Although Mexican Americans had a substantially greater incidence rate for the com- bination of ischemic stroke and ICH than non-Hispanic whites,40 there is insufficient evidence that the presence of diabetes mel- litus or other forms of glucose intolerance influenced this rate. In the Strong Heart Study (SHS), 6.8% of 4549 Native American participants 45 to 74 years of age at baseline without prior stroke had a first stroke over 12 to 15 years, and diabetes mellitus and impaired glucose tolerance increased the HR to 2.05.43 In NOMAS, which included 3298 stroke-free community residents, 572 reported a history of diabetes mellitus, and 59% (n=338) had elevated fasting blood glucose.287 Those subjects with an elevated fasting glucose had an increased stroke risk (HR, 2.7; 95% CI, 2.0 3.8), but those with a fasting blood glucose level of <126 mg/dL were not at increased risk. Stroke risk can be reduced in patients with diabetes mellitus. In the Steno-2 Study, 160 patients with type 2 diabetes mellitus and persistent microalbuminuria were assigned to receive either intensive therapy, including behavioral risk factor modification and the use of a statin, an ACEI, an ARB, or an antiplatelet drug as appropriate, or conventional therapy with a mean treatment Patients were subsequently followed up for an average of 5.5 years. The primary end point was time to death resulting from any cause. The risk of cardiovascular events was intensive versus conventional therapy, and strokes were reduced from 30 to 6. In addition, intensive therapy was associated with a 57% lower risk of death from cardiovascular causes (HR, 0.43; 95% CI, 0.19 0.94; P=0.04). Eighteen of the 30 strokes were fatal in the conventional group, and all 6 were fatal in the inten- sive group. 