Diabetes Mellitus a Risk Factor for Stroke

Diabetes mellitus is associated with a > 2 fold increased risk for atherosclerotic vascular disease . The risk for stroke in patients with diabetes compared to those without diabetes has been reported to be 2.8 fold higher for men and 1.9 fold higher for women in the Framingham study (1) and 2.8 fold higher for the men in the MRFIT study (2, 3).
A 12 year follow-up of 690 diabetic and 6908 non-diabetic subjects in the Honolulu Heart Study (free of coronary disease or stroke at entry) showed a 2-fold relative risk for stroke with diabetes mellitus (4).
Similar increase in risk has been reported from other large observational studies (5). The stroke incidence in a target population of 241000 Swedish residents followed for 8 years indicated a relative risk of stroke in diabetic men of 4.1 (95% CI 3.2-5.2) and in women of 5.8 (95% CI 3.7-6.9) (5). Furthermore the overall mortality in the diabetic population was 4.4-times higher in men and 5.1-times higher in women. The observations of Asplund confirm the worse outcomes in diabetic vs. non-diabetic patients who have an ischemic stroke (6).
Few studies have reviewed risk factors for specific stroke types. Such an analysis was performed in an analysis of data from the German Stroke Bank (7). Diabetes mellitus was a risk factor (along with hypertension, hypercholesterolemia and obesity) in strokes associated with small vessel disease (lacunar strokes).
In the next section, general risk factors for stroke in non-diabetic and diabetic subjects will be discussed.