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Hyperglycemia in stroke

Shuai Zhang, Wei Zhang, Guangqian Zhou
Stroke causes disability and high mortality, while it can be prevented by increasing public awareness of risk factors. The common known risk factors are hypertension, atrial fibrillation, heart failure, smoking, alcohol consumption, low physical activity, overweight and hypercholesterolemia. However, the deep understanding of risk factors is limited. Moreover, more risk factor emerges in recent years. To further increase the awareness of risk factors for stroke prevention, this review indicates the reasonable application of antihypertensive agents according to the age-dependent changes of hypertension, and some new risk factors including chronic kidney disease, obstructive sleep apnea, migraine with aura, working environment, genetic factors and air pollution...
March 13, 2019: Journal of the National Medical Association
Liying Xing, Shuang Liu, Yuanmeng Tian, Han Yan, Li Jing, Kangjing Chen, Fei Yan, Yingqiu Li, Jianfeng Lv, Yingxian Sun
BACKGROUND: Limited data are available on the impact of fasting plasma glucose (FPG) on outcomes in nondiabetic acute ischemic stroke patients. METHODS: The prospective, multi-center, and observational study was performed at 8 hospitals in the Liaoning Province between 2015-2016, sought to elucidate the relationship between FPG and the 6-month functional outcomes in nondiabetic acute ischemic stroke patients. The primary effect measure was the adjusted odds ratio for a shift in the direction of unfavorable outcome on the modified Rankin Scale (mRS) score at 6 months, estimated with an ordinal logistic regression, and adjusted for common prognostic factors...
March 11, 2019: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Xiaochuan Huo, Raynald Liu, Feng Gao, Ning Ma, Dapeng Mo, Xiaoling Liao, Chunjuan Wang, Xuan Sun, Ligang Song, Baixue Jia, Lian Liu, Bo Wang, Yuesong Pan, Yilong Wang, Liping Liu, Xingquan Zhao, Yongjun Wang, Zhongrong Miao
Background: Sporadic data showed hyperglycemia at presentation is associated with poor outcomes in patients with acute ischemic stroke (AIS) under mechanical thrombectomy (MT) treatment. Objective: This study aims to evaluate the relationship of admission hyperglycemia and outcomes in patients treated with solitaire stent thrombectomy. Methods: This multicenter prospective study registered patients with AIS due to anterior circulation large vessel occlusion (LVO) suitable for MT with Solitaire stent retriever...
2019: Frontiers in Neurology
Michał Wiciński, Maciej Socha, Bartosz Malinowski, Eryk Wódkiewicz, Maciej Walczak, Karol Górski, Maciej Słupski, Katarzyna Pawlak-Osińska
Liraglutide is a GLP-1 analog (glucagon like peptide-1) used primarily in the treatment of diabetes mellitus type 2 (DM2) and obesity. The literature starts to suggest that liraglutide may reduce the effects of ischemic stroke by activating anti-apoptotic pathways, as well as limiting the harmful effects of free radicals. The GLP-1R expression has been reported in the cerebral cortex, especially occipital and frontal lobes, the hypothalamus, and the thalamus. Liraglutide reduced the area of ischemia caused by MCAO (middle cerebral artery occlusion), limited neurological deficits, decreased hyperglycemia caused by stress, and presented anti-apoptotic effects by increasing the expression of Bcl-2 and Bcl-xl proteins and reduction of Bax and Bad protein expression...
February 28, 2019: International Journal of Molecular Sciences
Wei-Yuan Huang, Gang Wu, Shan-Xi Guo, Dao-Ying Geng, Jian-Jun Li, Kai Yang
The aim of the study is to verify the effect of hyperglycemia on ischemia-reperfusion injury and to explore the feasibility of noninvasive observation of ischemic-reperfusion injury in hyperglycemic ischemic stroke by MRI technique. According to the duration of ischemia and blood glucose levels, 40 rats were divided into hyperglycemic ischemic 2-hr (H-I2h), hyperglycemic ischemic 6-hr (H-I6h), non- hyperglycemic ischemic 2-hr (NH-I2h), and non- hyperglycemic ischemic 6-hr (NH-I6h) groups. T2W imaging, DW imaging, T2 mapping, T2* mapping, DCE, and T1 mapping after enhancement sequences were acquired before reperfusion and approximately 3-hr after reperfusion...
