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Diabetes as risk factor for transient ischaemic attacks as opposed to strokes
V U Fritz1, T Bilchik, L J Levien
1Neurology Department, Johannesburg Hospital, South Africa.
Insights
Diabetes mellitus increases stroke risk, making diabetics more prone to irreversible brain damage than transient ischemic attacks. Aggressive screening of asymptomatic diabetics with vascular disease is advised.
Area of Science:
- Neurology
- Endocrinology
- Vascular Medicine
Background:
- Diabetes mellitus is a common comorbidity associated with cerebrovascular disease.
- The relationship between diabetes and the type of ischemic stroke (transient vs. permanent) requires further clarification.
Purpose of the Study:
- To test the hypothesis that diabetes mellitus predisposes individuals to irreversible ischemic brain damage over reversible transient ischemic attacks (TIAs).
Main Methods:
- A cohort of 525 patients presenting with transient or minor strokes was analyzed.
- Patients were categorized into diabetic (n=54) and non-diabetic (n=471) subgroups.
- Prevalence of strokes and TIAs was compared between the subgroups, with statistical analysis of risk factors.
Main Results:
- Diabetes was not a significant risk factor for TIAs (P < 0.001).
- Diabetics were 3-4 times more likely to present with a stroke than non-diabetics (P < 0.0001).
- The diabetic subgroup exhibited significantly higher rates of hypertension (P < 0.001).
Conclusions:
- Findings support the hypothesis that diabetes increases the risk of permanent cerebral ischemia without preceding TIAs.
- Diabetics represent a high-risk subgroup for stroke, particularly when co-existing extracranial carotid vascular disease is present.
- Aggressive screening of asymptomatic diabetic patients is recommended.
Abstract:
This study examined the hypothesis that diabetes mellitus predisposes the brain to irreversible ischaemic damage rather than to reversible transient ischaemic attacks. Of 525 patients presenting with transient or minor strokes, 54 patients were found to have diabetes mellitus and 471 patients had no evidence of diabetes. The diabetic subgroup was significantly more hypertensive than the non-diabetic subgroup (P less than 0.001). In an overall comparison of the prevalence of strokes and transient ischaemic attacks in diabetic and non-diabetic subgroups, 26 (6.7%) of 388 patients with transient ischaemic attacks had diabetes mellitus, and 362 (93.3%) of 388 patients with transient ischaemic attacks were non-diabetic. Thus diabetes was not a significant risk factor for TIAs (P less than 0.001). However when the role of diabetes in causing strokes was assessed in all 525 patients evaluated in the study, 28 of 54 diabetics presented with strokes whereas 109 of 471 non-diabetics presented with strokes. Statistically diabetics were 3-4 times more likely to present with a stroke than non-diabetics (P less than 0.0001) in keeping with the findings in other centres. The findings of this study appear to support the hypothesis that diabetics are at a greater risk of permanent cerebral ischaemia without prior warning of a transient ischaemic event than their non-diabetic counterparts. It may be advisable to screen asymptomatic diabetic patients aggressively and to consider these patients as a high risk subgroup for potential stroke if extracranial carotid vascular disease is present.