Relationship Between Glycated Hemoglobin and Stroke Risk: A Systematic Review and Meta-Analysis

Journal of the American Heart Association
John Peter MitsiosVincent Thijs

Abstract

Diabetes mellitus is a major risk factor for ischemic stroke. Rising hemoglobin A1c (HbA1c) levels are associated with microvascular diabetes mellitus complication development; however, this relationship has not been established for stroke risk, a macrovascular complication. We conducted a systematic review and meta-analysis of observational cohort and nested case-control cohort studies assessing the association between rising HbA1c levels and stroke risk in adults (≥18 years old) with and without type 1 or type 2 diabetes mellitus. Random-effects model meta-analyses were used to calculate pooled adjusted hazard ratios (HRs) and their precision. The systematic review yielded 36 articles, of which 29 articles (comprising n=532 779 participants) were included in our meta-analysis. Compared to non-diabetes mellitus range HbA1c (<5.7%), diabetes mellitus range HbA1c (≥6.5%) was associated with an increased risk of first-ever stroke with average HR (95% confidence interval) of 2.15 (1.76, 2.63), whereas pre-diabetes mellitus range HbA1c (5.7-6.5%) was not (average HR [95% confidence interval], 1.19 [0.87, 1.62]). For every 1% HbA1c increment (or equivalent), the average HR (95% confidence interval) for first-ever stroke was 1.12 (0....Continue Reading

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Citations

Apr 19, 2019·Circulation. Arrhythmia and Electrophysiology·Mia Vicki FangelMartin Bach Jensen
May 28, 2019·The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences·Alessandra MarengoniAmaia Calderón-Larrañaga
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Jul 17, 2021·Neural Regeneration Research·Federica FerrariRoberto Federico Villa

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