Abstract
This chapter discusses the key findings from the literature regarding stroke incidence in patients with diabetes (DM), DM-specific and non-specific risk factors of stroke in the diabetic population, course and outcome of stroke in subjects with DM, and the peculiarities of type, site, and size of stroke in diabetic patients. The results of major clinical trials aimed at correcting hyperglycemia, hypertension, and dyslipidemia to prevent stroke in people with DM are also reviewed.
DM has been consistently shown to represent a strong independent risk factor of ischemic stroke. The same applies to the full cluster of the insulin resistance syndrome. The contribution of hyperglycemia to increased stroke risk is not proven. The association of diabetes with the risk of hemorrhagic stroke remains controversial. The course of stroke in patients with DM is characterized by higher mortality, more severe disability, and higher recurrence rate compared to non-diabetic subjects. Aggressive control of arterial hypertension and dyslipidemia allows to substantially decrease the risk of stroke in diabetic patients, while the importance of glucose control for stroke prevention remains unproven.
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References
Rosamond WD, Folsom AR, Chambless LE, et al. Stroke incidence and survival among middle-aged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort. Stroke 1999; 30:736–743.
Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics—2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009; 119: e21–e181
Stegmayr B, Asplund K. Diabetes as a risk factor for stroke. A population perspective. Diabetologia 1995; 38:1061–1068.
Folsom AR, Rasmussen ML, Chambless ME, et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Diabetes Care 1999; 22:1077–1083.
Kissela BM, Khoury J, Kleindorfer D, et al. Epidemiology of ischemic stroke in patients with diabetes: the greater Cincinnati/Northern Kentucky Stroke Study. Diabetes Care 2005; 28:355–359.
Lee CM, Huxley RR, Lam TH, et al. Prevalence of diabetes mellitus and population attributable fractions for coronary heart disease and stroke mortality in the WHO South-East Asia and Western Pacific regions. Asia Pac J Clin Nutr 2007; 16:87–92.
Currie CJ, Morgan CL, Gill L, Scott NC, Peters JR. Epidemiology and costs of acute hospital care for cerebrovascular disease in diabetic and nondiabetic populations. Stroke 1997; 28:1142–1146.
Bottle A, Millett C, Khunti K, Majeed A. Trends in cardiovascular admissions and procedures for people with and without diabetes in England, 1996–2005. Diabetologia 2009; 52:74–80.
Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingam study. JAMA 1979; 241:2035–2038.
Abbott RD, Donahue RO, MacMahon SW, Reed DM, Yano K. Diabetes and the risk of stroke. The Honolulu Heart Program. JAMA 1987; 257:949–952.
Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Predictors of stroke in middle-aged patients with non–insulin-dependent diabetes. Stroke 1996; 27:63–68.
Niskanen L, Turpeinen A, Penttila I, Uusitupa MI. Hyperglycemia and compositional lipoprotein abnormalities as predictors of cardiovascular mortality in type 2 diabetes: a 15-year follow-up from the time of diagnosis. Diabetes Care 1998; 21:1861–1869.
Wannamethee SG, Perry IJ, Shaper AG. Nonfasting serum glucose and insulin concentrations and the risk of stroke. Stroke 1999; 30:780–786.
Abu-Lebdeh HS, Hodge DO, Nguyen TT. Predictors of macrovascular disease in patients with type 2 diabetes mellitus. Mayo Clin Proc 2001; 76:707–712.
Kuusisto J, Mykkanen L, Pyorala K, Laakso M. Non-insulin-dependent diabetes and its metabolic control are important predictors of stroke in elderly patients. Stroke 1994; 25:1157–1164.
Hart CL, Hole DJ, Smith GD. Comparison of risk factors for stroke incidence and stroke mortality in 20 years of follow-up in men and women in the Renfrew/Paisley Study in Scotland. Stroke 2000; 31:1893–1896.
Manson JE, Colditz GA, Stampfer MJ, et al. A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. Arch Intern Med 1991; 151:1141–1147.
Aronow WC, Ahn C. Risk factors for new atherothrombotic brain infarction in older Hispanic men and women. J Gerontol A Biol Sci Med Sci 2002; 57:M61–M63.
Mulnier HE, Seaman HE, Raleigh VS, et al. Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database. Diabetologia 2006; 49:2859–2865.
Almdal T, Scharling H, Jensen JS, Vestergaard H. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up. Arch Intern Med 2004; 164:1422–1426.
Ottenbacher KJ, Ostir GV, Peek MK, Markides KS. Diabetes mellitus as a risk factor for stroke incidence and mortality in Mexican American older adults. J Gerontol A Biol Sci Med Sci 2004; 59:640–645.
Schramm TK, Gislason GH, Køber L, et al. Diabetes patients requiring glucose-lowering therapy and nondiabetics with a prior myocardial infarction carry the same cardiovascular risk: a population study of 3.3 million people. Circulation 2008; 117:1945–1954.
Jeerakathil T, Johnson JA, Simpson SH, Majumdar SR. Short-term risk for stroke is doubled in persons with newly treated type 2 diabetes compared with persons without diabetes: a population-based cohort study. Stroke 2007; 38:1739–1743.
Ho JE, Paultre F, Mosca L, for the Women’s Pooling Project. Is diabetes mellitus a cardiovascular disease risk equivalent for fatal stroke in women? Data from the Women’s Pooling Project. Stroke 2003; 34:2812–2816.
