Hyperglycemia, Risk of Subsequent Stroke, and Efficacy of Dual Antiplatelet Therapy: A Post Hoc Analysis of the POINT Trial
Background One‐quarter of all strokes are subsequent events. It is not known whether higher levels of blood glucose are associated with an increased risk of subsequent stroke after high‐risk transient ischemic attack or minor ischemic stroke. Methods and Results We performed a secondary analysis of...
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| Format: | Article |
| Language: | English |
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Wiley
2022-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.023223 |
| _version_ | 1827765194657366016 |
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| author | Brian Mac Grory Jonathan P. Piccini Shadi Yaghi Sven Poli Adam De Havenon Sara K. Rostanski Martin Weiss Ying Xian S. Claiborne Johnston Wuwei Feng |
| author_facet | Brian Mac Grory Jonathan P. Piccini Shadi Yaghi Sven Poli Adam De Havenon Sara K. Rostanski Martin Weiss Ying Xian S. Claiborne Johnston Wuwei Feng |
| author_sort | Brian Mac Grory |
| collection | DOAJ |
| description | Background One‐quarter of all strokes are subsequent events. It is not known whether higher levels of blood glucose are associated with an increased risk of subsequent stroke after high‐risk transient ischemic attack or minor ischemic stroke. Methods and Results We performed a secondary analysis of the POINT (Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke) trial to evaluate the relationship between serum glucose hyperglycemia (≥180 mg/dL) versus normoglycemia (<180 mg/dL) before enrollment in the trial and outcomes at 90 days. The primary end point was subsequent ischemic stroke modeled by a multivariable Cox model with adjustment for age, sex, race, ethnicity, study treatment assignment, index event, and key comorbidities. Of 4878 patients included in this study, 267 had a recurrent stroke. There was a higher hazard of subsequent stroke in patients with hyperglycemia compared with normoglycemia (adjusted hazard ratio [HR], 1.50 [95% CI, 1.05–2.14]). Treatment with dual antiplatelet therapy was not associated with a reduced hazard of subsequent stroke in patients with hyperglycemia (HR, 1.18 [95% CI, 0.69–2.03]), though the wide confidence interval does not exclude a treatment effect. When modeled as a continuous variable, there was evidence of a nonlinear association between serum glucose and the hazard of subsequent stroke (P<0.001). Conclusions Hyperglycemia on presentation is associated with an increased risk of subsequent ischemic stroke after high‐risk transient ischemic attack or minor stroke. A rapid, simple assay of serum glucose may be a useful biomarker to identify patients at particularly high risk of subsequent ischemic stroke. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT0099102. |
| first_indexed | 2024-03-11T11:15:40Z |
| format | Article |
| id | doaj.art-a16606558f7946d18b18af9b35fc4d22 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-11T11:15:40Z |
| publishDate | 2022-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-a16606558f7946d18b18af9b35fc4d222023-11-11T04:49:37ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-02-0111310.1161/JAHA.121.023223Hyperglycemia, Risk of Subsequent Stroke, and Efficacy of Dual Antiplatelet Therapy: A Post Hoc Analysis of the POINT TrialBrian Mac Grory0Jonathan P. Piccini1Shadi Yaghi2Sven Poli3Adam De Havenon4Sara K. Rostanski5Martin Weiss6Ying Xian7S. Claiborne Johnston8Wuwei Feng9Department of Neurology Duke University School of Medicine Durham NCDivision of Cardiology Department of Medicine Duke University School of Medicine Durham NCDepartment of Neurology Warren Alpert Medical School of Brown University Providence RIDepartment of Neurology & Stroke and Hertie Institute for Clinical Brain Research Eberhard Karls University Tübingen Tübingen GermanyDepartment of Neurology Yale University School of Medicine New Haven CTDepartment of Neurology NYU Grossman School of Medicine New York NYDepartment of Neurology Duke University School of Medicine Durham NCDepartment of Neurology Duke University School of Medicine Durham NCDean’s Office Dell Medical School The University of Texas at Austin Austin TXDepartment of Neurology Duke University School of Medicine Durham NCBackground One‐quarter of all strokes are subsequent events. It is not known whether higher levels of blood glucose are associated with an increased risk of subsequent stroke after high‐risk transient ischemic attack or minor ischemic stroke. Methods and Results We performed a secondary analysis of the POINT (Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke) trial to evaluate the relationship between serum glucose hyperglycemia (≥180 mg/dL) versus normoglycemia (<180 mg/dL) before enrollment in the trial and outcomes at 90 days. The primary end point was subsequent ischemic stroke modeled by a multivariable Cox model with adjustment for age, sex, race, ethnicity, study treatment assignment, index event, and key comorbidities. Of 4878 patients included in this study, 267 had a recurrent stroke. There was a higher hazard of subsequent stroke in patients with hyperglycemia compared with normoglycemia (adjusted hazard ratio [HR], 1.50 [95% CI, 1.05–2.14]). Treatment with dual antiplatelet therapy was not associated with a reduced hazard of subsequent stroke in patients with hyperglycemia (HR, 1.18 [95% CI, 0.69–2.03]), though the wide confidence interval does not exclude a treatment effect. When modeled as a continuous variable, there was evidence of a nonlinear association between serum glucose and the hazard of subsequent stroke (P<0.001). Conclusions Hyperglycemia on presentation is associated with an increased risk of subsequent ischemic stroke after high‐risk transient ischemic attack or minor stroke. A rapid, simple assay of serum glucose may be a useful biomarker to identify patients at particularly high risk of subsequent ischemic stroke. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT0099102.https://www.ahajournals.org/doi/10.1161/JAHA.121.023223antithrombotic therapyclinical trialdiabeteshyperglycemiaischemic stroke |
| spellingShingle | Brian Mac Grory Jonathan P. Piccini Shadi Yaghi Sven Poli Adam De Havenon Sara K. Rostanski Martin Weiss Ying Xian S. Claiborne Johnston Wuwei Feng Hyperglycemia, Risk of Subsequent Stroke, and Efficacy of Dual Antiplatelet Therapy: A Post Hoc Analysis of the POINT Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease antithrombotic therapy clinical trial diabetes hyperglycemia ischemic stroke |
| title | Hyperglycemia, Risk of Subsequent Stroke, and Efficacy of Dual Antiplatelet Therapy: A Post Hoc Analysis of the POINT Trial |
| title_full | Hyperglycemia, Risk of Subsequent Stroke, and Efficacy of Dual Antiplatelet Therapy: A Post Hoc Analysis of the POINT Trial |
| title_fullStr | Hyperglycemia, Risk of Subsequent Stroke, and Efficacy of Dual Antiplatelet Therapy: A Post Hoc Analysis of the POINT Trial |
| title_full_unstemmed | Hyperglycemia, Risk of Subsequent Stroke, and Efficacy of Dual Antiplatelet Therapy: A Post Hoc Analysis of the POINT Trial |
| title_short | Hyperglycemia, Risk of Subsequent Stroke, and Efficacy of Dual Antiplatelet Therapy: A Post Hoc Analysis of the POINT Trial |
| title_sort | hyperglycemia risk of subsequent stroke and efficacy of dual antiplatelet therapy a post hoc analysis of the point trial |
| topic | antithrombotic therapy clinical trial diabetes hyperglycemia ischemic stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.023223 |
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