An autopsy study of cerebrovascular accident in diabetes mellitus.

IN SEVERAL PREVIOUS REPORTS1-3 we have reviewed the evidence purporting to show that arteriosclerosis appears earlier and more frequently in patients with diabetes mellitus than in the general population, and have indicated the areas of doubt with respect to this contention. As Baker et al.4 have recently pointed out, this increase in frequency and intensity of arteriosclerosis in diabetes has been particularly stressed in regard to the coronary and renal arteries as well as to the arterial tree of the lower extremities, and they have presented data indicating that it may also apply to the cerebral arterial circulation. Support for this contention derives, in part, from the undoubted increase in the frequency of myocardial infaretion, renal pathology, and peripheral gangrene in diabetes, but the evidence for an increase in the frequency of cerebrovascular accident (CVA) remains doubtful. Joslin5 has reported that CVA accounts for only 8 per cent of all diabetic deaths, an incidence which is about of the same order of magnitude as the 8.4 per cent found by Webster6 in a large autopsy series (2,400 cases) in which there were only two cases with both diabetes and CVA. Other reports dealing with vital statistics show an incidence of CVA of 13.1 per cent in a diabetic group7 as compared with 11.4 per cent in the general population.8 While the foregoing do not com-