Nurcennet Kaynak, Valentin Kennel, Torsten Rackoll, Daniel Schulze, Matthias Endres, Alexander H Nave
{"title":"葡萄糖代谢受损与缺血性中风后血管事件和死亡风险：系统回顾与荟萃分析。","authors":"Nurcennet Kaynak, Valentin Kennel, Torsten Rackoll, Daniel Schulze, Matthias Endres, Alexander H Nave","doi":"10.1186/s12933-024-02413-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus (DM), prediabetes, and insulin resistance are highly prevalent in patients with ischemic stroke (IS). DM is associated with higher risk for poor outcomes after IS.</p><p><strong>Objective: </strong>Investigate the risk of recurrent vascular events and mortality associated with impaired glucose metabolism compared to normoglycemia in patients with IS and transient ischemic attack (TIA).</p><p><strong>Methods: </strong>Systematic literature search was performed in PubMed, Embase, Cochrane Library on 21st March 2024 and via citation searching. Studies that comprised IS or TIA patients and exposures of impaired glucose metabolism were eligible. Study Quality Assessment Tool was used for risk of bias assessment. Covariate adjusted outcomes were pooled using random-effects meta-analysis.</p><p><strong>Main outcomes: </strong>Recurrent stroke, cardiac events, cardiovascular and all-cause mortality and composite of vascular outcomes.</p><p><strong>Results: </strong>Of 10,974 identified studies 159 were eligible. 67% had low risk of bias. DM was associated with an increased risk for composite events (pooled HR (pHR) including 445,808 patients: 1.58, 95% CI 1.34-1.85, I<sup>2</sup> = 88%), recurrent stroke (pHR including 1.161.527 patients: 1.42 (1.29-1.56, I<sup>2</sup> = 92%), cardiac events (pHR including 443,863 patients: 1.55, 1.50-1.61, I<sup>2</sup> = 0%), and all-cause mortality (pHR including 1.031.472 patients: 1.56, 1.34-1.82, I<sup>2</sup> = 99%). Prediabetes was associated with an increased risk for composite events (pHR including 8,262 patients: 1.50, 1.15-1.96, I<sup>2</sup> = 0%) and recurrent stroke (pHR including 10,429 patients: 1.50, 1.18-1.91, I<sup>2</sup> = 0), however, not with mortality (pHR including 9,378 patients, 1.82, 0.73-4.57, I<sup>2</sup> = 78%). Insulin resistance was associated with recurrent stroke (pHR including 21,363 patients: 1.56, 1.19-2.05, I<sup>2</sup> = 55%), but not with mortality (pHR including 21,363 patients: 1.31, 0.66-2.59, I<sup>2</sup> = 85%).</p><p><strong>Discussion: </strong>DM is associated with a 56% increased relative risk of death after IS and TIA. Risk estimates regarding recurrent events are similarly high between prediabetes and DM, indicating high cardiovascular risk burden already in precursor stages of DM. There was a high heterogeneity across most outcomes.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":null,"pages":null},"PeriodicalIF":8.5000,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366144/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impaired glucose metabolism and the risk of vascular events and mortality after ischemic stroke: A systematic review and meta-analysis.\",\"authors\":\"Nurcennet Kaynak, Valentin Kennel, Torsten Rackoll, Daniel Schulze, Matthias Endres, Alexander H Nave\",\"doi\":\"10.1186/s12933-024-02413-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Diabetes mellitus (DM), prediabetes, and insulin resistance are highly prevalent in patients with ischemic stroke (IS). DM is associated with higher risk for poor outcomes after IS.</p><p><strong>Objective: </strong>Investigate the risk of recurrent vascular events and mortality associated with impaired glucose metabolism compared to normoglycemia in patients with IS and transient ischemic attack (TIA).</p><p><strong>Methods: </strong>Systematic literature search was performed in PubMed, Embase, Cochrane Library on 21st March 2024 and via citation searching. Studies that comprised IS or TIA patients and exposures of impaired glucose metabolism were eligible. Study Quality Assessment Tool was used for risk of bias assessment. Covariate adjusted outcomes were pooled using random-effects meta-analysis.</p><p><strong>Main outcomes: </strong>Recurrent stroke, cardiac events, cardiovascular and all-cause mortality and composite of vascular outcomes.</p><p><strong>Results: </strong>Of 10,974 identified studies 159 were eligible. 