Hu G, Jousilahti P, Sarti C, Antikainen R, Tuomilehto J. The effect of diabetes and stroke at baseline and during follow-up on stroke mortality. Diabetologia 2006; 49:2309–2316.
Lee CD, Folsom AR, Pankow JS, Brancati FL, Atherosclerosis Risk in Communities (ARIC) Study Investigators. Cardiovascular events in diabetic and nondiabetic adults with or without history of myocardial infarction. Circulation 2004; 109:855–860.
Danaei G, Lawes CM, van der Hoorn S, Murray CJ, Ezzati M. Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk assessment. Lancet 2006; 368:1651–1659.
Sacco RL, Boden-Albala B, Abel G, et al. Race-ethnic disparities in the impact of stroke risk factors: the Northern Manhattan Stroke Study. Stroke 2001; 32:1725–1731.
Noto D, Barbagallo M, Cavera G, et al. Leukocyte count, diabetes mellitus and age are strong predictors of stroke in a rural population in southern Italy: an 8-year follow-up. Atherosclerosis 2001; 157:225–231.
Lin M, Chen Y, Sigal RJ. Stroke associated with diabetes among Canadians: sex and age differences. Neuroepidemiology 2007; 28:46–49.
Laing SP, Swerdlow AJ, Carpenter LM, et al. Mortality from cerebrovascular disease in a cohort of 23 000 patients with insulin-treated diabetes. Stroke 2003; 34:418–421.
Fuller JH, Stevens LK, Wang SL, the WHO Multinational Study Group Risk factors for cardiovascular mortality and morbidity: The WHO multinational study of vascular disease in diabetes. Diabetologia 2001; 44:S54–S64.
Janghorbani M, Hu FB, Willett WC, et al. Prospective study of type 1 and type 2 diabetes and risk of stroke subtypes: the Nurses’ Health Study. Diabetes Care 2007; 30:1730–1735.
De Marco R, Locatelli F, Zoppini G, Verlato G, Bonora E, Muggeo M. Cause-specific mortality in type 2 diabetes. The Verona Diabetes Study. Diabetes Care 1999; 22:756–761.
Tuomilehto J, Rastenyte D, Jousilahti P, Sarti C, Vartiainen E. Diabetes mellitus as a risk factor for death from stroke. Prospective study of the middle-aged Finnish population. Stroke 1996; 27:210–215.
Olsson T, Vitanen M, Asplund K, Eriksson S, Hagg E. Prognosis after stroke in diabetic patients. A controlled prospective study. Diabetologia 1990; 33:244–249.
Barrett-Connor E, Khaw KT. Diabetes mellitus: an independent risk factor for stroke? Am J Epidemiol 1988; 128:116–123.
Davis TM., Millns H, Stratton IM, Holman RR, Turner RC. Risk factors for stroke in type 2 diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS) 29. Arch Intern Med 1999; 159:1097–1103.
Sasaki A, Horiuchi N, Hasegawa K, Uehara M. Mortality from coronary heart disease and cerebrovascular disease and associated risk factors in diabetic patients in Osaka District, Japan. Diab Res Clin Pract 1995; 27:77–83.
Yoshinari M, Kaku R, Iwase M, et al. Development of ischemic stroke in normotensive and hypertensive diabetic patients with or without antihypertensive treatment: an 8-year follow up study. J Diabetes Complications 1997; 11:9–14.
Yang X, Kong AP, So WY, et al. Effects of chronic hyperglycaemia on incident stroke in Hong Kong Chinese patients with type 2 diabetes. Diabetes Metab Res Rev 2007; 23:220–226.
Giorda CB, Avogaro A, Maggini M, et al. Incidence and risk factors for stroke in type 2 diabetic patients: the DAI study. Stroke 2007; 38:1154–1160.
Selvin E, Coresh J, Shahar E, Zhang L, Steffes M, Sharrett AR. Glycaemia (haemoglobin A1c) and incident ischaemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Lancet Neurol 2005; 4:821–826.
Elley CR, Kenealy T, Robinson E, Drury PL. Glycated haemoglobin and cardiovascular outcomes in people with Type 2 diabetes: a large prospective cohort study. Diabet Med 2008; 25:1295–1301.
Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004; 141:421–431.
Boden-Albala B, Cammack S, Chong J, et al. Diabetes, fasting glucose levels, and risk of ischemic stroke and vascular events: findings from the Northern Manhattan Study (NOMAS). Diabetes Care 2008; 31:1132–1137.
Eguchi K, Boden-Albala B, Jin Z, et al. Usefulness of fasting blood glucose to predict vascular outcomes among individuals without diabetes mellitus (from the Northern Manhattan Study). Am J Cardiol 2007; 100:1404–1409.
Moss SE, Klein R, Klein BEK, Meuer SM. The association of glycemia and cause-specific mortality in diabetic population. Arch Intern Med 1994; 154:2473–2479.
Lowe LP, Liu K, Greenland P, Metzger BE, Dyer AR, Stamler J. Diabetes, asymptomatic hyperglycemia, and 22-year mortality in black and white men. The Chicago Heart Association Detection Project in Industry Study. Diabetes Care 1997; 20:163–169.
