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Recurrent vascular events partially explain association between diabetes and poor prognosis in young ischemic stroke
Mahina Azeem Haja Shareef1, Kaavya Narasimhalu2, Seyed Ehsan Saffari3
1Duke-NUS Medical School, Singapore.
Insights
Diabetes mellitus significantly predicts poor long-term outcomes in young stroke survivors. Recurrent vascular events further worsen outcomes specifically in young diabetic stroke patients.
Area of Science:
- Neurology
- Cardiology
- Endocrinology
Background:
- Stroke is a leading global cause of death and disability.
- There is a concerning rise in stroke incidence among younger populations.
- Identifying prognostic factors for young stroke patients is crucial.
Purpose of the Study:
- To identify factors associated with poor long-term prognosis in young ischemic stroke patients.
- To analyze the impact of diabetes mellitus on functional outcomes.
- To investigate the role of recurrent vascular events in young stroke prognosis.
Main Methods:
- A longitudinal observational study of 147 young ischemic stroke patients.
- Follow-up for functional outcome (modified Rankin score), recurrent vascular events, and hospitalizations.
- Univariate and multivariable logistic regression analyses were performed.
Main Results:
- At 7-year follow-up, 22% of patients had poor functional outcome (mRS ≥ 3).
- Diabetes mellitus was the sole independent predictor of poor long-term function (OR=9.01).
- Recurrent vascular events were associated with poor outcomes in young diabetic patients, but not in non-diabetic patients.
Conclusions:
- Diabetes mellitus negatively impacts long-term functional outcomes in young ischemic stroke survivors.
- The adverse effect of diabetes on stroke prognosis is partly mediated by recurrent vascular events.
- Targeting diabetes management and preventing vascular events are critical for improving outcomes in young stroke patients.
Background And Aims:
Stroke is the second leading cause of death and third leading cause of disability worldwide. There is an increasing incidence of stroke among the young. In this study, we aimed to identify factors associated with poor long-term prognosis in young stroke patients.
Methods:
In this longitudinal observational study, we recruited 147 young ischemic stroke patients within one week of ischemic stroke and followed them up for functional outcome (modified Rankin score (mRS)), recurrent vascular events, and recurrent hospitalisation. Poor function was labelled as mRS score of 3 and above. We performed univariate and multivariable logistic regression analyses to determine factors associated with poor long term functional outcome.
Results:
At a median follow-up of 7-years, 32 (22%) of the 147 patients had poor functional outcome. In multivariable analyses, diabetes mellitus (OR = 9.01, CI 3.15 to 26.92), was the only independent predictor of poor function. In analyses stratified by diabetic status, recurrent vascular events (OR = 4.47, CI 1.40 to 14.28) were associated with poor functional outcome within young diabetic patients but not in non-diabetic patients.
Conclusions:
Our findings suggest that diabetes mellitus affects long-term functional outcome in young ischemic stroke and that its effect is mediated partly by recurrent vascular events.
Data Access Statement:
Data obtained from Multi-Centre Retinal study (MCRS), Singapore site. Data cannot be made publicly available due to potentially identifiable research participant information.
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