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Chongolo AM, Alphonce B, Mbelele PM, Meda J, Nyundo A. Predictors of 30-day mortality following the first episode of stroke among patients admitted at referral hospitals in Dodoma, central Tanzania: A prospective longitudinal observational study. Health Sci Rep 2024; 7:e2198. [PMID: 38933419 PMCID: PMC11199172 DOI: 10.1002/hsr2.2198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 05/12/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
Background and Aims Stroke is the leading cause of disability and the second most common cause of death after ischemic heart disease worldwide. Understanding predictors of early poststroke mortality provides opportunities for interventions and favorable outcomes. This study aimed to determine the incidence and predictors of 30-day mortality among patients admitted with the first stroke at referral hospitals in Dodoma. Methods A prospective longitudinal observational design enrolled patients with acute stroke confirmed by CT scan or MRI admitted at referral hospitals in Dodoma. The National Institute of Health Stroke Scale was used to assess stroke severity at baseline. A comparison of risk factors, clinical profiles, and mortality was done using the Chi-square test. A logistic regression model was used to determine the predictors of 30-day mortality in patients with the stroke while the 30-day probability of survival was estimated using Kaplan-Meier analysis. Results Out of 226 patients with first-ever stroke, 121(54%) were males, and the population mean age was 63(15) years. The 140(62%) had Ischemic stroke, and 154(68%) survived at the 30th day. Patients with a history of smoking 2.4 [95% confidence interval (CI) (1.0-5.6), p = 0.048], loss of consciousness 2.7 [95% CI (1.2-6.4; p = 0.019] and unequal pupil size 13.7 [95% CI (4.1-58.1, p < 0.001 were significantly more associated with mortality within 30 days. The median survival was 7 (3-9) days, whereas alcohol drinkers and those aged above 60 years had a shorter time to mortality compared to non-alcohol drinkers and those aged <60 years. Conclusion The study showed a high incidence of mortality within 30 days after the first stroke episode, with the highest proportion dying within 7 days of being hospitalized. Advanced age of ≥60 years, smoking, alcohol use, and severe stroke at admission warrant special attention.
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Affiliation(s)
- Anna M. Chongolo
- Kibong'oto Infectious Diseases HospitalSihaTanzania
- Department of Internal Medicine, School of Medicine and DentistryThe University DodomaDodomaTanzania
| | - Baraka Alphonce
- Department of Internal Medicine, School of Medicine and DentistryThe University DodomaDodomaTanzania
| | | | - John Meda
- Department of Internal Medicine, School of Medicine and DentistryThe University DodomaDodomaTanzania
- Department of CardiologyThe Benjamin Mkapa HospitalDodomaTanzania
- Department of Internal MedicineThe Benjamin Mkapa HospitalDodomaTanzania
| | - Azan Nyundo
- Department of Internal Medicine, School of Medicine and DentistryThe University DodomaDodomaTanzania
- Department of Internal MedicineThe Benjamin Mkapa HospitalDodomaTanzania
- Department of Psychiatry and Mental Health, School of Medicine and DentistryThe University of DodomaDodomaTanzania
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Abdu H, Seyoum G. Sex Differences in Stroke Risk Factors, Clinical Profiles, and In-Hospital Outcomes Among Stroke Patients Admitted to the Medical Ward of Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. Degener Neurol Neuromuscul Dis 2022; 12:133-144. [PMID: 36304698 PMCID: PMC9595065 DOI: 10.2147/dnnd.s383564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A stroke is a vascular accident that affects both men and women. The threat of stroke and outcome status differ between the sexes. Such data are lacking in Ethiopia. Therefore, this study assessed sex differences in stroke risk factors, clinical profiles, and outcomes in the medical ward of Dessie comprehensive specialized hospital. METHODS A retrospective cross-sectional study was employed among stroke patients. Medical records with complete information and a confirmed diagnosis of stroke using imaging techniques were included in the study. Using simple random sampling, 344 medical records were selected, 312 of which fulfilled the inclusion criteria. Bivariate and multivariate logistic regression analyses and a chi-square test were employed. The frequency, percentage, and mean and standard deviation of the variables were described using descriptive statistics. Findings with a P-value <0.05 were considered statistically significant. RESULTS Most of the patients were above or equal to 45 years old in both sexes. A significantly higher number of male than female patients were aged less than 45 years (p-value-0.001). Younger age (AOR: 2.998, p = 0.000), cigarette smoking (AOR: 2.911, p = 0.009), and Khat chewing (AOR: 3.650, p = 0.001) were risk factors for stroke in males. A higher number of males presented with hemiplegia/hemiparesis 89 (28.5%), aphasia 45 (14.4%), and facial palsy 19 (6.1%). However, more females were unconscious (15.1%). Significant differences were not seen in the stroke outcomes. Furthermore, there were no apparent differences in risk factors for stroke-related mortality. CONCLUSION Males developed stroke at a younger age. Women were older at the time of stroke onset and presented unconscious. More males experienced hemiplegia/hemiparesis, aphasia, and facial palsy. Smoking, drinking, and khat chewing were risk factors for stroke in men. There were no gender differences in the stroke death rate. Therefore, educating the public about stroke risk factors, lifestyle modification, and conducting prospective research is required.
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Affiliation(s)
- Hussen Abdu
- Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia,Correspondence: Hussen Abdu, Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia, Tel +251-910916321, Email
| | - Girma Seyoum
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Lea-Pereira MC, Amaya-Pascasio L, Martínez-Sánchez P, Rodríguez Salvador MDM, Galván-Espinosa J, Téllez-Ramírez L, Reche-Lorite F, Sánchez MJ, García-Torrecillas JM. Predictive Model and Mortality Risk Score during Admission for Ischaemic Stroke with Conservative Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063182. [PMID: 35328867 PMCID: PMC8950776 DOI: 10.3390/ijerph19063182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
Background: Stroke is the second cause of mortality worldwide and the first in women. The aim of this study is to develop a predictive model to estimate the risk of mortality in the admission of patients who have not received reperfusion treatment. Methods: A retrospective cohort study was conducted of a clinical–administrative database, reflecting all cases of non-reperfused ischaemic stroke admitted to Spanish hospitals during the period 2008–2012. A predictive model based on logistic regression was developed on a training cohort and later validated by the “hold-out” method. Complementary machine learning techniques were also explored. Results: The resulting model had the following nine variables, all readily obtainable during initial care. Age (OR 1.069), female sex (OR 1.202), readmission (OR 2.008), hypertension (OR 0.726), diabetes (OR 1.105), atrial fibrillation (OR 1.537), dyslipidaemia (0.638), heart failure (OR 1.518) and neurological symptoms suggestive of posterior fossa involvement (OR 2.639). The predictability was moderate (AUC 0.742, 95% CI: 0.737–0.747), with good visual calibration; Pearson’s chi-square test revealed non-significant calibration. An easily consulted risk score was prepared. Conclusions: It is possible to create a predictive model of mortality for patients with ischaemic stroke from which important advances can be made towards optimising the quality and efficiency of care. The model results are available within a few minutes of admission and would provide a valuable complementary resource for the neurologist.
