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��ࡱ�>��	������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������	����bjbjҰҰ	7������N�������ppppp��������d�\��U�D(llll���oTYU[U[U[U[U[U[U�W�pZP[U9p�U^���[Uppll��U����plplYU��YU��F1P�Tl������}������ASTEU�U0�U�S,�Z���Z��T�Zp�T���������[U[U�����U�������������������������������������������������������������������������Z��������� 6:	Article type: Research Article
Received: 19 December 2020
Accepted: 25 January 2021
Published: 30 January 2021
PubMed Short Name: Biochem Mol Bio

A Study to find out the Association of Serum Concentrations of Uric Acid and Lipid Profile in Stroke Patients with Diabetes Mellitus

Shrinwanti Karmakar*

Department of Biochemistry, Burdwan Medical College, India

*Corresponding author: Shrinwanti Karmakar, Department of Biochemistry, Burdwan Medical College, India, Tel: 8768576868; Email: shrinwantikarmakar@gmail.com; drsumitsarkar94@gmail.com

Abstract
Background: Stroke is one of the most common causes of death in the developed as well as developing nations. India is also suffering huge social and economic burden in the rehabilitation of stroke patients.

Aims and Objectives: Our present study is to determine serum uric acid and lipid profile level as risk factors of stroke with diabetes mellitus.

Materials and Methods: This is a Cross-sectional observational study conducted in a tertiary care centre, Burdwan Medical College and Hospital, from February 2017 to July 2018. 50 patients of stroke with diabetes mellitus, 50 patients of stroke without diabetes mellitus and 50 patients of diabetes mellitus without stroke were taken according to inclusion and exclusion criteria. Serum Uric acid and Lipid profile were measured by standard biochemical method in all patients. Age, sex distribution and duration of diabetes mellitus are also studied.

Results: Stroke is more common in older population with male predominance. The differences of mean uric acid level in between CVA+DM group (8.172± 1.366mg/dl) and ONLY CVA group (6.235� � 1.247mg/dl); & CVA+DM group and ONLY DM group (5.911± 1.528mg/dl) are statistically significant (p value <0.05). In Lipid profile there is variable result, the mean difference of TG level, VLDL level and reduced HDL level among the three groups (CVA+DM, ONLY CVA, ONLY DM) are statistically significant (p value <0.05). The mean difference of Cholesterol level and LDL level between CVA+DM group and ONLY CVA group is statistically not significant (p value >0.05) but between CVA+DM group and ONLY DM group is statistically significant (p value <0.05).

Conclusion: Hyperuricemia is a probable risk factor of stroke, in patients with Diabetes mellitus. Total cholesterol and LDL cholesterol levels are almost similarly elevated in diabetic stroke patients and non diabetic stroke patients. High Triglyceride, high VLDL and reduced HDL Cholesterol are probable risk factors of stroke in patients with Diabetes mellitus. Chance of developing stroke is more in diabetic patients having greater HbA1C level.

Keywords: Uric acid; Lipid profile; Stroke; Diabetes Mellitus

Introduction
WHO defines the clinical syndrome of stroke as rapidly developing clinical signs of focal (or global) disturbance of cerebral function with symptoms lasting 24 hours or longer or leading to death having no apparent cause other than vascular origin. The Stroke is one of the leading causes of death in the developed nations accounting for nearly 4.5 million deaths each year. Stroke is also a leading cause of functional impairments, with 20% of survivors requiring institutional care after 3 months and 15%-30% being permanently disabled [1-4]. Crude prevalence rate of stroke is 147/100,000 and annual incidence rate is 36/100,000.

Stroke is an event that can change the life of the affected person and their family and caregivers. Stroke is divided into two broad categories according to its pathophysiology:

Ischemic strokes: It is caused by either cerebral thrombosis or embolism and it account for 50%�85% of all strokes worldwide.

Haemorrhagic strokes: These are caused by subarachnoid haemorrhage or intracerebral haemorrhage and account for 1%-7% and 7%-27% respectively of all strokes worldwide.

