Diabetes mellitus y riesgo de ictus
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DESARROLLO: La diabetes mellitus (DM) se asocia a un riesgo relativo de ictus isquémico entre 1,8 y 6; para el ictus hemorrágico esta asociación es controversial. Las mujeres diabéticas tipo 1 tienen mayor riesgo que aquellas con DM tipo 2. Además, la DM predice estadía hospitalaria prolongada, y mayor mortalidad y discapacidad en pacientes con ictus, los que sufren ictus fatales tienden a tener mayores niveles de HbA1c y de glicemia. Por otra parte, cerca del 9% de las recurrencias del ictus fueron atribuibles a la DM, por ello está incluida en las escalas pronosticas de recurrencia de la isquemia cerebral; además, es un factor de riesgo para la demencia post–ictus. Aunque en la DM tipo 1 el tratamiento intensivo de los niveles de glicemia se asoció a menores niveles de HbA1c y microalbuminuria, lo cual le confirió una reducción de eventos cardiovaculares en un 42%; en grandes ensayos clínicos con tratamiento intensivo para la DM tipo 2, la reducción de los niveles de glicemia y HbA1c, reducen las complicaciones microvasculares, pero no los eventos vasculares mayores. En cambio, el control más estricto de la tensión arterial, el uso de estatinas y una dieta tipo DASH, producen una reducción marcada del riesgo de ictus en diabéticos tipo 2.
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