We know that people with type 2 diabetes are at a higher risk of cardiovascular disease, including stroke. People with type 2 diabetes have over double the risk of having ischemic stroke (the type of stroke that occurs when there is blockage of a blood vessel providing blood to the brain), and 1.6x times higher risk of having a hemorrhagic (bleeding type) stroke, compared to people without type 2 diabetes. Strokes cause damage to the brain, with consequences ranging from mild to debilitating. Importantly, strokes are also associated with a higher risk for cognitive decline and dementia (called ‘vascular dementia). Sadly, one in eight deaths in people with type 2 diabetes may be attributed to stroke.
Ischemic strokes are seen much more often than hemorrhagic strokes. In people with diabetes, small vessel blockage is the most common type of ischemic stroke. With every 1% increase in A1C (diabetes ‘report card’ blood test, which reflects blood sugar control), there is a 17% increased risk of first-ever stroke, and a 49% increased risk of first-ever ischemic stroke.
We know that many other factors beyond blood sugar control increase the risk of stroke, including:
- blood pressure above target
- cholesterol above target
- smoking
- obesity
Important treatments that reduce stroke risk (or stroke risk factors) in people with type 2 diabetes include:
- optimizing blood sugars (though we haven’t clearly proven that lowering A1C reduces stroke risk, we do know that a higher A1C is associated with higher stroke risk, so it stands to reason that improving blood sugars is an important part of managing stroke risk)
- controlling blood pressure
- optimizing LDL (‘bad cholesterol’) to targets
- icosapent ethyl (in people with elevated triglycerides)
- treating obesity
- smoking cessation
- increased physical activity
- GLP1 receptor agonists – diabetes medications that lower blood sugar and lower body weight
BOTTOM LINE: People with type 2 diabetes are at higher risk of stroke. For people with diabetes, talk to your health care provider to make sure you are getting all the support and treatments you need to reduce stroke risk. For health care providers, always be sure to run through your ‘vascular risk reduction’ checklist to make sure you have considered all potential avenues to help your patient reduce risk of stroke.
FOR HEALTH CARE PROVIDERS INTERESTED TO LEARN MORE: check out our recent accredited 16 minute PeerVoice continuing medical education (CME) video on the topic here (Dr Melanie Davies (endocrinologist in UK), Dr Christina Kruuse (neurologist in Denmark), and myself as faculty!) (accredited by the European Board for Accreditation of Continuing Education for Health Professionals).
Share this blog post using your favorite social media link below!
Follow me on twitter! @drsuepedersen
www.drsue.ca © 2022