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Affiliation(s)
| | - Laura Amaya-Pascasio
- Department of Neurology and Stroke Unit, Hospital Universitario Torrecárdenas, 04009 Almería, Spain; (L.A.-P.); (P.M.-S.)
| | - Patricia Martínez-Sánchez
- Department of Neurology and Stroke Unit, Hospital Universitario Torrecárdenas, 04009 Almería, Spain; (L.A.-P.); (P.M.-S.)
| | | | - José Galván-Espinosa
- Alejandro Otero Research Foundation (FIBAO), Hospital Universitario Torrecárdenas, 04009 Almería, Spain;
| | - Luis Téllez-Ramírez
- Biomedical Research Unit, Hospital Universitario Torrecárdenas, 04009 Almería, Spain;
| | | | - María-José Sánchez
- Escuela Andaluza de Salud Pública, 18011 Granada, Spain;
- Instituto de Investigación Biomédica Ibs. Granada, 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain
| | - Juan Manuel García-Torrecillas
- Biomedical Research Unit, Hospital Universitario Torrecárdenas, 04009 Almería, Spain;
- Instituto de Investigación Biomédica Ibs. Granada, 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Emergency Medicine, Hospital Universitario Torrecárdenas, 04009 Almería, Spain
- Correspondence:
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Ambawatte SB, Weerathunga DN, Dissanayake A, Somaratne SC, Athukorala K, Wijewickrama PSA. Ischemic Stroke Subtypes: Socio-demographic Factors, Risk Factors, and Outcomes in Southern Sri Lanka. Ethn Dis 2021; 31:509-518. [PMID: 34720554 DOI: 10.18865/ed.31.4.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Stroke is a heterogeneous, catastrophic disease. A comprehensive clinical analysis of ischemic stroke (IS) risk factors and outcomes is crucial for optimum management in resource-poor settings. Methods A prospective cross-sectional study of acute cerebrovascular disease (ACVD) involving 592 patients was conducted in a tertiary care center in Sri Lanka from November 2018 to May 2019. We aimed to describe the ACVD subtypes and the relationship of IS subtypes and subtype-categories (as defined by the Oxfordshire Community Stroke Project clinical classification) with risk factors, severity, and outcome. Results The majority (63.3%) had IS. Partial anterior circulation syndromes (PACS), total anterior circulation syndrome (TACS), posterior circulation syndromes (POCS), and lacunar syndromes (LACS) accounted for 102 (29.7%), 58 (16.9%), 88 (25.7%) and 95 (27.7%) of the cases, respectively. The most common PACS sub-category was higher-cerebral-dysfunction-with-homonymous-hemianopia (HCD+HH,39 cases;38.2%). Cerebellar-signs-without-long-tract-signs (CS-LTS) sub-category constituted the highest among POCS (47 cases; 53.4%). The leading sub-category within LACS was pure-motor (PM) strokes (43 cases; 45.3%).Patients aged ≥50 years (adjusted-OR [AOR]2.439; 95%CI,1.163-5.116;P=.018), IHD(AOR 2.520; 95%CI,1.347-4.713; P=.004) and BMI>23kg/m2(AOR 2.607; 95% CI,1.420-4.784; P=.002) were 2.5 times more likely to associate with TACS. Patients with a history of TIA (AOR 1.910; 95%CI,1.036-3.524; P=.038) and arrhythmias (AOR 5.933; 95%CI,3.294-10.684; P<.001) were 1.9 and 5.9 times more likely to be associated with POCS respectively. Those with hypertension were 2.3 times more likely to associate with LACS (AOR 2.233; 95%CI,1.270-3.926; P=.005).NIHSS(P<.001), mRS on admission (P=.001) and in 3 months (P<.001), deaths during hospital stay (P=.003) and within 28 days (P<.001) had a stronger relationship with individual stroke subtypes. Conclusion The comparative risk of different IS subtypes depends on different risk factors. The findings of this study demonstrate that sub-categories within each stroke subtype may behave independently with regard to risk factors and outcomes, thus warranting the need for individual assessment.
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Prospects of Therapeutic Target and Directions for Ischemic Stroke. Pharmaceuticals (Basel) 2021; 14:ph14040321. [PMID: 33916253 PMCID: PMC8065883 DOI: 10.3390/ph14040321] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 12/12/2022] Open
Abstract
Stroke is a serious, adverse neurological event and the third leading cause of death and disability worldwide. Most strokes are caused by a block in cerebral blood flow, resulting in neurological deficits through the death of brain tissue. Recombinant tissue plasminogen activator (rt-PA) is currently the only immediate treatment medication for stroke. The goal of rt-PA administration is to reduce the thrombus and/or embolism via thrombolysis; however, the administration of rt-PA must occur within a very short therapeutic timeframe (3 h to 6 h) after symptom onset. Components of the pathological mechanisms involved in ischemic stroke can be used as potential biomarkers in current treatment. However, none are currently under investigation in clinical trials; thus, further studies investigating biomarkers are needed. After ischemic stroke, microglial cells can be activated and release inflammatory cytokines. These cytokines lead to severe neurotoxicity via the overactivation of microglia in prolonged and lasting insults such as stroke. Thus, the balanced regulation of microglial activation may be necessary for therapy. Stem cell therapy is a promising clinical treatment strategy for ischemic stroke. Stem cells can increase the functional recovery of damaged tissue after post-ischemic stroke through various mechanisms including the secretion of neurotrophic factors, immunomodulation, the stimulation of endogenous neurogenesis, and neovascularization. To investigate the use of stem cell therapy for neurological diseases in preclinical studies, however, it is important to develop imaging technologies that are able to evaluate disease progression and to “chase” (i.e., track or monitor) transplanted stem cells in recipients. Imaging technology development is rapidly advancing, and more sensitive techniques, such as the invasive and non-invasive multimodal techniques, are under development. Here, we summarize the potential risk factors and biomarker treatment strategies, stem cell-based therapy and emerging multimodal imaging techniques in the context of stroke. This current review provides a conceptual framework for considering the therapeutic targets and directions for the treatment of brain dysfunctions, with a particular focus on ischemic stroke.
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Hu L, Ji J, Li Y, Liu B, Zhang Y. Quantile Regression Forests to Identify Determinants of Neighborhood Stroke Prevalence in 500 Cities in the USA: Implications for Neighborhoods with High Prevalence. J Urban Health 2021; 98:259-270. [PMID: 32888155 PMCID: PMC8079571 DOI: 10.1007/s11524-020-00478-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Stroke exerts a massive burden on the US health and economy. Place-based evidence is increasingly recognized as a critical part of stroke management, but identifying the key determinants of neighborhood stroke prevalence and the underlying effect mechanisms is a topic that has been treated sparingly in the literature. We aim to fill in the research gaps with a study focusing on urban health. We develop and apply analytical approaches to address two challenges. First, domain expertise on drivers of neighborhood-level stroke outcomes is limited. Second, commonly used linear regression methods may provide incomplete and biased conclusions. We created a new neighborhood health data set at census tract level by pooling information from multiple sources. We developed and applied a machine learning-based quantile regression method to uncover crucial neighborhood characteristics for neighborhood stroke outcomes among vulnerable neighborhoods burdened with high prevalence of stroke. Neighborhoods with a larger share of non-Hispanic blacks, older adults, or people with insufficient sleep tended to have a higher prevalence of stroke, whereas neighborhoods with a higher socio-economic status in terms of income and education had a lower prevalence of stroke. The effects of five major determinants varied geographically and were significantly stronger among neighborhoods with high prevalence of stroke. Highly flexible machine learning identifies true drivers of neighborhood cardiovascular health outcomes from wide-ranging information in an agnostic and reproducible way. The identified major determinants and the effect mechanisms can provide important avenues for prioritizing and allocating resources to develop optimal community-level interventions for stroke prevention.
