Abstract
ObjectiveHyperglycemia is related to stroke. Glycated hemoglobin (HbA1c) can reflect pre-stroke glycaemia status. However, the information on the direct association between HbA1c and recurrence after non-cardioembolic acute ischemic strokes is rare and there is no consistent conclusion.MethodsThe ACROSS-China database comprised of 2186 consecutive first-ever acute ischemic stroke patients with baseline HbA1c values. After excluding patients who died from non-stroke recurrence and patients lost to follow up, 1817 and 1540 were eligible for 3-month and 1-year analyses, respectively. Multivariate Cox regression was performed to evaluate the associations between HbA1c and 3-month and 1-year stroke recurrence.ResultsThe HbA1c values at admission were divided into 4 levels by quartiles: Q1 (<5.5%); Q2 (5.5 to <6.1%); Q3 (6.1% to <7.2%); and Q4 (≥7.2%). The cumulative recurrence rates were 8.3% and 11.0% for 3 months and 1 year, respectively. In multivariate analyses, when compared with Q1, the adjusted hazard ratios (AHRs) were 2.83 (95% confidence interval (CI) 1.28-6.26) in Q3 and 3.71(95% CI 1.68-8.21) in Q4 for 3-month stroke recurrence; 3.30 (95% CI 1.31-8.34) in Q3 and 3.35 (95% CI 1.36-8.21) in Q4 for 1-year stroke recurrence. Adding fasting plasma glucose in the multivariate analyses did not modify the association: AHRs were 2.75 (95% CI 1.24-6.11) in Q3 and 3.67 (95% CI 1.59-8.53) in Q4 for 3-month analysis; AHRs were 3.08 (95% CI 1.10-8.64) in Q3 and 3.31(95% CI 1.35-8.14) in Q4 for 1-year analysis.ConclusionsA higher “normal” HbA1c level reflecting pre-stroke glycaemia status independently predicts stroke recurrence within one year after non-cardioembolic acute ischemic stroke onset. HbA1c is recommended as a routine test in acute ischemic stroke patients.
Highlights
Stroke has surpassed heart disease and become the leading cause of mortality and adult disability in China
Prediabetes has widely been considered as a risk predictor for initial stroke [6,7] and impaired fasting glucose is associated with recurrent cardiovascular disease (CVD) [8]
Of all 2186 patients with first-ever acute ischemic stroke (AIS), 1817 patients with non-cardioembolic AIS were available for 3-month follow-up, among which 2 patients died from recurrent stroke and 180 live patients experienced stroke recurrence
Summary
The cumulative rate of stroke is 11.2% [1], and the most recent data show that the cumulative acute ischemic stroke (AIS) recurrence rate within 1 year is 17.7% [2] in China, which is apparently higher than that in the Western countries [3]. An HbA1c level of ≥6.5% is one of the criteria for diagnosing diabetes mellitus [9], and a range of HbA1c from 5.7% to. The baseline HbA1c value at admission to hospital presents the mean plasma glucose level of the 2-3 months preceding acute stroke onset, which reflects pre-stroke glycaemia status (PSGS) [11]. The present study aimed to determine such an association among patients with first-ever non-cardioembolic acute ischemic strokes (AIS) within 1 year after stroke onset. 1817 patients were available for 3-month analysis and 1540 patients were available for 1 year analysis (Figure 1)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