The effects of a stroke are determined by the extent and site of brain injury, but the clinical symptoms of stroke do not accurately predict its underlying cause or causes. Classic stroke symptoms include the acute onset of unilateral paralysis, loss of vision, speech impairment, memory loss, impaired reasoning ability, coma, or death. Thus, early identification of those at increased risk of stroke should represent a significant contribution to health improvement so that interventions can be targeted to those most likely to benefit. Because stroke risk prediction based only on conventional risk factors such as blood pressure (BP) is still not completely reliable, a continued search for predictive markers is of interest [5].

Diabetes mellitus plays an important role in cerebrovascular accident. The worldwide prevalence of DM has risen dramatically over the past two decades more so in India. With an increasing incidence worldwide, DM will be a leading cause of morbidity & mortality for the foreseeable future [6,7]. Uric acid is the ultimate catabolite of purine metabolism in human and higher primates. It exists in the extracellular compartment as sodium urate, and it is cleared from the plasma through the kidney.

Age and sex influence serum Uric acid level. Before puberty, the average serum uric acid level is 3.6mg/dl for males and females. Following puberty, value rises to adult levels in women typically 1mg/dl less than men. This lower level in women apparently reflects oestrogen related enhancement of renal urate clearance [8].

However, serum uric acid has been recently associated with insulin resistance. Serum uric acid is a soluble antioxidant scavenger, and oxidative stress is a hallmark of tissues� hyperglycaemic milieu. Furthermore, serum uric acid may be considered as a marker of acute endothelial dysfunction, since Hyperuricemia has been observed to be associated with raised endothelin levels, and there is evidence that involvement of uric acid, via purine metabolism, in the process of thrombus formation. Some studies have linked serum uric acid with stroke in diabetes mellitus. But it is debated. Therefore, we decide to evaluate Hyperuricemia as a risk factor for stroke in patients with diabetes mellitus. In our present study we aimed to find out association of uric acid level in diabetic stroke patients.

Materials and Methods

Patients admitted in the Neurology indoor and patients attending medicine outdoor in Burdwan Medical College and Hospital. Cross-sectional observational study was done from February 2017 to July 2018 with 50 patients of stroke with diabetes mellitus, 50 patients of stroke without diabetes mellitus and 50 patients of diabetes mellitus without stroke were taken.

Inclusion criteria:
Focal neurological deficit of sudden onset that persisted beyond 24 hours.
Cerebral infarction or haemorrhage documented by computed tomography or magnetic resonance imaging scan.

A case of Diabetes mellitus should have
Fasting blood glucose 126 mg/dl Or more,
In oral glucose tolerance test, 2 hours plasma glucose 200 mg/dl Or more OR,
Symptoms of diabetes (polyuria, polyphagia, polydipsia) with random blood glucose 200 mg/dl Or more
HbA1c (glycosylated haemoglobin) > = 6.5 %.

Exclusion criteria:
Focal neurological deficit of sudden onset that lasted less than 24 hrs,
Concurrent major renal, hepatic and cancerous diseases
History of recent clinical infection
Major trauma in previous month
Patients is on antiuricosuric drugs
Patients is on hypolipidemic drugs
Alcoholic patients.

Parameters to be studied
Pulse, blood pressure, neurological profile, serum uric acid, lipid profile, blood for fasting blood sugar, post prandial blood sugar, random blood sugar, HbA1c, Urea, creatinine, computed tomography or magnetic resonance imaging scan of brain.

Study tools
Computed Tomography machine/Magnetic Resonance Imaging machine
Auto analyser
Semi auto analyser
Centrifuge machine
Routine laboratory glass wares and PVC wares
Clot activator vials, oxalo-fluride vials, disposable syringes
Rubber tourniquet, spirit, cotton swab
Computer for data analysis.


