Overview

Prevention of stroke is an important consideration in patients with diabetes mellitus. Since diabetes is associated with a number of risk factors for stroke including hyperglycemia, hypertension, dyslipidemia and a procoagulant state (e.g., increased platelet aggregation, elevated levels of plasminogen activator inhibitor {PAI-1}), possible reduction in stroke risk can be estimated both from epidemiological studies and from intervention trials. Each of these study designs has limitations. Epidemiological studies may show a relationship between a risk factor and the prevalence of stroke, but this does not prove causality; nevertheless, often these are the best data that we have. Intervention trials for risk reduction for atherosclerotic disease events also have limitations. First, few studies have been done in diabetic patients as the primary study population, so information gleaned from the trial as a whole needs to be imputed to the subset of diabetic patients. Second, in many important prevention trials reduction in stroke was not the primary endpoint, and so - because of low event rates - reduction in the risk for stroke may not always be statistically significant.