Yuesong Pan1, Xueli Cai1, Jing Jing1, Xia Meng1, Hao Li1, Yongjun Wang1, Xingquan Zhao1, Liping Liu1, David Wang1, S Claiborne Johnston1, Tiemin Wei1, Yilong Wang2. 1. From the Department of Neurology, Beijing Tiantan Hospital (Y.P., J.J., X.M., H.L., Yongjun Wang, X.Z., L.L., Yilong Wang) and Department of Epidemiology and Health Statistics, School of Public Health (Y.P.), Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing (Y.P., J.J., X.M., H.L., Yongjun Wang, X.Z., L.L., Yilong Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.P., J.J., X.M., H.L., Yongjun Wang, X.Z., L.L., Yilong Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Y.P., J.J., X.M., H.L., Yongjun Wang, X.Z., L.L., Yilong Wang); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P.); Department of Neurology (X.C.) and Department of Cardiology (T.W.), Lishui Hospital of Zhejiang University (the Central Hospital of Lishui), China; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.). 2. From the Department of Neurology, Beijing Tiantan Hospital (Y.P., J.J., X.M., H.L., Yongjun Wang, X.Z., L.L., Yilong Wang) and Department of Epidemiology and Health Statistics, School of Public Health (Y.P.), Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing (Y.P., J.J., X.M., H.L., Yongjun Wang, X.Z., L.L., Yilong Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.P., J.J., X.M., H.L., Yongjun Wang, X.Z., L.L., Yilong Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Y.P., J.J., X.M., H.L., Yongjun Wang, X.Z., L.L., Yilong Wang); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P.); Department of Neurology (X.C.) and Department of Cardiology (T.W.), Lishui Hospital of Zhejiang University (the Central Hospital of Lishui), China; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.). yilong528@gmail.com.
Abstract
BACKGROUND AND PURPOSE: We aimed to determine the association between stress hyperglycemia and risk of new stroke in patients with a minor ischemic stroke or transient ischemic attack. METHODS: A subgroup of 3026 consecutive patients from 73 prespecified sites of the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) were analyzed. Stress hyperglycemia was measured by glucose/glycated albumin (GA) ratio. Glucose/GA ratio was calculated by fasting plasma glucose divided by GA and categorized into 4 even groups according to the quartiles. The primary outcome was a new stroke (ischemic or hemorrhagic) at 90 days. We assessed the association between glucose/GA ratio and risk of stroke by multivariable Cox regression models adjusted for potential covariates. RESULTS: Among 3026 patients included, a total of 299 (9.9%) new stroke occurred at 3 months. Compared with patients with the lowest quartile, patients with the highest quartile of glucose/GA ratio was associated with an increased risk of stroke at 3 months after adjusted for potential covariates (12.0% versus 9.2%; adjusted hazard ratio, 1.46; 95% confidence interval, 1.06-2.01). Similar results were observed after further adjusted for fasting plasma glucose. We also observed that higher level of glucose/GA ratio was associated with an increased risk of stroke with a threshold of 0.29 using a Cox regression model with restricted cubic spline. CONCLUSIONS:Stress hyperglycemia, measured by glucose/GA ratio, was associated with an increased risk of stroke in patients with a minor ischemic stroke or transient ischemic attack. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589.
RCT Entities:
BACKGROUND AND PURPOSE: We aimed to determine the association between stress hyperglycemia and risk of new stroke in patients with a minor ischemic stroke or transient ischemic attack. METHODS: A subgroup of 3026 consecutive patients from 73 prespecified sites of the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) were analyzed. Stress hyperglycemia was measured by glucose/glycated albumin (GA) ratio. Glucose/GA ratio was calculated by fasting plasma glucose divided by GA and categorized into 4 even groups according to the quartiles. The primary outcome was a new stroke (ischemic or hemorrhagic) at 90 days. We assessed the association between glucose/GA ratio and risk of stroke by multivariable Cox regression models adjusted for potential covariates. RESULTS: Among 3026 patients included, a total of 299 (9.9%) new stroke occurred at 3 months. Compared with patients with the lowest quartile, patients with the highest quartile of glucose/GA ratio was associated with an increased risk of stroke at 3 months after adjusted for potential covariates (12.0% versus 9.2%; adjusted hazard ratio, 1.46; 95% confidence interval, 1.06-2.01). Similar results were observed after further adjusted for fasting plasma glucose. We also observed that higher level of glucose/GA ratio was associated with an increased risk of stroke with a threshold of 0.29 using a Cox regression model with restricted cubic spline. CONCLUSIONS:Stress hyperglycemia, measured by glucose/GA ratio, was associated with an increased risk of stroke in patients with a minor ischemic stroke or transient ischemic attack. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589.
Authors: Patrizia Natale; Suetonia C Palmer; Valeria M Saglimbene; Marinella Ruospo; Mona Razavian; Jonathan C Craig; Meg J Jardine; Angela C Webster; Giovanni Fm Strippoli Journal: Cochrane Database Syst Rev Date: 2022-02-28
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