Abstract P150: Association of Non-Framingham Stroke Risk Factors With Incident Stroke Among Individuals With and Without Diabetes

Diabetes is a pro-inflammatory state characterized by a high burden of non-traditional risk factors not included in the Framingham stroke risk equation. We assessed the association between factors absent from the Framingham stroke risk equation with incident stroke among individuals with and without diabetes, separately, using the US population-based REasons for Geographic and Racial Differences in Stroke study. Diabetes was defined by self-report with concurrent insulin or oral hypoglycemic medication use, fasting serum glucose ≥126 mg/dL or non-fasting serum glucose ≥200 mg/dL. Non-Framingham risk factors included high sensitivity c-reactive protein >3.0 mg/dL, low high-density-lipoprotein (HDL-C; men: <40 mg/dL, women: <50 mg/dL), triglycerides >150 mg/dL, abdominal obesity (waist circumference: men >102 cm, women >88 cm), urinary albumin-to-creatinine-ratio (ACR) >30 mg/dL, and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m 2 . Bi-annual telephone contacts were used to identify incident stroke events that were subsequently adjudicated. During a median follow-up of 5.9 years, there were 329 and 697 incident strokes among individuals with (n = 6,258) and without (n = 22,226) diabetes, respectively. For individuals with and without diabetes, the prevalence of ≥3 non-Framingham risk factors was 50.4% and 23.9%, respectively. C-reactive protein >3.0 mg/dL and eGFR <60 ml/min/1.73 m 2 were associated with stroke among individuals with but not those without diabetes (Figure 1). In addition, ACR >30 mg/dL had a stronger association with stroke among individuals with versus without diabetes [HR (95% CI), 2.08 (1.65[[Unable to Display Character: –]]2.63) versus 1.36 (1.12[[Unable to Display Character: –]]1.66), respectively; p-interaction=0.04]. Low HDL-C, triglycerides >150 mg/dL and abdominal obesity were not associated with stroke among individuals with or without diabetes. In conclusion, non-Framingham stroke risk factors are common and associated with increased stroke risk among individuals with diabetes.