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Affiliation(s)
- Liangyuan Hu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, USA. .,Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jiayi Ji
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, USA.,Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Yiyi Zhang
- Division of General Medicine, Columbia University, New York, NY, USA
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Wei CY, Chuang SH, Lin CL, Kung WM, Tai HC, Tsai KWK, Kao CH, Chen CH, Yeh YH, Hsu CY. Reduced risk of stroke following cholecystectomy: A nationwide population-based study. J Gastroenterol Hepatol 2019; 34:1992-1998. [PMID: 31165511 DOI: 10.1111/jgh.14678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Gallstones and stroke are common diseases worldwide. The relationship between gallstones and stroke has been documented in the literature. In this work, to characterize the risk of stroke among gallstone patients with and without cholecystectomy, we investigated the effects of cholecystectomy in a nationwide population-based retrospective cohort study. METHODS Data were obtained from Taiwan's National Health Insurance Research Database. The study comprised 155 356 gallstone patients divided into two groups: those with and without cholecystectomy. RESULTS During the study period (2000-2012), 19 096 (17.8/1000 person-years) gallstone patients without cholecystectomy and 11 913 (10.6/1000 person-years) gallstone patients with cholecystectomy had a stroke. Following gallstone removal, the patients exhibited a significant decrease in the risk of overall stroke (hazard ratio [HR] = 0.60, 95% confidence interval [CI] = 0.59-0.61), ischemic stroke (HR = 0.59, 95% CI = 0.58-0.61), and hemorrhagic stroke (HR = 0.56, 95% CI = 0.53-0.59). Asymptomatic and symptomatic gallstone patients had lower overall stroke risk after cholecystectomy (HR = 0.64, 95% CI = 0.62-0.67 and HR = 0.57, 95% CI = 0.56-0.59) than did asymptomatic gallstone patients without cholecystectomy. CONCLUSIONS This population-based cohort study demonstrated that cholecystectomy is related to reduce the risk of overall stroke, ischemic stroke, and hemorrhagic stroke. Preventive measures for stroke may be considered for gallstone patients, particularly those presenting risk factor(s) for stroke.
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Affiliation(s)
- Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Shu-Hung Chuang
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
- IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Woon-Man Kung
- Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Hsu Chih Tai
- Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Kevin Wen-Kai Tsai
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chien-Hua Chen
- Digestive Disease Center, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Yung-Hsiang Yeh
- Digestive Disease Center, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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de la Fuente J, García-Torrecillas JM, Solinas G, Iglesias-Espinosa MM, Garzón-Umerenkova A, Fiz-Pérez J. Structural Equation Model (SEM) of Stroke Mortality in Spanish Inpatient Hospital Settings: The Role of Individual and Contextual Factors. Front Neurol 2019; 10:498. [PMID: 31156536 PMCID: PMC6533919 DOI: 10.3389/fneur.2019.00498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/24/2019] [Indexed: 01/15/2023] Open
Abstract
Introduction: Traditionally, predictive models of in-hospital mortality in ischemic stroke have focused on individual patient variables, to the neglect of in-hospital contextual variables. In addition, frequently used scores are betters predictors of risk of sequelae than mortality, and, to date, the use of structural equations in elaborating such measures has only been anecdotal. Aims: The aim of this paper was to analyze the joint predictive weight of the following: (1) individual factors (age, gender, obesity, and epilepsy) on the mediating factors (arrhythmias, dyslipidemia, hypertension), and ultimately death (exitus); (2) contextual in-hospital factors (year and existence of a stroke unit) on the mediating factors (number of diagnoses, procedures and length of stay, and re-admission), as determinants of death; and (3) certain factors in predicting others. Material and Methods: Retrospective cohort study through observational analysis of all hospital stays of Diagnosis Related Group (DRG) 14, non-lysed ischemic stroke, during the time period 2008-2012. The sample consisted of a total of 186,245 hospital stays, taken from the Minimum Basic Data Set (MBDS) upon discharge from Spanish hospitals. MANOVAs were carried out to establish the linear effect of certain variables on others. These formed the basis for building the Structural Equation Model (SEM), with the corresponding parameters and restrictive indicators. Results: A consistent model of causal predictive relationships between the postulated variables was obtained. One of the most interesting effects was the predictive value of contextual variables on individual variables, especially the indirect effect of the existence of stroke units on reducing number of procedures, readmission and in-hospital mortality. Conclusion: Contextual variables, and specifically the availability of stroke units, made a positive impact on individual variables that affect prognosis and mortality in ischemic stroke. Moreover, it is feasible to determine this impact through the use of structural equation methodology. We analyze the methodological and clinical implications of this type of study for hospital policies.
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Affiliation(s)
- Jesús de la Fuente
- Educational Psychology, School of Education and Psychology, University of Navarra, Pamplona, Spain
- Educational Psychology, School of Psychology, University of Almería, Almería, Spain
| | - Juan Manuel García-Torrecillas
- Emergency and Research Unit, University Hospital Torrecárdenas, Almería, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Giulliana Solinas
- Biotechnology, Department of Medicine, University of Sassari, Sassari, Italy
| | | | | | - Javier Fiz-Pérez
- Organizational and Developmental Psychology, Università Europea di Roma, Rome, Italy
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Chou CH, Yin JH, Chen SY, Lin CC, Sung YF, Chung CH, Chien WC, Tsai CK, Tsai CL, Lin GY, Lin YK, Lee JT. The potential impact of sleep-related movement disorders on stroke risk: a population-based longitudinal study. QJM 2017; 110:649-655. [PMID: 28482057 PMCID: PMC5914305 DOI: 10.1093/qjmed/hcx097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Sleep-related movement disorders (SRMD) have been shown to increase the risk of cardiovascular diseases. However, the relationship between SRMD and stroke remains unclear. AIM To explore the relationship between SRMD and stroke in the general population. DESIGN Two cohorts of patients with SRMD and without SRMD were followed up for the occurrence of hemorrhagic and ischemic stroke. METHODS The study cohort enrolled 604 patients who were initially diagnosed as SRMD between 2000 and 2005. 2,416 age- and sex-matched patients without prior stroke were selected as the comparison cohort. A Cox-proportional hazard regression analysis was performed for multivariate adjustment. RESULTS Patients with SRMD had a higher risk for developing all-cause stroke [adjusted hazard ratio (HR) = 2.29, 95% confidence interval (CI) = 1.42-3.80]. Patients of below 45 years old had the greatest stroke risk (HR = 4.03, 95% CI = 3.11-5.62), followed by patients aged ≥65 years (HR = 2.64, 95% CI = 1.12-3.44) and 45-64 years (HR = 1.07, 95% CI = 1.02-1.71). The age-stratified analysis suggested that the increased risk of hemorrhagic stroke was more significant than ischemic stroke among all age groups. Furthermore, males with SRMD were at greater risk to develop all-cause stroke (HR = 2.98, 95% CI = 1.74-4.50) than that of females (HR = 1.94, 95% CI = 1.01-3.77). CONCLUSIONS Patients with SRMD were found to have an increased risk of all-cause stroke along with a higher possibility of hemorrhagic stroke over ischemic stroke.