Stevens RJ, Coleman RL, Adler AI, Stratton IM, Matthews DR, Holman RR. Risk factors for myocardial infarction case fatality and stroke case fatality in type 2 diabetes: UKPDS 66. Diabetes Care 2004; 27:201–207.
Colagiuri S, Cull CA, Holman RR. Are lower fasting plasma glucose levels at diagnosis of type 2 diabetes associated with improved outcomes? U.K. Prospective diabetes study 61. Diabetes Care 2002; 25:1410–1417.
Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321:405–412.
Oizumi T, Daimon M, Jimbu Y, et al. Impaired glucose tolerance is a risk factor for stroke in a Japanese sample – the Funagata study. Metabolism 2008; 57:333–338.
Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H. Mortality from coronary heart disease and stroke in relation to degree of glycemia: the Whitehall study. BMJ 1983; 287:867–868.
Burchfiel CM, Curb D, Rodriguez BL, Abbott RD, Chiu D, Yano K. Glucose intolerance and 22-year stroke incidence. The Honolulu Heart Program. Stroke 1994; 25:951–957.
Rastenyte D, Tuomilehto J, Domarkiene S, Cepaitis Z, Reklaitiene R. Risk factors for death from stroke in middle-aged Lithuanian men. Results from a 20-year prospective study. Stroke 1996; 27:672–676.
Qureshi AI, Giles WH, Croft JB. Impaired glucose tolerance and the likelihood of nonfatal stroke and myocardial infarction: the Third National Health and Nutrition Examination Survey. Stroke 1998; 29:1329–1332.
Manolio TA, Kronmal RA, Burke GL, O’Leary DH, Price TR, for the CHS Collaborative Research Group. Short-term predictors of incident stroke in older adults. The Cardiovascular Health Study. Stroke 1996; 27:1479–1486.
Cheung N, Rogers S, Couper DJ, Klein R, Sharrett AR, Wong TY. Is diabetic retinopathy an independent risk factor for ischemic stroke? Stroke 2007; 38:398–401.
Petitti DB, Bhatt H. Retinopathy as a risk factor for nonembolic stroke in diabetic subjects. Stroke 1995; 26:593–596.
Klein R, Sharrett AR, Klein BE, et al. The association of atherosclerosis, vascular risk factors, and retinopathy in adults with diabetes: the atherosclerosis risk in communities study. Ophthalmology 2002; 109:1225–1234.
Klein R, Klein BE, Moss SE, Cruickshanks KJ. Association of ocular disease and mortality in a diabetic population. Arch Ophtalmol 1999; 117:1487–1495.
Klein BE, Klein R, McBride PE, et al. Cardiovascular disease, mortality, and retinal microvascular characteristics in type 1 diabetes: Wisconsin epidemiologic study of diabetic retinopathy. Arch Intern Med 2004; 164:1917–1924.
Klein R, Klein BE, Moss SE, Wong TY. Retinal vessel caliber and microvascular and macrovascular disease in type 2 diabetes: XXI: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Ophthalmology 2007; 114:1884–1892.
Guerrero-Romero F, Rodriguez-Moran M. Proteinuria is an independent risk factor for ischemic stroke in non-insulin-dependent diabetes mellitus. Stroke 1999; 30:1787–1791.
Miettinen H, Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Proteinuria predicts stroke and other atherosclerotic vascular disease events in nondiabetic and non-insulin-dependent diabetic subjects. Stroke 1996; 27:2033–2039.
Valmadrid CT, Klein R, Moss SE, Klein BE. The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Intern Med 2000; 160:1093–1100.
Gall MA, Borch-Johnsen K, Hougaard P, Nielsen FS, Parving HH. Albuminuria and poor glycemic control predict mortality in NIDDM. Diabetes 1995; 44:1303–1309.
Spoelstra-De Man AM, Brouwer CB, Stehouwer CD, Smulders YM. Rapid progression of albumin excretion is an independent predictor of cardiovascular mortality in patients with type 2 diabetes and microalbuminuria. Diabetes Care 2001; 24:2097–2101.
Cohen JA, Estacio RO, Lundgren RA, Esler AL, Schrier RW. Diabetic autonomic neuropathy is associated with an increased incidence of strokes. Auton Neurosci 2003; 108:73–78.
Toyry JP, Niskanen LK, Lansimies EA, Partanen KP, Uusitupa MI. Autonomic neuropathy predicts the development of stroke in patients with non-insulin-dependent diabetes mellitus. Stroke 1996; 27:1316–1318.
Pinto A, Tuttolomondo A, Di Raimondo D, et al. Ischemic stroke in patients with diabetic foot. Int Angiol 2007; 26:266–269.
National Heart, Lung, and Blood Institute. National Cholesterol Education Program: Executive Summary of the Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497.
World Health Organization Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation. Part I: Diagnosis and classification of diabetes mellitus. Geneva: World Health Organization, 1999.
Alberti KG, Zimmet P, Shaw J. The metabolic syndrome – a new worldwide definition. Lancet 2005; 366:1059–1062.
Ninomiya JK, L’Italien G, Criqui MH, Whyte JL, Gamst A, Chen RS. Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey. Circulation 2004; 109:42–46.
Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24:683–689.
Kurl S, Laukkanen JA, Niskanen L, et al. Metabolic syndrome and the risk of stroke in middle-aged men. Stroke 2006; 37:806–811.
