Diabetes, the Metabolic Syndrome, and Ischemic Stroke
Epidemiology and possible mechanisms
- Ellen L. Air, MD, PHD1 and
- Brett M. Kissela, MD2
- 1Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
- 2Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Address correspondence and reprint requests to Brett M. Kissela, Department of Neurology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0525, Cincinnati, OH 45267-0525. E-mail: brett.kissela{at}uc.edu
- ARIC, Atherosclerosis Risk in Communities
- CAD, coronary artery disease
- CARDS, Collaborative AtoRvastatin Diabetes Study
- CHD, coronary heart disease
- CIMT, carotid intima-media thickness
- EPIC, European Prospective Investigation Into Cancer
- GCNKSS, Greater Cincinnati–Northern Kentucky Stroke Study
- NHANES III, Third National Health and Nutrition Survey
- TIA, transient ischemic attack
- UKPDS, UK Prevention in Diabetes Study
- WHR, waist-to-hip ratio
Stroke affects more than 700,000 individuals each year; it is the third largest cause of death and the largest cause of adult disability in the U.S. Diabetes is a major risk factor for the development of stroke, yet this risk is not realized or understood by patients with diabetes. This likely reflects a lack of understanding within the medical community of how diabetes confers this risk. We will explore the potential underlying mechanisms that lead to increased incidence of stroke among diabetic patients. Beyond diabetes itself, the metabolic syndrome and its components will also be discussed. The impact of diabetes and hyperglycemia on stroke outcomes and a discussion of current approaches to reduce stroke in this high-risk population are included. Because type 2 diabetes affects the vast majority of those diagnosed with diabetes, it will be the primary focus of this discussion.
DEFINING THE PROBLEM—
It has been well documented that diabetes confers a significantly increased risk of stroke, as well as increased mortality following stroke (1–7). Stroke is a preventable disease with high personal and societal cost. While great progress has been made in understanding the link between diabetes and coronary heart disease (CHD), the literature on diabetes and stroke has been less enlightening. CHD is a larger problem that accounts for 40–50% of mortality in diabetes. Because of the overwhelming impact of CHD, the impact of stroke has been relatively underappreciated. Thus, physicians, diabetes educators, and nurses are less equipped to educate patients. We therefore review the relationship between diabetes and stroke.
Given that more than one million people are diagnosed with diabetes yearly, a figure that is expected to rise, the impact of diabetes on the incidence of stroke is of increasing importance. Diabetic patients compose roughly 6.3% of the U.S. population but account for 15–27% of all …
