Abstract | OBJECTIVE: RESEARCH DESIGN AND METHODS: A total of 6,445 Hong Kong Chinese patients with type 2 diabetes and free of stroke at enrollment were followed up for a median of 5.37 years. Spline Cox proportional hazard regression was used to obtain hazard ratio curves, which were used to identify cutoff points of A1C and spot urinary albumin-to- creatinine ratio for increased ischemic stroke risk. The identified cutoff point of A1C was used to check biological interaction between A1C and albuminuria (micro- and macroalbuminuria). The biological interaction was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index. RESULTS: During the follow-up period, 4.45% (n = 287) of patients developed ischemic stroke. A1C was associated with increased hazard ratios of ischemic stroke in a near-linear manner except for two points-6.2 and 8.0%-where the slope between these two points accelerated. For A1C values <6.2%, the presence of micro/macroalbuminuria did not confer additional risk, while significant biological interaction between A1C and micro/macroalbuminuria for values >or=6.2% was observed (RERI 0.92, 95% CI 0.16-1.68, and AP 0.40, 0.01-0.78). CONCLUSIONS: A1C >or=6.2% and micro/macroalbuminuria interact to markedly increase the ischemic stroke risk, which explains a large proportion of risk in patients with type 2 diabetes harboring both risk factors.
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Authors | Xilin Yang, Gary T C Ko, Wing Yee So, Ronald C W Ma, Alice P S Kong, Christopher W K Lam, Chung Shun Ho, Chun-Chung Chow, Peter C Y Tong, Juliana C N Chan, Hong Kong Diabetes Registry |
Journal | Diabetes care
(Diabetes Care)
Vol. 31
Issue 12
Pg. 2294-300
(Dec 2008)
ISSN: 1935-5548 [Electronic] United States |
PMID | 18809627
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Adult
- Aged
- Albuminuria
(complications)
- Cohort Studies
- Diabetes Mellitus, Type 2
(complications)
- Female
- Hong Kong
- Humans
- Hyperglycemia
(complications)
- Male
- Middle Aged
- Registries
- Risk Factors
- Stroke
(epidemiology, etiology)
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