February 27, 2019: Scientific Reports
Harsha Kashyap, Sarika Gupta, Renu Bist
Diabetes is a metabolic hyperglycemic condition that progressively develops, effect small and large sensory fibers in affected population. It has various complications as hypertension, coronary artery disease, stroke, blindness, kidney disease as well as peripheral neuropathy. Sulfonylureas, thiazolidinediones, metformin, biguanidine, acarbose and insulin are commonly used drugs by diabetic patients, but these all have certain side effects. Even metformin, that is known as the miracle drug for diabetes has been found to be associated with side effects, as during treatment it involves complications with eyes, kidneys, peripheral nerves, heart and vasculature...
February 19, 2019: Current Molecular Medicine
L G Mellbin, A Wang, L Rydén
Cardiovascular disease (CVD) is the main reason for premature death in patients with type 2 diabetes. Hyperglycemia, the hallmark of diabetes, has long been considered the link between diabetes and CVD, and many trials focused on preventing CVD manifestations by means of tight glucose control. However, diabetes is a multifactorial disease in which, e. g., insulin resistance, endothelial dysfunction, and factors such as hypertension and dyslipidemia contribute. Thus, treatment needs to be multifactorial and take cardiovascular aspects into account...
February 25, 2019: Herz
Ángel Chamorro, Scott Brown, Sergio Amaro, Michael D Hill, Keith W Muir, Diederik W J Dippel, Wim van Zwam, Ken Butcher, Gary A Ford, Heleen M den Hertog, Peter J Mitchell, Andrew M Demchuk, Charles B L M Majoie, Serge Bracard, Igor Sibon, Ashutosh P Jadhav, Blanca Lara-Rodriguez, Aad van der Lugt, Elizabeth Osei, Arturo Renú, Sébastien Richard, David Rodriguez-Luna, Geoffrey A Donnan, Anand Dixit, Mohammed Almekhlafi, Sandrine Deltour, Jonathan Epstein, Benoit Guillon, Serge Bakchine, Meritxell Gomis, Richard du Mesnil de Rochemont, Demetrius Lopes, Vivek Reddy, Gernot Rudel, Yvo B W E M Roos, Alain Bonafe, Hans-Christoph Diener, Olvert A Berkhemer, Geoffrey C Cloud, Stephen M Davis, Robert van Oostenbrugge, Francis Guillemin, Mayank Goyal, Bruce C V Campbell, Bijoy K Menon
Background and Purpose- Hyperglycemia is a negative prognostic factor after acute ischemic stroke but is not known whether glucose is associated with the effects of endovascular thrombectomy (EVT) in patients with large-vessel stroke. In a pooled-data meta-analysis, we analyzed whether serum glucose is a treatment modifier of the efficacy of EVT in acute stroke. Methods- Seven randomized trials compared EVT with standard care between 2010 and 2017 (HERMES Collaboration [highly effective reperfusion using multiple endovascular devices])...
March 2019: Stroke; a Journal of Cerebral Circulation
Wenzhen Li, Dongming Wang, Xiaojun Wang, Yanhong Gong, Shiyi Cao, Xiaoxv Yin, Xianbo Zhuang, Wenhuan Shi, Zhihong Wang, Zuxun Lu
BACKGROUND: The metabolic syndrome (MetS) is related with cardiovascular disease. However, its relationship with diabetes mellitus (DM) has not been examined in Chinese population with a larger sample. We aimed to assess the relationship between metabolic syndrome (MetS) and its components, and DM, and to determine the best one from the available definitions of Mets when assessing the risk of DM. METHODS: This was a cross-sectional survey in a nationally representative sample of 109,551 Chinese adults aged ≥40 years in 2014-15...
February 14, 2019: BMC Public Health
Jiamei Shen, Radhika Rastogi, Xiaokun Geng, Yuchuan Ding
Nicotinamide adenine dinucleotide phosphate oxidase (NOX) is a multisubunit enzyme complex that utilizes nicotinamide adenine dinucleotide phosphate to produce superoxide anions and other reactive oxygen species. Under normal circumstances, reactive oxygen species mediate a number of important cellular functions, including the facilitation of adaptive immunity. In pathogenic circumstances, however, excess reactive oxygen species generated by NOX promotes apoptotic cell death. In ischemic stroke, in particular, it has been shown that both NOX activation and derangements in glucose metabolism result in increased apoptosis...
