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Impaired Glucose Tolerance Raises Risk of Stroke in TIA Patients

Posted: Friday, July 14, 2006

Impaired glucose tolerance is independently linked to an elevated stroke risk in non-diabetic patients who have already experienced a TIA or minor stroke.

Impaired glucose tolerance, typically defined as a nonfasting glucose level between 7.8 and 11.0 mmol/L (140.4 - 198 mg/dL), has been linked to stroke in patients with coronary artery disease. However, it was unclear if this metabolic derangement increased the risk in patients with a prior TIA or minor stroke.

As reported in the June issue of Stroke, Dr. Sarah E. Vermeer, from the Erasmus Medical Center in Rotterdam, and colleagues assessed the impact of glucose tolerance on stroke risk in 3127 patients with a prior TIA or minor stroke who participated in a trial comparing aspirin and atenolol with placebo. The average follow-up period was 2.6 years.

During follow-up, 272 patients developed a stroke and 200 patients experienced an MI or cardiac death.

An 80% increased stroke risk was seen in patients with impaired glucose tolerance, but patients with excessively low glucose levels (< 4.6 mmol/L) also had a 50% greater risk than did those with normal glucose levels. The biggest risk of stroke -- a nearly threefold increased risk compared with normal glucose levels -- was in patients with overt diabetes.

By contrast, the glucose levels seemed to have no bearing on the risk of MI or cardiac death, the report indicates.

"Intensive glucose control in both type 1 and type 2 diabetic patients seems to reduce stroke and other macrovascular events," the authors state. "New secondary prevention trials should be initiated to investigate whether intensive glucose control reduces stroke incidence in these patients."

Source: Diabetes In Control: Stroke 2006;37:1413-1417