Diabetes Mellitus: A Risk Factor for Ischemic Stroke in a Large Bi-Racial Population

MedicalResearch.com eInterview with Jane C Khoury, PhD

Associate Professor
Division of Biostatistics and Epidemiology
Cincinnati Children’s Hospital Medical Center
MLC 5041, 3333 Burnet Avenue
Cincinnati, Ohio 45229-3039

MedicalResearch.com: What are the main findings of the study?

Dr. Khoury: Over all age groups, those with diagnosed diabetes have at least 3-fold increased risk of incident ischemic stroke compared to those without diabetes. This is even more pronounced in those less than 65 years of age, with 5-fold and 12-fold increase for those of black and white race respectively.  All rates are adjusted to the 2000 population.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Khoury: The increased risk for incident ischemic stroke for those with diabetes was not unexpected.

However, we are seeing a shift over time, 1993/94 to 2005 with evidence of higher ischemic stroke risk in whites compared with blacks conferred by diabetes at virtually all ages. This is striking as there have been recent publications showing the overall incident ischemic stroke rate in whites is going down over that period.

MedicalResearch.com: Are the findings generalizable outside of the study area?

Dr. Khoury:  This is a population-based study, part of the Greater Cincinnati / Northern Kentucky Epidemiology of Stroke Study. Over the three study periods; 1993/94, 1999 and 2005 the population reflects that of the US with respect to percentage of blacks, percentage of women, median age, income and educational level. Thus, changes observed may be generalizable to the US population.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Khoury: Clinicians and patients alike should be aware of the added risk of stroke conferred by diabetes, especially in those younger than 65 years. With the increasing numbers of people diagnosed with diabetes this becomes a much larger public health problem, especially the long-term morbidity in the younger population.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Khoury: Future research would include examination of those with pre-diabetes, elevated blood glucose levels that are below the cut-off for overt diabetes, to examine the additional risk for stroke in this subgroup. Our population-based collection period currently underway, will allow us to examine this question.

Take home messages:

Diabetes is a risk factor for stroke at any age, but is especially so for those under 65 years.  As always education is paramount, the public should be aware of the risk factors and warning signs for stroke, especially those people with diabetes.

Risk factors for ischemic stroke: Diabetes, high blood pressure, heart disease, high cholesterol, smoking, heavy alcohol use, physical inactivity and obesity, atrial fibrillation and family history of stroke.

Warning signs of ischemic stroke: Facial droop or uneven smile, Arm numbness or weakness, Slurred speech or difficulty speaking or understanding.


Diabetes Mellitus: A Risk Factor for Ischemic Stroke in a Large Bi-Racial Population.

Khoury JC, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, Adeoye O, Flaherty ML,
Khatri P, Ferioli S, Broderick JP, Kissela BM.

From the Division of Biostatistics and Epidemiology,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
Stroke. 2013 Apr 25. [Epub ahead of print]