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Meta-Analysis
. 2024 Aug 31;23(1):323.
doi: 10.1186/s12933-024-02413-w.

Impaired glucose metabolism and the risk of vascular events and mortality after ischemic stroke: A systematic review and meta-analysis

Nurcennet Kaynak  1   2   3   4   5 , Valentin Kennel  1   2 , Torsten Rackoll  2   6 , Daniel Schulze  7 , Matthias Endres  1   2   4   5   8 , Alexander H Nave  9   10   11   12
Affiliations
Meta-Analysis

Impaired glucose metabolism and the risk of vascular events and mortality after ischemic stroke: A systematic review and meta-analysis

Nurcennet Kaynak et al. Cardiovasc Diabetol. .

Abstract

Background: Diabetes mellitus (DM), prediabetes, and insulin resistance are highly prevalent in patients with ischemic stroke (IS). DM is associated with higher risk for poor outcomes after IS.

Objective: Investigate the risk of recurrent vascular events and mortality associated with impaired glucose metabolism compared to normoglycemia in patients with IS and transient ischemic attack (TIA).

Methods: Systematic literature search was performed in PubMed, Embase, Cochrane Library on 21st March 2024 and via citation searching. Studies that comprised IS or TIA patients and exposures of impaired glucose metabolism were eligible. Study Quality Assessment Tool was used for risk of bias assessment. Covariate adjusted outcomes were pooled using random-effects meta-analysis.

Main outcomes: Recurrent stroke, cardiac events, cardiovascular and all-cause mortality and composite of vascular outcomes.

Results: Of 10,974 identified studies 159 were eligible. 67% had low risk of bias. DM was associated with an increased risk for composite events (pooled HR (pHR) including 445,808 patients: 1.58, 95% CI 1.34-1.85, I2 = 88%), recurrent stroke (pHR including 1.161.527 patients: 1.42 (1.29-1.56, I2 = 92%), cardiac events (pHR including 443,863 patients: 1.55, 1.50-1.61, I2 = 0%), and all-cause mortality (pHR including 1.031.472 patients: 1.56, 1.34-1.82, I2 = 99%). Prediabetes was associated with an increased risk for composite events (pHR including 8,262 patients: 1.50, 1.15-1.96, I2 = 0%) and recurrent stroke (pHR including 10,429 patients: 1.50, 1.18-1.91, I2 = 0), however, not with mortality (pHR including 9,378 patients, 1.82, 0.73-4.57, I2 = 78%). Insulin resistance was associated with recurrent stroke (pHR including 21,363 patients: 1.56, 1.19-2.05, I2 = 55%), but not with mortality (pHR including 21,363 patients: 1.31, 0.66-2.59, I2 = 85%).

Discussion: DM is associated with a 56% increased relative risk of death after IS and TIA. Risk estimates regarding recurrent events are similarly high between prediabetes and DM, indicating high cardiovascular risk burden already in precursor stages of DM. There was a high heterogeneity across most outcomes.

Keywords: Diabetes; Insulin resistance; Ischemic stroke; Mortality; Prediabetes; Vascular events.

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Conflict of interest statement

NK, VK, DS report no conflicts of interest. ME reports grants from Bayer and fees paid to the Charité from Amgen, AstraZeneca, Bayer Healthcare, Boehringer Ingelheim, BMS, Daiichi Sankyo, Sanofi, Pfizer, all outside the submitted work. AHN receives funding from the Corona foundation and the German Center for cardiovascular research (DZHK), no conflict of interest. TR receives funding from the European Commission, no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the screening and selection process of the systematic review
Fig. 2
Fig. 2
a Forest plot for the meta-analysis of studies that reported the association of diabetes with composite outcome. b Forest plot for the meta-analysis of studies that reported the association of prediabetes with composite outcome
Fig. 3
Fig. 3
a Forest plot for the meta-analysis of studies that reported the association of diabetes with recurrent stroke. b Forest plot for the meta-analysis of studies that reported the association of prediabetes with recurrent stroke. c Forest plot for the meta-analysis of studies that reported the association of insulin resistance with recurrent stroke
Fig. 4
Fig. 4
a Forest plot for the meta-analysis of studies that reported the association of diabetes with all-cause mortality. b Forest plot for the meta-analysis of studies that reported the association of prediabetes with all-cause mortality. c Forest plot for the meta-analysis of studies that reported the association of insulin resistance with all-cause mortality
See this image and copyright information in PMC

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