11–13 In the diabetic population, elevated total cholesterol, decreased HDL cholesterol, and elevated triglycerides have all been identified as risk factors for stroke. 1–9 In the general population, the relationship between lipid levels and stroke is complicated by an inverse association between total cholesterol and hemorrhagic stroke, 10 but depressed high-density lipoprotein (HDL) cholesterol, elevated ratio of total to HDL cholesterol (T:H), and elevated triglycerides have all been reported to increase overall risk of stroke. 1,2 Risk factors for increased risk of stroke in the type 2 diabetic population include elevated blood pressure, smoking, age, male sex, atrial fibrillation (AF), and hyperglycemia. In people with type 2 diabetes, there is a 2- to 5-fold increased risk for stroke compared with those without diabetes. The use of the model is illustrated with a hypothetical study power calculation.Ĭonclusions- This model forecasts the absolute risk of a first stroke in people with type 2 diabetes using variables readily available in routine clinical practice. Not included in the model were body mass index, hemoglobin A1c, ethnicity, and ex-smoking status. Results- Variables included in the final model were duration of diabetes, age, sex, smoking, systolic blood pressure, total cholesterol to high-density lipoprotein cholesterol ratio and presence of atrial fibrillation. Diagnostic plots were used to compare survival probabilities calculated by the model with those calculated using nonparametric methods. Model fitting was carried out by maximum likelihood estimation using the Newton-Raphson method. Methods- During 30 700 person-years of follow-up, 188 first strokes (52 fatal) occurred. We developed mathematical models to estimate the risk of a first stroke using data from 4549 newly diagnosed type 2 diabetic patients enrolled in the UK Prospective Diabetes Study. Relative risks have been examined in earlier work, but there is no readily available method for predicting the absolute risk of stroke in a diabetic individual. Customer Service and Ordering Informationīackground and Purpose- People with type 2 diabetes are at elevated risk of stroke compared with those without diabetes.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).Role of Insulin Resistance in Endothelial Dysfunction, Ranganath Muniyappa, James R.

Obesity and dyslipidemia, Franssen R1, Monajemi H, Stroes ES, Kastelein JJ., Med Clin North Am.

Insulin resistance and lipid metabolism, Howard B, Am J Cardiol. Multiple risk factors for cardiovascular disease and diabetes mellitus, Smith SC Jr, Am J Med. Epidemiology of type 2 diabetes and cardiovascular disease: translation from population to prevention: the Kelly West award lecture 2009. Venkat Narayan, and Nikhil Tandon, Indian JMed Res. Diabetes & coronary heart disease: Current perspectives, Mohammed K.

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