Stroke：糖尿病患者缺血性卒中风险或无种族差异

　　美国一项研究表明，无论种族如何，糖尿病患者在各年龄段仍表现为卒中风险极大升高，并且在<65岁时尤为显著。论文4月25日在线发表于《卒中》（Stroke）。

　　既往研究显示在糖尿病患者中缺血性卒中发病率在黑人和白人中升高，尤其是那些年龄<55岁的患者。此项基于人群研究对1993～1994、1999和2005年间年龄≥20岁的黑人和白人中的首次缺血性卒中进行了分析。对性别、种族和年龄进行适当校正之后计算发病率。

　　结果显示，1993～1994、1999和2005年间，首次缺血性卒中患者中糖尿病病史报告率分别为28%、29%和33%。在黑人中，伴和未伴糖尿病者卒中发病率危险比（RR）由1993～1994的5.6降至2005年的3.2；在白人中上述两个时间段的危险比则均保持在3.8不变。然而，RR随年龄不同有所差异；20～65岁患者中观察到风险总体升高5至14倍。

与糖尿病相关的拓展阅读：

• Clin Gastroenterol H：巴雷特食管与2型糖尿病相关
• Diabetes Care：良好的血糖和血压控制有益于延长糖尿病患者生存期
• Diabetic Med：高血压患者治疗时HDL低预示新发糖尿病风险更高
• AACE2013：糖尿病治疗方案
• NEJM：美国糖尿病防治十年进展回顾 更多信息请点击：有关糖尿病更多资讯

Diabetes Mellitus: A Risk Factor for Ischemic Stroke in a Large Bi-Racial Population.
BACKGROUND AND PURPOSE
We previously reported increased incidence of ischemic stroke among both blacks and whites with diabetes mellitus, especially in those aged <55 years. With rising prevalence of diabetes mellitus in the past decade, we revisit the impact of diabetes mellitus on stroke incidence in the same population (≈1.3 million) 5 and 10 years later.
METHODS
This is a population-based study. First ischemic strokes among black and white residents of the 5-county Greater Cincinnati/Northern Kentucky region, aged ≥20 years, for periods 7/1993 to 6/1994, 1999, and 2005, were included in this analysis. Incidence rates were adjusted for sex, race, and age, as appropriate, to the 2000 US population.
RESULTS
History of diabetes mellitus among first ischemic strokes was reported for 493/1709 (28%) in 1993/1994, 522/1778 (29%) in 1999, and 544/1680 (33%) in 2005. Risk ratios (95% confidence interval) for rates of stroke in those with versus without diabetes mellitus for blacks reduced significantly from 5.6 in 1993/1994 to 3.2 in 2005; for whites the risk ratio remained stable at 3.8 in 1993/1994 and 2005. However, risk ratios varied with age, with an overall 5- to 14-fold increased risk observed in those aged 20 to 65 years.
CONCLUSIONS
Those with diabetes mellitus remain at greatly increased risk for stroke at all ages, especially <65 years, regardless of race. The rates and risk ratios for 1999 and 2005, although similar to those previously reported for the mid-1990s, take on increased significance, given the epidemic of diabetes mellitus and metabolic syndrome throughout the US and the world.