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      Impact of Female Gender on Prognosis in Type 2 Diabetic Patients with Ischemic Stroke

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          A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women.

          We examined the relationship of maturity-onset clinical diabetes mellitus with the subsequent incidence of coronary heart disease, stroke, total cardiovascular mortality, and all-cause mortality in a cohort of 116,177 US women who were 30 to 55 years of age and free of known coronary heart disease, stroke, and cancer in 1976. During 8 years of follow-up (889 255 person-years), we identified 338 nonfatal myocardial infarctions, 111 coronary deaths, 259 strokes, 238 cardiovascular deaths, and 1349 deaths from all causes. Diabetes was associated with a markedly increased risk of nonfatal myocardial infarction and fatal coronary heart disease (age-adjusted relative risk [RR] = 6.7; 95% confidence interval [CI], 5.3 to 8.4), ischemic stroke (RR = 5.4; 95% CI, 3.3 to 9.0), total cardiovascular mortality (RR = 6.3; 95% CI, 4.6 to 8.6), and all-cause mortality (RR = 3.0; 95% CI, 2.5 to 3.7). A major independent effect of diabetes persisted in multivariate analyses after simultaneous control for other known coronary risk factors (for these end points, RR [95% CI] = 3.1 [2.3 to 4.2], 3.0 [1.6 to 5.7], 3.0 [1.9 to 4.8], and 1.9 [1.4 to 2.4], respectively). The absolute excess coronary risk due to diabetes was greater in the presence of other risk factors, including cigarette smoking, hypertension, and obesity. These prospective data indicate that maturity-onset clinical diabetes is a strong determinant of coronary heart disease, ischemic stroke, and cardiovascular mortality among middle-aged women. The adverse effect of diabetes is amplified in the presence of other cardiovascular risk factors, many of which are modifiable.
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            Association between diabetes and stroke subtype on survival and functional outcome 3 months after stroke: data from the European BIOMED Stroke Project.

            Although diabetes is a strong risk factor for stroke, it is still unclear whether stroke subtype, severity, and prognosis are different in diabetic and nondiabetic patients. We sought to evaluate stroke features, prognosis, and functional outcome in patients with diabetes compared with patients without diabetes. In a European Union Concerted Action involving 7 countries and 4537 patients hospitalized for a first-in-a-lifetime stroke, defined according to the Oxfordshire Community Stroke Project criteria, we collected data on demographics, risk factors, clinical presentation, and outcome. We used logistic regression to examine the relationship between diabetes and outcome at 3 months (disability, handicap, and death), controlling for risk factors, clinical presentation, and demographics. Overall, diabetes was present in 937 patients (21%). Diabetic patients, compared with those without diabetes, were more likely to have limb weakness (P<0.02), dysarthria (P<0.001), ischemic stroke (P<0.001), and lacunar cerebral infarction (P=0.03). At 3 months, the case fatality rates were not higher in the diabetic groups (P=0.33). Handicap (Rankin Scale) and disability (Barthel Index) were significantly higher in diabetic patients (P=0.005 and P=0.016, respectively). Stroke in diabetic patients has a specific clinical pattern and a poor prognosis in terms of motor function, which emphasizes the need for early diagnosis and treatment of every case of diabetes.
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              Predicting functional outcome and survival after acute ischemic stroke.

              Disability and mortality represent the most relevant clinical outcome after acute ischemic stroke. However, validated and comprehensive prognostic models for recovery have not been developed. An accurate model including all previously suggested independent outcome predictors could improve the design and analysis of clinical trials. We therefore developed prognostic models for functional dependence and death after 100 days in a large cohort of stroke patients. From the German Stroke Database, 1754 prospectively collected records of patients with acute ischemic stroke were used for the development of prognostic models. Intubated patients and patients with low functional status before stroke were excluded. Functional independence was defined as a Barthel Index >/=95 after 100 days. Prognostic factors assessable within 72 hours after admission were identified by a systematic literature review. The final models of binary logistic regression analyses were internally validated and calibrated. The resulting cross-validated and calibrated models correctly classified more than 80 % of the patients and yielded the following prognostic factors for functional independence: Age, right and left arm paresis at admission, NIH-Stroke Scale at admission, Rankin Scale 48-72 hours later, gender, prior stroke, diabetes, fever, lenticulostriate infarction, neurological complications. The following variables were identified as prognostic factors for death: Age, NIH-Stroke Scale at admission, and fever. Our work gives an important insight into prognostic factors after acute ischemic stroke and presents predictive models with high prognostic accuracy. Together with a prospective validation study, currently underway, we hence hope to improve the prediction of functional outcome after ischemic stroke.
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                Author and article information

                Journal
                ENE
                Eur Neurol
                10.1159/issn.0014-3022
                European Neurology
                S. Karger AG
                0014-3022
                1421-9913
                2006
                September 2006
                08 September 2006
                : 56
                : 1
                : 6-12
                Affiliations
                aCerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, University of Barcelona, bClinical Information Systems, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, and cDepartment of Internal Medicine, Hospital Universitari del Sagrat Cor, Barcelona, Spain
                Article
                94249 Eur Neurol 2006;56:6–12
                10.1159/000094249
                16804310
                6ac56cd1-fddb-4942-91a2-1a1a1cb5b9a3
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 06 January 2006
                : 07 April 2006
                Page count
                Pages: 7
                Categories
                Original Paper

                Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
                Cerebrovascular event,Ischemic stroke,Diabetes

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