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Affiliation(s)
- C-H Chou
- From the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - J-H Yin
- From the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Division of Neurology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan, R.O.C
| | - S-Y Chen
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taiwan, R.O.C
- Department of Hyperbaric Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan, R.O.C
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, R.O.C
| | - C-C Lin
- From the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Y-F Sung
- From the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - C-H Chung
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, R.O.C
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - W-C Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - C-K Tsai
- From the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - C-L Tsai
- From the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - G-Y Lin
- From the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Y-K Lin
- From the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - J-T Lee
- From the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C
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Zhou XH, Wang X, Duncan A, Hu G, Zheng J. Statistical evaluation of adding multiple risk factors improves Framingham stroke risk score. BMC Med Res Methodol 2017; 17:58. [PMID: 28410581 PMCID: PMC5391616 DOI: 10.1186/s12874-017-0330-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 03/27/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Framingham Stroke Risk Score (FSRS) is the most well-regarded risk appraisal tools for evaluating an individual's absolute risk on stroke onset. However, several widely accepted risk factors for stroke were not included in the original Framingham model. This study proposed a new model which combines an existing risk models with new risk factors using synthesis analysis, and applied it to the longitudinal Atherosclerosis Risk in Communities (ARIC) data set. METHODS Risk factors in original prediction models and new risk factors in proposed model had been discussed. Three measures, like discrimination, calibration and reclassification, were used to evaluate the performance of the original Framingham model and new risk prediction model. RESULTS Modified C-statistics, Hosmer-Lemeshow Test and classless NRI, class NRI were the statistical indices which, respectively, denoted the performance of discrimination, calibration and reclassification for evaluating the newly developed risk prediction model on stroke onset. It showed that the NEW-STROKE (new stroke risk score prediction model) model had higher modified C-statistics, smaller Hosmer-Lemeshow chi-square values after recalibration than original FSRS model, and the classless NRI and class NRI of the NEW-STROKE model over the original FSRS model were all significantly positive in overall group. CONCLUSION The NEW-STROKE integrated with seven literature-derived risk factors outperformed the original FSRS model in predicting the risk score of stroke. It illustrated that seven literature-derived risk factors contributed significantly to stroke risk prediction.
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Affiliation(s)
- Xiao-Hua Zhou
- Changchun University of Chinese Medicine Affiliated Hospital, Changchun, Jilin, China. .,Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, 98195, USA.
| | - Xiaonan Wang
- School of Statistics, Renmin University of China, Beijing, 100872, China
| | | | | | - Jiayin Zheng
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, 98195, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, USA.,School of Mathematical Sciences, Peking University, Beijing, China
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11
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Tsai CL, Chou CH, Lee PJ, Yin JH, Chen SY, Lin CC, Sung YF, Yang FC, Chung CH, Chien WC, Tsai CK, Lee JT. The potential impact of primary headache disorders on stroke risk. J Headache Pain 2016; 17:108. [PMID: 27905079 PMCID: PMC5130928 DOI: 10.1186/s10194-016-0701-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 11/22/2016] [Indexed: 01/03/2023] Open
Abstract
Background Headache such as migraine is associated with stroke. Studies focused on primary headache disorders (PHDs) as a risk factor for stroke are limited. The purpose of this population-based cohort study was to explore whether patients with PHDs were at a high risk for developing stroke. Methods A total of 1346 patients with PHDs were enrolled and compared with 5384 age-, gender- and co-morbidity-matched control cohorts. International Classification of Diseases, Clinical Modification codes were administered for the definition of PHDs, stroke, and stroke risk factors. Cox proportional-hazards regressions were performed for investigating hazard ratios (HR). Results PHDs patients exhibited a 1.49 times (95% CI :1.15–1.98, p < 0.01) higher risk for developing ischaemic stroke compared with that of control cohorts. Both migraine (HR = 1.22, 95% CI :1.13–1.97, p < 0.05) and tension-type headache (HR = 2.29, 95% CI :1.22–2.80, p < 0.01) were associated with an increased risk of ischemic stroke. Females with PHDs were at greater risk of developing ischaemic stroke (HR = 1.49, 95% CI :1.13–1.90, p < 0.01) than those without PHDs. PHDs patient aged 45 to 64 years displayed significantly higher risk to develop ischaemic stroke (HR = 1.50, 95% CI: 1.11–2.10, p < 0.05) than the matched controls. The impact of PHDs on ischaemic stroke risk became gradually apparent by different following time intervals beyond 2 years after first diagnosis. Conclusion PHDs is suggestive of an incremental risk for ischaemic stroke with gender-dependent, age-specific and time-dependent characteristics. Electronic supplementary material The online version of this article (doi:10.1186/s10194-016-0701-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chia-Lin Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Cheng-Kung Road, 11490, Taipei, Taiwan, Republic of China.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chung-Hsing Chou
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Cheng-Kung Road, 11490, Taipei, Taiwan, Republic of China.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Pei-Jung Lee
- Departments of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Jiu-Haw Yin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Cheng-Kung Road, 11490, Taipei, Taiwan, Republic of China.,Division of Neurology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Shao-Yuan Chen
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taiwan, ROC.,Department of Hyperbaric Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan, ROC.,School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Chun-Chieh Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Cheng-Kung Road, 11490, Taipei, Taiwan, Republic of China
| | - Yueh-Feng Sung
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Cheng-Kung Road, 11490, Taipei, Taiwan, Republic of China
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Cheng-Kung Road, 11490, Taipei, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC.,School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Cheng-Kung Road, 11490, Taipei, Taiwan, Republic of China
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Cheng-Kung Road, 11490, Taipei, Taiwan, Republic of China. .,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC.
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12
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Abstract
Stroke is the third leading cause of death in adults. Although vascular disease is the prime contributor to its pathogenesis, dyslipidaemia is not unambiguously established as a risk factor for stroke in the same way that it is for coronary artery disease. Non-statin treatments of dyslipidaemia have not been shown clearly to help in preventing stroke. However, large clinical trials of treatment with statins over a number of years have demonstrated that these drugs decrease ischaemic stroke rates in persons at risk. Whether this reflects the efficacy of statins in lowering low density lipoprotein-cholesterol (LDL-c) concentrations alone or whether additional mechanisms may apply is not clear.
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Affiliation(s)
- Brendan M Buckley
- Department of Pharmacology and Therapeutics, University College Cork, 2200 Cork Airport Business Park, Kinsale Road, Cork, Ireland,
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13
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Nayor M, Enserro DM, Beiser AS, Cheng S, DeCarli C, Vasan RS, Seshadri S. Association of Exhaled Carbon Monoxide With Stroke Incidence and Subclinical Vascular Brain Injury: Framingham Heart Study. Stroke 2015; 47:383-9. [PMID: 26696648 DOI: 10.1161/strokeaha.115.010405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/16/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Exhaled carbon monoxide (CO) is associated with cardiometabolic traits, subclinical atherosclerosis, and cardiovascular disease, but its specific relations with stroke are unexplored. We related exhaled CO to magnetic resonance imaging measures of subclinical cerebrovascular disease cross-sectionally and to incident stroke/transient ischemic attack prospectively in the Framingham Offspring study. METHODS We measured exhaled CO in 3313 participants (age 59±10 years; 53% women), and brain magnetic resonance imaging was available in 1982 individuals (age 58±10 years; 54% women). Participants were analyzed according to tertiles of exhaled CO concentration. RESULTS In age- and sex-adjusted models, the highest tertile of exhaled CO was associated with lower total cerebral brain volumes, higher white-matter hyperintensity volumes, and greater prevalence of silent cerebral infarcts (P<0.05 for all). The results for total cerebral brain volume and white-matter hyperintensity volume were consistent after removing smokers from the sample, and the association with white-matter hyperintensity volume persisted after multivariable adjustment (P=0.04). In prospective analyses (mean follow-up 12.9 years), higher exhaled CO was associated with 67% (second tertile) and 97% (top tertile) increased incidence of stroke/transient ischemic attack relative to the first tertile that served as referent (P<0.01 for both). These results were consistent in nonsmokers and were partially attenuated upon adjustment for vascular risk factors. CONCLUSIONS In this large, community-based sample of individuals without clinical stroke/transient ischemic attack at baseline, higher exhaled CO was associated with a greater burden of subclinical cerebrovascular disease cross-sectionally and with increased risk of stroke/transient ischemic attack prospectively. Further investigation is necessary to explore the biological mechanisms linking elevated CO with stroke.
