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[Diabetes mellitus and stroke]
Giuseppe Licata1, Antonino Tuttolomondo, Domenico Sinagra
1Istituto di Clinica Medica I, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi, Azienda Universitaria Policlinico Piazza delle Cliniche, 2, 90127 Palermo.
Insights
Diabetes significantly increases stroke risk and worsens outcomes. Effective prevention involves managing blood sugar and using medications like ramipril, statins, and antiplatelet drugs.
Area of Science:
- Neurology
- Endocrinology
- Cardiovascular Medicine
Context:
- Ischemic stroke is a leading cause of death, with its link to diabetes still under investigation.
- Diabetic individuals exhibit higher stroke prevalence, recurrence rates, and poorer prognoses.
- Small vessel disease and the atherogenic diabetic profile contribute to cerebrovascular risk.
Purpose:
- To explore the relationship between diabetes and ischemic stroke.
- To identify key pathogenetic mechanisms, including acute hyperglycemia.
- To outline secondary prevention strategies for stroke in diabetic patients.
Summary:
- Diabetes is associated with increased stroke incidence, recurrence, and mortality.
- Acute hyperglycemia acts as a direct neuronal damage mediator and negative prognostic marker.
- Effective cerebrovascular risk management in diabetics includes glycemic control and medications (e.g., ramipril, statins, antiplatelet agents).
Impact:
- Highlights the critical need for targeted stroke prevention in diabetic populations.
- Underscores the role of hyperglycemia in stroke pathogenesis and prognosis.
- Provides evidence-based recommendations for secondary stroke prevention in diabetes management.
Abstract:
Ischemic stroke represents the third mortality cause after cardiac diseases and tumors and the relationship between diabetes and stroke incidence is still unclear. Several studies (Framingham, Copenhagen Stroke Study, Northern Sweden MONICA, NHANES) showed a higher prevalence, recurrence rate and worse prognosis of stroke in diabetic subjects. As for cerebral ischemia pathogenesis small vessel disease of deep perforating arterioles plays a crucial role although the higher cerebrovascular risk is also related to the additional risk factors and the characteristic atherogenic diabetic profile. Significant appears the pathogenetic role of acute hyperglycemia as a direct neuronal damage mediator and negative prognostic marker. On the basis of epidemiological data, cerebrovascular risk prevention in diabetic subjects consists of secondary prevention strategies regarding glycemic control, vascular protection by ramipril and perindopril, statins and antiplatelet drugs like acetylsalicylic acid and clopidogrel as shown by randomized trials (UKPDS, DCCT, HOPE, PROGRESS, 4S, WOSCOPS, CARE, LIPID, CAPRIE, etc.).