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Risk of recurrent stroke and mortality after cryptogenic stroke in diabetic patients
Alberto Vera1, Alberto Cecconi2, Álvaro Ximénez-Carrillo3
1Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, c/Diego de León 62, 28006, Madrid, Spain.
Insights
Diabetic patients with cryptogenic stroke (CS) face a significantly higher risk of recurrent stroke and death. Other key predictors include hypertension, chronic kidney disease (CKD), and NTproBNP levels.
Area of Science:
- Neurology
- Cardiology
- Endocrinology
Background:
- Diabetes mellitus is a prevalent chronic disease.
- It increases the risk of stroke recurrence across various subtypes.
- Limited data exists on diabetes' prognostic role in cryptogenic stroke (CS).
Purpose of the Study:
- To investigate the prognostic impact of diabetes on outcomes in patients with cryptogenic stroke.
- To identify independent predictors of stroke recurrence and mortality in CS patients.
Main Methods:
- Prospective cohort study of 78 consecutive CS patients from April 2019 to November 2021.
- Patients were stratified based on the presence of diabetes.
- Primary outcome: composite of stroke recurrence and death. Secondary outcome: stroke recurrence.
Main Results:
- The cohort had a mean age of 78 years; 23% had diabetes.
- Diabetic patients showed higher rates of stroke recurrence and mortality (HR 5.8, p=0.002).
- Diabetes independently predicted stroke recurrence and death (aHR 33.8, p=0.013). Hypertension, CKD, and NTproBNP were also independent predictors.
Conclusions:
- Diabetic patients with CS have an elevated risk of stroke recurrence and mortality.
- Hypertension, CKD, and elevated NTproBNP levels are significant independent predictors of adverse outcomes post-CS.
Background:
Diabetes mellitus is a highly prevalent and growing chronic disease that is associated with increased risk of recurrence among several stroke subtypes. However, evidence on the prognostic role of diabetes in the setting of cryptogenic stroke (CS) remains scarce.
Methods:
From April 2019 to November 2021, we recruited prospectively 78 consecutive patients with CS. Patients were classified according to the presence of diabetes. Main outcome was the composite of stroke recurrence and death. Secondary outcome was stroke recurrence.
Results:
Mean age of the cohort was 78 ± 7.7 years and 18 patients (23%) had diabetes. After a median clinical follow-up of 23 months the incidence of stroke recurrence and mortality [HR 5.8 (95% CI 1.9-19), p = 0.002] and the incidence of stroke recurrence [HR 16.6 (95% CI 1.8-149), p = 0.012], were higher in patients with diabetes. After adjusting for potential confounders diabetes was identified as an independent predictor of stroke recurrence and death in patients with CS [HR 33.8 (95% CI 2.1-551), p = 0.013]. Other independent predictors of stroke recurrence and mortality were hypertension [HR 31.4 (95% CI 1.8-550), p = 0.018], NTproBNP [HR 1.002 (95% CI 1.001-1.004), p = 0.013] and chronic kidney disease (CKD) [HR 27.4 (95% CI 1.4-549) p = 0.03]. Furthermore, diabetes was an independent predictor of stroke recurrence [HR 103 (95% CI 1.3-8261), p = 0.038].
Conclusion:
Diabetic patients with CS are at higher risk of stroke recurrence and death. Hypertension CKD and NTproBNP are also independent predictors of stroke recurrence and death after CS.
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