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Affiliation(s)
- Matthew Nayor
- From the Framingham Heart Study, MA (M.N., A.S.B., S.C., R.S.V., S.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N., S.C.); Departments of Biostatistics (D.M.E., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (A.S.B., S.S) and Sections of Preventive Medicine & Epidemiology and Cardiology, Department of Medicine (R.S.V.), Boston University School of Medicine, MA; and Department of Neurology and Center for Neuroscience, University of California at Davis (C.D.)
| | - Danielle M Enserro
- From the Framingham Heart Study, MA (M.N., A.S.B., S.C., R.S.V., S.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N., S.C.); Departments of Biostatistics (D.M.E., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (A.S.B., S.S) and Sections of Preventive Medicine & Epidemiology and Cardiology, Department of Medicine (R.S.V.), Boston University School of Medicine, MA; and Department of Neurology and Center for Neuroscience, University of California at Davis (C.D.)
| | - Alexa S Beiser
- From the Framingham Heart Study, MA (M.N., A.S.B., S.C., R.S.V., S.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N., S.C.); Departments of Biostatistics (D.M.E., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (A.S.B., S.S) and Sections of Preventive Medicine & Epidemiology and Cardiology, Department of Medicine (R.S.V.), Boston University School of Medicine, MA; and Department of Neurology and Center for Neuroscience, University of California at Davis (C.D.)
| | - Susan Cheng
- From the Framingham Heart Study, MA (M.N., A.S.B., S.C., R.S.V., S.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N., S.C.); Departments of Biostatistics (D.M.E., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (A.S.B., S.S) and Sections of Preventive Medicine & Epidemiology and Cardiology, Department of Medicine (R.S.V.), Boston University School of Medicine, MA; and Department of Neurology and Center for Neuroscience, University of California at Davis (C.D.)
| | - Charles DeCarli
- From the Framingham Heart Study, MA (M.N., A.S.B., S.C., R.S.V., S.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N., S.C.); Departments of Biostatistics (D.M.E., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (A.S.B., S.S) and Sections of Preventive Medicine & Epidemiology and Cardiology, Department of Medicine (R.S.V.), Boston University School of Medicine, MA; and Department of Neurology and Center for Neuroscience, University of California at Davis (C.D.)
| | - Ramachandran S Vasan
- From the Framingham Heart Study, MA (M.N., A.S.B., S.C., R.S.V., S.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N., S.C.); Departments of Biostatistics (D.M.E., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (A.S.B., S.S) and Sections of Preventive Medicine & Epidemiology and Cardiology, Department of Medicine (R.S.V.), Boston University School of Medicine, MA; and Department of Neurology and Center for Neuroscience, University of California at Davis (C.D.)
| | - Sudha Seshadri
- From the Framingham Heart Study, MA (M.N., A.S.B., S.C., R.S.V., S.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N., S.C.); Departments of Biostatistics (D.M.E., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (A.S.B., S.S) and Sections of Preventive Medicine & Epidemiology and Cardiology, Department of Medicine (R.S.V.), Boston University School of Medicine, MA; and Department of Neurology and Center for Neuroscience, University of California at Davis (C.D.)
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Malek AM, Cushman M, Lackland DT, Howard G, McClure LA. Secondhand Smoke Exposure and Stroke: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Prev Med 2015; 49:e89-97. [PMID: 26117341 PMCID: PMC4656115 DOI: 10.1016/j.amepre.2015.04.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/30/2015] [Accepted: 04/21/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Stroke is a major public health concern worldwide given the associated morbidity and mortality. Smoking is a risk factor for stroke, but the relationship between secondhand smoke (SHS) exposure and stroke has been inconsistent to date. The aim of the current study was to examine the association of SHS exposure and risk of stroke and its subtypes (ischemic and hemorrhagic stroke) among nonsmokers. METHODS Demographic and clinical characteristics were compared by SHS exposure status for African American and white nonsmokers aged ≥45 years in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study in 2014. Hazard ratios (HRs) and corresponding 95% CIs were calculated by Cox proportional hazards models to assess the relationship between SHS exposure and stroke risk. RESULTS Of the 21,743 participants (38% African American, 45% male), SHS exposure in the past year was reported by 23%. Compared with those without SHS exposure, exposed participants were more likely to be female, white, younger, and reside with a smoker (all p<0.001). A total of 428 incident strokes were observed from April 2003 to March 2012 during a mean follow-up of 5.6 years. The risk of overall stroke was increased 30% among those with SHS exposure after adjustment for other stroke risk factors (95% CI=2%, 67%). This relationship appeared to be driven by ischemic strokes. CONCLUSIONS SHS exposure is independently associated with an increased risk of stroke. Future studies are needed to confirm these findings and examine the role of long-term effects of SHS exposure on stroke outcomes.
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Affiliation(s)
- Angela M Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont, Colchester, Vermont
| | - Daniel T Lackland
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Leslie A McClure
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
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15
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Samai AA, Martin-Schild S. Sex differences in predictors of ischemic stroke: current perspectives. Vasc Health Risk Manag 2015; 11:427-36. [PMID: 26251609 PMCID: PMC4524454 DOI: 10.2147/vhrm.s65886] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Globally, stroke is a significant public health concern affecting more than 33 million individuals. Of growing importance are the differences between males and females in the predictors and overall risk of stroke. Given that women have a higher lifetime risk for stoke and account for more than half of all stroke deaths, sex-specific stroke risk factors merit investigation and may help target public health interventions. This review aims to discuss the current body of knowledge regarding sex-specific predictors of ischemic stroke including both modifiable and non-modifiable risk factors, as well as specific pathologies known to increase stroke risk.
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Affiliation(s)
- Alyana A Samai
- Department of Neurology, Stroke Program, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Sheryl Martin-Schild
- Department of Neurology, Stroke Program, Tulane University School of Medicine, New Orleans, LA, USA
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16
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Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases 2015; 3:418-429. [PMID: 25984516 PMCID: PMC4419105 DOI: 10.12998/wjcc.v3.i5.418] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 01/14/2015] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients.