Study techniques:
History of hypertension, diabetes, heart disease, dyslipidemia, renal disease, malignancy , gout, past history of similar episodes, smoking, drinking, family history.
General Survey (Pulse, Blood Pressure)
Clinical assessment
Imaging Evaluation
Estimation of serum uric acid by auto analyser
Estimation of serum lipid profile by auto and semi auto analyser.
Estimation of plasma glucose by standard biochemical method
Record Analysis.

Results
Demographic profile of the study population: A total number of 150 patients were taken according to inclusion and exclusion criteria mentioned earlier and divided in 3 groups 

Group 1(CVA+DM): 50 patients having stroke (CVA) with diabetes mellitus (DM)
Group 2 (ONLY CVA): 50 patients having stroke (CVA) without diabetes mellitus (DM)
Group 3(ONLY DM): 50 patients having diabetes mellitus (DM) without stroke (CVA)

Age distribution: In our study mean age of total patients are 64.60�7.41 years, among them group 1 (CVA+DM) is 64.68�8.02 years, group 2 (ONLY CVA) is 66.28�6.62 years and group 3(ONLY DM) is 62.84�7.25 years (Figure 1 and Table 1).

Sex distribution: There are 91(61%) male patients and 59(39%) female patients included in our study. Among them in group1 (CVA + DM), 29(58%) patents are male and 21(42%) patients are female, in group 2 (ONLY CVA), 32(64%) are male and 18(36%) are female and in group 3 (ONLY DM) 30(60%) are male and 20(40%) are female. So stroke is more common in men (Figure 2, Figure 3 and Table 2).

Two main parameters were taken namely uric acid and lipid profile in this study which is quantitative data. To know whether the data is normally distributed or not the Test of Normality (Kolmogorov �Smirnov test) is done (Table 3).

This values are normally distributed as because the Test of Normality (Kolmogorov � Smirnov test) shows significance level 0 .200 which is greater than 0.05.

As this was a normally distributed quantitative data so that parametric test was done. We had to compare mean uric acid between group1& group2 and between group 1 & group 3.So unpaired t-test was done.

This is a cross sectional observational study including a total of 150 patients out of which 50 patients have CVA+ DM , 50 patients have ONLY CVA and 50 patients have ONLY DM. This study is done to find out whether there is any association of serum concentration of Uric acid and Lipid profile in Stroke patients with Diabetes mellitus [9,10].

The study is done among the patients admitted in Neurology/Medicine Indoor or attended OPD of Burdwan Medical College & Hospital. The patients are taken according to the inclusion and exclusion criteria [11]. Uric acid and Lipid profile levels were estimated by standard method and Statistical analysis was done by using SPSS.

It is found that, mean uric acid level in patients of CVA+DM group is 8.172� 1.366 mg/dl, in ONLY CVA group is 6.235 � 1.247mg/dl and in ONLY DM group is 5.911 �1.528 mg/dl. The differences of mean uric acid level in between CVA+DM group and ONLY CVA group; & CVA+DM group and ONLY DM group are statistically significant (p value<0.05).

In this study, mean Cholesterol level among patients having CVA with DM is 220.640� 34.254mg/dl, in patients having ONLY CVA is 216.440 � 35.635mg/dl and in patients having ONLY DM is 184.780�22.489mg/dl.

The mean difference of Cholesterol level between CVA+DM group and ONLY CVA group is statistically not significant (p value >0.05) but between CVA+DM group and ONLY DM group is statistically significant (p value <0 .05).

In our study we found mean Triglyceride level among patients having CVA with DM is 302.500�49.513mg/dl, patients having ONLY CVA is 158.240�26.496mg/dl and in patients with ONLY DM is 233�47.596mg/dl and the mean difference of TG level among the three groups (CVA+DM, ONLY CVA, ONLY DM) are statistically significant ( p value <0.05).

In this study, mean HDL cholesterol level in CVA+ DM group is 24.960� 4.548mg/dl, in ONLY CVA group is 38.480�4.769mg/dl and in ONLY DM group is 30.480�5.953mg/dl and mean difference of HDL -C level among the three groups (CVA+DM, ONLY CVA, ONLY DM) are statistically significant (p value <0.05).

