Influence of prestroke glycemic status on outcomes by age in patients with acute ischemic stroke and diabetes mellitus
Background This study aimed to explore the association between admission HbA1c and the risk of 1‐year vascular outcomes stratified by age group in patients with acute ischemic stroke (AIS) and diabetes mellitus (DM). Methods This study analyzed prospective multicenter data from patients with AIS and...
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Published in | European journal of neurology Vol. 32; no. 1; pp. e70004 - n/a |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
John Wiley & Sons, Inc
01.01.2025
John Wiley and Sons Inc |
Subjects | |
Online Access | Get full text |
ISSN | 1351-5101 1468-1331 1468-1331 |
DOI | 10.1111/ene.70004 |
Cover
Abstract | Background
This study aimed to explore the association between admission HbA1c and the risk of 1‐year vascular outcomes stratified by age group in patients with acute ischemic stroke (AIS) and diabetes mellitus (DM).
Methods
This study analyzed prospective multicenter data from patients with AIS and DM. Admission HbA1C were categorized as:≤6.0%, 6.1%–7.0%, 7.1%–8.0%, and >8.0%. Age was analyzed in categories:≤55 years, 56–65 years, 66–75 years, 76–85 years, and >85 years. The primary outcome was 1‐year composite of stroke, MI, and all‐cause mortality. The modifying effect of age on the relationships between HbA1c and 1‐year primary outcome was explored by Cox proportional hazards model.
Results
A total of 16,077 patients (age 69.0 ± 12.4 years; 59.4% males) were analyzed in this study. Among patients ≤55 years, the hazard ratio (HR) of the 1‐year primary outcomes increased with an HbA1C > 8.0% (adjusted HR 1.39[1.13–1.70]). For patients aged 56–65 and 66–75, the highest HRs were observed for an HbA1c of 7.1–8.0% (aHRs; 1.21 [1.01–1.46] and 1.22 [1.05–1.41], respectively). In the 85+ age group, the highest HR occurred for HbA1c ≤ 6.0% (aHR 1.47 [0.98–2.19]). The HbA1c 8.0% showed evident age‐dependent heterogeneity in the post hoc HR plots.
Conclusion
Our study revealed that in patients with AIS and diabetes under 55, higher admission hbA1c was associated with an increased risk of the 1‐year primary outcome, while in patients aged over 85, lower HbA1c value (≤6.0%) may be associated with an increased risk of vascular events. The results of our study suggest the age‐stratified, heterogeneous associations between admission HbA1c and 1‐year vascular outcomes in patients with AIS and diabetes. |
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AbstractList | BackgroundThis study aimed to explore the association between admission HbA1c and the risk of 1‐year vascular outcomes stratified by age group in patients with acute ischemic stroke (AIS) and diabetes mellitus (DM).MethodsThis study analyzed prospective multicenter data from patients with AIS and DM. Admission HbA1C were categorized as:≤6.0%, 6.1%–7.0%, 7.1%–8.0%, and >8.0%. Age was analyzed in categories:≤55 years, 56–65 years, 66–75 years, 76–85 years, and >85 years. The primary outcome was 1‐year composite of stroke, MI, and all‐cause mortality. The modifying effect of age on the relationships between HbA1c and 1‐year primary outcome was explored by Cox proportional hazards model.ResultsA total of 16,077 patients (age 69.0 ± 12.4 years; 59.4% males) were analyzed in this study. Among patients ≤55 years, the hazard ratio (HR) of the 1‐year primary outcomes increased with an HbA1C > 8.0% (adjusted HR 1.39[1.13–1.70]). For patients aged 56–65 and 66–75, the highest HRs were observed for an HbA1c of 7.1–8.0% (aHRs; 1.21 [1.01–1.46] and 1.22 [1.05–1.41], respectively). In the 85+ age group, the highest HR occurred for HbA1c ≤ 6.0% (aHR 1.47 [0.98–2.19]). The HbA1c 8.0% showed evident age‐dependent heterogeneity in the post hoc HR plots.ConclusionOur study revealed that in patients with AIS and diabetes under 55, higher admission hbA1c was associated with an increased risk of the 1‐year primary outcome, while in patients aged over 85, lower HbA1c value (≤6.0%) may be associated with an increased risk of vascular events. The results of our study suggest the age‐stratified, heterogeneous