Qiao Q, Laatikainen T, Zethelius B, et al. Comparison of definitions of metabolic syndrome in relation to the risk of developing stroke and coronary heart disease in Finnish and Swedish cohorts. Stroke 2009; 40:337–343.
Najarian RM, Sullivan LM, Kannel WB, Wilson PW, D’Agostino RB, Wolf PA. Metabolic syndrome compared with type 2 diabetes mellitus as a risk factor for stroke: the Framingham Offspring Study. Arch Intern Med 2006; 166:106–111.
Koren-Morag N, Goldbourt U, Tanne D. Relation between the metabolic syndrome and ischemic stroke or transient ischemic attack: a prospective cohort study in patients with atherosclerotic cardiovascular disease. Stroke 2005; 36:1366–1371.
Protopsaltis I, Korantzopoulos P, Milionis HJ, et al. Metabolic syndrome and its components as predictors of ischemic stroke in type 2 diabetic patients. Stroke 2008; 39:1036–1038.
Bravata DM, Wells CK, Kernan WN, Concato J, Brass LM, Gulanski BI. Association between impaired insulin sensitivity and stroke. Neuroepidemiology 2005; 25:69–74.
Adachi H, Hirai Y, Tsuruta M, Fujiura Y, Imaizumi T. Is insulin resistance or diabetes mellitus associated with stroke? An 18-year follow-up study. Diabetes Res Clin Pract 2001; 51:215–223.
Adler AI, Levy JC, Matthews DR, Stratton IM, Hines G, Holman RR. Insulin sensitivity at diagnosis of Type 2 diabetes is not associated with subsequent cardiovascular disease (UKPDS 67). Diabet Med 2005; 22:306–311.
Shinozaki K, Naritomi H, Shimizu T, et al. Role of insulin resistance associated with compensatory hyperinsulinemia in ischemic stroke. Stroke 1996; 27:37–43.
Zunker P, Schick A, Buschmann HC, et al. Hyperinsulinism and cerebral microangiopathy. Stroke 1996; 27:219–223.
Lindahl B, Dinesen B, Eliasson M, Roder M, Hallmans G, Stegmayr B. High proinsulin levels precede first-ever stroke in nondiabetic population. Stroke 2000; 31:2936–2941.
Burchfiel CM, Sharp DS, Curb JD, et al. Hyperinsulinemia and cardiovascular disease in elderly men: the Honolulu Heart Program. Arterioscler Thromb Vasc Biol 1998; 18:450–457.
Pyorala M, Miettinen H, Laakso M, Pyorala K. Hyperinsulinemia and the risk of stroke in healthy middle-aged men: the 22-year follow-up results of the Helsinki Policemen Study. Stroke 1998; 29:1860–1866.
Pyorala M, Miettinen H, Laakso M, Pyorala K. Plasma insulin and all-cause, cardiovascular and noncardiovascular mortality. The 22-year follow-up results of the Helsinki Policemen Study. Diabetes Care 2000; 23:1097–1102.
Lakka HM, Lakka TA, Tuomilehto J, Sivenius J, Salonen JT. Hyperinsulinemia and the risk of cardiovascular death and acute coronary and cerebrovascular events in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Arch Intern Med 2000; 160:1160–1168.
Wiberg B, Sundström J, Zethelius B, Lind L. Insulin sensitivity measured by the euglycaemic insulin clamp and proinsulin levels as predictors of stroke in elderly men. Diabetologia 2009; 52:90–96.
Lithner F, Asplund K, Eriksson S, Hagg E, Strand T, Wester PO. Clinical characteristics in diabetic stroke patients. Diabete Metab 1988; 4:15–19.
Neaton JD, Wentworth DN, Cutler J, Stamler J, Kuller L. Risk factors for death from different types of stroke. Multiple Risk Factor Intervention Trial Research Group. Ann Epidemiol 1993; 3:493–499.
Janghorbani M, Hu FB, Willett WC, et al. Prospective study of type 1 and type 2 diabetes and risk of stroke subtypes: the Nurses’ Health Study. Diabetes Care 2007; 30:730–735.
Adams HP, Putman SF, Kassell NF, Torner JC. Prevalence of diabetes mellitus among patients with subarachnoid hemorrhage. Arch Neurol 1984; 41:1033–1035.
Bell ET. A post-mortem study of vascular disease in diabetes. Arch Pathol 1952; 53:444–455.
Alex M, Baron EK, Goldenberg S, Blumenthal HT. An autopsy study of cerebrovascular accident in diabetes mellitus. Circulation 1962; 25:663–673.
Aronson SM. Intracranial vascular lesions in patients with diabetes mellitus. J Neuropathol Exp Neurol 1973; 32:183–196.
Njolstad I, Arnesen E, Lund-Larsen PG. Body height, cardiovascular risk factors, and risk of stroke in middle-aged men and women. A 14-year follow-up of the Finnmark Study. Circulation 1996; 94:2877–2882.
Jorgensen H, Nakayama H, Raaschou HO, Olsen TS. Stroke in patients with diabetes. The Copenhagen Stroke Study. Stroke 1994; 25:1977–1984.
Zia E, Pessah-Rasmussen H, Khan FA, et al. Risk factors for primary intracerebral hemorrhage: a population-based nested case-control study. Cerebrovasc Dis 2006; 21:18–25.
Rodriguez BL, D’Agostino R, Abbott RD, et al. Risk of hospitalized stroke in men enrolled in the Honolulu Heart program and the Framingham Study: A comparison of incidence and risk factor effects. Stroke 2002; 33:230–236.
