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Atherogenic effects are already well established at the time of a diagnosisof type 2 diabetes, warranting immediate aggressive efforts in primary strokeprevention, investigators announced at the American Stroke Association'sInternational Stroke Conference, held February 16–18 in Kissimmee,Fla.
Thomas Jeerakathil, MD, and colleagues at the University of Alberta inEdmonton, identified 12,272 new cases of type 2 diabetes in Saskatchewanduring 1991–1996. Men comprised 55% of the population, and the mean agewas 64 years.
During 5 years of follow-up, 9.4% of the patients with newly diagnoseddiabetes were admitted to the hospital with a first stroke. The risk of strokein the newly diagnosed patients was double that of the general population."This suggests that atherosclerosis risk factors are already inplace," according toJeerakathil.
"Hypertension accelerates the progression of atherosclerosis,"he says. "For most people, lowering blood pressure 10–12 mmHglowers stroke risk by about 40% in relative terms. In diabetics, [previousstudies] showed that if you lower blood pressure from 154 systolic to 144systolic there is a 44% reduction in stroke," Jeerakathil explains toDOC News. "If you compare someone with a systolic pressureabove 160 mmHg—poorly controlled—with someone at around 144systolic—better, but not even optimal by today's standards—thecombined risk reduction is around 60%."
Jeerakathil says people with diabetes have a 9% chance of being admitted tothe hospital with a stroke-related diagnosis. Comparatively, an averagehealthy 65-year-old male has a 2.5% chance of having a stroke over 5years.
"The implications of this study are that persons with diabetes shouldhave aggressive control of cardiovascular risk factors such as hypertension,elevated cholesterol, sedentary lifestyle, and obesity, even shortly afterdiagnosis, because the effects of atherosclerosis are already becomingestablished early in the disease," Jeerakathil says.
STROKE AT A YOUNGER AGE
Brett Kissela, MD, and colleagues at the University of Cincinnati presenteda similar study that found the risk of stroke in people with type 2 diabeteswas greatest before the age of 55 years. In addition, people who get diabetesat a younger age have a significantly increased risk of stroke.
"This suggests that the risk is front-loaded," Kisselasays.
In an analysis of 2,423 strokes in the metropolitan Cincinnati area, 33%occurred in patients with diabetes, the researchers found. Mean age at firststroke was 70 years in patients with diabetes and 73 years in those who didnot have the disease.
While risk in diabetic patients was "elevated across the agespectrum," it was greatest in those <55—five to nine timeshigher than in people the same age without diabetes—and greater inblacks than in whites.
"We must address glycemic control, but also cardiovascular riskfactors," Kissela says, echoing Jeerakathil. "Each component ofthe metabolic profile carries a stroke risk. There is something inflammatoryat the heart of the problem." 
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