Association of Prestroke Glycemic Control With Vascular Events During 1-Year Follow-up
Jun Young Chang1, Wook-Joo Kim1, Jee Hyun Kwon1
1From the Department of Neurology (J.Y.C.) and Clinical Research Center (J.S.L.), Asan Medical Center; Department of Neurology (J.Y.C., W.-J.K., J.H.K.), University of Ulsan College of Medicine, Seoul; Department of Neurology (W.-J.K., J.H.K.), Ulsan University Hospital; Department of Neurology (B.J.K., H.-J.B., M.-K.H.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (B.J.K., H.-J.B., M.-K.H.), Seoul National University College of Medicine, Seoul; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Neurology (J.L.), Yeungnam University Hospital, Daegu; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang; Department of Neurology (S.J.L.), Eulji University Hospital, Daejeon; Department of Neurology (J.-M.P.), Uijeongbu Eulji Medical Center, Eulji University; Department of Neurology (B.-C.L., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (S.-H.L., C.K.), Chuncheon Sacred Heart Hospital; Department of Neurology (D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P.), Seoul Medical Center; Department of Neurology (J.C.C.), Jeju National University Hospital; Department of Neurology (D.-I.S.), Chungbuk National University Hospital, Cheongju; and Department of Neurology (S.-I.S., J.-H.H.), Keimyung University Dongsan Medical Center, Daegu, South Korea.
Insights
High admission glycated hemoglobin (HbA1c) increases vascular event risk in diabetic stroke patients. Optimal HbA1c levels, below 6.8%-7.0%, vary by stroke subtype, guiding personalized risk management.
Area of Science:
- Cardiology
- Neurology
- Endocrinology
Background:
- Diabetes and acute ischemic stroke significantly increase the risk of secondary vascular events.
- Glycated hemoglobin (HbA1c) is a key indicator of long-term glycemic control.
- Understanding the relationship between admission HbA1c and vascular events is crucial for patient management.
Purpose of the Study:
- To evaluate the association between admission glycated hemoglobin (HbA1c) and the risk of composite vascular events in patients with acute ischemic stroke and diabetes.
- To determine optimal HbA1c thresholds for minimizing vascular event risk.
- To explore how stroke subtype influences this association.
Main Methods:
- Retrospective cohort study of 18,567 patients with acute ischemic stroke and diabetes.
- Utilized a stroke registry from the Clinical Research Center for Stroke in Korea.
- Employed Fine-Gray models for association analysis and fractional polynomial/linear-quadratic models for subtype-specific risk exploration.
Main Results:
- A total of 1,437 patients experienced composite vascular events (stroke, MI, vascular death) within 1 year.
- Admission HbA1c levels of 6.8%-7.0% were associated with significantly increased risk.
- The optimal HbA1c range for minimizing risk was lowest for small vessel occlusion (6.6%) compared to large artery atherosclerosis (7.3%) or cardioembolic (7.4%) subtypes.
Conclusions:
- Admission HbA1c is a significant predictor of composite vascular events in diabetic patients with ischemic stroke.
- Maintaining admission HbA1c below 6.8%-7.0% is recommended to reduce vascular event risk.
- Personalized glycemic targets based on ischemic stroke subtype may further optimize secondary prevention strategies.
Background And Objectives:
We evaluated the association between admission glycated hemoglobin (HbA1c) and subsequent risk of composite vascular events, including stroke, myocardial infarction (MI), and vascular death, in patients with acute ischemic stroke and diabetes.
Methods:
Patients who had a TIA or an acute ischemic stroke within 7 days of symptom onset and diabetes were included in a retrospective cohort design using the stroke registry of the Clinical Research Center for Stroke in Korea. The association between admission HbA1c and composite vascular events, including stroke, MI, and vascular death, during 1-year follow-up was estimated using the Fine-Gray model. The risk of composite vascular events according to the ischemic stroke subtype was explored using fractional polynomial and linear-quadratic models.
Results:
Of the 18,567 patients, 1,437 developed composite vascular events during follow-up. In multivariable analysis using HbA1c as a categorical variable, the risk significantly increased at a threshold of 6.8%-7.0%. The influence of admission HbA1c level on the risk of composite vascular events was pronounced particularly among those in whom fasting glucose at admission was ≤130 mg/dL. The optimal ranges of HbA1c associated with minimal risks for composite vascular events were lowest for the small vessel occlusion subtype (6.6 [95% confidence internal [CI], 6.3-6.9]) compared to the large artery atherosclerosis (7.3 [95% CI, 6.8-7.9]) or the cardioembolic subtype (7.4 [95% CI, 6.3-8.5]).
Dicussion:
In patients with ischemic stroke and diabetes, the risks of composite vascular events were significantly associated with admission HbA1c. The optimal range of admission HbA1c was below 6.8%-7.0% and differed according to the ischemic stroke subtype.
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