Gandolfo C, Caponnetto C, Del Sette M, Santoloci D, Loeb C. Risk factors in lacunar syndromes: a case-control study. Acta Neurol Scand 1988; 77:22–26.
Ghika A, Bogousslavsky J, Regli F. Infarcts in the territory of the deep perforators from the carotid system. Neurology 1989; 39:507–512.
Tuttolomondo A, Pinto A, Salemi G, et al. Diabetic and non-diabetic subjects with ischemic stroke: differences, subtype distribution and outcome. Nutr Metab Cardiovasc Dis 2008; 18:152–157.
Tuszynski MH, Petito CK, Levy DE. Risk factors and clinical manifestations of pathologically verified lacunar infarctions. Stroke 1989; 20:990–999.
Arboix A, Martii Vilalta JL, Garsia JH. Clinical study of 227 patients with lacunar infarcts. Stroke 1990; 21:842–847.
Horowitz DR, Tuhrim S, Weinberger JM, Rudolph SH. Mechanisms in lacunar infarction. Stroke 1992; 23:325–327.
Ohira T, Shahar E, Chambless LE, Rosamond WD, Mosley Jr. TH, Folsom AR. Risk factors for ischemic stroke subtypes: the Atherosclerosis Risk in Communities study. Stroke 2006; 37:2493–2498.
Kappelle LJ, van Gijn J. Lacunar infarcts. Clin Neurol Neurosurg 1986; 17:3–17.
Bejot Y, Catteau A, Caillier M, et al. Trends in incidence, risk factors, and survival in symptomatic lacunar stroke in Dijon, France, from 1989 to 2006. A population-based study. Stroke 2008; 39:1945–1951.
Jackson C, Sudlow C. Are lacunar strokes really different? A systematic review Stroke 2005; 36:891–901.
Chamorro A, Sacco RL, Mohr JP, et al. Clinical-computed tomographic correlations of lacunar infarction in the Stroke Data Bank. Stroke 1991; 22:175–181.
Petty GW, Brown RD, Whisnant JP, Sicks JRD, O’Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke 1999; 30:2513–2516.
Lodder J, Bamford JM, Sandercock PAG, Jones LN, Warlow CP. Are hypertension or cardiac embolism likely causes of lacunar infarction? Stroke 1990; 21:375–381.
Tanne D, Yaari S, Goldbourt U. Risk profile and prediction of long-term ischemic stroke mortality. A 21-year follow-up in the Israeli Ischemic Heart Disease (IIHD) Project. Circulation 1998; 98:1365–1371.
Haheim LL, Holme I, Hjermann I, Leren P. Nonfasting serum glucose and the risk of fatal stroke in diabetic and nondiabetic subjects. 18-year follow-up of the Oslo Study. Stroke 1995; 26:774–777.
Pulsinelli WA, Levy DE, Sigsbee B, Scherer K, Plum F. Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus. Am J Med 1983; 74:540–544.
Oppenheimer S, Halfbraid BI, Oswald GA, Yudkin JS. Diabetes mellitus and early mortality from stroke. BMJ 1985; 291:1014–1015.
Kushner M, Nencini P, Reivich M, et al. Relation of hyperglycemia early in ischemic brain infarction to cerebral anatomy, metabolism, and clinical outcome. Ann Neurol 1990; 28:129–135.
Kiers L, Davis SM, Larkins R, et al. Stroke topography and outcome in relation to hyperglycaemia and diabetes. J Neurol Neurosurg Psychiatry 1992; 55:263–270.
van Kooten F, Hoogerbrugge N, Naarding P, Koudstall PJ. Hyperglycemia in the acute phase of stroke is not caused by stress. Stroke 1993; 24:1129–1132.
Lai SM, Alter M, Friday G, Sobel E. Prognosis for survival after an initial stroke. Stroke 1995; 26:2011–2015.
Wong KS. Risk factors for early death in acute ischemic stroke and intracerebral hemorrhage: A prospective hospital-based study in Asia. Asian Stroke Advisory Panel. Stroke 1999; 30:2326–2330.
Oliveira TV, Gorz AM, Bittencourt PR. Diabetes mellitus as a prognostic factor in ischemic cerebrovascular disease. Arq Neuropsiquiatr 1988; 46:287–291.
Asplund K, Hagg E, Helmers C, Lithner F, Strand T, Wester PO. The natural history of stroke in diabetic patients. Acta Med Scand 1980; 297:417–424.
Hornig CR, Buttner T, Hoffmann O, Dorndorf W. Short-term prognosis of vertebrobasilar ischemic stroke. Cerebrovasc Dis 1992; 2:273–281.
Clavier I, Hommel M, Besson G, Noelle B, Perret JE. Long-term prognosis of symptomatic lacunar infarcts. A hospital-based study. Stroke 1994; 25:2005–2009.
Howard G, Toole JF, Frye-Pierson J, Hinshelwood LC. Factors influencing the survival of 451 transient ischemic attack patients. Stroke 1987; 18:552–557.
Simpson Jr. RK, Contant CF, Fischer DK, Cech DA, Robertson CS, Narayan RK. The influence of diabetes mellitus on outcome from subarachnoid hemorrhage. Diabetes Res 1991; 16:165–169.
