XVII. European Stroke Conference
Nice, France

Oral Session:

Stroke and diabetes
Date: Wednesday 14 May 2008  
Time: 8:30 - 8:40 -  Room: Euterpe
Chair: I. Henriques, Portugal and D.W.J. Dippel, The Netherlands

01
Insulin resistance is not associated to carotid atherosclerosis after correction for components of the metabolic syndrome: Crossectional data form the SAPHIR study
T.C.Wascher    H. Sourij    B. Paulweber    B. Iglseder                                          
 

Hanuschkrankenhaus der WKGG

AUSTRIA

Background: Insulin resistance is a risk factor for carotid atherosclerosis and stroke. Its independent contribution, however, is still under debate. We compared associations of two different indices of insulin resistance, the HOMA index and kITT from a short insulin-tolerance-test with carotid artery IMT and plaque. Methods: The SAPHIR study investigated 1771 middle-aged Caucasians free of manifest vascular disease. Average intima-media thickness (IMTavg) and carotid plaque were quantified by ultrasound. HOMA was calculated from fasting glucose and insulin and a short insulin-tolerance-test was performed. The metabolic syndrome was diagnosed using the NCEP-ATP III criteria. Statistical analysis was done by multiple regression analysis. Results: HOMA and kITT were significant predictors for average carotid IMT (p<0.001). After adjustment for age and the components of the metabolic syndrome, HOMA still remained an independent predictor for IMTavg (p=0.02) whereas kITT failed to do so. HOMA and kITT were also predictive (p=0.004 and p=0.024) for the presence of carotid plaques and the extend of carotid atherosclerosis (p<0.001). After adjustment for age and the components of the metabolic syndrome, neither HOMA nor kITT were independently predictive anymore. Discussion: In conclusion, our results provide evidence that HOMA rather than kITT is associated with carotid atherosclerosis and that the association is largely explained by the clustered expression of the components of the metabolic syndrome.

Stroke and diabetes
Date: Wednesday 14 May 2008  
Time: 8:40 - 8:50 -  Room: Euterpe
Chair: I. Henriques, Portugal and D.W.J. Dippel, The Netherlands

02
Repeated encouragement to be physical active improves insulin sensitivity after ischemic stroke
L.H.Krarup    T. Truelsen    G. Boysen                                                 
The ExStroke Pilot Trial Group

Bispebjerg Hospital, Copenhagen University Hospital

DENMARK

Background Physical activity and training after stroke could decrease the risk of recurrent stroke through favourable effects on multiple risk factors including insulin resistance. Previous studies have shown that stroke patients can improve their physical activity and insulin sensitivity through outpatient training. Stroke patients often reduce their physical activity after formal training has ceased. We examined if stroke patients randomized to repeated encouragement to be physically active could improve their insulin sensitivity. Methods The ExStroke Pilot Trial is a randomized multi-center trial examining stroke patients’ level of physical activity after repeated information and encouragement given six times by a physiotherapist over a two-year period. Participants had fasting blood samples taken at the end-of-trial visit. Blood samples were analyzed for glucose and insulin and the results used to calculate the HOMA2-S% measure for insulin sensitivity. Two-sample t-test was used to compare HOMA2-S% in the two groups and multiple linear regression was used to adjust for differences in baseline physical activity level. Results A total of 107 (56%) of eligible patients were included: Forty-nine from the intervention group and 58 from the control group. Median (IQR) age was 68.5 years (58-76), and 54 (51%) were female. Insulin sensitivity differed significantly between the two groups: Geometric mean (SD) HOMA2-S% was 128.2 (1.6) in intervention group vs. 100.9 (1.8) in the control group, P=0.049. Adjusting for baseline level of physical activity did not alter the result, P=0.043. Conclusion Insulin sensitivity was significantly higher in the intervention group also after adjusting for baseline level of physical activity.