associations between admission HbA1c and 1‐year vascular outcomes in patients with AIS and diabetes. Background This study aimed to explore the association between admission HbA1c and the risk of 1‐year vascular outcomes stratified by age group in patients with acute ischemic stroke (AIS) and diabetes mellitus (DM). Methods This study analyzed prospective multicenter data from patients with AIS and DM. Admission HbA1C were categorized as:≤6.0%, 6.1%–7.0%, 7.1%–8.0%, and >8.0%. Age was analyzed in categories:≤55 years, 56–65 years, 66–75 years, 76–85 years, and >85 years. The primary outcome was 1‐year composite of stroke, MI, and all‐cause mortality. The modifying effect of age on the relationships between HbA1c and 1‐year primary outcome was explored by Cox proportional hazards model. Results A total of 16,077 patients (age 69.0 ± 12.4 years; 59.4% males) were analyzed in this study. Among patients ≤55 years, the hazard ratio (HR) of the 1‐year primary outcomes increased with an HbA1C > 8.0% (adjusted HR 1.39[1.13–1.70]). For patients aged 56–65 and 66–75, the highest HRs were observed for an HbA1c of 7.1–8.0% (aHRs; 1.21 [1.01–1.46] and 1.22 [1.05–1.41], respectively). In the 85+ age group, the highest HR occurred for HbA1c ≤ 6.0% (aHR 1.47 [0.98–2.19]). The HbA1c 8.0% showed evident age‐dependent heterogeneity in the post hoc HR plots. Conclusion Our study revealed that in patients with AIS and diabetes under 55, higher admission hbA1c was associated with an increased risk of the 1‐year primary outcome, while in patients aged over 85, lower HbA1c value (≤6.0%) may be associated with an increased risk of vascular events. The results of our study suggest the age‐stratified, heterogeneous associations between admission HbA1c and 1‐year vascular outcomes in patients with AIS and diabetes. This study aimed to explore the association between admission HbA1c and the risk of 1-year vascular outcomes stratified by age group in patients with acute ischemic stroke (AIS) and diabetes mellitus (DM). This study analyzed prospective multicenter data from patients with AIS and DM. Admission HbA1C were categorized as:≤6.0%, 6.1%-7.0%, 7.1%-8.0%, and >8.0%. Age was analyzed in categories:≤55 years, 56-65 years, 66-75 years, 76-85 years, and >85 years. The primary outcome was 1-year composite of stroke, MI, and all-cause mortality. The modifying effect of age on the relationships between HbA1c and 1-year primary outcome was explored by Cox proportional hazards model. A total of 16,077 patients (age 69.0 ± 12.4 years; 59.4% males) were analyzed in this study. Among patients ≤55 years, the hazard ratio (HR) of the 1-year primary outcomes increased with an HbA1C > 8.0% (adjusted HR 1.39[1.13-1.70]). For patients aged 56-65 and 66-75, the highest HRs were observed for an HbA1c of 7.1-8.0% (aHRs; 1.21 [1.01-1.46] and 1.22 [1.05-1.41], respectively). In the 85+ age group, the highest HR occurred for HbA1c ≤ 6.0% (aHR 1.47 [0.98-2.19]). The HbA1c 8.0% showed evident age-dependent heterogeneity in the post hoc HR plots. Our study revealed that in patients with AIS and diabetes under 55, higher admission hbA1c was associated with an increased risk of the 1-year primary outcome, while in patients aged over 85, lower HbA1c value (≤6.0%) may be associated with an increased risk of vascular events. The results of our study suggest the age-stratified, heterogeneous associations between admission HbA1c and 1-year vascular outcomes in patients with AIS and diabetes. This study aimed to explore the association between admission HbA1c and the risk of 1-year vascular outcomes stratified by age group in patients with acute ischemic stroke (AIS) and diabetes mellitus (DM).BACKGROUNDThis study aimed to explore the association between admission HbA1c and the risk of 1-year vascular outcomes stratified by age group in patients with acute ischemic stroke (AIS) and diabetes mellitus (DM).This study analyzed prospective multicenter data from patients with AIS and DM. Admission HbA1C were categorized as:≤6.0%, 6.1%-7.0%, 7.1%-8.0%, and >8.0%. Age was analyzed in categories:≤55 years, 56-65 years, 66-75 years, 76-85 years, and >85 years. The primary outcome was 