In this study, we found mean LDL cholesterol level among patients having CVA with DM is 135.140� 29.170mg/dl, in patients with ONLY CVA is 146.300�34.383mg/dl and in patients with ONLY DM is 107.660�19.818mg/dl. The mean difference of LDL Cholesterol level between CVA+DM group and ONLY CVA group is statistically not significant (p value >0 .05) but in between CVA+DM group and ONLY DM group is statistically significant (p<0 .05).

In the present study, mean VLDL cholesterol level in CVA+ DM group is 60.180� 9.323mg/dl, in ONLY CVA group is 31.660�5.243mg/dl and in ONLY DM group is 46.640�9.503mg/dl and mean difference of VLDL Cholesterol level among the three groups (CVA+DM, ONLY CVA, ONLY DM) are statistically significant ( p value <0.05).

In our present study we found that the mean HbA1C level in CVA +DM group is (9.12�0.79) higher than the mean in ONLY DM group (7.95�0.66) and the mean difference between these two groups are statistically significant ( p value <0.05).

Discussion
In this study an effort was made to compare the level of the serum Uric acid & lipid profile among stroke patients having diabetes mellitus and stroke patients without having Diabetes mellitus and in patients having only Diabetes mellitus [12].

Total 150 patients were taken (among them 50 patients of stroke (CVA) with diabetes mellitus (DM), 50 patients of stroke (CVA) without diabetes mellitus (DM) and 50 of diabetes mellitus (DM) without stroke).

Most of the patients of this study are above 50 years of age. Mean age of patients having stroke with Diabetes mellitus (CVA+DM) is 64.68 � 8.022 years and of stroke patients (ONLY CVA) is 66.28 � 6.624 years [13-15]. This is a well known fact that incidence of stroke is more in older population. So this study is showing same type of finding.

The greater prevalence of stroke in men is well known, but recent issues emphasize the importance of stroke in women.68 Knowledge of sex differences might be of interest in improving preventive strategies and the in-hospital management of stroke patients. In our study, 21 patients were female out of 50 stroke patients (42%) in group 1(CVA+DM) and 18 patients were female out of 50 patients (36%) in group 2(ONLY CVA).

In this study, mean uric acid level in patients of CVA+DM group is 8.172� 1.366 mg/dl, in ONLY CVA group is 6.235 � 1.247mg/dl and in ONLY DM group is 5.911 � 1.528 mg/dl. The differences of mean uric acid level in between CVA+DM group and ONLY CVA group; & CVA+DM group and ONLY DM group are statistically significant (p value<0.05). This finding is similar with previous studies [16,17].

Hyperuricemia has previously been described as a strong predictor of well-defined cerebrovascular complications (stroke) in a Finnish cohort of patients with type 2 diabetes. Guan MP et.al. also observed that the type 2 diabetic patients with stroke had significantly higher mean levels of serum uric acid than simple diabetic patients [18,19]. Hyperuricemia was associated with a significantly higher risk of both stroke incidence and mortality [20].

Several patho-physiological mechanisms like endothelial dysfunction, oxidative metabolism, platelet adhesiveness and aggregation, related to hyperuricemia have been suggested.

Hyperuricemia is also found to be associated with elevated circulating levels of systemic inflammatory mediators such as monocytes chemo attractant protein-1, NF-�B, interleukin-1�, interleukin-6, and tumor necrosis factor-�, and vascular smooth muscle proliferation .

Hypertension, one of the most common causes of stroke is closely related to hyperuricemia.

