Poor glycemic control and posterior circulation ischemic stroke

Fukuoka Stroke Registry Investigators

研究成果: ジャーナルへの寄稿記事

抄録

Background: This study aimed at determining whether diabetes or glucose metabolism is associated with ischemic stroke in the posterior circulation.

Methods: We included 10,245 patients with acute ischemic stroke (mean age 72.7 ± 12.5 years, men 59.5%) who were enrolled in a multicenter hospital-based stroke registry in Fukuoka, Japan, between June 2007 and August 2016. Posterior circulation ischemic stroke (PCIS) was defined as brain infarction in the territory of the posterior cerebral artery and vertebro-basilar arteries. We investigated the associations between diabetes or glycemic parameters, including plasma glucose concentrations, hemoglobin A1c, and the homeostatic model assessment of insulin resistance (HOMA-IR), and PCIS using logistic regression analysis. To improve covariate imbalance, we further evaluated associations after propensity score matching using 1:1 nearest neighbor matching and inverse probability weighting.

Results: Diabetes was significantly associated with PCIS even after adjusting for multiple confounding factors (odds ratio-OR [95% confidence interval], 1.37 [1.25-1.50]). Similarly, fasting (1.07 [1.02-1.12]/SD), casual plasma glucose (1.16 [1.11-1.20]/SD) concentrations, and hemoglobin A1c (1.12 [1.08-1.17]/SD), but not HOMA-IR (1.02 [0.97-1.07]/SD), were associated with PCIS. These associations were maintained in patients with ischemic stroke because of thrombotic etiology and were unchanged even after the propensity score matching methods. In patients with diabetes, the ORs of PCIS further increased with an increase in hemoglobin A1c and the presence of microvascular complications.

Conclusions: Poor glycemic control may be associated with an increased risk of thrombotic infarction that occurs preferentially in the posterior circulation of the brain.

元の言語英語
ページ(範囲)129-139
ページ数11
ジャーナルNeurology: Clinical Practice
9
発行部数2
DOI
出版物ステータス出版済み - 4 1 2019

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Stroke
Propensity Score
Hemoglobins
Glucose
Insulin Resistance
Brain Infarction
Posterior Cerebral Artery
Basilar Artery
Infarction
Registries
Fasting
Japan
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals
Brain

これを引用

Poor glycemic control and posterior circulation ischemic stroke. / Fukuoka Stroke Registry Investigators.

:: Neurology: Clinical Practice, 巻 9, 番号 2, 01.04.2019, p. 129-139.

研究成果: ジャーナルへの寄稿記事

Fukuoka Stroke Registry Investigators. / Poor glycemic control and posterior circulation ischemic stroke. :: Neurology: Clinical Practice. 2019 ; 巻 9, 番号 2. pp. 129-139.
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title = "Poor glycemic control and posterior circulation ischemic stroke",
abstract = "Background: This study aimed at determining whether diabetes or glucose metabolism is associated with ischemic stroke in the posterior circulation.Methods: We included 10,245 patients with acute ischemic stroke (mean age 72.7 ± 12.5 years, men 59.5{\%}) who were enrolled in a multicenter hospital-based stroke registry in Fukuoka, Japan, between June 2007 and August 2016. Posterior circulation ischemic stroke (PCIS) was defined as brain infarction in the territory of the posterior cerebral artery and vertebro-basilar arteries. We investigated the associations between diabetes or glycemic parameters, including plasma glucose concentrations, hemoglobin A1c, and the homeostatic model assessment of insulin resistance (HOMA-IR), and PCIS using logistic regression analysis. To improve covariate imbalance, we further evaluated associations after propensity score matching using 1:1 nearest neighbor matching and inverse probability weighting.Results: Diabetes was significantly associated with PCIS even after adjusting for multiple confounding factors (odds ratio-OR [95{\%} confidence interval], 1.37 [1.25-1.50]). Similarly, fasting (1.07 [1.02-1.12]/SD), casual plasma glucose (1.16 [1.11-1.20]/SD) concentrations, and hemoglobin A1c (1.12 [1.08-1.17]/SD), but not HOMA-IR (1.02 [0.97-1.07]/SD), were associated with PCIS. These associations were maintained in patients with ischemic stroke because of thrombotic etiology and were unchanged even after the propensity score matching methods. In patients with diabetes, the ORs of PCIS further increased with an increase in hemoglobin A1c and the presence of microvascular complications.Conclusions: Poor glycemic control may be associated with an increased risk of thrombotic infarction that occurs preferentially in the posterior circulation of the brain.",
author = "{Fukuoka Stroke Registry Investigators} and Junya Kuroda and Ryu Matsuo and Yuko Yamaguchi and Noriko Sato and Masahiro Kamouchi and Jun Hata and Yoshinobu Wakisaka and Tetsuro Ago and Takanari Kitazono",
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T1 - Poor glycemic control and posterior circulation ischemic stroke

