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Diabetes raises stroke risk in Japanese adults
By jeremyc | November 27, 2009
Source: MedWire News
Diabetes is an independent risk factor for ischemic stroke in both men and women, a study of the Japanese population has found.
Interestingly, the same study found that diabetes was a risk factor for coronary heart disease (CHD) in women but not in men, an unexpected result that requires further investigation, say the study authors writing in the journalStroke.
Yasufumi Doi (Kyushu University, Fukuoka, Japan) and team sought to clarify the relationship between glucose handling and different forms of cardiovascular disease in a defined community-dwelling Japanese population.
The study participants were 2421 men and women living in Fukuoka, southern Japan, who were screened in 1988 and followed-up annually for 14 years as part of the Hisayama study. All participants were free of stroke and CHD at baseline.
Doi et al performed a range of analyses, looking at the risks for stroke and CHD according to baseline glucose tolerance status, defined by a 75-mg oral glucose tolerance test (OGTT) and interpreted using the 1998 World Health Organization criteria.
In multivariable analysis, the risks for ischemic stroke in both genders and for CHD in women were significantly increased in subjects with diabetes (fasting plasma glucose [FPG] ≥7.0 mmol/l and/or 2-hour plasma glucose [PG] ≥11.1 mmol/l) versus those with normal glucose tolerance (FPG <6.1 mmol/l and 2-hour PG <7.8 mmol/l).
After adjusting for age and other confounding factors, the hazard ratios (HRs) associated with diabetes were 2.54 for ischemic stroke in men, 2.02 for ischemic stroke in women, and 3.46 for CHD in women. The HR for CHD in men was non-significant at 1.26.
In an analysis of stroke subtypes, diabetes was a significant independent risk factor for lacunar infarction in women and for nonlacunar infarction in men, with adjusted HRs of 2.65 and 3.78, respectively.
The risks for ischemic stroke and CHD were not significantly increased in individuals with intermediate glucose handling – defined as either impaired fasting glucose or impaired glucose tolerance – in men or women, however.
In their discussion, Doi et al note that very few prospective studies have provided evidence of the association between glucose tolerance levels and incidence of stroke and CHD. This study supports diabetes as a strong independent risk factor for ischemic stroke in both genders as well as CHD in women, but not men.
“Although the precise reasons for this sex difference in the CHD risk conferred by diabetes are unknown, the higher prevalence of smoking in men may be responsible for this phenomenon,” they suggest.
“A smoking habit, which is a major risk factor for CHD, is considered to increase the risk of CHD in subjects with normal glucose levels, which would weaken the association of diabetes with CHD in men.”
They add: “Because the risks of stroke and CHD and the prevalence of diabetes differ among races, further investigations are required to clarify the relationship between hyperglycemia and type of cardiovascular disease in other ethnic populations.”
Topics: | Diabetes |
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