FOR RELEASE:
9 a.m. EST, Thursday
Feb. 16, 2006

CONTACT:
For information Feb. 16-18 call:
Bridgette McNeill, Carole Bullock,
or Julie Del Barto (broadcast)
at the Gaylord Palms, Kissimmee, Fla.
(407) 586-2901

Abstracts P115 and P356

American Stroke Association meeting report:
Newly diagnosed diabetics and young adults with diabetes have higher stroke risk
KISSIMMEE, Fla., Feb. 16 – Diabetes is a leading risk factor for stroke, especially among newly diagnosed adults with type 2 diabetes and diabetic adults who are younger than age 55, according to two new studies presented today at the American Stroke Association’s International Stroke Conference 2006.

Canadian researchers report that patients newly diagnosed with type 2 diabetes have double the rate of stroke of the general population (Abstract P115).

“One would think that the consequences of diabetes would occur over a long period, but we found that new-onset diabetics have double the rate of stroke in the first five years after diagnosis as the general population,” said Thomas Jeerakathil, M.D., lead author of the study and assistant professor of medicine and neurology at the University of Alberta in Edmonton, Canada.  “The finding suggests some of the cardiovascular effects of diabetes are already established at the time of diagnosis and aggressive prevention is justified in this patient group.”

Studies have shown that having type 2 diabetes is associated with a higher risk for stroke and cardiovascular disease, but most studies have focused on people who have had diabetes for years.  Researchers have also known that while diabetic patients tend to focus on blood sugar control, they don’t tend to have optimum control of blood pressure — a major risk factor for heart disease and stroke.

To examine the short-term risk for stroke in newly diagnosed diabetics, Jeerakathil and colleagues analyzed a database of people in the provinces of Saskatchewan, Canada.  They identified 12,272 people (average age 64) who had new prescriptions for diabetes medications between 1991 and 1996, and followed them for about five years.

More than 9 percent were admitted to the hospital for stroke and one-fifth of that population died during those five years.  Researchers compared stroke rates to a similar-aged group in the general population.

“Our findings suggest that, particularly if people have a new diagnosis of diabetes, they should have all their cardiovascular risk factors managed optimally,” Jeerakathil said.  “That means strict control of blood pressure and elevated cholesterol, avoiding a sedentary lifestyle and an adequate diet high in vegetables and whole grains — things that we’ve found in other studies to lower the risk of heart disease.”

Additional studies should further explore the early risk from diabetes in other world populations and strategies to improve risk factor control in diabetic patients, he said.

In a separate study, (Abstract P356) American researchers report that diabetes increased stroke risk most before age 55 and in African Americans.

“If you look across the age spectrum, diabetes increases the risk for stroke by about three fold,” said lead author Brett Kissela, M.D., associate professor in the department of neurology at the University of Cincinnati in Ohio.  “But our study suggests that a lot of that risk is front loaded.  It’s a bigger risk for younger than older people, and probably higher for blacks than for whites.”

Kissela and colleagues analyzed an existing database of people living in five counties in the Greater Cincinnati area.  They compared the incidence rate of stroke in those patients with type 2 diabetes to those without.

They found that 2,432 strokes occurred in the Cincinnati metropolitan region in 1999, and 33 percent of patients were diagnosed with diabetes before their stroke occurred.  The average age for stroke was 70 years for the diabetic patients, versus 73 years for those without diabetes.

The researchers report that 25 percent of the diabetic patients who had a stroke were African American versus 15 percent of the non-diabetic patients who had stroke.

“We published an earlier paper that suggested the combination of diabetes and high blood pressure really increases stroke risk (more than either condition alone), and people who have diabetes tend to have high blood pressure,” Kissela said.  “In this study we found that 82 percent of people who had diabetes and a stroke also had high blood pressure, whereas only 66 percent of the nondiabetic patients with stroke had high blood pressure.”

Other risk factors also came into play:

• 31 percent of people who had diabetes and a stroke had diagnosed high cholesterol, versus 18 percent of non-diabetic patients who had a stroke.
• Of the stroke patients with diabetes, 19 percent had already had a heart attack, versus 12 percent of the non-diabetic stroke patients.
• The greatest risk for stroke was in patients younger than 55 in both races; however, African Americans had a seven- to nine-fold increased risk for stroke before age 45 among those who have diabetes versus those who do not.  Among Caucasians, there increased risk ranged between six- and 17-fold for those under age 55.

“In essence, while diabetes means a higher stroke risk at every age, this risk is especially prominent among young people who have diabetes diagnosed at an early age.  They need to be especially diligent about treating high blood pressure, which will lower their risk for stroke.”

Kissela believes this study should change the thinking that diabetes is the fourth or fifth biggest risk factor for stroke.

“I would argue that diabetes is the second biggest risk factor after hypertension,” he said.  “I think we’re going to find that diabetes will keep growing in importance as long as we continue to have this epidemic of diabetes.  It’s an important trend to know and understand if we’re going to do our best to prevent stroke.”

Kissela’s co-authors are Kathleen Alwell, R.N.; Richard W Hornung, Ph.D.; Jane C. Khoury, M.S.; Charles J. Moomaw, Ph.D.; Dawn Kleindorfer, M.D.; Irene Ewing, R.N.; Rosie Miller, R.N.; Daniel Woo, M.D.; Matthew L. Flaherty, M.D.; Alex Schneider, M.D.; and Joseph P. Broderick, M.D.

This study was funded by a grant from the National Institutes of Neurological Diseases and Stroke.

Jeerakathil’s co-authors are Jeffrey A. Johnson, Ph.D.; Scot H. Simpson, Pharm.D.; and Sumit R. Majumdar, M.D., MPH.   This study was funded by the Institute for Health Economics, in Edmonton, Alberta, and the Alberta Heritage Foundation for Medical Research.

Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position.  The American Heart Association makes no representation or warranty as to their accuracy or reliability.

NR06-1013 (ISC06/Jeerakathil/Kissela)

####