Serum Glucose Identifies Hospitalized Stroke Patients at Greatest Risk for Recurrence

Presence of hyperglycemia at hospital admission for stroke was linked with elevated risk for subsequent stroke by 90 days, an increase that dual antiplatelet therapy seemingly failed to curtail.

Every ischemic stroke represents a critical opportunity to prevent another, potentially more severe, stroke. The risk of subsequent stroke is as high as 17% in the 90 days following the index event, but this risk is front‐loaded within the first seven days.

Hyperglycemia, an elevation in serum glucose, is associated with an increase in lesion volume and worse functional outcomes after acute ischemic stroke. Several studies have shown that a history of diabetes is associated with subsequent stroke after transient ischemic attack (TIA) or minor ischemic stroke.

Neurologists at Duke University School of Medicine (Durham, NC, USA) performed a secondary analysis of the POINT (Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke) trial to evaluate the relationship between serum glucose hyperglycemia (≥180 mg/dL) versus normoglycemia (<180 mg/dL) before enrollment in the trial and outcomes at 90 days. The scientists enrolled 4,881 patients aged 18 years or older who presented with a high‐risk TIA (ABCD2 score ≥4) or acute minor ischemic stroke (National Institutes of Health Stroke Scale score ≤3) between May 2010 and December 2017 at 269 hospitals.

The investigators reported that of 4,878 patients included in this study, 267 had a recurrent stroke. There was a higher hazard of subsequent stroke in patients with hyperglycemia compared with normoglycemia (adjusted hazard ratio [HR], 1.50, with a cumulative incidence of 9.7% in patients with hyperglycemia and 5.2% in those normoglycemic. Treatment with dual antiplatelet therapy was not associated with a reduced hazard of subsequent stroke in patients with hyperglycemia (HR, 1.18) though the wide confidence interval does not exclude a treatment effect. When modeled as a continuous variable, there was evidence of a nonlinear association between serum glucose and the hazard of subsequent stroke.

Brian Mac Grory, MB BCh BAO, MRCP, assistant Professor of Neurology and the corresponding author of the study, said. “The risk of subsequent stroke is as high as 17% in the 90 days following the index event, but this risk is front-loaded within the first week. For this reason, there is a need to incorporate dynamic physiological metrics into risk stratification schemes, and not simply long-term risk factors. Serum glucose is an intriguing potential predictor of recurrent stroke risk, because it is already assessed in the majority of patients with acute stroke using widely available, low-cost assays.”

The authors concluded that in their study, there was a higher rate of subsequent ischemic stroke and no clear benefit to dual antiplatelet therapy in patients with hyperglycemia on admission. The study may provide further support for developing innovative secondary prevention strategies in this high‐risk patient population. The study was published on January 19, 2022 in the Journal of the American Heart Association.

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