Zubair Muhammad, Kainat Raza Naqvi Syeda, Aslam Rehan, Ahmad Hooria, Farooq Ayesha, Islam Samra
Otorhinolaryngology, M. Islam Teaching Hospital, Gujranwala, PAK.
Surgery, National Hospital and Medical Centre, Lahore, PAK.
Cureus. 2024 Dec 18;16(12):e75925. doi: 10.7759/cureus.75925. eCollection 2024 Dec.
Elevated HbA1c, a marker of poor glycemic control, is associated with adverse cardiovascular outcomes and mortality. HbA1c influences outcomes through distinct mechanisms of vascular dysfunction and atherosclerosis in ischemic stroke, during atrial remodeling and thrombus formation in paroxysmal atrial fibrillation (PAF). Optimal HbA1c thresholds are generally below optimal levels, with levels above this being linked to higher mortality in both populations. At extremes of glycemic control in ischemic stroke, patients face recurrence and poor recovery, while PAF patients experience amplified thromboembolic risks. In patients with both conditions, poor HbA1c control synergistically raises mortality. This systematic review explores how HbA1c levels directly contribute to mortality in patients with ischemic stroke and PAF, aiming to establish a causal link between elevated HbA1c and increased mortality risk. This review includes a comprehensive analysis of four cross-sectional studies, five randomized controlled trials (RCTs), and 17 cohort studies, providing a diverse range of evidence on the topic. The inclusion of these study designs offers a well-rounded understanding of the impact and outcomes observed in the research. Mortality metrics include short-term mortality, such as 30-day or 90-day, and long-term mortality over one, three, or five years. Specific metrics, like cardiovascular mortality, focus on deaths from stroke; some studies link mortality to functional decline post-stroke, where complications from immobility or recurrent vascular events contribute to outcomes. Secondary outcomes include survival metrics, functional recovery metrics, and complications. Studies use narrative synthesis due to its ability to accommodate heterogeneity in study designs, populations, and outcome measures, enabling a nuanced interpretation of complex, context-dependent data. HbA1c levels' impact on stroke outcomes, considering age, gender, and severity, is also examined. Confounding factors, functional recovery, and complications are also considered. A narrative synthesis was chosen. The study emphasizes the importance of strict glycemic control in patients with ischemic stroke or PAF, especially those with elevated HbA1c levels. It supports clinical guidelines for individualized HbA1c targets, with most stroke patients having a target of <7%. Clinicians should prioritize close monitoring and tailor treatment plans to avoid extreme HbA1c levels, which could inform more personalized and effective treatment strategies. Tight control of HbA1c levels entails individualized targets based on patient characteristics, with an emphasis on personalized treatment strategies that may include lifestyle modifications, oral hypoglycemics, or insulin therapy to optimize glycemic control.
糖化血红蛋白（HbA1c）升高是血糖控制不佳的一个指标，与不良心血管结局和死亡率相关。HbA1c通过缺血性卒中时血管功能障碍和动脉粥样硬化的不同机制、阵发性心房颤动（PAF）时心房重塑和血栓形成的机制来影响结局。最佳HbA1c阈值通常低于最佳水平，高于此水平与这两类人群的较高死亡率相关。在缺血性卒中血糖控制极差的情况下，患者面临复发和恢复不佳的问题，而PAF患者经历的血栓栓塞风险增加。在同时患有这两种疾病的患者中，HbA1c控制不佳会协同增加死亡率。本系统评价探讨了HbA1c水平如何直接导致缺血性卒中和PAF患者的死亡，旨在确立HbA1c升高与死亡风险增加之间的因果联系。本评价包括对四项横断面研究、五项随机对照试验（RCT）和十七项队列研究的全面分析，提供了关于该主题的各种证据。纳入这些研究设计有助于全面了解研究中观察到的影响和结局。死亡率指标包括短期死亡率，如30天或90天死亡率，以及一年、三年或五年的长期死亡率。特定指标，如心血管死亡率，关注卒中死亡情况；一些研究将死亡率与卒中后功能下降联系起来，其中不动或复发性血管事件的并发症会影响结局。次要结局包括生存指标、功能恢复指标和并发症。由于叙事性综述能够适应研究设计、人群和结局测量的异质性，因此研究采用叙事性综述，从而能够对复杂的、依赖于背景的数据进行细致入微的解释。还研究了HbA1c水平对卒中结局的影响，同时考虑了年龄、性别和严重程度。还考虑了混杂因素、功能恢复和并发症。本研究采用了叙事性综述。该研究强调了对缺血性卒中和PAF患者进行严格血糖控制的重要性，尤其是那些HbA1c水平升高的患者。它支持针对个体化HbA1c目标的临床指南，大多数卒中患者的目标是<7%。临床医生应优先密切监测并制定治疗计划以避免HbA1c水平过高，这可为更个性化和有效的治疗策略提供依据。严格控制HbA1c水平需要根据患者特征制定个体化目标，重点是个性化治疗策略，可能包括生活方式改变、口服降糖药或胰岛素治疗以优化血糖控制。
