DIABETES-MELLITUS AS A RISK FACTOR FOR DEATH FROM STROKE - PROSPECTIVE-STUDY OF THE MIDDLE-AGED FINNISH POPULATION

Background and Purpose High blood pressure is the most important risk factor for stroke. It is also known that diabetic patients are at incr eased risk of both hypertension and stroke. The aim of this study was to assess the independent effect of diabetes as a risk factor for stro ke. Results from the previous studies of this question have been somew hat inconclusive. Methods We performed a prospective study (average fo llow-up, 16.4 years) of 8077 men and 8572 women who had participated i n risk factor surveys in Eastern Finland in 1972 (20 years of follow-u p) and 1977 (15 years of follow-up). Risk factors included in the curr ent analyses were smoking, blood pressure, antihypertensive drug treat ment, serum total cholesterol. and diabetes either at baseline or deve loped during the follow-up. Age- and risk factor-adjusted relative ris ks for death of stroke were determined with the Cox proportional hazar ds model. Results Diabetes mellitus was the strongest risk factor for death from stroke among both men and women in univariate and multivari ate analyses. In addition, smoking and systolic blood pressure appeare d to be independent risk factors among both sexes, as did serum total cholesterol among men. Men with diabetes at baseline appeared to be at a sixfold increased risk of death from stroke, while relative risk fo r men who developed diabetes during the follow-up was 1.7. In women, t hose who were diabetic at baseline were at higher risk of stroke than women who developed diabetes later (relative risks, 8.2 and 3.7, respe ctively). Of stroke deaths, 16% in men and 33% in women were attribute d to diabetes. Conclusions Diabetic subjects have a very high risk of death from stroke, particularly women. Our data also suggest that the duration of diabetes is an important factor contributing to the risk o f stroke.