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17
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Sacco S, Ornello R, Ripa P, Tiseo C, Degan D, Pistoia F, Carolei A. Migraine and risk of ischaemic heart disease: a systematic review and meta-analysis of observational studies. Eur J Neurol 2015; 22:1001-11. [PMID: 25808832 DOI: 10.1111/ene.12701] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/06/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Several studies have assessed the risk of ischaemic heart diseases in migraineurs, drawing different conclusions. To define and update the issue, a systematic review and meta-analysis of the available observational studies was performed. METHODS PubMed and EMBASE were systematically searched up to April 2014 for observational studies dealing with the risk of any form of ischaemic heart disease in migraineurs. Studies assessing migraine as exposure and several types of ischaemic heart disease as outcomes were included in the analysis. A random effects model was used to pool the effect sizes. RESULTS Out of 3348 records, 15 studies (one case-control, one cross-sectional and 13 cohort studies) were identified and were included in the meta-analysis. The pooled analysis indicated an increased risk of myocardial infarction (pooled adjusted effect estimate 1.33, 95% confidence interval 1.08-1.64; P = 0.007) and of angina (pooled adjusted effect estimate 1.29, 95% confidence interval 1.17-1.43; P < 0.0001) in migraineurs compared to non-migraineurs. CONCLUSIONS Based on our data indicating an association of migraine with myocardial infarction and angina and on previous data showing an association of migraine, and particularly migraine with aura, with an increased risk for stroke, migraine can be appropriately considered an overall risk factor for cardiovascular diseases.
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Affiliation(s)
- S Sacco
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, L'Aquila, Italy
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Tsivgoulis G, Psaltopoulou T, Wadley VG, Alexandrov AV, Howard G, Unverzagt FW, Moy C, Howard VJ, Kissela B, Judd SE. Adherence to a Mediterranean diet and prediction of incident stroke. Stroke 2015; 46:780-5. [PMID: 25628306 PMCID: PMC4621211 DOI: 10.1161/strokeaha.114.007894] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/23/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE There are limited data on the potential association of adherence to Mediterranean diet (MeD) with incident stroke. We sought to assess the longitudinal association between greater adherence to MeD and risk of incident stroke. METHODS We prospectively evaluated a population-based cohort of 30 239 individuals enrolled in REasons for Geographic and Racial Differences in Stroke (REGARDS) study, after excluding participants with stroke history, missing demographic data or food frequency questionnaires, and unavailable follow-up information. Adherence to MeD was categorized using MeD score. Incident stroke was adjudicated by expert panel review of medical records during a mean follow-up period of 6.5 years. RESULTS Incident stroke was identified in 565 participants (2.8%; 497 and 68 cases of ischemic stroke [IS] and hemorrhagic stroke, respectively) of 20 197 individuals fulfilling the inclusion criteria. High adherence to MeD (MeD score, 5-9) was associated with lower risk of incident IS in unadjusted analyses (hazard ratio, 0.83; 95% confidence interval, 0.70-1.00; P=0.046). The former association retained its significance (hazard ratio, 0.79; 95% confidence interval, 0.65-0.96; P=0.016) after adjustment for demographics, vascular risk factors, blood pressure levels, and antihypertensive medications. When MeD was evaluated as a continuous variable, a 1-point increase in MeD score was independently associated with a 5% reduction in the risk of incident IS (95% confidence interval, 0-11%). We documented no association of adherence to MeD with incident hemorrhagic stroke. There was no interaction of race (P=0.37) on the association of adherence to MeD with incident IS. CONCLUSIONS High adherence to MeD seems to be associated with a lower risk of incident IS independent of potential confounders. Adherence to MeD is not related to the risk of incident hemorrhagic stroke.
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Affiliation(s)
- Georgios Tsivgoulis
- From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).
| | - Theodora Psaltopoulou
- From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.)
| | - Virginia G Wadley
- From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.)
| | - Andrei V Alexandrov
- From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.)
| | - George Howard
- From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.)
| | - Frederick W Unverzagt
- From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.)
| | - Claudia Moy
- From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.)
| | - Virginia J Howard
- From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.)
| | - Brett Kissela
- From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.)
| | - Suzanne E Judd
- From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.)
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Park JM, Cho YJ, Lee KB, Park TH, Lee SJ, Han MK, Ko Y, Lee J, Cha JK, Lee BC, Yu KH, Oh MS, Lee JS, Lee J, Bae HJ. Internet-based control recruitment for a case-control study of major risk factors for stroke in Korea: lessons from the experience. J Stroke Cerebrovasc Dis 2014; 23:2559-2565. [PMID: 25238923 DOI: 10.1016/j.jstrokecerebrovasdis.2014.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/28/2014] [Accepted: 05/29/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND This study aimed to estimate the population-attributable risks (PARs) of 9 major risk factors for stroke in Korea through a case-control study and to test the feasibility and validity of internet-based control recruitment. METHODS From April 2008 to September 2009, controls were enrolled via internet after providing consent for participation through a web-based survey. The cases included patients who were admitted to the participating centers due to acute stroke or transient ischemic attack within 7 days of onset during the study period. Each control was age- and sex-matched with 2 cases. Adjusted odd ratios, age-standardized prevalence, and PARs were estimated for the 9 major risk factors using the prevalence of risk factors in the control group and the age and sex characteristics from Korea's national census data. RESULTS In total, 1041 controls were matched to 2082 stroke cases. Because of a shortage of elderly controls in the internet-based recruitment, 248 controls were recruited off-line. The PARs were 23.44%, 10.95%, 51.32%, and 6.35% for hypertension, diabetes, smoking, and stroke history, respectively. Hypercholesterolemia, atrial fibrillation, obesity, coronary heart disease, and a family history of stroke were not associated with stroke. Comparison with education and religion of the control group with that mentioned in the national census data showed a notable difference. CONCLUSIONS The study results imply that internet-based control recruitment for a case-control study requires careful selection of risk factors with high self-awareness and effective strategies to facilitate the recruitment of elderly participants.
