Duration of Diabetes and Risk of Ischemic Stroke The Northern Manhattan Study

作者：Banerjee Chirantan; Moon Yeseon P; Paik Myunghee C; Rundek Tatjana; Mora McLaughlin Consuelo; Vieira Julio R; Sacco Ralph L; Elkind Mitchell S V^*

来源：Stroke, 2012, 43(5): 1212-1217.

DOI：10.1161/STROKEAHA.111.641381

• acute stroke
• cerebral infarct
• diabetes mellitus
• epidemiology
• risk factors

Background and Purpose-Diabetes increases stroke risk, but whether diabetes status immediately before stroke improves prediction and whether duration is important are less clear. We hypothesized that diabetes duration independently predicts ischemic stroke. %26lt;br%26gt;Methods-Among 3298 stroke-free participants in the Northern Manhattan Study, baseline diabetes and age at diagnosis were determined. Incident diabetes was assessed annually (median, 9 years). Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% CI for incident ischemic stroke using baseline diabetes, diabetes as a time-dependent covariate, and duration of diabetes as a time-varying covariate; models were adjusted for demographic and cardiovascular risk factors. %26lt;br%26gt;Results-Mean age was 69 +/- 10 years (52% Hispanic, 21% white, and 24% black); 22% had diabetes at baseline and 10% had development of diabetes. There were 244 ischemic strokes, and both baseline diabetes (HR, 2.5; 95% CI, 1.9-3.3) and diabetes considered as a time-dependent covariate (HR, 2.4; 95% CI, 1.8-3.2) were similarly associated with stroke risk. Duration of diabetes was associated with ischemic stroke (adjusted HR, 1.03 per year with diabetes; 95% CI, 1.02-1.04). Compared to nondiabetic participants, those with diabetes for 0 to 5 years (adjusted HR, 1.7; 95% CI, 1.1-2.7), 5 to 10 years (adjusted HR, 1.8; 95% CI, 1.1-3.0), and %26gt;= 10 years (adjusted HR, 3.2; 95% CI, 2.4-4.5) were at increased risk. %26lt;br%26gt;Conclusions-Duration of diabetes is independently associated with ischemic stroke risk adjusting for risk factors. The risk increases 3% each year, and triples with diabetes %26gt;= 10 years. (Stroke. 2012; 43: 1212-1217.)

• 出版日期2012-5