Rozanski M, Richter TB, Grittner U, Endres M, Fiebach JB, and Jungehulsing GJ. Elevated Levels of Hemoglobin A1c Are Associated With Cerebral White Matter Disease in Patients With Stroke. Stroke. 2014
“Patchy, nonspecific T2/FLAIR hyperintense white matter disease that is greater than expected for age.” These words, or something similar grace many an MRI read. A number of studies have found consistent correlations between white matter disease (WMD), age and HTN, however there has been inconsistent or even contradictory correlations between WMD and other factors such as DM, HL, smoking and renal function. In this study, Rozanski et al found that in patients with first acute ischemic stroke (AIS), WMD was significantly associated with age, HTN and higher levels of HbA1c, but not elevated levels of TG, LDL, or total cholesterol.
512 patients with first AIS were enrolled in the study. Standard screening labs were drawn at admission, and fasting lipids and HbA1c on day 2. The mean age was 68.5, 37% were women, and the median NIHSS was 3. MRI imaging was performed during workup, and WMD burden was measured utilizing the Wahlund score (WS). Of all patients, 77% had HTN, 49.5% had HL, 24% had AFib and 23% had DM.
Per the authors, this is the first study that they know of that shows a correlation between elevated HbA1c and WMD burden. Median levels of HbA1c were 5.7 to 5.9% in patients with any sign of WMD, vs. 5.3% in patients without hyperintensities. Interestingly, DM alone did not correlate as strongly, which the authors felt may be explained by the fact that patients diagnosed with DM may be under better control, thus have lower HbA1c’s.
WMD has gained interest in the potential role it may play in cognitive decline and as a risk factor in stroke, and by all accounts appears related to ongoing microvascular damage. This study reaffirms the role of age and HTN play in the process, but in this case at least, also points to elevated HbA1c as another key causative factor—even independent of a diagnosis of DM. All this underscores, yet again, the critical importance of risk factor monitoring and management, hopefully long before a first AIS.
I was pre-hypertensive since 2001 until I was finally put on Hypertension medication in 2010. I was diagnosed with White Matter Disease in 2012, after several MRI studies. Subsequent MRI did not show changes in the White Matter lesions, but I had a Stroke in 2013. I have read about associations between White Matter Disease and Stroke as well as elevated levels of HbA1C in Stroke patients with WMD.
A day before I had the stroke, I had a sudden elevation in my blood pressure 180/105 and I went to ER. In ER, I was given Toradol IV (30 mg) and I was released after a few hours when my blood pressure returned to normal with an extra dose of my blood pressure medication. About 24 hours later I started getting migraines with zigzag lines. Tylenol relieved the silent migraine but the visual disturbances continued. The next day I woke up with field of vision loss on upper left side and I went to another hospital (Stanford) where I was diagnosed with having mild Stroke.
I read an abstract of your publication on link between elevated HbA1C levels and WMD. I also read about WMD and increased risk of Stroke. After my Stroke diagnosis, my HbA1C was found to be 5.8. Would this high value be a contributing factor to my Stroke? Is the elevated HbA1C the cause of WMD or a result of it?
Thanks