CONTRIBUTING FACTORS FOR STROKE:
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1 CONTRIBUTING FACTORS FOR STROKE: DIABETES AND OBESITY Fruzsina K. Johnson, MD Professor of Preclinical Sciences William Carey University College of Osteopathic Medicine
2 LEARNING OBJECTIVES The learner will be able to discuss the impact of obesity on the risk of cerebrovascular disease and stroke. The learner will be able to discuss the impact of diabetes on the risk of cerebrovascular disease and stroke. The learner will be familiar with current recommendations and guidelines regarding the management of obesity and diabetes as risk factors for stroke.
3 DIABETES
4 DIABETES INCLUDING ESTIMATED UNDIAGNOSED CASES
5 FROM 1980 THROUGH 2011, THE NUMBER OF AMERICANS WITH DIABETES HAS MORE THAN TRIPLED, FROM 5.6 MILLION TO 20.9 MILLION
6 PROJECTED INCREASE IN DIABETES BURDEN
7 PREDIABETES ALSO INCREASES THE RISK OF STROKE
8 PREDIABETES
9 OBESITY AND TYPE 2 DIABETES
10 OBESITY AND TYPE 2 DIABETES
11 METABOLIC SYNDROME INCREASES RISK OF ATHEROSCLEROSIS AND CVD Caplan, Louis R. Caplan's Stroke: A Clinical Approach. 5 th edition. Cambridge University Press 2016; Chapter 18: Stroke prevention
12 METABOLIC SYNDROME GREATLY INCREASES THE RISK OF CVD
13 DIABETES MELLITUS IS A MAJOR RISK FACTOR FOR STROKE The risk of stroke is increased by fold for patients with diabetes Diabetes also doubles the risk of stroke recurrence Stroke outcomes are significantly worse among patients with diabetes including: increased hospital and long-term stroke mortality: at 1 year, mortality was twofold higher in people with diabetes compared with those without it after 5 years, only one-fifth of patients with diabetes survive. more residual neurological, functional disability longer hospital stays increases the risk of stroke-related dementia by more than threefold Idris, I., Thomson, G.A., Sharma, J.C. Diabetes mellitus and stroke. Review. Int J Clin Pract, January 2006, 60, 1,
14 DIABETES CHANGES CLINICAL PRESENTATION OF STROKE Idris, I., Thomson, G.A., Sharma, J.C. Diabetes mellitus and stroke. Review. Int J Clin Pract, January 2006, 60, 1,
15 RISK FACTORS FOR STROKE FATALITY IN DIABETIC PATIENTS Idris, I., Thomson, G.A., Sharma, J.C. Diabetes mellitus and stroke. Review. Int J Clin Pract, January 2006, 60, 1,
16 CLINICAL TRIALS RELATING TO STROKE IN DIABETES Idris, I., Thomson, G.A., Sharma, J.C. Diabetes mellitus and stroke. Review. Int J Clin Pract, January 2006, 60, 1,
17 RECOMMENDATIONS FOR STROKE PREVENTION IN DIABETES Idris, I., Thomson, G.A., Sharma, J.C. Diabetes mellitus and stroke. Review. Int J Clin Pract, January 2006, 60, 1,
18 DIABETES AND CARDIOVASCULAR DISEASE
19 STROKE IS A MAJOR COMPLICATION OF DIABETES
20 1) STROKE IS SECOND ONLY TO ACUTE MYOCARDIAL INFARCTION (MI) AMONG DIABETES-RELATED COMPLICATIONS 2) IMPROVED GLYCEMIC CONTROL DECREASES THE RATE OF STROKE AND OTHER COMPLICATIONS
21 AMERICAN DIABETES ASSOCIATION RECOMMENDATIONS FOR REDUCTION OF CARDIOVASCULAR DISEASE RISK IN DIABETES Glycemic control note: tight control has not been shown to confer greater protection, but can increase stroke risk by promoting hypoglycemia Note: recent studies suggest that sulfonylureas may increase ischemic stroke damage by inhibiting KATP channels in nerve and glia cells that are important for neuroprotection during ischemia Blood pressure control in diabetic patients angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) should be first line of therapy confer renoprotection Lipid control Antiplatelet agents For details see: American Diabetes Association. Cardiovascular disease and risk management. Sec. 9. In Standards of Medical Care in Diabetes Diabetes Care 2017;40(Suppl. 1): S75 S87
22 REFERENCES/RESOURCES 1. Caplan, Louis R. Caplan's Stroke: A Clinical Approach. 5 th edition. Cambridge University Press 2016; Chapter 18: Stroke prevention. 2. American Diabetes Association website: 3. Idris, I., Thomson, G.A., Sharma, J.C. Diabetes mellitus and stroke. Review. Int J Clin Pract, January 2006, 60, 1, American Diabetes Association. Standards of Medical Care in Diabetes Diabetes Care 2017;40(Suppl. 1) full text available for free at: 5. Riu L., at al: Cerebrovascular Safety of Sulfonylureas: The Role of K ATP Channels in Neuroprotection and the Risk of Stroke in Patients With Type 2 Diabetes. Diabetes 2016 Sep; 65(9): Full text available for free at:
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