Gender difference in diabetes-associated risk of first-ever and recurrent ischemic stroke

Objective: To evaluate the effect of diabetes by gender on the peak- risk of first-everischemic stroke and its recurrence. Methods: Administrative datasets including all hospital discharges for ischemic stroke (N=43,332) in the diabetic (N=207,568) and non-diabetic (N=2,808,554) population of the Tuscany region, Italy were used to calculate Hazard ratios (HR) after Cox-regression, of first-ever and recurrent ischemic strokes, between 2005 and 2011. Results: Overall, diabetes increased the HR of first-ever ischemic stroke by about 50% in both genders. However, this risk significantly declined with age and was higher in women aged 55-74 yr than in men of the same age (HR; 95%CI: 1.392; 1.228-1.579 in ageclass 55-64yr and 1.203; 1.110-1.304 in age class 65-74yr; p<0.001). Diabetes also increased the adjusted risk of three-year-stroke recurrence (N=5,998) in women, independently of age, whereas this was the case in men <70yr. Conclusions: Diabetes is associated with increased risk of ischemic stroke although it declines with age though at lower rate among women than men. Moreover, diabetic women have greater risk of recurrence than in men > 70yrs old, supporting a high-risk “time-window” in postmenopausal-elderly diabetic women.