Risk of stroke surges after 10 years in diabetes patients

Manhattan study: Ischemic stroke has long been associa-ted with diabetes, but a large longitudinal study enabled investigators to explore how risk changes over time, said a research fellow at the Neurological Institute of New York at Columbia University.

University researchers fol-lowed 3,298 multi-ethnic patients who had no prior history of stroke, assessing for diabetes at baseline and annually, beginning in 1993. At baseline, the mean age of subjects was 69 years (range, 59-79). More than half were Hispanic, with 24% black and 21% white.

Initially, 717 patients (22%) had diabetes and 338 (10%) developed new-onset diabetes over the course of the study.

During a median of 9 years of follow-up, 224 patients were diagnosed. The risk of ischemic stroke more than tripled in patients with a 10-year history of diabetes, according to results of the population-based Northern with ischemic stroke.

In Cox proportional hazards models, patients with diabetes at baseline faced a 2.5-fold increased risk of having an ischemic stroke during the study period. Among those patients and those who developed denovo diabetes, the risk of ischemic stroke rose over time. Risk was elevated 70% among patients with diabetes for 5 years or less, 80% for those with a 5- to 10-year history of diabetes, and 3.3-fold for those with at least a 10-year history of the disease.

The majority of patients in the study had type 2 diabetes, following his presentation.

Although risk of ischemic stroke was present from the start in diabetic patients, it did not triple for a decade, he stressed in the interview. “Diabetes, like hypertension and all of the other risk factors for cardiovascular disease, takes a while to really cause big damage.” That’s exactly what we’re seeing here.”

The message for physicians and patients alike is, “you have a lot of time for intervention.”

In his own experience, warning diabetic patients of impending problems with their eyes, hearts, or extremities does not always get their attention. Perhaps it would be more sobering to tell them that they have 10 years to get the disease under control, or face a tripling of their risk of a potentially fatal or disabling stroke.

“Maybe people will get the message.”