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United Kingdom Prospective Diabetes Study (UKPDS) 29

Timothy M. E. Davis, FRACP; Helen Millns, PhD; Irene M. Stratton, MSc; Rury R. Holman, FRCP; Robert C. Turner, MD, FRCP; for the UK Prospective Diabetes Study Group

Arch Intern Med. 1999;159:1097-1103.

Objective  To investigate modifiable and nonmodifiable risk factors for stroke in type 2 diabetes mellitus.

Patients and Methods  A total of 3776 patients aged 25 to 65 years newly diagnosed as having type 2 diabetes mellitus without known cardiovascular or other serious disease were studied for a median of 7.9 years. An initial stepwise evaluation of risk factors was done in 2704 patients with all risk factors measured, with the final Cox model analysis being of 3776 patients who had complete data on the selected variables.

Results  Of 3776 patients, 99 (2.6%) had a stroke. Significant risk factors for stroke in a multivariate model were age (estimated hazard ratio [95% confidence interval], 4.78 [2.56-8.92] for 60 vs <50 years), male sex (1.63 [1.08-2.47)] vs female), hypertension (2.47 [1.64-3.74)] vs normotension), and in 3728 patients who had electrocardiography at study entry, atrial fibrillation (8.05 [3.52-18.44] vs sinus rhythm). Obesity, lack of exercise, smoking, poor glycemic control, hyperinsulinemia, dyslipidemia, and microalbuminuria were not significantly associated with stroke in the model.

Conclusion  In patients with type 2 diabetes, aggressive antihypertensive therapy and routine anticoagulation therapy for atrial fibrillation may reduce the risk of stroke.

From the Department of Medicine, University of Western Australia, Fremantle (Dr Davis); and Diabetes Research Laboratories, University of Oxford, Oxford, England (Drs Millns, Holman, and Turner and Mss Stratton). A complete list of study participants was published previously (BMJ. 1998;317:703-713).

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