Background: Stroke remains a major complication of type 2 diabetes (T2D) but there is evidence that better cardiovascular risk factor management has significantly reduced stroke risk over the past 20 years [1].
Objective: To determine independent predictors of first stroke in a contemporary community-based sample of patients with T2D.
Study Design: Longitudinal observational study.
Methods: Participants from Fremantle Diabetes Study Phase II (FDS 2) with T2D, no history of cerebrovascular disease at entry and valid prospective data (n=1,390, mean age 65.0±11.6 years, 51.2% males, median [inter-quartile range] diabetes duration 8.0 [2.3-15.3] years) were assessed between 2008 and 2011 and followed until 2013. Cox proportional hazard modelling with age as time-line was used to assess the relationship between clinically plausible risk factors and incident stroke.
Results: During 5,019 patient-years of follow-up (mean±SD 3.6±1.1 years), 21 (1.5%) were hospitalised for/with or died from stroke. Independent predictors of incident first stroke were atrial fibrillation/flutter (hazard ratio (95% CI) 5.38 (2.09–14.48); P<0.001) and eGFR ≥90 ml/min/1.73m2 (4.33 (1.50–12.47); P=0.007), but carotid bruit did not enter the model (1.61 (0.46–5.62); P=0.46).
Conclusion: Atrial fibrillation/flutter was a strong expected predictor of first stroke in T2D. Patients with a high eGFR are likely to include those with hyperfiltration (eGFR 120 - 1 mL/min per year after 40 years of age [2]) and its association with stroke has not been reported previously. The significant relationship between carotid bruit and first stroke in FDS Phase I 15 years before [3] was not observed, consistent with improved management of cardiovascular risk factors over time.