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 inEuropean journal of neurology Vol. 32; no. 1; pp. e70004 - n/a
Main Authors Kim, Joon‐Tae, Lee, Ji Sung, Kim, Hyunsoo, Kim, Beom Joon, Kang, Jihoon, Lee, Keon‐Joo, Park, Jong‐Moo, Kang, Kyusik, Lee, Soo Joo, Kim, Jae Guk, Cha, Jae‐Kwan, Kim, Dae‐Hyun, Park, Tai Hwan, Lee, Kyungbok, Lee, Jun, Hong, Keun‐Sik, Cho, Yong‐Jin, Park, Hong‐Kyun, Lee, Byung‐Chul, Yu, Kyung‐Ho, Oh, Mi Sun, Kim, Dong‐Eog, Choi, Jay Chol, Kwon, Jee‐Hyun, Kim, Wook‐Joo, Shin, Dong‐Ick, Yum, Kyu Sun, Sohn, Sung Il, Hong, Jeong‐Ho, Lee, Sang‐Hwa, Kim, Chulho, Park, Man‐Seok, Ryu, Wi‐Sun, Park, Kwang‐Yeol, Lee, Juneyoung, Saver, Jeffrey L., Bae, Hee‐Joon
Format Journal Article
LanguageEnglish
Published England John Wiley & Sons, Inc 01.01.2025
John Wiley and Sons Inc
Subjects
Online AccessGet full text
ISSN1351-5101
1468-1331
1468-1331
DOI10.1111/ene.70004

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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.
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
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/39714194$$D View this record in MEDLINE/PubMed
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– notice: 2024. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
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Issue 1
Keywords glycated hemoglobin (hbA1c)
prestroke glycemic status
diabetes
acute ischemic stroke
age
Language English
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2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
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Snippet 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...
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
URI https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fene.70004
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