June 2019: Neural Regeneration Research
Krishna Nalleballe, Rohan Sharma, Sukanthi Kovvuru, Aliza Brown, Sen Sheng, Sukumar Gundapaneni, Saritha Ranabothu, Poornachand Veerapaneni, Renee Joiner, Nidhi Kapoor, William Culp, Sanjeeva Onteddu
OBJECTIVE: The purpose of this study was to determine reasons for not giving intravenous tissue plasminogen activator to eligible patients with acute ischemic stroke in a telestroke network. METHODS: We performed a retrospective analysis of prospectively collected data of patients who were seen as a telestroke consultation during 2015 and 2016 with the Arkansas Stroke Assistance through Virtual Emergency Support programme for possible acute ischemic stroke. RESULTS: Total consultations seen were 809 in 2015 and 744 in 2016, out of which 238 patients in 2015 and 247 patients in 2016 received intravenous tissue plasminogen activator...
February 10, 2019: Journal of Telemedicine and Telecare
Raheleh Gholamzadeh, Mehdi Eskandari, Mohammad Reza Bigdeli, Hossein Mostafavi
Introduction: Brain Ichemic-Reperfusion Injury (IRI) activates different pathophysiological processes. It also changes physiological parameters such as Blood Glucose (BG) level. An increase in BG after stroke is associated with poor clinical outcomes. Erythropoietin has been shown to be effective on both reducing inflammation and BG level. Therefore, in this study the erythropoietin pretreatment effect on BG and its relationship with inflammatory markers after brain IRI was investigated...
September 2018: Basic and Clinical Neuroscience
Carlos Aguiar, Rui Duarte, Davide Carvalho
Diabetes, a metabolic disease with vascular consequences due to accelerated atherosclerosis, is one of the 21st century's most prevalent chronic diseases. Characterized by inability to produce or use insulin, leading to hyperglycemia and insulin deficiency, diabetes causes a variety of microvascular (such as retinopathy and kidney disease) and macrovascular complications (including myocardial infarction and stroke) which reduce the quality of life and life expectancy of individuals with diabetes. We describe the close relationship between diabetes, cardiovascular risk factors, and cardiovascular disease, and examine multifactorial approaches to diabetes treatment, including reducing cardiovascular risk in individuals with type 2 diabetes...
January 23, 2019: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Ju-Bin Kang, Dong-Kyun Kim, Dong-Ju Park, Murad-Ali Shah, Myeong-Ok Kim, Eun-Jung Jung, Han-Shin Lee, Phil-Ok Koh
Hyperglycemia is one of the major risk factors for stroke. Hyperglycemia can lead to a more extensive infarct volume, aggravate neuronal damage after cerebral ischemia. α-Synuclein is especially abundant in neuronal tissue, where it underlies the etiopathology of several neurodegenerative diseases. This study investigated whether hyperglycemic conditions regulate the expression of α-synuclein in middle cerebral artery occlusion (MCAO)-induced cerebral ischemic injury. Male Sprague-Dawley rats were treated with streptozotocin (40 mg/kg) via intraperitoneal injection to induce hyperglycemic conditions...
December 2018: Laboratory Animal Research
Yu-Ting Kuo, Chih-Chan Lin, Hsiao-Tzu Kuo, Jui-Hsiang Hung, Ching-Hsuan Liu, Alagie Jassey, Ming-Hong Yen, Shu-Jing Wu, Liang-Tzung Lin
Type 2 diabetes mellitus (T2DM) is a chronic disease characterized by hyperglycemia that can lead to long-term complications including heart diseases, stroke, retinopathy, and renal failure. Treatment strategies include stimulating glucose uptake and controlling blood glucose level. Bofutsushosan (BOF) and Daisaikoto (DAI) are two herb-based kampo medicines that have been demonstrated to improve metabolism-associated disorders including obesity, hyperlipidemia, and nonalcoholic fatty liver. Given their bioactivities against metabolic syndromes, we explored in this study the effect of BOF and DAI extracts on glucose absorption and used them as source to identify phytochemical stimulator of glucose absorption...