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Affiliation(s)
- Jong-Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Yong-Jin Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youngchai Ko
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University College of Medicine, Pyeongchon, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University College of Medicine, Pyeongchon, Korea
| | - Mi-Sun Oh
- Department of Neurology, Hallym University College of Medicine, Pyeongchon, Korea
| | - Ji Sung Lee
- Biostatistical Consulting Unit, Soonchunhyang University Medical Center, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
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Heuschmann PU, Kircher J, Nowe T, Dittrich R, Reiner Z, Cifkova R, Malojcic B, Mayer O, Bruthans J, Wloch-Kopec D, Prugger C, Heidrich J, Keil U. Control of main risk factors after ischaemic stroke across Europe: data from the stroke-specific module of the EUROASPIRE III survey. Eur J Prev Cardiol 2014; 22:1354-62. [DOI: 10.1177/2047487314546825] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 07/21/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Germany
- Clinical Trial Center Würzburg, University Hospital Würzburg, Germany
| | - Julia Kircher
- Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Germany
| | - Tim Nowe
- Department of Neurology, Vivantes Klinikum Neukölln, Germany
| | - Ralf Dittrich
- Department of Neurology, University of Münster, Germany
| | - Zeljko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Croatia
| | - Renata Cifkova
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Center for Cardiovascular Prevention, Charles University Medical School I and Thomayer Hospital, Prague, Czech Republic
| | - Branko Malojcic
- Department of Neurology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Croatia
| | - Otto Mayer
- Department of Medicine II University Hospital Pilsen, Czech Republic
| | - Jan Bruthans
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Center for Cardiovascular Prevention, Charles University Medical School I and Thomayer Hospital, Prague, Czech Republic
| | | | - Christof Prugger
- INSERM U970, Paris Cardiovascular Research Centre, University Paris Descartes, Paris, France
| | - Jan Heidrich
- Epidemiological Cancer Registry North Rhine-Westphalia, Münster, Germany
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
| | - Ulrich Keil
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
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van Zyl S, van der Merwe LJ, Walsh CM, van Rooyen FC, van Wyk HJ, Groenewald AJ. A risk-factor profile for chronic lifestyle diseases in three rural Free State towns. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2010.10873940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Wajima D, Nakagawa I, Takamura Y, Aketa S, Yonezawa T, Nakase H. Carotid artery stenosis is exacerbated in spontaneously obese model rats with diabetes. J Atheroscler Thromb 2014; 21:1253-9. [PMID: 25069812 DOI: 10.5551/jat.24661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Population studies have shown obesity and diabetes to be risk factors for atherosclerosis. We assessed changes in the common carotid arteries in rat models of obesity and diabetes without hypertension. METHODS Twenty 30-week-old male spontaneously diabetic and obese model Otsuka Long-Evans Tokushima Fatty (OLETF) and 20 control Long-Evans Tokushima Otsuka (LETO) rats were used in the experiments. The animals were considered diabetic if the plasma glucose level peaked at >300 mg/dL and remained at >200 mg/dL for 120 minutes. Blood gas physiological parameters were continuously monitored under anesthesia, and the flow of the carotid artery was assessed with ultrasonography. All animals were sacrificed with an overdose of anesthesia at the end of the experiment. Sections of the middle portion of the internal carotid artery were cut and stained with hematoxylin and eosin to assess the overall morphology. RESULTS All OLETF rats were diabetic, and all LETO rats were non-diabetic. The physiological parameters did not differ significantly between the control and model rats, whereas the carotid artery wall thickness (19.3 ± 3.2 vs. 6.1 ± 4.5 μm) was significantly different between the two groups. The blood flow velocity in the common carotid artery determined using ultrasonography and color Doppler sonography was significantly increased during systole in the model rats compared with that observed in the control rats (203 ± 20.3 vs. 55.3 ± 21.4 cm/sec). CONCLUSIONS The OLETF rats were obese, and diabetes worsened the degree of carotid artery stenosis. These results indicate the possibility of new therapies for carotid artery stenosis in obese and diabetic patients.
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Husaini B, Cain V, Novotny M, Samad Z, Levine R, Moonis M. Variation in risk factors of dementia among four elderly patient cohorts. World J Neurol 2014; 4:7-11. [DOI: 10.5316/wjn.v4.i2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/07/2014] [Accepted: 06/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine variation in risk factors that contributed to dementia among four elderly cohorts by race and gender.
METHODS: We examined 2008 Tennessee Hospital Discharged database for vascular factors that play a role in both stroke and dementia. Risk factors for dementia were examined for black and white patients aged 65+. Four race-gender groups of patients-white males (WM), black males (BM), white females (WF), and black females (BF) were compared for prevalence of dementia and stroke. A logistic model predicting dementia in each group separately used several vascular factors affecting dementia directly or indirectly through stroke.
RESULTS: Three point six percent of patients hospitalized in 2008 had dementia and dementia was higher among females than males (3.9% vs 3.2%, P < 0.001), and higher among blacks than whites (4.2% vs 3.5%, P < 0.000). Further, BF had higher prevalence of dementia than WF (4.2% vs 3.8%, P < 0.001); similarly BM had more dementia than WM (4.1% vs 3.1%, P < 0.001). In logistic regression models, however, different patterns of risk factors were associated with dementia in four groups: among WF and WM, hypertension, diabetes, congestive heart failure, and stroke predicted dementia. Among BF and BM, only stroke and diabetes were related to dementia.
CONCLUSION: Aggressive management of risk factors (hypertension and diabetes) may subsequently reduce stroke and dementia hospitalization.
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Modifiable etiological factors and the burden of stroke from the Rotterdam study: a population-based cohort study. PLoS Med 2014; 11:e1001634. [PMID: 24781247 PMCID: PMC4004543 DOI: 10.1371/journal.pmed.1001634] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 03/17/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Stroke prevention requires effective treatment of its causes. Many etiological factors for stroke have been identified, but the potential gain of effective intervention on these factors in terms of numbers of actually prevented strokes remains unclear because of the lack of data from cohort studies. We assessed the impact of currently known potentially modifiable etiological factors on the occurrence of stroke. METHODS AND FINDINGS This population-based cohort study was based on 6,844 participants of the Rotterdam Study who were aged ≥55 y and free from stroke at baseline (1990-1993). We computed population attributable risks (PARs) for individual risk factors and for risk factors in combination to estimate the proportion of strokes that could theoretically be prevented by the elimination of etiological factors from the population. The mean age at baseline was 69.4 y (standard deviation 6.3 y). During follow-up (mean follow-up 12.9 y, standard deviation 6.3 y), 1,020 strokes occurred. The age- and sex-adjusted combined PAR of prehypertension/hypertension, smoking, diabetes mellitus, atrial fibrillation, coronary disease, and overweight/obesity was 0.51 (95% CI 0.41-0.62) for any stroke; hypertension and smoking were the most important etiological factors. C-reactive protein, fruit and vegetable consumption, and carotid intima-media thickness in combination raised the total PAR by 0.06. The PAR was 0.55 (95% CI 0.41-0.68) for ischemic stroke and 0.70 (95% CI 0.45-0.87) for hemorrhagic stroke. The main limitations of our study are that our study population comprises almost exclusively Caucasians who live in a middle and high income area, and that risk factor awareness is higher in a study cohort than in the general population. CONCLUSIONS About half of all strokes are attributable to established causal and modifiable factors. This finding encourages not only intervention on established etiological factors, but also further study of less well established factors. Please see later in the article for the Editors' Summary.
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Lee JT, Chung WT, Lin JD, Peng GS, Muo CH, Lin CC, Wen CP, Wang IK, Tseng CH, Kao CH, Hsu CY. Increased risk of stroke after septicaemia: a population-based longitudinal study in Taiwan. PLoS One 2014; 9:e89386. [PMID: 24586739 PMCID: PMC3931764 DOI: 10.1371/journal.pone.0089386] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/20/2014] [Indexed: 11/18/2022] Open
Abstract
Inflammation and infection have been noted to increase stroke risk. However, the association between septicaemia and increased risk of stroke remains unclear. This population-based cohort study, using a National Health Insurance database, aimed to investigate whether patients with septicaemia are predisposed to increased stroke risk. The study included all patients hospitalised for septicaemia for the first time between 2000 and 2003 without prior stroke. Patients were followed until the end of 2010 to evaluate incidence of stroke. An age-, gender- and co-morbidities-matched cohort without prior stroke served as the control. Cox's proportional hazards regressions were used to assess differences in stroke risk between groups. Based on hazard ratios (HRs), patients with septicaemia had greater stroke risk, especially in the younger age groups (age <45: HR = 4.16, 95% CI: 2.39-7.24, p<0.001; age 45-64: HR = 1.76, 95% CI: 1.41-2.19, p<0.001; age ≥ 65: HR = 1.05, 95% CI: 0.91-1.22, p>0.05). Haemorrhagic stroke was the dominant type (ischaemic stroke: HR = 1.20, 95% CI: 1.06-1.37, p<0.01; haemorrhagic stroke: HR = 1.82, 95% CI: 1.35-2.46, p<0.001) and patients without co-morbidities were at slightly higher risk (without co-morbidities: HR = 1.49, 95% CI: 1.02-2.17, p<0.05; with co-morbidities: HR = 1.24, 95% CI: 1.10-1.41, p<0.001). The impact of septicaemia on stroke risk was highest within 6 months of the event and gradually declined over time. Our results suggest that septicaemia is associated with an increase in stroke risk, which is greatest in haemorrhagic stroke. Closer attention to patients with history of septicaemia may be warranted for stroke preventive measures, especially for younger patients without co-morbidities.
