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Background and ObjectivesPatients with a new diagnosis of cancer carry an increased risk of acute ischemic stroke (AIS) and this risk varies depending on age, cancer type, stage, and time from diagnosis. Whether AIS patients with a new diagnosis of neoplasm represent a distinct subset from those with a previously known active malignancy remains unclear. We aimed to estimate the rate of stroke in patients with newly diagnosed cancer and previously known active cancer and to compare the demographic and clinical features, stroke mechanisms, and long-term outcomes between groups.MethodsUsing 2003-2021 data from the ASTRAL registry, we compared patients with known active cancer to patients with newly diagnosed cancer (cancer identified during AIS hospitalization or within the following 12 months). Patients with inactive and no history of cancer were excluded. Outcomes were the modified Rankin Scale (mRS) score at 3 months and mortality and recurrent stroke at 12 months. We used multivariable regression analyses to compare outcomes between groups while adjusting for important prognostic variables.ResultsAmong 6686 patients with AIS, 362 (5.4%) had active cancer, including 102 (1.5%) with newly diagnosed cancer. Gastrointestinal and genitourinary cancers were the most frequent cancer types. Among all patients with active cancer, 152 (42.5%) AISs were classified as cancer-related, with nearly half of these cases attributed to hypercoagulability. In multivariable analysis, patients with newly diagnosed cancer had less pre-stroke disability (aOR 0.62, 95%CI 0.44-0.86) and fewer prior stroke/TIA events (aOR 0.43, 95%CI 0.21-0.88) than patients with known active cancer. 3-month mRS scores were similar between cancer groups (aOR 1.27, 95%CI 0.65-2.49), and were predominantly driven by the presence of newly diagnosed brain metastases (aOR 7.22, 95%CI 1.49-43.17) and metastatic cancer (aOR 2.19, 95%CI 1.22-3.97). At 12 months, mortality risk was higher in patients with newly diagnosed cancer versus patients with known active cancer (HR 2.11, 95%CI 1.38-3.21) while recurrent stroke risk was similar between groups (aHR 1.27, 95%CI 0.67-2.43).DiscussionIn a comprehensive institutional registry spanning nearly two decades, 5.4% of patients with AIS had active cancer, a quarter of which were diagnosed during or within 12 months after the index stroke hospitalization. Patients with newly diagnosed cancer had less disability and prior cerebrovascular disease, but a higher 1-year risk of subsequent death than patients with known active cancer.

The incidence of diabetes is increasing and affects 180 million adults worldwide, including 24 million in the United States, or 7.8% of the population. In 2007, 1.6 million new cases were diagnosed in U.S. residents aged 20 years or more.1 Despite the large number of antidiabetic agents on the market, the condition is still inadequately controlled in 30% of affected patients.2 Among available therapies, dipeptidyl-peptidase IV (DPPIV) inhibitors offer a new promising alternative for the treatment of type 2 diabetes, through their ability to improve glucose tolerance and insulin response to oral carbohydrates.3 DPPIV is involved in the rapid N-terminal cleavage of incretins, ie, peptide hormones such as glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide 1 (GLP-1), which are released from the gut in response to nutrients intake, thus enhancing glucose-stimulated insulin secretion and inhibiting glucagon secretion.3 Sitagliptin (Januvia) was the first DPPIV inhibitor marketed in the United States in 2006, subsequently approved in the European Union. Vildagliptin (Galvus) received EMEA approval in 2007 but is currently not marketed in the United States. Many analogs of DPPIV inhibitors are currently under development. A metaanalysis evaluated the efficacy and safety of DPPIV inhibitors based on 17 randomized controlled clinical trials involving 7823 patients treated with vildagliptin or sitagliptin over 12 to 52 weeks; DPPIV inhibitors appear well tolerated, with, however, an increased risk of nasopharyngitis, cystitis, and headache.4 Postmarketing surveillance of patients treated with sitagliptin and vildagliptin reported cases of angioedema, most often during the first 3 months of treatment, with some reactions observed already after the first dose. Consequently, the Summaries of Product Characteristics and Package Leaflets of both compounds were updated to include angioedema among potential adverse effects.5,6 Although DPPIV theoretically inactivates or interacts with a large number of biologically active peptides,7 …