Tuhrim S, Dambrosia JM, Price TR, et al. Intracerebral hemorrhage: external validation and extension of a model for prediction of 30-day survival. Ann Neurol 1991; 29:658–663.
Arboix A, Massons J, Garcia-Eroles L, Oliveres M, Targa C. Diabetes is an independent risk factor for in-hospital mortality from acute spontaneous intracerebral hemorrhage. Diabetes Care 2000; 23:1527–1532.
The Dutch TIA Trial Study Group. Predictors of major vascular events in patients with a transient ischemic attack or nondisabling stroke. Stroke 1993; 24:527–531.
Evans BA, Sicks JD, Whisnant JP. Factors affecting survival and occurrence of stroke in patients with transient ischemic attacks. Mayo Clin Proc 1994; 69:416–421.
Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA 2000; 284:2901–2906.
Carlberg B, Asplund K, Hagg E. Factors influencing admission blood pressure levels in patients with acute stroke. Stroke 1991; 22:527–530.
Lefkovits J, Davis SM, Rossiter SC, et al. Acute stroke outcome: effects of stroke type and risk factors. Aust N Z J Med 1992; 22:30–35.
Sacco RL, Foulkes MA, Mohr JP, Wolf PA, Hier DB, Price TR. Determinants of early recurrence of cerebral infarction. The Stroke Data Bank. Stroke 1989; 20:983–989.
Hier DB, Foulkes MA, Swiontoniowski M, et al. Stroke recurrence within 2 years after ischemic infarction. Stroke 1991; 22:155–161.
Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS. Stroke recurrence: predictors, severity, and prognosis. The Copenhagen Stroke Study. Neurology 1997; 48:891–895.
Friday G, Alter M, Lai SM. Control of hypertension and risk of stroke recurrence. Stroke 2002; 33:2652–2657.
Censori B, Manara O, Agostinis C, et al. Dementia after first stroke. Stroke 1996; 27:1205–1210.
Luchsinger JA, Tang MX, Stern Y, Shea S, Mayeux R. Diabetes mellitus and risk of Alzheimer’s disease and dementia with stroke in a multiethnic cohort. Am J Epidemiol 2001; 154:635–641.
Henon H, Durieu I, Guerouaou D, Lebert F, Pasquier F, Leys D. Poststroke dementia: Incidence and relationship to prestroke cognitive decline. Neurology 2001; 57:1216–1222.
Peres NS, Fane WC, Aronson SM. Central nervous system findings in a tenth decade autopsy population. Prog Brain Res 1973; 40:473–483.
Kameyama M, Fushimi H, Udaka F. Diabetes mellitus and cerebral vascular disease. Diab Res Clin Pract 1994; 24:S205–S208.
Iwase M, Yamamoto M, Yoshinari M, Ibayashi S, Fujishima M. Stroke topography in diabetic and nondiabetic patients by magnetic resonance imaging. Diabetes Res Clin Pract 1998; 42:109–116.
Cambon H, Derouesne C, Yelnik A, Duyckaerts C, Hauw JJ. Effect of diabetes mellitus and blood glucose on the size of cerebral infarction and causes of death. Neuropathological study of 77 cases of infarction in the sylvian artery area. Rev Neurol 1991; 147:727–734.
Mankovsky BN, Patrick JT, Metzger BE, Saver JL. The size of subcortical ischemic infarction in patients with and without diabetes mellitus. Clin Neurol Neurosurg 1996; 98:137–141.
Horowitz SH, Zito JL, Donnarumma R, Patel M, Alvir J. Clinical-radiographic correlations within the first five hours of cerebral infarctions. Acta Neurol Scand 1992; 86:207–214.
Candelise L, Landi G, Orazio EN, Boccardi E. Prognostic significance of hyperglycemia in acute stroke. Arch Neurol 1985; 42:661–663.
Murros K, Fogelholm R, Kettunen S, Vuorela AL, Valve J. Blood glucose, glycosylated haemoglobin, and outcome of ischemic brain infarction. J Neurol Sci 1992; 111:59–64.
Toni D, De Michele M, Fiorelli M, et al. Influence of hyperglycemia on infarct size and clinical outcome of acute ischemic stroke in patients with intracranial arterial occlusion. J Neurol Sci 1994; 123:129–133.
Nathan DM, Cleary PA, Backlund JY, et al. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005; 353:2643–2653.
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352:837–853.
ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358:2560–2572.
Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358:2545–2559.
Kuller LH, Velentgas P, Barzilay J, Beauchamp NJ, O’Leary DH, Savage PJ. Diabetes mellitus: subclinical cardiovascular disease and risk of incident cardiovascular disease and all-cause mortality. Arterioscler Thromb Vasc Biol 2000; 20:823–829.
UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352:854–865.
Olsson J, Lindberg G, Gottsater M, et al. Increased mortality in Type II diabetic patients using sulphonylurea and metformin in combination: a population-based observational study. Diabetologia 2000; 43:558–560.
Wilcox R, Bousser MG, Betteridge DJ, et al. Effects of pioglitazone in patients with type 2 diabetes with or without previous stroke: results from PROactive (PROspective pioglitAzone Clinical Trial In macroVascular Events 04). Stroke 2007; 38:865–873.
Mazzone T, Meyer PM, Feinsten SB, et al. Effect of pioglitazone compared with glimepiride on carotid intima-media thickness in type 2 diabetes. A randomized trial. JAMA 2006; 296:E1–E10.