1-year composite of stroke, MI, and all-cause mortality. The modifying effect of age on the relationships between HbA1c and 1-year primary outcome was explored by Cox proportional hazards model.METHODSThis study analyzed prospective multicenter data from patients with AIS and DM. Admission HbA1C were categorized as:≤6.0%, 6.1%-7.0%, 7.1%-8.0%, and >8.0%. Age was analyzed in categories:≤55 years, 56-65 years, 66-75 years, 76-85 years, and >85 years. The primary outcome was 1-year composite of stroke, MI, and all-cause mortality. The modifying effect of age on the relationships between HbA1c and 1-year primary outcome was explored by Cox proportional hazards model.A total of 16,077 patients (age 69.0 ± 12.4 years; 59.4% males) were analyzed in this study. Among patients ≤55 years, the hazard ratio (HR) of the 1-year primary outcomes increased with an HbA1C > 8.0% (adjusted HR 1.39[1.13-1.70]). For patients aged 56-65 and 66-75, the highest HRs were observed for an HbA1c of 7.1-8.0% (aHRs; 1.21 [1.01-1.46] and 1.22 [1.05-1.41], respectively). In the 85+ age group, the highest HR occurred for HbA1c ≤ 6.0% (aHR 1.47 [0.98-2.19]). The HbA1c 8.0% showed evident age-dependent heterogeneity in the post hoc HR plots.RESULTSA total of 16,077 patients (age 69.0 ± 12.4 years; 59.4% males) were analyzed in this study. Among patients ≤55 years, the hazard ratio (HR) of the 1-year primary outcomes increased with an HbA1C > 8.0% (adjusted HR 1.39[1.13-1.70]). For patients aged 56-65 and 66-75, the highest HRs were observed for an HbA1c of 7.1-8.0% (aHRs; 1.21 [1.01-1.46] and 1.22 [1.05-1.41], respectively). In the 85+ age group, the highest HR occurred for HbA1c ≤ 6.0% (aHR 1.47 [0.98-2.19]). The HbA1c 8.0% showed evident age-dependent heterogeneity in the post hoc HR plots.Our study revealed that in patients with AIS and diabetes under 55, higher admission hbA1c was associated with an increased risk of the 1-year primary outcome, while in patients aged over 85, lower HbA1c value (≤6.0%) may be associated with an increased risk of vascular events. The results of our study suggest the age-stratified, heterogeneous associations between admission HbA1c and 1-year vascular outcomes in patients with AIS and diabetes.CONCLUSIONOur study revealed that in patients with AIS and diabetes under 55, higher admission hbA1c was associated with an increased risk of the 1-year primary outcome, while in patients aged over 85, lower HbA1c value (≤6.0%) may be associated with an increased risk of vascular events. The results of our study suggest the age-stratified, heterogeneous associations between admission HbA1c and 1-year vascular outcomes in patients with AIS and diabetes. |
Author | Lee, Jun Hong, Keun‐Sik Lee, Ji Sung Kim, Chulho Lee, Soo Joo Park, Jong‐Moo Yum, Kyu Sun Kim, Joon‐Tae Kim, Beom Joon Kang, Kyusik Kim, Jae Guk Saver, Jeffrey L. Cho, Yong‐Jin Lee, Byung‐Chul Kim, Wook‐Joo Shin, Dong‐Ick Oh, Mi Sun Kwon, Jee‐Hyun Park, Man‐Seok Yu, Kyung‐Ho Lee, Sang‐Hwa Kim, Hyunsoo Park, Hong‐Kyun Lee, Juneyoung Cha, Jae‐Kwan Choi, Jay Chol Kang, Jihoon Lee, Kyungbok Lee, Keon‐Joo Kim, Dong‐Eog Bae, Hee‐Joon Kim, Dae‐Hyun Sohn, Sung Il Park, Kwang‐Yeol Park, Tai Hwan Ryu, Wi‐Sun Hong, Jeong‐Ho |
AuthorAffiliation | 10 Department of Neurology Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine Seoul Korea 9 Department of Neurology Seoul Medical Center Seoul Korea 14 Department of Neurology Dongguk University Ilsan Hospital Goyang Korea 23 Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine University of California Los Angeles California USA 16 Department of Neurology Ulsan University College of Medicine Ulsan Korea 12 Department of Neurology Ilsan Paik Hospital, Inje University Goyang Korea 5 Department of Neurology Uijeongbu Eulji Medical Center, Eulji University School of Medicine Uijeongbu‐si Korea 15 Department of Neurology Jeju National University Hospital, Jeju National University School of Medicine Jeju Korea 13 Department of Neurology Hallym University Sacred Heart Hospital Anyang Korea 17 Department of Neurology Chungbuk National University Hospital Cheongju Korea 18 Department of Neurology Keimyung University Dongsan Medical Ce |
