Chen Weiqi, Pan Yuesong, Jing Jing, Zhao Xingquan, Liu Liping, Meng Xia, Wang Yilong, Wang Yongjun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
J Am Heart Assoc. 2017 Jun 1;6(6):e005446. doi: 10.1161/JAHA.116.005446.
We aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events) trial.
In total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of METS and DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS, 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither, METS only, DM only, and both, respectively. After 90 days of follow-up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89-3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95% CI 1.98-3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different METS or DM status for the risk of recurrent stroke (=0.82 for interaction in the fully adjusted model of CDS) was observed. Using the METS (IDF) criteria demonstrated similar results.
Concurrent METS and DM was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack.
我们旨在通过CHANCE（急性非致残性脑血管事件高危患者的氯吡格雷）试验，确定代谢综合征（METS）和糖尿病（DM）对轻度缺血性卒中或短暂性脑缺血发作患者复发性卒中的风险。
共纳入3044例患者。患者被分为4组：均无、仅患有METS、仅患有DM或两者皆有。METS采用中国糖尿病学会（CDS）和国际糖尿病联盟（IDF）的定义。主要结局为90天时的新发卒中（包括缺血性和出血性）。采用多变量Cox回归模型评估METS和DM状态与经潜在协变量调整后的复发性卒中风险之间的关系。根据CDS的METS标准，分别有53.2%、17.2%、19.8%和9.8%的患者被诊断为均无、仅患有METS、仅患有DM和两者皆有。随访90天后，有299例新发卒中（293例缺血性，6例出血性）。仅患有DM的患者（16.1%对6.8%；调整后风险比2.50，95%置信区间1.89 - 3.39）和两者皆有的患者（17.1%对6.8%；调整后风险比2.76，95%置信区间1.98 - 3.86）复发性卒中发生率显著增加。未观察到不同METS或DM状态的抗血小板治疗对复发性卒中风险的交互作用（在CDS的完全调整模型中交互作用P = 0.82）。采用METS（IDF）标准显示了相似的结果。
在轻度卒中和短暂性脑缺血发作患者中，METS和DM并存与复发性卒中风险增加相关。
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