Glycated hemoglobin independently predicts stroke recurrence within one year after acute first-ever non-cardioembolic strokes onset in A Chinese cohort study

PLoS One. 2013 Nov 13;8(11):e80690. doi: 10.1371/journal.pone.0080690. eCollection 2013.

Abstract

Objective: Hyperglycemia is related to stroke. Glycated hemoglobin (HbA1c) can reflect pre-stroke glycaemia status. However, the information on the direct association between HbA1c and recurrence after non-cardioembolic acute ischemic strokes is rare and there is no consistent conclusion.

Methods: The ACROSS-China database comprised of 2186 consecutive first-ever acute ischemic stroke patients with baseline HbA1c values. After excluding patients who died from non-stroke recurrence and patients lost to follow up, 1817 and 1540 were eligible for 3-month and 1-year analyses, respectively. Multivariate Cox regression was performed to evaluate the associations between HbA1c and 3-month and 1-year stroke recurrence.

Results: The HbA1c values at admission were divided into 4 levels by quartiles: Q1 (<5.5%); Q2 (5.5 to <6.1%); Q3 (6.1% to <7.2%); and Q4 (≥ 7.2%). The cumulative recurrence rates were 8.3% and 11.0% for 3 months and 1 year, respectively. In multivariate analyses, when compared with Q1, the adjusted hazard ratios (AHRs) were 2.83 (95% confidence interval (CI) 1.28-6.26) in Q3 and 3.71(95% CI 1.68-8.21) in Q4 for 3-month stroke recurrence; 3.30 (95% CI 1.31-8.34) in Q3 and 3.35 (95% CI 1.36-8.21) in Q4 for 1-year stroke recurrence. Adding fasting plasma glucose in the multivariate analyses did not modify the association: AHRs were 2.75 (95% CI 1.24-6.11) in Q3 and 3.67 (95% CI 1.59-8.53) in Q4 for 3-month analysis; AHRs were 3.08 (95% CI 1.10-8.64) in Q3 and 3.31(95% CI 1.35-8.14) in Q4 for 1-year analysis.

Conclusions: A higher "normal" HbA1c level reflecting pre-stroke glycaemia status independently predicts stroke recurrence within one year after non-cardioembolic acute ischemic stroke onset. HbA1c is recommended as a routine test in acute ischemic stroke patients.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • China
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin*
  • Humans
  • Hyperglycemia / blood
  • Male
  • Middle Aged
  • Odds Ratio
  • Prognosis
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Stroke / blood*
  • Stroke / diagnosis*
  • Stroke / etiology
  • Stroke / mortality
  • Time Factors

Substances

  • Glycated Hemoglobin A

Grants and funding

This study was funded jointly by the Beijing Science and Technology Committee (grant no. 7102050, www.bjkw.gov.cn), the National Science Foundation (grant no. 81071115, www.nsfc.gov.cn), the Young Scientists Fund of the Beijing Health Bureau (grant No. 2009—009, www.bjhb.gov.cn), and the State Key Development, Program of (for) Basic Research of China (2009CB521905 http://www.973.gov.cn/Default_3.aspx). This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.