AuthorAffiliation_xml | – name: 7 Department of Neurology, Daejeon Eulji Medical Center Eulji University School of Medicine Daejeon Korea – name: 12 Department of Neurology Ilsan Paik Hospital, Inje University Goyang Korea – name: 15 Department of Neurology Jeju National University Hospital, Jeju National University School of Medicine Jeju Korea – name: 4 Department of Neurology Korea University Guro Hospital Seoul Korea – name: 3 Department of Neurology Seoul National University College of Medicine, Seoul National University Bundang Hospital Seongnam Korea – name: 20 Artificial Intelligence Research Center, JLK Inc. Seoul Korea – name: 13 Department of Neurology Hallym University Sacred Heart Hospital Anyang Korea – name: 1 Department of Neurology Chonnam National University Hospital, Chonnam National University Medical School Gwangju Korea – name: 14 Department of Neurology Dongguk University Ilsan Hospital Goyang Korea – name: 5 Department of Neurology Uijeongbu Eulji Medical Center, Eulji University School of Medicine Uijeongbu‐si Korea – name: 17 Department of Neurology Chungbuk National University Hospital Cheongju Korea – name: 21 Department of Neurology Chung‐Ang University College of Medicine, Chung‐Ang University Hospital Seoul Korea – name: 11 Department of Neurology Yeungnam University Hospital Daegu Korea – name: 18 Department of Neurology Keimyung University Dongsan Medical Center Daegu Korea – name: 16 Department of Neurology Ulsan University College of Medicine Ulsan Korea – name: 19 Department of Neurology Hallym University Chuncheon Sacred Heart Hospital Chuncheon‐si Gangwon‐do Korea – name: 22 Department of Biostatistics Korea University College of Medicine Seoul Korea – name: 10 Department of Neurology Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine Seoul Korea – name: 2 Clinical Research Center Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine Seoul Korea – name: 23 Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine University of California Los Angeles California USA – name: 6 Department of Neurology Nowon Eulji Medical Center, Eulji University School of Medicine Seoul Korea – name: 8 Department of Neurology Dong‐A University Hospital Busan Korea – name: 9 Department of Neurology Seoul Medical Center Seoul Korea |
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Jeffrey L. surname: Saver fullname: Saver, Jeffrey L. organization: University of California – sequence: 37 givenname: Hee‐Joon orcidid: 0000-0003-0051-1997 surname: Bae fullname: Bae, Hee‐Joon email: braindoc@snu.ac.kr organization: Seoul National University College of Medicine, Seoul National University Bundang Hospital |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39714194$$D View this record in MEDLINE/PubMed |
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Keywords | glycated hemoglobin (hbA1c) prestroke glycemic status diabetes acute ischemic stroke age |
Language | English |
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This study aimed to explore the association between admission HbA1c and the risk of 1‐year vascular outcomes stratified by age group in patients... This study aimed to explore the association between admission HbA1c and the risk of 1-year vascular outcomes stratified by age group in patients with acute... BackgroundThis study aimed to explore the association between admission HbA1c and the risk of 1‐year vascular outcomes stratified by age group in patients with... |
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SubjectTerms | acute ischemic stroke Age Age Factors Age groups Aged Aged, 80 and over Blood Glucose - metabolism Diabetes Diabetes mellitus Diabetes Mellitus - blood Diabetes Mellitus - epidemiology Female glycated hemoglobin (hbA1c) Glycated Hemoglobin - analysis Glycated Hemoglobin - metabolism Heterogeneity Humans Ischemia Ischemic Stroke - blood Ischemic Stroke - epidemiology Male Middle Aged Original prestroke glycemic status Prospective Studies Risk Statistical models Stroke |
Title | Influence of prestroke glycemic status on outcomes by age in patients with acute ischemic stroke and diabetes mellitus |
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