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Original Article

Risk of Ischemic Stroke After an Acute Myocardial Infarction in Patients With Diabetes Mellitus

Stina Jakobsson, Lisa Bergström, Fredrik Björklund, Tomas Jernberg, Lars Söderström, Thomas Mooe
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https://doi.org/10.1161/CIRCOUTCOMES.113.000311
Circulation: Cardiovascular Quality and Outcomes. 2014;7:95-101
Originally published January 21, 2014
Stina Jakobsson
From the Department of Public Health and Clinical Medicine, Umeå University, Sweden (S.J., T.M.); Department of Internal Medicine, Section of Neurology (L.B.), and Department of Internal Medicine, Section of Cardiology (F.B., T.M.), Östersund Hospital, Sweden; Department of Medicine, Section of Cardiology, Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (T.J.); and Unit of Clinical Research Center, County of Jämtland, Östersund, Sweden (L.S.).
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Lisa Bergström
From the Department of Public Health and Clinical Medicine, Umeå University, Sweden (S.J., T.M.); Department of Internal Medicine, Section of Neurology (L.B.), and Department of Internal Medicine, Section of Cardiology (F.B., T.M.), Östersund Hospital, Sweden; Department of Medicine, Section of Cardiology, Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (T.J.); and Unit of Clinical Research Center, County of Jämtland, Östersund, Sweden (L.S.).
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Fredrik Björklund
From the Department of Public Health and Clinical Medicine, Umeå University, Sweden (S.J., T.M.); Department of Internal Medicine, Section of Neurology (L.B.), and Department of Internal Medicine, Section of Cardiology (F.B., T.M.), Östersund Hospital, Sweden; Department of Medicine, Section of Cardiology, Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (T.J.); and Unit of Clinical Research Center, County of Jämtland, Östersund, Sweden (L.S.).
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Tomas Jernberg
From the Department of Public Health and Clinical Medicine, Umeå University, Sweden (S.J., T.M.); Department of Internal Medicine, Section of Neurology (L.B.), and Department of Internal Medicine, Section of Cardiology (F.B., T.M.), Östersund Hospital, Sweden; Department of Medicine, Section of Cardiology, Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (T.J.); and Unit of Clinical Research Center, County of Jämtland, Östersund, Sweden (L.S.).
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Lars Söderström
From the Department of Public Health and Clinical Medicine, Umeå University, Sweden (S.J., T.M.); Department of Internal Medicine, Section of Neurology (L.B.), and Department of Internal Medicine, Section of Cardiology (F.B., T.M.), Östersund Hospital, Sweden; Department of Medicine, Section of Cardiology, Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (T.J.); and Unit of Clinical Research Center, County of Jämtland, Östersund, Sweden (L.S.).
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Thomas Mooe
From the Department of Public Health and Clinical Medicine, Umeå University, Sweden (S.J., T.M.); Department of Internal Medicine, Section of Neurology (L.B.), and Department of Internal Medicine, Section of Cardiology (F.B., T.M.), Östersund Hospital, Sweden; Department of Medicine, Section of Cardiology, Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (T.J.); and Unit of Clinical Research Center, County of Jämtland, Östersund, Sweden (L.S.).
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Abstract

Background—Incidence, any trend over time, and predictors of ischemic stroke after an acute myocardial infarction (AMI) in diabetic patients are unknown.

Methods and Results—Data for 173 233 unselected patients with an AMI, including 33 503 patients with diabetes mellitus, were taken from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA) during 1998 to 2008. Ischemic stroke events were recorded during 1 year of follow-up. Patients with diabetes mellitus more often had a history of cardiovascular disease, received less reperfusion therapy, and were treated with acetylsalicylic acid, P2Y12 inhibitors, and statins to a lesser extent compared with patients without diabetes mellitus. However, the use of evidence-based therapies increased markedly in both groups during the study period. The incidence of ischemic stroke during the first year after AMI decreased from 7.1% to 4.7% in patients with diabetes mellitus and from 4.2% to 3.7% in patients without diabetes mellitus. Risk reduction was significantly larger in the diabetic subgroup. Reperfusion therapy, acetylsalicylic acid, P2Y12 inhibitors, and statins were independently associated with the reduced stroke risk.

Conclusions—Ischemic stroke is a fairly common complication after an AMI in patients with diabetes mellitus, but the risk of stroke has decreased during recent years. The increased use of evidence-based therapies contributes importantly to this risk reduction, but there is still room for improvement.

  • diabetes mellitus
  • myocardial infarction
  • stroke
  • Received March 1, 2013.
  • Accepted November 20, 2013.
  • © 2013 American Heart Association, Inc.
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January 2014, Volume 7, Issue 1
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    Risk of Ischemic Stroke After an Acute Myocardial Infarction in Patients With Diabetes Mellitus
    Stina Jakobsson, Lisa Bergström, Fredrik Björklund, Tomas Jernberg, Lars Söderström and Thomas Mooe
    Circulation: Cardiovascular Quality and Outcomes. 2014;7:95-101, originally published January 21, 2014
    https://doi.org/10.1161/CIRCOUTCOMES.113.000311

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    Risk of Ischemic Stroke After an Acute Myocardial Infarction in Patients With Diabetes Mellitus
    Stina Jakobsson, Lisa Bergström, Fredrik Björklund, Tomas Jernberg, Lars Söderström and Thomas Mooe
    Circulation: Cardiovascular Quality and Outcomes. 2014;7:95-101, originally published January 21, 2014
    https://doi.org/10.1161/CIRCOUTCOMES.113.000311
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  • Heart Failure and Cardiac Disease
    • Myocardial Infarction
  • Epidemiology, Lifestyle, and Prevention
    • Secondary Prevention
    • Diabetes, Type 2
    • Diabetes, Type 1
  • Stroke
    • Ischemic Stroke

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