Conclusion
Stroke is more common in older population with male predominance.
The occurrence of stroke is quite high among female also.
Hyperuricemia is a probable risk factor of stroke, in patients with Diabetes mellitus .
Elevated total Cholesterol & LDL cholesterol levels are probable risk factors for developing stroke in patients with diabetes mellitus.
Total cholesterol and LDL cholesterol levels are almost similarly elevated in diabetic stroke patients and non diabetic stroke patients.
High Triglyceride, high VLDL and reduced HDL Cholesterol are probable risk factors of stroke in patients with Diabetes mellitus.
Chance of developing stroke is more in diabetic patients having greater HbA1C level.

References
Goldstein M, Brnett HJ, Orgogogzo JM, Sartorius N (1989) Recommendations on stroke prevention , disgnosis and therapy. Report of WHO Task force on Stroke an otherCerevrovascular Disorders. Stroke 20: 1407-1431
Banerjee TK, Mukherjee CS, Sarkhel A (2001) Stroke in the urban population of Calcutta and epidemiological study. Neuroepidemiology 20: 201�207.
Napoli MD (2005)  HYPERLINK "https://www.ahajournals.org/doi/full/10.1161/01.STR.0000165929.78756.ed" Evaluation of C-Reactive Protein Measurement for Assessing the  HYPERLINK "https://www.ahajournals.org/doi/full/10.1161/01.STR.0000165929.78756.ed" Risk and Prognosis in Ischemic Stroke : A Statement for Health Care Professionals From the CRP Pooling Project Members May 2005. Stroke. 36: 1316�1329.
Barr WG (1990) Uric acid. In: Walker HK,Hall WD, Hurst JW, editors. Clinical Methods. The History, Physical, and Laboratory Examination, 3rd ed. Boston: Butter worth 760-763.
Heo SH, Lee SH (2010) High levels of serum Uric acid are associated with silent brain infarctivn. Jaurnal of the Neurol Scien 297: 6-15.
To�yry JP, Niskanen LK, La�nsimies EA, Partanen KP, Uusitupa MI (1996) Autonomic neuropathy predicts the development of stroke in patients with non�insulin-dependent diabetes mellitus. Stroke 27: 1316 �1318.
Steinberg HO, Brechtel G, Johnson A, Fineberg N, Baron AD (1994) Insulinmediatedskeletal muscle vasodilatation is nitric oxide dependent. J Clin Invest 94: 1172�1179.
Suarna C, Dean RT, May J, Stocker R (1995) Human atherosclerotic plaque contains both oxidized lipids and relatively large amounts of alpha-tocopherolandascorbate. ArteriosclerThrombVasc Biol 15: 1616�1624.
Selby JV, Friedman GD, Quesenberry CP (1990) Precursors of essential hypertension: pulmonary function, heart rate, uric acid, serum cholesterol, and other serum chemistries. Am J Epidemiol 131: 1017�1027.
Wilson PW, Garrison RJ, Abbott RD, Castelli WB (1983) Factors associated with lipoprotein cholesterol levels: the Framingham Study. Arteriosclerosis 3: 273�281.
Ebrahim S, Sung J, Song YM, Ferrer RL, Lawlor DA, et al. (2006) Serum cholesterol, haemorrhagic stroke, ischaemic stroke, and myocardial infarction: Korean national health system prospective cohort study. BMJ 333: 22.
Sanossian N, Saver JL, Navab M, Ovbiagele B (2007) High-density lipoprotein cholesterol: an emerging target for stroke treatment. Stroke 38: 1104�1109.
Michael Donography, Reader in Clinical neurology, University of Oxford, Brain�s

