What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Ischemic stroke (n=92). Intervention: HbA1c levels vs. Patients without carotid plaque. Primary outcome: Association of HbA1c levels with the presence of carotid artery plaque (p=0.008).

What does this research mean for the field?

Higher HbA1c levels are significantly associated with the presence of carotid artery plaques in patients with ischemic stroke. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 1, 2013Open Access

Relation of glycated hemoglobin with carotid atherosclerosis in ischemic stroke patients

ASAmitShankar SinghGovind Ballabh Pant Hospital VAVirendra AtamKing George's Medical University SCShyamChand ChaudharyKing George's Medical University

Key Result

Higher HbA1c levels were significantly associated with the presence of carotid artery plaques (8.10% vs 7.12%, P=0.008) in patients with ischemic stroke.

Study Design

Type

Cross-Sectional (n=92)

Blinding

Single-blind

Multicenter

Structured PICO

Does HbA1c level associate with carotid atherosclerosis (CIMT and plaque) in ischemic stroke patients?

Population

92 ischemic stroke patients >30 years of age with symptoms persisting for >24 hours, admitted to a single center in India. Excluded: isolated TIA, cardio-embolic stroke, vasculitis, subarachnoid/intracerebral hemorrhage, and coagulation disorders.

Outcome

Association between HbA1c levels and markers of atherosclerosis (Carotid intima media thickness [CIMT] and carotid plaque)surrogate

Higher HbA1c levels are significantly associated with the presence of carotid plaques in ischemic stroke patients, suggesting its utility as a marker for advanced atherosclerosis.

Main Result

Absolute Event Rate: 8.103% vs 7.122%

p-value: p=0.008

Limitations

Cross-sectional study design prevents establishing a definite causal relationship between HbA1c and ischemic stroke.
Diagnosis of diabetes was largely based on previous records and verbal information.
The duration of increased HbA1c levels required to cause an ischemic stroke cannot be established.

Abstract

CONTEXT: Glycated hemoglobin A1c(HbA1c) indicates long-term uncontrolled hyperglycemia in the body, which in diabetic patients leads to various vascular complications as a part of generalized atherosclerosis culminating ultimately into ischemic stroke. AIMS: Study aims to show the association between marker of uncontrolled long-term hyperglycemia HbA1c and marker of atherosclerosis (Carotid intima media thickness CIMT and carotid plaque) in ischemic stroke patients. SUBJECTS AND METHODS: Carotid sonography using high resolution 7.5 MHz sonography technique was done in each patient to find the occurrence of increased CIMT and presence of plaque according to Mannheim CIMT Consensus (2004-2006). Levels of HbA1c measured in blood in both diabetic and non-diabetic patients and a comparison made between them. Finally an association sought between HbA1c levels with CIMT and plaque. RESULTS: The average value of HbA1c of this cohort was 7.51 ± 1.75% with higher values in diabetic patients (9.29 ± 1.73%). The patients with high CIMT (>0.8 mm) had higher values of HbA1c then that of normal CIMT patients and this was nearly significantly (P = 0.06). However, HbA1c levels of blood were significantly associated with stroke patients with presence of carotid arteries plaque (P = 0.008). CONCLUSIONS: Prediction of future risk and prevention strategies for ischemic stroke could be formulated by utilizing HbA1c levels in both diabetic and non-diabetic population.

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