Open AccessRelationship Between Glycated Hemoglobin and Stroke Risk: A Systematic Review and Meta‐Analysis
Author(s) -
Mitsios John Peter,
Ekinci Elif Ilhan,
Mitsios Gregory Peter,
Churilov Leonid,
Thijs Vincent
Publication year - 2018
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.007858
Subject(s) - medicine , diabetes mellitus , glycated hemoglobin , stroke (engine) , hazard ratio , type 2 diabetes mellitus , confidence interval , cohort study , risk factor , meta analysis , type 2 diabetes , endocrinology , mechanical engineering , engineering
Background Diabetes mellitus is a major risk factor for ischemic stroke. Rising hemoglobin A 1c (HbA 1c ) levels are associated with microvascular diabetes mellitus complication development; however, this relationship has not been established for stroke risk, a macrovascular complication. Methods and Results We conducted a systematic review and meta‐analysis of observational cohort and nested case‐control cohort studies assessing the association between rising HbA 1c 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 HbA 1c (<5.7%), diabetes mellitus range HbA 1c (≥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 HbA 1c (5.7–6.5%) was not (average HR [95% confidence interval], 1.19 [0.87, 1.62]). For every 1% HbA 1c increment (or equivalent), the average HR (95% confidence interval) for first‐ever stroke was 1.12 (0.91, 1.39) in non–diabetes mellitus cohorts and 1.17 (1.09, 1.25) in diabetes mellitus cohorts. For every 1% HbA 1c increment, both non–diabetes mellitus and diabetes mellitus cohorts had a higher associated risk of first‐ever ischemic stroke with average HR (95% confidence interval) of 1.49 (1.32, 1.69) and 1.24 (1.11, 1.39), respectively. Conclusions A rising HbA 1c level is associated with increased first‐ever stroke risk in cohorts with a diabetes mellitus diagnosis and increased risk of first‐ever ischemic stroke in non–diabetes mellitus cohorts. These findings suggest that more intensive HbA 1c glycemic control targets may be required for optimal ischemic stroke prevention.