Weih M, Amberger N, Wegener S, Dirnagl U, Reuter T, Einhaupl K. Sulfonylurea drugs do not influence initial stroke severity and in-hospital outcome in stroke patients with diabetes. Stroke 2001; 32:2029–2032.
Kunte H, Schmidt S, Eliasziw M, et al. Sulfonylureas improve outcome in patients with type 2 diabetes and acute ischemic stroke. Stroke 2007; 38:2526–2530.
Asia Pacific Cohort Studies Collaboration, Kengne AP, Patel A, Barzi F, et al. Systolic blood pressure, diabetes and the risk of cardiovascular diseases in the Asia-Pacific region. J Hypertens 2007; 25:1205–1213.
Hu G, Sarti C, Jousilahti P, et al. The impact of history of hypertension and type 2 diabetes at baseline on the incidence of stroke and stroke mortality. Stroke 2005; 36:2538–2543.
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317:703–713.
Tuomilehto J, Rastenyte D, Birkenhager WH, et al. for the Systolic Hypertension in Europe Trial Investigators. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999; 340:677–684.
Wang JG, Staessen JA, Gong L, Liu L, for the Systolic Hypertension in China (Syst-China) Collaborative Group. Chinese Trial on Isolated Systolic Hypertension in the Elderly. Arch Intern Med 2000; 160:211–220.
Curb JD, Pressel SL, Cutler JA, et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group. JAMA 1996; 276:1886–1892.
Hansson L, Zanchetti A, Carruthers SG, et al. for the HOT Study Group. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998; 351:1755–1762.
Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355:253–259.
Bosch J, Yusuf S, Pogue J, et al. for HOPE Investigators. Heart outcomes prevention evaluation. BMJ 2002; 324:699–702.
Patel A, MacMahon S, ADVANCE Collaborative Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomized trial. Lancet 2007; 370:829–840.
American Diabetes Association. Standards of medical care – 2008. Diabetes Care 2008; 31:S12–S54.
Rydén L, Standl E, Bartnik M, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 2007; 28:88–136.
Adler AI, Stratton IM, Neil HAW, et al. on behalf of the UK Prospective Study Group. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000; 321:412–419.
UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 1998; 317:713–720.
Estacio RO, Jeffers BW, Hiatt WR, Biggerstaff SL, Gifford N, Schrier RW. The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. N Engl J Med 1998; 338:645–652.
Tatti P, Pahr M, Byington RB, et al. Outcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and NIDDM. Diabetes Care 1998; 21:597–603.
Hansson L, Lindholm LH, Niskanen L, et al. for the Captopril Prevention Project (CAPPP) study group. Effect of angiotensin-converting enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPP) randomized trial. Lancet 1999; 353:611–616.
Hansson L, Hedner T, Lund-Johansen P, et al. for the NORDIL Study Group. Randomised trial of effects of calcium antagonists compared with diuretics and b-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000; 356:359–365.
Niskanen L, Hedner T, Hansson L, Lanke J, Niklason A, for the CAPPR study group. Reduced cardiovascular morbidity and mortality in hypertensive diabetic patients on first-line therapy with an ACE inhibitor compared with a diuretic/b-blocker-based treatment regimen: a subanalysis of the Captopril Prevention Project. Diabetes Care 2001; 24:2091–2096.
Hansson L, Lindholm LH, Ekbom T, et al. for the STOP-Hypertension-2 study group. Randomized trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 1999; 354:1751–1756.
Lindholm L, Hansson L, Ekbom T, et al. for the STOP-Hypertension-2 Study Group. Comparison of antihypertensive treatment in preventing cardiovascular events in elderly diabetic patients: results from Swedish Trial in Old Patients with hypertension-2. J Hypertens 2002; 18:1671–1675.
Opie LH, Schall R. Evidence-based evaluation of calcium channel blockers for hypertension: equality of mortality and cardiovascular risk relative to conventional therapy. J Am Coll Cardiol 2002; 39:315–322.
Whelton PK, Barzilay J, Cushman WC, et al. for the ALLHAT Collaborative Research Group. Clinical outcomes in antihypertensive treatment of type 2 diabetes, impaired fasting glucose concentration, and normoglycemia: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med 2005; 165:1401–1409.
Grossman E, Messerli FH. Are calcium antagonists beneficial in diabetic patients with hypertension? Am J Med 2004; 116:44–49.
Lindholm LH, Ibsen H, Dahlof B, et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359:1004–1010.
The ONTARGET Investigators. Telmasartan, ramipiril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358:1547–1559.
Ostergren J, Poulter NR, Sever PS, et al. for the ASCOT investigators. The Anglo-Scandinavian Cardiac Outcomes Trial: blood pressure-lowering limb: effects in patients with type II diabetes. J Hypertens 2008; 26:2103–2111.
Asia Pacific Cohort Studies Collaboration. Cholesterol, diabetes and major cardiovascular diseases in the Asia-Pacific region. Diabetologia 2007; 50:2289–2297.
Hitman GA, Colhoun H, Newman C, et al. for the CARDS Investigators. Stroke prediction and stroke prevention with atorvastatin in the Collaborative Atorvastatin Diabetes Study (CARDS). Diabet Med 2007; 24:1313–1321.