AU - Fukuoka Stroke Registry Investigators

AU - Kuroda, Junya

AU - Matsuo, Ryu

AU - Yamaguchi, Yuko

AU - Sato, Noriko

AU - Kamouchi, Masahiro

AU - Hata, Jun

AU - Wakisaka, Yoshinobu

AU - Ago, Tetsuro

AU - Kitazono, Takanari

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: This study aimed at determining whether diabetes or glucose metabolism is associated with ischemic stroke in the posterior circulation.Methods: We included 10,245 patients with acute ischemic stroke (mean age 72.7 ± 12.5 years, men 59.5%) who were enrolled in a multicenter hospital-based stroke registry in Fukuoka, Japan, between June 2007 and August 2016. Posterior circulation ischemic stroke (PCIS) was defined as brain infarction in the territory of the posterior cerebral artery and vertebro-basilar arteries. We investigated the associations between diabetes or glycemic parameters, including plasma glucose concentrations, hemoglobin A1c, and the homeostatic model assessment of insulin resistance (HOMA-IR), and PCIS using logistic regression analysis. To improve covariate imbalance, we further evaluated associations after propensity score matching using 1:1 nearest neighbor matching and inverse probability weighting.Results: Diabetes was significantly associated with PCIS even after adjusting for multiple confounding factors (odds ratio-OR [95% confidence interval], 1.37 [1.25-1.50]). Similarly, fasting (1.07 [1.02-1.12]/SD), casual plasma glucose (1.16 [1.11-1.20]/SD) concentrations, and hemoglobin A1c (1.12 [1.08-1.17]/SD), but not HOMA-IR (1.02 [0.97-1.07]/SD), were associated with PCIS. These associations were maintained in patients with ischemic stroke because of thrombotic etiology and were unchanged even after the propensity score matching methods. In patients with diabetes, the ORs of PCIS further increased with an increase in hemoglobin A1c and the presence of microvascular complications.Conclusions: Poor glycemic control may be associated with an increased risk of thrombotic infarction that occurs preferentially in the posterior circulation of the brain.

AB - Background: This study aimed at determining whether diabetes or glucose metabolism is associated with ischemic stroke in the posterior circulation.Methods: We included 10,245 patients with acute ischemic stroke (mean age 72.7 ± 12.5 years, men 59.5%) who were enrolled in a multicenter hospital-based stroke registry in Fukuoka, Japan, between June 2007 and August 2016. Posterior circulation ischemic stroke (PCIS) was defined as brain infarction in the territory of the posterior cerebral artery and vertebro-basilar arteries. We investigated the associations between diabetes or glycemic parameters, including plasma glucose concentrations, hemoglobin A1c, and the homeostatic model assessment of insulin resistance (HOMA-IR), and PCIS using logistic regression analysis. To improve covariate imbalance, we further evaluated associations after propensity score matching using 1:1 nearest neighbor matching and inverse probability weighting.Results: Diabetes was significantly associated with PCIS even after adjusting for multiple confounding factors (odds ratio-OR [95% confidence interval], 1.37 [1.25-1.50]). Similarly, fasting (1.07 [1.02-1.12]/SD), casual plasma glucose (1.16 [1.11-1.20]/SD) concentrations, and hemoglobin A1c (1.12 [1.08-1.17]/SD), but not HOMA-IR (1.02 [0.97-1.07]/SD), were associated with PCIS. These associations were maintained in patients with ischemic stroke because of thrombotic etiology and were unchanged even after the propensity score matching methods. In patients with diabetes, the ORs of PCIS further increased with an increase in hemoglobin A1c and the presence of microvascular complications.Conclusions: Poor glycemic control may be associated with an increased risk of thrombotic infarction that occurs preferentially in the posterior circulation of the brain.

U2 - 10.1212/CPJ.0000000000000608

DO - 10.1212/CPJ.0000000000000608

M3 - Article

VL - 9

SP - 129

EP - 139

JO - Neurology: Clinical Practice

JF - Neurology: Clinical Practice

SN - 2163-0402

IS - 2

ER -