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Influence of prestroke glycemic status on outcomes by age in patients with acute ischemic stroke and diabetes mellitus

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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

Issue Date
2025-01
Publisher
Blackwell Publishing Inc.
Citation
European Journal of Neurology, Vol.32 No.1, p. e70004
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.
ISSN
1351-5101
URI
https://hdl.handle.net/10371/216392
DOI
https://doi.org/10.1111/ene.70004
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  • College of Medicine
  • Department of Medicine
Research Area 뇌경색, 뇌졸중, 혈관성 인지장애 및 치매

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