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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of TIA, stroke, and neuropathy was studied in a community-based maturity-onset diabetic population. The frequencies of TIA and stroke were increased in maturity-onset diabetic patients as compared to the population of Rochester, Minnesota. The median age of occurrence of TIA and stroke in diabetics was 74 years, not significantly different from that in non-diabetics. Diabetic patients with hypertension at the time of diagnosis of diabetes mellitus had an increased frequency of TIA and stroke. Control of hypertension and/or diabetes mellitus was associated with a decreased frequency of TIA or stroke. Obesity, clinical coronary heart disease, and an abnormal electrocardiogram at the time of diagnosis of diabetes mellitus were not associated with a significantly increased frequency of TIA or stroke. The most common type of peripheral neuropathy in diabetes mellitus was distal polyneuropathy. Mononeuropathy and autonomic neuropathy were much less frequent. The frequency of distal polyneuropathy increased with the duration of diabetes mellitus. The frequency of neuropathy was increased in patients with poor control, reemphasizing the importance of diabetic control in the prevention of diabetic complications.
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PMID:Neurologic complications of diabetes mellitus: transient ischemic attack, stroke, and peripheral neuropathy. 21 54

A total of 969 (73%) of 1,328 patients with cases of suspected transient ischemic attacks (TIAs) who came to six institutions during a 21-month period were followed up. Factors were identified and prospectively analyzed for risk for further TIAs, stroke, and deatn. A history of multiple carotid artery TIAs was significantly related to further TIAs. A single TIA placed the patient at greater risk for early infarction. Older age, male sex, and unreliability to take dangerous medication were risk factors for cerebral infarction. Anticoagulant therapy, older age, male sex, diabetes mellitus, heart disease, abnormal ECG, and poor surgical risk were factors for death. The increased mortality associated with anticoagulants was confined to the older age group. While white patients treated with antiplatelet-aggregating agents had a lower mortality than those treated otherwise, this was not true amont black patients.
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PMID:Cooperative study of hospital frequency and character of transient ischemic attacks. VIII. Risk factors. 67 2

Fifty-seven cases admitted to the Karolinska Hospital 1973-1976 with the diagnosis transient cerebral ischemia were reviewed. Seventeen cases were excluded as not fulfilling the strict TIA definition. An analysis of the records and the supplementary questionnaire of the remaining cases showed considerable sex differences in the stroke-prone profile. In the male group arteriosclerosis in the extracranial cerebral arteries was demonstrated in 90% of these examined by angiography. In the female group factors recognized as interfering with the coagulation system were obvious in more than 70% and two women had fibromuscular dysplasia. These differences may have therapeutic and prognostic implications. In the total material only 35% had hypertension. Diabetes was not present in any of the patients. Of the men 46.6% had abnormal blood lipids against 15.4% of the women. Seventy-five percent of the patients with verified arteriosclerosis were regular smokers. At a mean follow-up time of 18.7 months only one patient, in the untreated group, developed completed stroke.
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PMID:Pathogenetic profile of TIA before 55. A three-year investigation. 68 66

In 50 patients with encephalomalacia and 50 patients with a transient cerebral ischemic attack (TIA) the risk factors and viscosity of the whole blood as well as the hematocrit were determined before the start of treatment. Compared to a control group, the blood viscosity in patients with encephalomalacia was significantly increased (p less than 0.001) in all ranges of shearing velocity tested, in patients with TIA only at that shearing velocity which may be assumed for the area of microcirculation. This increase was related to the presence of arterial hypertension, hyperlipemia, heart failure, diabetes mellitus, hyperfibrinogenemia and increased tendency of thrombocytes and erythrocytes to aggregate. From the results obtained it was concluded that increased blood viscosity in the cerebral area of microcirculation with insufficient cerebral collateral circulation may decisively favor the development of encephalomalacia.
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PMID:[Clinical significance of changes in blood viscosity in cerebrovascular insufficiency (author's transl)]. 81 Jun 86

An investigation limited to patients under 70 years of age was undertaken to study the incidence of new cerebrovascular strokes (cerebral hemorrhage, cerebral infarction, and cerebral embolism) in all cases from Uppsala county between 1967-1971. The total incidence of stroke is 36/1000,000 in this age category; the mean age was 59.9 years for men and 60.8 years for women. Of the total number, 25% were recurrences. The occurrence of a moderate but significant decrease during the period of study has been attributed to an extended and improved treatment of hypertension. All of the 6 females who had suffered strokes below 40 years of age had been on oral contraceptives at the time. A high incidence of diabetes and symptoms of cardiovascula r impairment (hypertension, transient ischemic attack, cardiosclerotic disease) was found. A high incidence of myocardial infarction and of strokes was found among parents of those suffering cerebral hemorrhage and cerebral infarctions, respectively.
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PMID:Studies on cerebrovascular stroke. I. Epidemiology of first-time strokes in persons under 70 years of age. 120 87

The experience of the authors performing carotid endarterectomy in Puerto Rico is reported. The study was stimulated by the recently published results of the Carotid Endarterectomy Cooperative Trial groups in North America and Europe. This series consists of 61 carotid endarterectomies performed on 53 patients. The majority of the patients suffered from hypertension, diabetes mellitus, smoking, and ischemic heart disease. Most of the patients presented with Transient Ischemic Attacks (64%) or Reversible Ischemic Neurologic Deficits (19%). One patient died of a presumptive myocardial infarction and one patient had a post-operative worsening of his neurologic condition. The permanent morbidity and mortality rate was 3.2%.
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PMID:Carotid endarterectomy in Puerto Rico. 129