Sever PS, Poulter NR, Dahlöf B, et al. Reduction in cardiovascular events with atorvastatin in 2,532 patients with type 2 diabetes: Anglo-Scandinavian Cardiac Outcomes Trial–lipid-lowering arm (ASCOT-LLA). Diabetes Care 2005; 28:1151–1157.
Keech A, Colquhoun D, Best J, et al. for the LIPID Study Group. Secondary prevention of cardiovascular events with long-term pravastatin in patients with diabetes or impaired fasting glucose: results from the LIPID trial. Diabetes Care 2003; 26:2713–2721.
Goldberg RB, Mellies MJ, Sacks FM, et al. for the CARE Investigators. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels. Subgroup analyses in the Cholesterol And Recurrent Events (CARE) Trial. Circulation 1998; 98:2513–2519.
Pyorala K, Pedersen TR, Kjekshus J, Faergeman O, Olsson AG, Thorgeirsson G. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). Diabetes Care 1997; 20:614–620.
Collins R, Armitage J, Parish S, Sleight P, Peto R, and Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet 2004; 363:757–767.
Shepherd J, Barter P, Carmena R, et al. Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes: the Treating to New Targets (TNT) study. Diabetes Care 2006; 29:1220–1226.
Cholesterol Treatment Trialists’ (CTT) Collaborators, Kearney PM, Blackwell L, Collins R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008; 371:117–125.
Keech A, Simes RJ, Barter P, et al. for the FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366:1849–1861.
Allemann S, Diem P, Egger M, Christ ER, Stettler C. Fibrates in the prevention of cardiovascular disease in patients with type 2 diabetes mellitus: meta-analysis of randomised controlled trials. Curr Med Res Opin 2006; 22:617–623.
Colwell JA. Aspirin therapy in diabetes (Technical review). Diabetes Care 1997; 20: 1767–1771.
He J, Whelton PK, Klag MJ. Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials. JAMA 1998; 280:1930–1935.
Sacco RL, Adams R, Albers G, et al. American Heart Association; American Stroke Association Council on Stroke; Council on Cardiovascular Radiology and Intervention; American Academy of Neurology. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke 2006; 37:577–617.
Nicolucci A, De Berardis G, Sacco M, Tognoni G. AHA/ADA vs. ESC/EASD recommendations on aspirin as a primary prevention strategy in people with diabetes: how the same data generate divergent conclusions. Eur Heart J 2007; 28:1925–1927.
CAPRIE Steering Committee. A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348:1329–1339.
Diener HC, Bogousslavsky J, Brass LM, et al. for the MATCH investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004; 364:331–337.
Bhatt DL, Fox KA, Hacke W, et al. for the CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006; 354:1706–1717.
Pfeffer MA, Jarcho JA. The charisma of subgroups and the subgroups of CHARISMA. N Engl J Med 2006; 354:1744–1746.
Sivenius J, Laakso M, Piekkinen Sr, Smets P, Lowenthal A. European stroke prevention study: effectiveness of antiplatelet therapy in diabetic patients in secondary prevention of stroke. Stroke 1992; 23:851–854.
ESPRIT Study Group, Halkes PH, van Gijn J, Kappelle LJ, Koudstaal PJ, Algra A. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet 2006; 367:1665–1673.
Halkes PH, Gray LJ, Bath PM, et al. Dipyridamole plus aspirin versus aspirin alone in secondary prevention after TIA or stroke: a meta-analysis by risk. Neurol Neurosurg Psychiatry 2008; 79:1218–1223.
Gaede P, Vedel P, Larsen N, Jensen GVH, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348:383–393.
Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008; 358:580–591.
Hu FB, Stampfer MJ, Solomon C, et al. Physical activity and risk for cardiovascular events in diabetic women. Ann Intern Med 2001; 134:96–105.
Rautio A, Eliasson M, Stegmayr B. Favorable Trends in the Incidence and Outcome in Stroke in Nondiabetic and Diabetic Subjects: Findings From the Northern Sweden MONICA Stroke Registry in 1985 to 2003. Stroke 2008; 39:3137–3144.
Goldstein LB, Adams R, Becker K, et al. Primary prevention of ischemic stroke. A statement for health care professionals from the stroke council of the American Heart Association. Stroke 2001; 32:280–293.
Ahari A, Bergqvist D, Troeng T, et al. Diabetes mellitus as a risk factor for early outcome after carotid endarterectomy – a population-based study. Eur J Vasc Endovasc Surg 1999; 18:122–126.
Pistolese GR, Appolloni A, Ronchey S, Martelli E. Carotid endarterectomy in diabetic patients. J Vasc Surg 2001; 33:148–154.
Cunningham EJ, Bond R, Mehta Z, Mayberg MR, Warlow CP, Rothwell PM. Long-term durability of carotid endarterectomy for symptomatic stenosis and risk factors for late postoperative stroke. Stroke 2002; 33:2658–2663.
Ballotta E, Da Giau G, Renon L. Is diabetes a risk factor for carotid endarterectomy? A prospective study. Surgery 2001; 129:146–152.
Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJM, for the Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004; 363:915–924.
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Mankovsky, B.N. (2009). Stroke and Diabetes Mellitus. In: Biessels, G., Luchsinger, J. (eds) Diabetes and the Brain. Contemporary Diabetes. Humana Press. https://doi.org/10.1007/978-1-60327-850-8_8
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