mortality risk, regardless of the length of follow-up.
“Since many previous similar studies did not include older patients in their analysis, we were curious to investigate the diabetes-associated risk for long-term mortality, especially for these patients,” Zamir said. “We were surprised to find that not only the effect of diabetes was insignificant in that age group; it was most profound in the younger age groups and also interacted with time of follow-up. Interestingly, it did not interact with sex, in contrast to prior large-scale studies.”
Zamir added there is a lack of data on the cause of increased mortality for people with diabetes following a stroke and how glycemic control affects the risk.
“It will be very interesting to investigate whether the long-term outcome following a first ischemic stroke is improved for diabetic patients with better glycemic control and whether the effect of glycemic control is different between young and elderly patients,” Zamir said.
For more information:
Efrat Zamir, BSc, can be reached at efratmendel@mail.tau.ac.il.
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