[ Diabetes Type 1 ]

Serum Uric Acid Is a Strong Predictor of Stroke in Patients With Non–Insulin-Dependent Diabetes Mellitus

Aldose reductase (AR), the first enzyme in the polyol pathway, has been implicated in a wide variety of physiological and pathological functions, such as diabetic vascular and neural complications. It is the most common of the endocrine disorders and is characterized by chronic hyperglycemia due to relative or absolute lack of insulin… In animal models, diabetic db/db mice exhibit larger infarct volumes relative to their non-diabetic db/ + littermates following a cerebral hypoxicischemic (HI) insult. Cognitive impairment and dementia associated with DM may also be mediated via vascular risk factors, in particular brain ischemia, the occurrence of which can have an additive or synergistic effect with concomitant neurodegenerative processes. Although stroke can and does occur in infants and children, the focus of this article is the adult population. An atherogenic diet in apolipoprotein E knock-out (ApoE−/−) mice induced microglial activation in the brain parenchyma within 8weeks and increased expression of vascular adhesion molecules. Fifty patients were enrolled in diabetic group and 50 in non-diabetic.

None of the criteria predicted hemorrhagic stroke. As reported by the Taiwan National Health Research Institute, there were no statistically significant differences in age, gender, or health care costs between the sample group and all enrollees.14 The LHID includes all claims data for these 1 000 000 subjects, offering a unique opportunity to examine the risk of stroke among patients with tuberculosis. However, serum uric acid has been recently associated with insulin resistance.6 7 Furthermore, in nondiabetic subjects an elevated level of uric acid has been shown to be an independent predictor of coronary heart disease and total mortality.8 9 10 11 Therefore, we examined serum uric acid as a risk factor for stroke in a prospective population-based study that included a large number of patients with NIDDM. All diabetic patients in Finland who need antidiabetic drug therapy receive it free of charge according to the Sickness Insurance Act. However, there is a lack of specific recommendations and guidelines for stroke management in young adults. Based on this register, we identified all diabetic patients aged 45 to 64 years who were born and living in the Kuopio University Hospital district (East Finland) and in the Turku University Central Hospital district (West Finland). The other major pathology that directly involves the walls of penetrating arteries is infiltration of the coats of these vessels with materials foreign to vessels.

Possible explanations for the neutral effect on stroke incidence are a lack of power (the expected stroke rate in the placebo group was 8%, compared with an actual event rate of 4.5%) and the duration of the trial, which lasted only 3 years. A stroke can lead to emotional problems. This can distort and injure tissue. It is unlikely, however, that the underrepresentation of diet-treated diabetic patients in our series could influence our results concerning the main study objective (the evaluation of risk factors for stroke in patients with NIDDM), because the mode of treatment of diabetes appeared to be quite similar in both study areas. We must therefore keep an open mind as to what the appropriate pharmacologic targets for vascular inflammation might be in the future. Also, symptoms may be transient as the embolus is partially resorbed and moves to a different location or dissipates altogether. Hypertension means that the blood is exerting more pressure than is normal or healthy.

And in the grimmest of cases, bleeding has caused so much damage to the brain that surgical intervention is futile. Conclusions My comparisons of the epidemiology of lacunar versus non-lacunar ischaemic stroke subtypes revealed differences in the risk factor profiles and risks of recurrent stroke and myocardial infarction which suggest that a distinct, nonatherothrombotic arteriopathy underlies many lacunar ischaemic strokes. Journal of the Neurological Sciences. Division. If you drink, do so in moderation It has been suggested that wine may actually help reduce stroke risk. Blood pressure was measured with the patients in a sitting position after a 5-minute rest with use of a mercury sphygmomanometer and read to the nearest 2 mm Hg. We will also aim to determine PPAR-γ receptor density among cases.

Researchers closely followed the Declaration of Helsinki – Ethical Principles for Medical Research in all steps of the study. All laboratory specimens were drawn at 8 am, after a 12-hour fast. All analyses except that for glycohemoglobin A1 (GHbA1) were performed in duplicate. 2006;27(3):290–295. GHbA1 was determined by affinity chromatography (Isolab). The plasma C-peptide response to glucagon was assessed according to the method of Faber and Binder.17 Plasma C-peptide was determined by radioimmunoassay (antiserum M 1230, Novo).18 Serum lipids and lipoproteins were determined from fresh serum samples drawn after a 12-hour overnight fast. Serum total cholesterol and triglycerides were assayed by automated enzymatic methods (Boehringer).19 Serum HDL cholesterol was determined enzymatically after precipitation of low-density and very-low-density lipoproteins with dextran sulfate MgCl2.20 Serum uric acid was measured with use of an enzymatic calorimetric method (Amer Division, Miles Laboratories).21 The subjects were classified into two categories, according to the median of serum uric acid: low uric acid (≤295 μmol/L) and high uric acid (>295 μmol/L) groups.

Brain hemorrhages can result from many conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension), overtreatment with anticoagulants and weak spots in your blood vessel walls (aneurysms). Thus, thromboembolic and hemorrhagic strokes but not subarachnoid hemorrhage, were included in the diagnosis of stroke. J Clin Invest.1997; 100: 1230–9. C) primary hyperthyroidism. The results for continuous variables are given as mean±SEM and proportions as percentages. The differences between the groups were assessed by the χ2 test or the Student two-tailed t test for independent samples when appropriate. A univariate and multivariate Cox regression model23 was used to investigate the association of cardiovascular risk factors with the incidence of stroke events.

This study was approved by the Ethics Committees of the Kuopio University Central Hospital and the Turku University Central Hospital. In a systematic review, relative risk of in-hospital or 30-day mortality after an ischemic stroke was 3.3 in hyperglycemic patients without known DM and 2.0 in those with known DM when compared to patients with normoglycemia [24]. Oligodendroglia are the glial cells responsible for myelin production within the CNS. Altogether, 114 patients (55 men [10.0%] and 59 women [12.7%]) had a fatal or nonfatal stroke event.

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