Stroke and diabetes
Date: Wednesday 14 May 2008  
Time: 8:50 - 9:00 -  Room: Euterpe
Chair: I. Henriques, Portugal and D.W.J. Dippel, The Netherlands

03
The impact of diabetes and admission blood glucose on outcomes in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET)
D.A.De Silva    M. Ebinger    S. Christensen    C. Levi    M.W.Parsons    A. Peeters    P.A.Barber    G.A.Donnan    S.M.Davis       
For the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) Investigators

Royal Melbourne Hospital

AUSTRALIA

Background and Purpose Diabetes and post-stroke hyperglycemia are predictors of poor outcome following stroke. We aimed to study the impact of diabetes and admission blood glucose on radiological and clinical outcomes among ischemic stroke patients in the Echoplanar Imaging Thrombolytic Evaluation Trial. Methods EPITHET is a prospective randomized placebo-controlled trial of intravenous tPA versus placebo 3-6 hour time window. Admission serum glucose was measured within 6 hours of symptom onset and prior to study treatment. Outcome measures were infarct expansion (baseline-day 90) on MRI, and poor functional status (mRS 3-6) at day 90. Results One hundred patients (mean age 71.5 years, median NIHSS 13.5) were randomized to tPA (52) or placebo (48). The median admission blood glucose was 6.9 mmol/L and 22 were diabetic. The median admission blood glucose was higher among diabetics (10.2 vs 6.4 mmol/L, p<0.001). There were no differences in age, admission neurological status, baseline radiological volumes (diffusion-weighted imaging, perfusion-weighted imaging and mismatch lesions), reperfusion (>90%, baseline-day 3) and recanalization (baseline-day 3) rates between diabetics and non-diabetics. With tPA treatment, median relative infarct growth was greater in diabetics (1.27 vs0.96, p=0.007) and was independent of admission blood glucose in linear regression (p=0.027). Patients with poor functional outcome had higher median admission blood glucose levels (7.4 vs 6.4 mmol/L, p=0.002) in the tPA group. These findings were not observed in the placebo group. The impact of tPA versus placebo on infarct growth was significantly different between diabetics and non-diabetics, evidenced by the statistical interaction between treatment allocation and presence of diabetes in predicting relative infarct growth (p=0.029). Conclusions Our findings suggest that diabetic patients and those with higher blood glucose levels receive less benefit from thrombolytic therapy and future trials should consider stratification for these variables prior to randomization.

Stroke and diabetes
Date: Wednesday 14 May 2008  
Time: 9:00 - 9:10 -  Room: Euterpe
Chair: I. Henriques, Portugal and D.W.J. Dippel, The Netherlands

04
Metabolic syndrome in lacunar stroke: prevalence and association with lacunar stroke subtype
C.E.Zhang     E.P.van Raak     R,P.Rouhl     J. Lodder     J. Staals     I.L.Knottnerus    R.J.van Oostenbrugge                     
 

University Hospital Maastricht, Maastricht

THE NETHERLANDS

BACKGROUND - Metabolic syndrome (MetS) is a cluster of vascular risk factors associated with increased morbidity and mortality. It is present when three or more of the following are met: obesity, elevated blood pressure, elevated triglyceride level, elevated glucose level, and low high-density lipoprotein level. In absence of further data on MetS in lacunar stroke (LS) patients, we determined the prevalence of MetS in LS and its association with LS subtypes. METHODS - Patients were selected from the Maastricht Stroke Registry (March 2003 – April 2007). We included 107 patients with a first-ever LS, and, as control group, 135 patients with a first-ever non-cardioembolic cortical stroke (CS), matched for age and gender. We determined the prevalence of MetS in three different patient groups: LS patients 1) with white matter lesions (WML), and 2) without WML, and 3) CS patients. We used MR to assess WML. RESULTS - 40.7% of all patients had MetS; 36.0% of LS patients and 44.0% of CS patients (N.S.). 44.4% of LS patients without WML had MetS compared to 23.7% of those with WML (OR 3.09; 95%CI 1.10-8.71). The prevalence of MetS did not differ between LS patients without WML and CS patients, whereas it significantly differed between LS patients with WML and CS patients (OR 0.41; 95%CI 0.17-0.99). DISCUSSION - The prevalence of MetS in ischemic stroke patients is high. LS patients without WML significantly more often had MetS than LS patients with WML. As no difference was found between the LS patients without WML and CS patients, MetS is possibly more strongly related to atherosclerotic disease (e.g. LS without WML) than with small vessel disease (LS with WML). Our results therefore suggest a different, non-atherosclerotic pathophysiology underlying LS with WML