In a case-controlled study into the risk factors for admission to hospital with stroke, 400 subjects and 400 age and sex-matched controls were recruited. All bar two subjects were followed until death or 6 months. Previous stroke and regular snoring (p = 0.0013 and p less than 0.0001 respectively) were the only two risk factors adversely to effect mortality. Transient ischaemic attack, ischaemic heart disease, hypertension, atrial fibrillation, diabetes mellitus did not significantly effect prognosis. An apparent beneficial effect of drinking alcohol and smoking became insignificant when the confounding influence of age was taken into account.
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PMID:Effect of the risk factors for stroke on survival. 135 99

Recent studies concerning secular trends in stroke incidence and mortality and identification of independent risk factors for stroke are reviewed. Stroke mortality has declined in many industrialized countries in recent decades. In France, it has been declining by more than 30% between 1968 and 1982 in all age groups and in both sexes except for women under 40 years. The decline in stroke mortality seems to be partly real and partly apparent. In the community-based study of Rochester, Minnesota, stroke incidence decreased by 54% between 1945-49 and 1975-79. Recent data from Rochester, however, suggest that the incidence of stroke may no longer be declining. Survival after stroke has also apparently been improving but several sources of potential bias may also have influenced the decrease in reported survival rates. Hypertension is a major risk factor for stroke. Prolonged differences in "usual" diastolic blood pressure of 5 to 10 mmHg are associated with about 40% difference in stroke incidence. Recent analysis suggests that stroke incidence reduction could arise rapidly after hypertension control and that a lower blood pressure should confer a lower risk of vascular disease, even in individuals conventionally considered as "normotensive". There is evidence that cigarette smoking is an important risk factor for stroke with an overall relative risk of 1.5 and that the risk of stroke declines rapidly after the cessation of smoking. A cardiac condition may be a marker for another risk factor or the primary substrate for cerebral embolism. In patients with atrial fibrillation, the risk of stroke is increased through both of these mechanisms. Diabetes mellitus, chronic alcohol consumption (> 3 drinks/day), and high fibrinogen levels are other independent risk factors for stroke. While high levels of cholesterol may be associated with ischemic stroke, an inverse association of the serum cholesterol with the occurrence of intracerebral hemorrhage in men has been reported. In patients with asymptomatic internal carotid stenosis, higher degrees of stenosis convey a higher risk of stroke. However, far from all these strokes are due to thromboembolism from an atheromatous plaque in the ipsilateral internal carotid artery. The relative risk of stroke during the first 5 years following a transient ischemic attack is 7 times that in persons without transient ischemic attack. More than a third of the subsequent strokes occur in a vascular territory different from that of the incident TIA. While the use of oral contraceptives may increase the relative risk of stroke, postmenopausal estrogen treatment may have a protective effect on the risk of vascular diseases.
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PMID:[Epidemiology of cerebrovascular accidents]. 143 51

Patients presenting with symptoms suggestive of amaurosis fugax, or with findings of Hollenhorst plaques on fundoscopy are frequently referred for duplex evaluation to detect possible carotid artery disease. To better determine the reliability of monocular visual loss and the presence of Hollenhorst plaques for predicting the presence or significance of carotid artery stenosis, we prospectively studied 66 patients with these ocular signs and symptoms. After evaluation, the patients were categorized as follows: 34 of 66 (52%) patients had amaurosis fugax, 23 (35%) had asymptomatic Hollenhorst plaques, 7 (11%) had retinal artery occlusion, and 2 (3%) had venous stasis retinopathy. All patients were evaluated ophthalmologically, with carotid duplex scanning and spectral analysis. A stenosis of greater than 60% was regarded as significant. The presence of risk factors including hypertension, diabetes, a history of CVA or TIA's, tobacco use and hyperlipidemia was recorded. There were no statistically significant differences (p greater than 0.05) in the incidence of atherosclerotic risk factors between the four groups. Patients with amaurosis fugax were more likely to have a significant carotid artery stenosis than those with asymptomatic Hollenhorst plaques or retinal artery occlusion (53% vs 9% vs 0% respectively) (p less than 0.006). We conclude that routine carotid duplex scanning is indicated in all patients with amaurosis fugax in view of the frequent association with significant carotid stenosis (53%). However, the presence of Hollenhorst plaques in the absence of visual symptoms appears not to have a significant association with carotid disease and may not necessarily require routine screening unless other risk factors for carotid stenosis are present.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Correlation of ophthalmic findings with carotid artery stenosis. 152 43

Recent reports of the risk of asymptomatic carotid stenosis have been compromised by flawed patient selection or the performance of a large number of carotid endarterectomies during follow-up. We report the natural history of a randomly selected group of asymptomatic patients (n = 188; 114 males and 74 females) with documented carotid artery disease who were prospectively followed without intervention for up to 8 years. Risk factors included ischaemic heart disease in 17%, diabetes in 10%, hypertension in 46% and 88% were smokers. The degree of internal carotid stenosis was classified by duplex scanning and a total of 259 vessels had evidence of atherosclerosis. Study end-points included TIA, CVA and death. At mean follow-up of 4 years 3% of the 96 patients with internal carotid artery stenosis of less than 50% had died and 2% suffered a stroke. Six per cent of patients with a stenosis of 50-79% had died and 4% and 2% had suffered a CVA and TIA, respectively. In the 59 patients with greater than 80% stenosis 7% had suffered a TIA and an additional 7% a CVA, while 2% had died. None of the patients suffering a stroke had an antecedent TIA. Though the incidence of ischaemic events is significantly higher in patients with greater than 80% stenosis the incidence of unheralded stroke remains low. We therefore continue to recommend a conservative approach to the management of asymptomatic carotid stenosis.
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PMID:Asymptomatic carotid stenosis: a benign lesion? 155 61


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