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. 2022 Sep 30:14:999568.
doi: 10.3389/fnagi.2022.999568. eCollection 2022.

Thirty-six months recurrence after acute ischemic stroke among patients with comorbid type 2 diabetes: A nested case-control study

Lu Wang  1 , Hongyun Li  1 , Jiheng Hao  2 , Chao Liu  2 , Jiyue Wang  2 , Jingjun Feng  2 , Zheng Guo  3 , Yulu Zheng  3 , Yanbo Zhang  4 , Hongxiang Li  4 , Liyong Zhang  2 , Haifeng Hou  1   3
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Thirty-six months recurrence after acute ischemic stroke among patients with comorbid type 2 diabetes: A nested case-control study

Lu Wang et al. Front Aging Neurosci. .

Abstract

Background: Stroke patients have to face a high risk of recurrence, especially for those with comorbid T2DM, which usually lead to much more serious neurologic damage and an increased likelihood of death. This study aimed to explore determinants of stroke relapse among patients with comorbid T2DM.

Materials and methods: We conducted this case-control study nested a prospective cohort of ischemic stroke (IS) with comorbid T2DM. During 36-month follow-up, the second stroke occurred in 84 diabetic IS patients who were allocated into the case group, while 613 patients without recurrence were the controls. We collected the demographic data, behaviors and habits, therapies, and family history at baseline, and measured the variables during follow-up. LASSO and Logistic regression analyses were carried out to develop a prediction model of stroke recurrence. The receiver operator characteristic (ROC) curve was employed to evaluate the performance of the prediction model.

Results: Compared to participants without recurrence, the higher levels of pulse rate (78.29 ± 12.79 vs. 74.88 ± 10.93) and hypertension (72.6 vs. 61.2%) were recorded at baseline. Moreover, a lower level of physical activity (77.4 vs. 90.4%), as well as a higher proportion of hypoglycemic therapy (36.9 vs. 23.3%) was also observed during 36-month follow-up. Multivariate logistic regression revealed that higher pulse rate at admission (OR = 1.027, 95 %CI = 1.005-1.049), lacking physical activity (OR = 2.838, 95% CI = 1.418-5.620) and not receiving hypoglycemic therapy (OR = 1.697, 95% CI = 1.013-2.843) during follow-up increased the risk of stroke recurrence. We developed a prediction model using baseline pulse rate, hypoglycemic therapy, and physical activity, which produced an area under ROC curve (AUC) of 0.689.

Conclusion: Physical activity and hypoglycemic therapy play a protective role for IS patients with comorbid diabetes. In addition to targeted therapeutics, the improvement of daily-life habit contributes to slowing the progress of the IS.

Keywords: diabetes mellitus; ischemic stroke; nested case-control study; recurrence; risk factors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart for study participant selection.
FIGURE 2
FIGURE 2
Biochemical tests. (A) The level of Homocysteine; (B) the level of HDL-C; (C) the level of LDL-Cs; (D) the level of Cholesterol; (E) the level of Triglyceride; (F) the level of FBG; the data shown in the graphs represent the mean ± SD. FBG, fasting blood-glucose; LDL-C, low density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; SD, standard deviations.
FIGURE 3
FIGURE 3
LASSO regression analysis for variable selection. (A) LASSO coefficient of 38 variables; (B) optimal penalty coefficient (λ = 0.000584) in LASSO regression identified with the minimum criterion; LASSO, least absolute shrinkage and selection operator; SE, standard error.
FIGURE 4
FIGURE 4
Forest plots of logistic regression. CI, confidence interval.
FIGURE 5
FIGURE 5
Receiver operator characteristic (ROC) curve.
FIGURE 6
FIGURE 6
Nomogram to predict 36-month risk of stroke recurrence. Draw a line perpendicular from the corresponding axis of each factor until it reaches the top line labeled “Points”. Sum up the number of points for all factors, then draw a line descending from the axis labeled “Total Points” until it intercepts each of the axes to predict 36-month risk of stroke recurrence.
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