Abstract
The relationship between ischemic stroke (IS), diabetes mellitus (DM), and sex is intriguing. The aim of this study was to assess the effect modification of sex in the association between DM and short- and long-term disability and mortality in first-ever IS patients. In a retrospective, observational, hospital-based study of a prospective series including first-ever IS patients from January 2006 until July 2011, differences in 3-month and 5-year mortality, and disability between diabetic and non-diabetic patients [modified Rankin Scale (mRS) from 3 to 5] were analyzed by sex. In total, 933 patients (36.3% with DM, 50.5% women) were included. Overall 3-month and 5-year mortality were 150 (16.1%) and 407 (44.1%), respectively. Adjusted for age, previous mRS, and stroke severity, patients with DM had significantly higher 3-month disability [hazard ratio (HR): 1.49 (95% confidence interval (CI): 1.39-1.70), p < 0.0001], 5-year disability [HR: 1.41 (95% CI: 1.07-1.86), p = 0.015], and 5-year mortality [HR: 1.48 (95% CI: 1.20-1.81), p < 0.0001], compared with the non-DM group. Compared with non-DM women, women with diabetes had worse 3-month disability [HR: 1.81 (95% CI: 1.33-2.46), p < 0.0001] and 5-year mortality [HR: 1.72 (95% CI: 1.30-2.20), p < 0.0001], and a trend for 5-year disability [HR: 1.40 (95% CI: 0.99-2.09), p = 0.057]. In men, DM had an effect on 3-month disability [HR: 1.45 (95% CI: 1.07-1.96), p = 0.018], a trend for 5-year disability [HR: 1.43 (95% CI: 0.94-2.19), p = 0.096], but no clear effect on 5-year mortality [HR: 1.22 (95% CI: 0.91-1.65), p = 0.186]. Sex has a modifier effect on mortality in first-ever IS diabetic patients. Long-term mortality is increased in diabetic women compared with non-diabetic women, a difference not observed in men.
Highlights
Diabetes mellitus (DM) is an independent risk factor for stroke and cardiovascular disease [1]
Women with diabetes showed higher 3-month disability, and 5-year mortality, and a trend for 5-year disability, compared with non-DM women (Table 3)
confidence intervals (CIs): 1.07–1.96, p = 0.018), a trend for 5-year disability, but no effect on 5-year mortality
Summary
Diabetes mellitus (DM) is an independent risk factor for stroke and cardiovascular disease [1]. DM raises ischemic stroke (IS) severity, and has been associated with a poor functional outcome, worse long-term vascular prognosis, and increased mortality after stroke onset, compared with non-diabetic patients [4,5,6]. Other studies have found increased mortality for both women and men with diabetes [15], a time-dependent mortality risk only for DM men [16], and lower adjusted mortality in DM women than in men [17] The reasons for these sex differences are unknown, and the majority of the research has focused on comparing men and women with DM, with little information about how sex can influence the short- and long-term impact of DM on post-IS prognosis. The relationship between ischemic stroke (IS), diabetes mellitus (DM), and sex is intriguing. The aim of this study was to assess the effect modification of sex in the association between DM and short- and long-term disability and mortality in first-ever IS patients
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