January 2019: Journal of Food and Drug Analysis
Giovane R Sousa, David Pober, Alfonso Galderisi, HuiJuan Lv, Liping Yu, Alexandre C Pereira, Alessandro Doria, Mikhail Kosiborod, Myra A Lipes
BACKGROUND: Poor glycemic control is associated with increased risk of cardiovascular disease (CVD) in type 1 diabetes mellitus (T1DM); however, little is known about mechanisms specific to T1DM. In T1DM, myocardial injury can induce persistent cardiac autoimmunity. Chronic hyperglycemia causes myocardial injury, raising the possibility that hyperglycemia-induced cardiac autoimmunity could contribute to long-term CVD complications in T1DM. METHODS: We measured the prevalence and profiles of cardiac autoantibodies (AAbs) in longitudinal samples from the DCCT (Diabetes Control and Complications Trial) in participants with mean hemoglobin A1c (HbA1c ) ≥9...
November 26, 2018: Circulation
A K Pancholia
Patients with type 2 diabetes mellitus (T2DM) exhibit an increased risk for cardiovascular (CV) events. Hyperglycemia itself contributes to the pathogenesis of atherosclerosis and heart failure (HF) in these patients, but glucose-lowering strategies studied to date have had little or no impact on reducing CV risk, especially in patients with a long duration of T2DM and prevalent CV disease (CVD). Sodium-glucose cotransporter-2 (SGLT2) inhibitors are the new class of glucose-lowering medications that increase urinary glucose excretion, thus improving glycemic control, independent of insulin...
November 2018: Indian Heart Journal
Madison Caldwell, Lisa Martinez, Jennifer G Foster, Dawn Sherling, Charles H Hennekens
Cardiovascular disease (CVD), principally myocardial infarction (MI) and stroke, is the leading clinical and public health problem in the United States and is rapidly becoming so worldwide. Their primary prevention is promising, in theory, but difficult to achieve in practice. The principal modalities that have demonstrated efficacy include therapeutic lifestyle changes (TLCs) and adjunctive drug therapies under the guidance of the health-care provider and tailored to the individual patient. The prevention and treatment of the pandemic of overweight and obesity and lack of regular physical activity, both of which are alarmingly common in the United States, prevention and treatment of hypertension, avoidance and cessation of cigarette smoking, adoption and maintenance of a healthy diet, and avoidance of heavy alcohol consumption all have proven benefits in decreasing the risks of a first MI and stroke as well as other clinical manifestations of CVD...
December 18, 2018: Journal of Cardiovascular Pharmacology and Therapeutics
Ismail Setyopranoto, Rusdy Ghazali Malueka, Andre Stefanus Panggabean, I Putu Eka Widyadharma, Ahmad Hamim Sadewa, Rusdi Lamsudin, Samekto Wibowo
BACKGROUND: Hyperglycemia is common in acute stroke patients. Hyperglycemia can induce the production of reactive oxygen species, causing increased activity of matrix metalloproteinase-9 (MMP-9). AIM: This study aimed to determine an association between the increased levels of MMP-9 and the incidence of hyperglycemia in acute ischemic stroke patients. METHODS: This is a case-control study. Acute ischemic stroke patients admitted to the Stroke Unit of a reference hospital in Yogyakarta, Indonesia was divided into the hyperglycemic and non-hyperglycemic group...
November 25, 2018: Open Access Macedonian Journal of Medical Sciences
XiaoJue Li, JinPing Wang, XiaoXia Shen, YaLi An, QiuHong Gong, Hui Li, Bo Zhang, Ying Shuai, YanYan Chen, YingHua Hu, GuangWei Li
BACKGROUND: Hypertension is more prevalent in subjects with impaired glucose tolerance (IGT), but whether higher blood pressure per se or the mild hyperglycemia in combination with the hypertension enhanced the risk of cardiovascular disease (CVD) remains unclear. METHODS: 568 participants with IGT in the original Daqing diabetes prevention study, 297 with hypertension (HBP) and 271 without hypertension (NBP), were enrolled in 1986 and the intervention phase lasted for 6 years...
December 16, 2018: Journal of Diabetes
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