67% had low risk of bias. DM was associated with an increased risk for composite events (pooled HR (pHR) including 445,808 patients: 1.58, 95% CI 1.34-1.85, I<sup>2</sup> = 88%), recurrent stroke (pHR including 1.161.527 patients: 1.42 (1.29-1.56, I<sup>2</sup> = 92%), cardiac events (pHR including 443,863 patients: 1.55, 1.50-1.61, I<sup>2</sup> = 0%), and all-cause mortality (pHR including 1.031.472 patients: 1.56, 1.34-1.82, I<sup>2</sup> = 99%). Prediabetes was associated with an increased risk for composite events (pHR including 8,262 patients: 1.50, 1.15-1.96, I<sup>2</sup> = 0%) and recurrent stroke (pHR including 10,429 patients: 1.50, 1.18-1.91, I<sup>2</sup> = 0), however, not with mortality (pHR including 9,378 patients, 1.82, 0.73-4.57, I<sup>2</sup> = 78%). Insulin resistance was associated with recurrent stroke (pHR including 21,363 patients: 1.56, 1.19-2.05, I<sup>2</sup> = 55%), but not with mortality (pHR including 21,363 patients: 1.31, 0.66-2.59, I<sup>2</sup> = 85%).</p><p><strong>Discussion: </strong>DM is associated with a 56% increased relative risk of death after IS and TIA. Risk estimates regarding recurrent events are similarly high between prediabetes and DM, indicating high cardiovascular risk burden already in precursor stages of DM. There was a high heterogeneity across most outcomes.</p>\",\"PeriodicalId\":9374,\"journal\":{\"name\":\"Cardiovascular Diabetology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":8.5000,\"publicationDate\":\"2024-08-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366144/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular Diabetology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12933-024-02413-w\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular Diabetology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12933-024-02413-w","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Impaired glucose metabolism and the risk of vascular events and mortality after ischemic stroke: A systematic review and meta-analysis.
Background: Diabetes mellitus (DM), prediabetes, and insulin resistance are highly prevalent in patients with ischemic stroke (IS). DM is associated with higher risk for poor outcomes after IS.
Objective: Investigate the risk of recurrent vascular events and mortality associated with impaired glucose metabolism compared to normoglycemia in patients with IS and transient ischemic attack (TIA).
Methods: Systematic literature search was performed in PubMed, Embase, Cochrane Library on 21st March 2024 and via citation searching. Studies that comprised IS or TIA patients and exposures of impaired glucose metabolism were eligible. Study Quality Assessment Tool was used for risk of bias assessment. Covariate adjusted outcomes were pooled using random-effects meta-analysis.
Main outcomes: Recurrent stroke, cardiac events, cardiovascular and all-cause mortality and composite of vascular outcomes.
Results: Of 10,974 identified studies 159 were eligible. 67% had low risk of bias. DM was associated with an increased risk for composite events (pooled HR (pHR) including 445,808 patients: 1.58, 95% CI 1.34-1.85, I2 = 88%), recurrent stroke (pHR including 1.161.527 patients: 1.42 (1.29-1.56, I2 = 92%), cardiac events (pHR including 443,863 patients: 1.55, 1.50-1.61, I2 = 0%), and all-cause mortality (pHR including 1.031.472 patients: 1.56, 1.34-1.82, I2 = 99%). Prediabetes was associated with an increased risk for composite events (pHR including 8,262 patients: 1.50, 1.15-1.96, I2 = 0%) and recurrent stroke (pHR including 10,429 patients: 1.50, 1.18-1.91, I2 = 0), however, not with mortality (pHR including 9,378 patients, 1.82, 0.73-4.57, I2 = 78%). Insulin resistance was associated with recurrent stroke (pHR including 21,363 patients: 1.56, 1.19-2.05, I2 = 55%), but not with mortality (pHR including 21,363 patients: 1.31, 0.66-2.59, I2 = 85%).
Discussion: DM is associated with a 56% increased relative risk of death after IS and TIA. Risk estimates regarding recurrent events are similarly high between prediabetes and DM, indicating high cardiovascular risk burden already in precursor stages of DM. There was a high heterogeneity across most outcomes.
期刊介绍：
Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.
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