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. 2025 Apr 8;104(7):e213480.
doi: 10.1212/WNL.0000000000213480. Epub 2025 Mar 13.

Risk of Ischemic and Hemorrhagic Stroke in Individuals With Type 1 and Type 2 Diabetes: A Nationwide Cohort Study in Sweden

Anastasios Mavridis  1 , Adam Viktorisson  1   2 , Björn Eliasson  2   3 , Mia von Euler  4 , Katharina S Sunnerhagen  1   2
Affiliations

Risk of Ischemic and Hemorrhagic Stroke in Individuals With Type 1 and Type 2 Diabetes: A Nationwide Cohort Study in Sweden

Anastasios Mavridis et al. Neurology. .

Abstract

Background and objectives: Diabetes significantly increases the risk of cardiovascular events, including stroke. Although the association with ischemic stroke is well established, the relationship with hemorrhagic stroke remains unclear. This study aimed to evaluate the risk of ischemic and hemorrhagic stroke in individuals with type 1 and type 2 diabetes compared with diabetes-free controls from the general population.

Methods: This cohort study included individuals with type 1 or type 2 diabetes from the Swedish National Diabetes Register between 2005 and 2019, matched to diabetes-free controls by age and sex. Data on baseline characteristics, comorbidities, medications, and outcomes were collected from multiple national registers. Stroke incidence rates and adjusted hazard ratios were estimated using Cox proportional hazard models, stratified by diabetes type, for ischemic and hemorrhagic stroke.

Results: The study included 47,720 individuals with type 1 diabetes (mean age 34.4, 44.8% female) and 686,158 with type 2 diabetes (mean age 65.3, 43.3% female), matched to 143,160 and 2,058,474 controls, respectively. In individuals with type 1 diabetes, the ischemic stroke risk was 2.54 times higher (95% CI 2.36-2.73) and the hemorrhagic stroke risk was 1.88 times higher (95% CI 1.57-2.26) compared with controls. In individuals with type 2 diabetes, the ischemic stroke risk was 1.37 times higher (95% CI 1.35-1.38) while the hemorrhagic stroke risk was not significantly increased (HR: 0.99, 95% CI 0.96-1.02). Higher HbA1c levels were associated with increased ischemic stroke risk for both diabetes types. For hemorrhagic stroke, individuals with type 1 diabetes had significantly higher risk starting at HbA1c > 52 mmol/mol while in those with type 2 diabetes, a modest risk increase was observed only at HbA1c > 72 mmol/mol.

Discussion: The risk of ischemic stroke was higher for both diabetes types. Individuals with type 1 diabetes also exhibited a higher risk of hemorrhagic stroke compared with diabetes-free controls while type 2 diabetes was significantly associated with risk of hemorrhagic stroke only when HbA1c was higher than 72 mmol/mol. These findings highlight the increased stroke risk in diabetes, with distinct patterns by stroke subtype and diabetes type. Tailored prevention strategies are essential to address these differences.

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Conflict of interest statement

The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Figures

Figure 1
Figure 1. Cumulative Incidence of Ischemic and Hemorrhagic Stroke in Individuals With Type 1 Diabetes vs Diabetes-Free Controls
Figure 2
Figure 2. Cumulative Incidence of Ischemic and Hemorrhagic Stroke in Individuals With Type 2 Diabetes vs Diabetes-Free Controls
Figure 3
Figure 3. Annual Incidence Rates of Ischemic and Hemorrhagic Stroke in Individuals With Type 1 Diabetes and Diabetes-Free Controls (2007–2022)
Figure 4
Figure 4. Annual Incidence Rates of Ischemic and Hemorrhagic Stroke in Individuals With Type 2 Diabetes and Diabetes-Free Controls (2007–2022)
See this image and copyright information in PMC

References

    1. Gregg EW, Sattar N, Ali MK. The changing face of diabetes complications. Lancet Diabetes Endocrinol. 2016;4(6):537-547. doi:10.1016/S2213-8587(16)30010-9 - DOI - PubMed
    1. GBD 2019 Diseases and Injuries Collaborators, Lim SS, Abbafati C, et al. . Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9 - DOI - PMC - PubMed
    1. Saeedi P, Petersohn I, Salpea P, et al. . Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res Clin Pract. 2019;157:107843. doi:10.1016/j.diabres.2019.107843 - DOI - PubMed
    1. Foreman KJ, Marquez N, Dolgert A, et al. . Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet. 2018;392(10159):2052-2090. doi:10.1016/S0140-6736(18)31694-5 - DOI - PMC - PubMed
    1. Rawshani A, Rawshani A, Franzén S, et al. . Mortality and cardiovascular disease in type 1 and type 2 diabetes. New Engl J Med. 2017;376(15):1407-1418. doi:10.1056/NEJMoa1608664 - DOI - PubMed