CONTRIBUTING FACTORS FOR STROKE: DIABETES AND OBESITY Fruzsina K. Johnson, MD Professor of Preclinical Sciences William Carey University College of Osteopathic Medicine
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.
DIABETES
DIABETES INCLUDING ESTIMATED UNDIAGNOSED CASES
FROM 1980 THROUGH 2011, THE NUMBER OF AMERICANS WITH DIABETES HAS MORE THAN TRIPLED, FROM 5.6 MILLION TO 20.9 MILLION
PROJECTED INCREASE IN DIABETES BURDEN
PREDIABETES ALSO INCREASES THE RISK OF STROKE
PREDIABETES
OBESITY AND TYPE 2 DIABETES
OBESITY AND TYPE 2 DIABETES
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
METABOLIC SYNDROME GREATLY INCREASES THE RISK OF CVD
DIABETES MELLITUS IS A MAJOR RISK FACTOR FOR STROKE The risk of stroke is increased by 1.5 3 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, 48 56.
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, 48 56.
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, 48 56.
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, 48 56.
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, 48 56.
DIABETES AND CARDIOVASCULAR DISEASE
STROKE IS A MAJOR COMPLICATION OF DIABETES
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
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: http://professional.diabetes.org/content/clinicalpractice-recommendations American Diabetes Association. Cardiovascular disease and risk management. Sec. 9. In Standards of Medical Care in Diabetes 2017. Diabetes Care 2017;40(Suppl. 1): S75 S87
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: http://professional.diabetes.org/slidelibrary 3. Idris, I., Thomson, G.A., Sharma, J.C. Diabetes mellitus and stroke. Review. Int J Clin Pract, January 2006, 60, 1, 48 56. 4. American Diabetes Association. Standards of Medical Care in Diabetes 2017. Diabetes Care 2017;40(Suppl. 1) full text available for free at: http://care.diabetesjournals.org/content/40/supplement_1 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): 2795-2809. Full text available for free at: http://diabetes.diabetesjournals.org/content/65/9/2795