Diseases of the Nervous System, 12th edn, 1004.
Barret E, Khaw KC (1988) Diabetes mellitus :An independent riak factor for stroke? Am J Epidemiology 128: 116-123.
O'Donnell MJ, Xavier D, Liu L (2010) Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 376: 112�123.
Stegmayr B (1995) Diabetes as a risk factor for stroke. A population perspective. Diabetologica 38: 1061-1068
Tuomilehto J, Rastenyle D, Jousilahti P, Vartianen SE (1996) Diabetes as a risk factor death from stroke . Prospective study of middle aged Finnish population. Stroke 27: 210-215.
Dutton GR, Lewis CE (2015) The Look AHEAD Trial: Implications for Lifestyle Intervention in Type 2 Diabetes Mellitus. Prog Cardiovasc Dis 58: 69�75.
Maahs DM, Daniels SR, de Ferranti SD, Dichek HL, Flynn J, et al. (2014) Cardiovascular disease risk factors in youth with diabetes mellitus: a scientific statement from the American Heart Association. Circulation 130:1532�1558.
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8DLT\d�NormalPraveen Kumar Boini8Microsoft Office Word@�2@L�`��@�p\���BGLN�����Qt	'�d.���@"Calibri------���@"Calibri---------	 2
m`cArticle type: ---	#2
m�cResearch Article---	
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m�c 	------	2
}`
cReceived: ---	
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}�c1	
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}�c9	
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}�c 	2
}�cDecem
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}�cber 2020	
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}c 	---	2
�`
cAccepted: ---	"2
��c25 January 2021	
2
��c 	---	2
�`cPublished: ---	"2
��c30 January 2021---	
2
��c 	---	(2
�`cPubMed Short Name: 	---	"2
��cBiochem Mol Bio
	
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�7c 		
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�`c 	���@"Calibri------	q2
�nDcA Study to find out the Association of Serum Concentrations of Uric 



	
	
	

			I2
��)cAcid and Lipid Profile in Stroke Patients
	
	


	
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��c 	,2
��cwith Diabetes Mellitus

	
2
��c 
	---	
2
`c 	---	)2
`cShrinwanti Karmakar*
	
2
�c 	---	
2
#`c 		52
4`cDepartment of Biochemistry, 

	.2
4cBurdwan Medical College		2
4�c, India	
2
4�c 		
2
D`c 	---	,2
T`c*Corresponding author:---	
2
T�c 	(2
T�cShrinwanti Karmakar	
	82
T[c, Department of Biochemistry, 

	.2
T�cBurdwan Medical College		 2
T�c, India, Tel: 		(2
d`c8768576868; Email: 
	+2
d�cshrinwantikarmakar@gm	

	2
dZcail.com
	2
d�c; 	12
d�cdrsumitsarkar94@gmail.com


	
2
d%c 		
2
u`c 	---	2
�`cAbstract

		
2
��c 
	---	2
�`cBackground:---	
2
��c 	�2
��acStroke is one of the most common causes of death in the developed as well as developing nations. 


			�2
�`acIndia is also suffering huge social and economic burden in the rehabilitation of stroke patients.
	
2
�mc 		
2
�`c 	---	2
�`cAim	%2
�vcs and Objectives:	---	
2
��c 	�2
��]cOur present study is to determine serum uric acid and lipid profile level as risk factors of 	

		82
�`cstroke with diabetes mellitus.	
	
2
�c 		
2
�`c 	---	,2
`cMaterials and Methods:---	
2
�c 	"2
�cThis is a Cross	
2
5c-	p2
9Ccsectional observational study conducted in a tertiary care centre, 	2
�cBurdwan		
2
�c 		52
`cMedical College and Hospital	�2
Tc, from February 2017 to July 2018. 50 patients of stroke with diabetes mellitus, 50 
	
		�2
!`lcpatients of stroke without diabetes mellitus and 50 patients of diabetes mellitus without stroke were taken 	

				@2
1`#caccording to inclusion and exclusio	w2
11Hcn criteria. Serum Uric acid and Lipid profile were measured by standard 
	
		�2
B`mcbiochemical method in all patients. Age, sex distribution and duration of diabetes mellitus are also studied.


