Authors: Mariam Alharbi , Abdulaziz Alluhayb , Saud Alamri , Omar Aldhuwayhi , Almathna Alharbi , Rana Alamri , Abdullah Almutairi , Ziyad Almazroui

Abstract

Background: Stroke is a leading cause of mortality and long-term disability, and poor glycemic control may influence recurrence and clinical outcomes. This study compared HbA1c levels among patients with ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA), and examined their associations with risk factor burden and in-hospital survival.

Methods: This retrospective cohort study included 903 patients diagnosed with stroke at King Fahad Specialist Hospital, Qassim, Saudi Arabia, between 2018 and 2025. Demographic and clinical data were extracted from electronic medical records and analyzed using SPSS version 27.

Results: Of the 903 patients, 715 (79.2%) had ischemic stroke, 80 (8.9%) hemorrhagic stroke, and 108 (12.0%) TIA. Overall, 503 (55.7%) had HbA1c ≥6.5%. Mean HbA1c was highest in ischemic stroke (7.59 ± 2.32%), followed by hemorrhagic stroke (7.25 ± 1.86%) and TIA (7.12 ± 1.89%), although the difference was not significant (p = 0.068). HbA1c correlated positively with risk factor burden (r = 0.313, p < 0.001). Uncontrolled glycemia was more common in patients with previous stroke (62.3% vs. 53.3%, p = 0.015). Each 1% increase in HbA1c was associated with 16% higher adjusted odds of ischemic stroke versus TIA (adjusted OR = 1.160, 95% CI: 1.035–1.301; p = 0.011). Older age and hemorrhagic stroke were associated with lower in-hospital survival.

Conclusion: Elevated HbA1c was associated with greater cardiovascular risk factor burden, previous stroke, and higher odds of ischemic stroke relative to TIA. Optimizing glycemic control and managing modifiable cardiovascular risk factors may improve stroke prevention and outcomes.

Keywords: Glycated hemoglobin, stroke, cardiovascular risk factors, risk factor burden, glycemic control, Saudi Arabia.