Increased fasting glucose and the prevalence of arterial stiffness: a cross-sectional study in Chinese adults.

OBJECTIVE: Previous studies have shown that diabetes increases the prevalence of arterial stiffness. However, it remains controversial whether impaired fasting glucose (IFG), a key pre-diabetes condition, is associated with increased risk of arterial stiffness. This study aimed to investigate the relationship between increased fasting plasma glucose (FPG) and the prevalence of arterial stiffness in a Chinese adult population. METHODS: A random sample of 5039 participants aged 40 years or older (40.0% female) were enrolled in this study. Information on potential risk factors for cardiovascular disease was collected, and the presence of arterial stiffness was assessed by measuring brachial-ankle pulse wave velocity (baPWV). Participants were stratified into three groups: normal fasting glucose (NFG), IFG, and diabetes mellitus (DM). The IFG group was further stratified by quartiles based on the level of FPG into Q1, Q2, Q3, and Q4. RESULTS: Fasting plasma glucose level was found to be independently and positively associated with baPWV. The adjusted odds ratios (ORs) (95% confidence interval (CI)) for arterial stiffness were 1.09 (0.80-1.48), 1.33 (0.98-1.81), 1.27 (0.93-1.73), 1.82 (1.31-2.53), and 2.15 (1.66-2.79) for those in IFG Q1, Q2, Q3, Q4, and DM groups compared with NFG group (P < 0.001), respectively, after adjusting for age, sex, and other potential confounders. Moreover, male participants and participants younger than 60 years were closely associated with the presence and severity of arterial stiffness (P < 0.001). CONCLUSION: Our study reports a previously unidentified positive association between increased FPG and the prevalence of arterial stiffness, suggesting the importance of FPG control in the prevention of arterial stiffness.

HbA1c is associated with increased all-cause mortality in the first year after acute ischemic stroke.

OBJECTIVES: To assess the association between baseline HbA1c and the poor outcomes within 1 year after acute ischemic stroke. METHODS: Acute ischemic stroke patients with HbA1c values at baseline (n  =  2186) were selected from the abnormal glucose regulation in patients with acute stroke across China study (ACROSS). Logistic regressions were performed to assess the association between HbA1c quartiles (<5.5% [37 mmol/mol], 5.5 to <6.1% [37 to <43 mmol/mol], 6.1 to <7.2% [43 to <55 mmol/mol], and ≥ 7.2% [≥ 55 mmol/mol]) and the poor outcomes within 1 year. Poor outcomes were defined as all-cause mortality (modified Rankin scale [mRS]  =  6) and poor functional outcome (mRS [2-6]). RESULTS: The risk for all-cause mortality was significantly increased in HbA1c level >5.5% [>37 mmol/mol] when compared to HbA1c quartile <5.5% [<37 mmol/mol] and dramatically increased to two to three times higher in the highest HbA1c quartile ≥ 7.2% [>55 mmol/mol] (1-year all-cause mortality model, odds ratios [ORs] were 1.07, 1.01, and 2.45, P for trend 0.009). After the further analysis with previous diabetes mellitus (DM) and post-stroke insulin use stratified, the risk of mortality was increased across the HbA1c levels (P for trend 0.020) and dramatically augmented in HbA1c ≥ 7.2% [>55 mmol/mol] in patients without a history of DM and without post-stroke insulin use. DISCUSSION: Elevated HbA1c (from 5.5% [37 mmol/mol]) presenting pre-stroke glycemia status has a significant trend in increasing the risk of 1-year all-cause mortality. HbA1c ≥ 7.2% (>55 mmol/mol) is an independent risk predictor for 1-year all-cause mortality after acute first-ever ischemic stroke. Such an association might be altered by glycometabolism status.

Metabolic syndrome and stroke recurrence in Chinese ischemic stroke patients--the ACROSS-China study.

OBJECTIVE: Metabolic syndrome has emerged as a novel risk factor in cardiovascular disease due to its potential for predicting stroke in population-based studies. We investigated the relationship of metabolic syndrome with stroke recurrence. METHODS: This was a retrospective analysis of Chinese patients enrolled in the prospective Abnormal gluCose Regulation in patients with acute strOke acroSS China (ACROSS-China) study after their first ischemic stroke. Metabolic syndrome was defined using the International Diabetes Federation (IDF) criteria. Vascular risk factors were assessed. Outcome was defined as recurrence of stroke within one year after the index ischemic stroke. Cox proportional hazards regression was performed to identify potential predictors of stroke recurrence. RESULTS: The prevalence of metabolic syndrome among 2639 ischemic stroke patients was 51.35%. During the one-year follow-up, 195 strokes (7.4%) recurred. The multivariate hazard ratio (95% CI) of stroke recurrence was 1.94 (1.39-2.73) for metabolic syndrome. After adjustment for components, metabolic syndrome lost its association with stroke recurrence; in this model, high fasting plasma glucose (IDF definition) was a predictor for stroke recurrence. CONCLUSION: Metabolic syndrome may not be predictive for stroke recurrence beyond its component individual factors for Chinese ischemic stroke patients.

Clinical characteristics, management, and functional outcomes in Chinese patients within the first year after intracerebral hemorrhage: analysis from China National Stroke Registry.

AIMS: The aim of this study was to understand the association between clinical characteristics, medical management, and functional outcomes in Chinese patients with nontraumatic intracerebral hemorrhage (ICH). METHODS: The China National Stroke Registry (CNSR) was a prospective cohort study that included 132 Chinese hospitals. Logistic regression was used to determine the risk factors associated with poor outcomes at 3, 6, and 12 months, post-ICH onset. RESULTS: Three thousand two hundred fifty five ICH patients with follow-up information up to 1 year post-ICH were included in this study. 49.1%, 47.1%, and 46.0% of ICH patients had poor outcomes at 3, 6, and 12 months, respectively. Age, admission systolic blood pressure, admission Glasgow Coma Score, hematoma volume, withdrawal of support, and complication of gastrointestinal hemorrhage were associated with poor outcomes at 3 and 12 months. Stroke unit care was associated with good outcome at 3 months. Intensive care unit (ICU)/Neurology ICU care was associated with poor outcome at 3 months. CONCLUSION: This is the first report of long-term functional outcomes in ICH patients from mainland China. Our study elucidates the risk factors that may influence functional outcomes post-ICH and therefore facilitate the development of management strategies to improve ICH care in China.