	
2
B�c 		
2
R`c 	---	2
b`cResults:---	
2
b�c 	k2
b�@cStroke is more common in older population with male predominance


	

	A2
b$c. The differences of mean uric acid 
		^2
s`7clevel in between CVA+DM group (8.172± 1.366mg/dl) and 	
	2
s�cONLY		
2
s�c 	J2
s�*cCVA group (6.235� � 1.247mg/dl); & CVA+DM 
			2
�`
cgroup and 	2
��cONLY		
2
��c 	�2
��gcDM group (5.911± 1.528mg/dl) are statistically significant (p value <0.05). In Lipid profile there is 
		�2
�`jcvariable result, the mean difference of TG level, VLDL level and reduced HDL level among the three groups 

		2
�`	c(CVA+DM, 	2
��cONLY		
2
��c 	2
��cCVA, 	2
��cONLY		
2
��c 	�2
��VcDM) are statistically significant (p value <0.05). The mean difference of Cholesterol 
		G2
�`(clevel and LDL level between CVA+DM group		
2
�Nc 	2
�Rcand 	2
�kcONLY		
2
��c 	j2
��?cCVA group is statistically not significant (p value >0.05) but 		12
�`cbetween CVA+DM group and 		2
�cONLY		
2
�c 	\2
�"6cDM group is statistically significant (p value <0.05).	
2
�?c 		
2
�`c 	---	2
�`cConclusion:---	
2
��c 	�2
��UcHyperuricemia is a probable risk factor of stroke, in patients with Diabetes mellitus
	
	)2
�mc. Total cholesterol 		�2
�`wcand LDL cholesterol levels are almost similarly elevated in diabetic stroke patients and non diabetic stroke patients. 

		�2
`ncHigh Triglyceride, high VLDL and reduced HDL Cholesterol are probable risk factors of stroke in patients with 			2
`cDiabete	�2
�`cs mellitus. Chance of developing stroke is more in diabetic patients having greater HbA1C level.

	
2
�c 		
2
&`c 	---	2
6`	cKeywords:
---	
2
6�c 	2
6�cUric 	
2
6�ca	2
6�ccid	2
6�c; 	2
6�cLipid 	
2
6�cp	2
6�crofile	2
6c; 	
2
6cS	2
6$ctroke; 	%2
6FcDiabetes Mellitus	
2
6�c 	---	
2
M`c 
		2
g`cIntroduction		
2
g�c 
	---	�2
z`ucWHO defines the clinical syndrome of stroke as rapidly developing clinical signs of focal (or global) disturbance of 	
		52
�`ccerebral function with sympt	
	�2
�Rcoms lasting 24 hours or longer or leading to death having no apparent cause other 
		�2
�`octhan vascular origin. The Stroke is one of the leading causes of death in the developed nations accounting for 		2
�`cnearl	:2
�}cy 4.5 million deaths each year.
	
2
�!c 	22
�#cStroke is also a leading c	;2
�� cause of functional impairments, 

	2
�Wcwith		
2
�oc 	%2
�qc20% of survivors 			X2
�`3crequiring institutional care after 3 months and 15%
		
2
�xc-	82
�|c30% being permanently disabled	
	
2
�/c 	2
�2c[1	
2
�=c-	2
�Ac4]	/2
�Lc. Crude prevalence rate 		>2
�`"cof stroke is 147/100,000 and annua	:2
�%cl incidence rate is 36/100,000.	
2
��c 		
2
�`c 		.2
�`cStroke is an event that	
2
��c 	M2
��,ccan change the life of the affected person a	:2
��cnd their family and caregivers.
	
2
��c 	2
��
cStroke is 		A2
�`$cdivided into two broad categories ac		:2
�)ccording to its pathophysiology:	
2
��c 		
2

`c 	���@"Calibri------���	@ Calibri----------------	#2
`cIschemic strokes---	
2
�c:---	
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�c ---	g2
�=cIt is caused by either cerebral thrombosis or embolism and it


---	
2
'c ---	"2
,caccount for 50%		
2
�c�	2
�c85% 		2
�cof all 	���@"Calibri---------	&2
-`cstrokes worldwide.		---	
2
-�c 	---	
2
>`c 	c'����"System�fG�Õ}'s�--ccbbaa����՜.��+,��D��՜.��+,��,�hp|�������
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