Population-based Study Comparing Predictors of Ischemic Stroke Recurrence After Index Ischemic Stroke in Non-elderly Adults with or without Diabetes

Marwa Elsaeed Elhefnawy,1 Siti Maisharah Sheikh Ghadzi,1 Balamurugan Tangiisuran,1 Hadzliana Zainal,1 Irene Looi,2 Khairul Azmi Ibrahim,3 Norsima Nazifah Sidek,3 Keat Wei Loo,4 Keng Yee Lee,5 Zariah Abdul Aziz,3 Sabariah Noor Harun1 1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800, Malaysia; 2Clinical Research Centre, Seberang Jaya Hospital, Penang, Malaysia; 3Clinical Research Centre, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia; 4Department of Biological Science, Faculty of Science, Universiti Tunku Abdul Rahman (UTAR) Kampar Campus, Perak, Malaysia; 5National Clinical Research Centre, Kuala Lumpur, MalaysiaCorrespondence: Sabariah Noor HarunDiscipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800, MalaysiaTel +604-6532487Email sabariahnoor@usm.myBackground and Purpose: Factors associated with ischemic stroke (IS) recurrence and the contribution of pharmacological treatment as secondary preventions among nondiabetics especially in the non-elderly population are unclear and not widely investigated. This was a population-based study that aimed to identify recurrent IS predictors and to determine the possible impact of secondary preventive medications on the IS recurrence in non-elderly adults with or without diabetes.Methods: Data of 3386 patients < 60 years old who had a history of index IS were extracted from the Malaysian National Neurology Registry (NNEUR) from 2009 to 2016. Recurrent IS was defined as any IS event recorded after the index IS in the NNEUR database. Multivariate logistic regression analysis was performed by using SPSS version 22.Results: Ischemic heart disease (IHD) was the significant predictor of IS recurrence in non-elderly adults both with or without diabetes (adjusted odds ratio (AOR) of 3.210; 95%CI: 1.909– 5.398 and 2.989; 95%CI: 1.515– 5.894) respectively). Receiving antiplatelet as secondary stroke prevention (AOR: 0.194; 95%CI: 0.046– 0.817) and continuation of antidiabetic medication after the index IS event (AOR: 0.510; 95%CI: 0.298– 0.872) reduced the odds of IS recurrence only in non-elderly diabetic adults. Among non-elderly adults without diabetes, hyperlipidemia and every increased in 1 mmHg of systolic blood pressure significantly increased the odds of IS recurrence following the indexing event (AOR: 1.796; 95%CI: 1.058– 3.051 and 1.009; 95%CI: 1.002– 1.016 respectively).Conclusion: IHD was found as the main predictor of IS recurrence regardless of diabetes status in non-elderly adults after the index IS event. Receiving antidiabetic and antiplatelet medications upon discharge after index IS were significant predictors of recurrent IS in non-elderly diabetic adults. A proper randomized clinical trial may be required to determine the impact of secondary preventive medication on IS recurrence, especially in non-elderly adults.Keywords: ischemic stroke, recurrence, prevention, diabetic, nondiabetic, non-elderly