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Affiliation(s)
- Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- * E-mail:
| | - Wen Ting Chung
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Jin-Ding Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Giia-Sheun Peng
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chih-Hsin Muo
- Department of Public Health, China Medical University Hospital, Taichung, Taiwan, Republic of China
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Chi-Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan, Republic of China
| | - I-Kuan Wang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan, Republic of China
- Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
- Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Chun-Hung Tseng
- Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan, Republic of China
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Nobel L, Mayo NE, Hanley J, Nadeau L, Daskalopoulou SS. MyRisk_Stroke Calculator: A Personalized Stroke Risk Assessment Tool for the General Population. J Clin Neurol 2014; 10:1-9. [PMID: 24465256 PMCID: PMC3896642 DOI: 10.3988/jcn.2014.10.1.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 06/19/2013] [Accepted: 06/19/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE There is a variety of stroke risk factors, and engaging individuals in reducing their own personal risk is hugely relevant and could be an optimal dissemination strategy. The aim of the present study was to estimate the stroke risk for specific combinations of health- and lifestyle-related factors, and to develop a personalized stroke-risk assessment tool for health professionals and the general population (called the MyRisk_Stroke Calculator). METHODS This population-based, longitudinal study followed a historical cohort formed from the 1992 or 1998 Santé Québec Health Surveys with information for linkage to health administrative databases. Stroke risk factors were ascertained at the time of survey, and stroke was determined from hospitalizations and death records. Cox proportional hazards models were used, modeling time to stroke in relationship to all variables. RESULTS A total of 358 strokes occurred among a cohort of 17805 persons (men=8181) who were followed for approximately 11 years (i.e., -200000 person-years). The following regression parameters were used to produce 10-year stroke-risk estimates and assign risk points: for age (1 point/year after age 20 years), male sex (3 points), low education (4 points), renal disease (8 points), diabetes (7 points), congestive heart failure (5 points), peripheral arterial disease (2 points), high blood pressure (2 points), ischemic heart disease (1 point), smoking (8 points), >7 alcoholic drinks per week (3 points), low physical activity (2 points), and indicators of anger (4 points), depression (4 points), and anxiety (3 points). According to MyRisk_Stroke Calculator, a person with <50, 75, and 90 risk points has a 10-year stroke risk of <3%, 28%, and >75%, respectively. CONCLUSIONS The MyRisk_Stroke Calculator is a simple method of disseminating information to the general population about their stroke risk.
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Affiliation(s)
- Lisa Nobel
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. ; Division of Clinical Epidemiology, Department of Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Nancy E Mayo
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. ; Division of Clinical Epidemiology, Department of Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - James Hanley
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. ; Division of Clinical Epidemiology, Department of Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Lyne Nadeau
- Division of Clinical Epidemiology, Department of Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Stella S Daskalopoulou
- Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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ALDH2 protects against stroke by clearing 4-HNE. Cell Res 2013; 23:915-30. [PMID: 23689279 PMCID: PMC3698638 DOI: 10.1038/cr.2013.69] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 02/05/2013] [Accepted: 03/20/2013] [Indexed: 12/16/2022] Open
Abstract
Aldehyde dehydrogenase 2 (ALDH2) is a mitochondrial enzyme that metabolizes ethanol and toxic aldehydes such as 4-hydroxy-2-nonenal (4-HNE). Using an unbiased proteomic search, we identified ALDH2 deficiency in stroke-prone spontaneously hypertensive rats (SHR-SP) as compared with spontaneously hypertensive rats (SHR). We concluded the causative role of ALDH2 deficiency in neuronal injury as overexpression or activation of ALDH2 conferred neuroprotection by clearing 4-HNE in in vitro studies. Further, ALDH2-knockdown rats revealed the absence of neuroprotective effects of PKCε. Moderate ethanol administration that is known to exert protection against stroke was shown to enhance the detoxification of 4-HNE, and to protect against ischemic cerebral injury through the PKCε-ALDH2 pathway. In SHR-SP, serum 4-HNE level was persistently elevated and correlated inversely with the lifespan. The role of 4-HNE in stroke in humans was also suggested by persistent elevation of its plasma levels for at least 6 months after stroke. Lastly, we observed that 21 of 1 242 subjects followed for 8 years who developed stroke had higher initial plasma 4-HNE levels than those who did not develop stroke. These findings suggest that activation of the ALDH2 pathway may serve as a useful index in the identification of stroke-prone subjects, and the ALDH2 pathway may be a potential target of therapeutic intervention in stroke.
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Reboldi G, Angeli F, Verdecchia P. Multivariable analysis in cerebrovascular research: practical notes for the clinician. Cerebrovasc Dis 2013; 35:187-93. [PMID: 23429297 DOI: 10.1159/000345491] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/24/2012] [Indexed: 11/19/2022] Open
Abstract
The term 'multivariate analysis' is often used when one is referring to a multivariable analysis. 'Multivariate', however, implies a statistical analysis with multiple outcomes. In contrast, multivariable analysis is a statistical tool for determining the relative contributions of various factors to a single event or outcome. The purpose of this article is to focus on analyses where multiple predictors are considered. Such an analysis is in contrast to a univariable (or 'simple') analysis, where single predictor variables are considered. We review the basics of multivariable analyses, what assumptions underline them and how they should be interpreted and evaluated.
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Affiliation(s)
- Gianpaolo Reboldi
- Department of Internal Medicine, University of Perugia, Perugia, Italy.
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Veiga Abecasis P, Chimenos-Küstner E. Can Orthopantomography be used as a tool for screening of carotid atheromatous pathology and thus be used to help reduce the prevalence of ischemic stroke within the population? J Clin Exp Dent 2012; 4:e19-22. [PMID: 24558519 PMCID: PMC3908804 DOI: 10.4317/jced.50643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 11/03/2011] [Indexed: 11/21/2022] Open
Abstract
Objective: To assess the possibility of Dentists being able to screen patients with higher risk of vascular diseases.
Material: Kodak 8000C Orthopantomographer, eco-Doppler Logiq-500 General Electric at the Lisbon Hospital Particular.
Methods: Assessment of orthopantomographies made to 142 patients aged 50 or more, as well as the existing risk factors. Conduction of carotid eco-Doppler to patients who appear to have calcified plaques of the atheroma.
Results: Strong dependence between dichotomised age and having the pathology (p = 0.02).Smokers are twice more likely to present plaques (OR= 2). Being hypertensive increases in about 1.4 the likelihood of having a stroke (OR= 1.4).
Of the 27 individuals who presented calcifications in the Orthopantomography, they were all submitted to an eco-Doppler and 21 had the pathology confirmed. 27 individuals, who did not show any plaques in the Orthopantomography, were randomly selected to be the control group. They were submitted to an eco-Doppler. And 23 confirmed the non-existence of plaques.
Conclusions: Orthopantomography used for assessing the oral cavity reveals more information which should be the object of the Dentist’s attention.
Key words:Orthopantomography, atheroma, stroke.
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Affiliation(s)
- Pedro Veiga Abecasis
- Assistente auxiliar, Instituto Superior de Ciências da Saúde-Egas Moniz- Departamento de Imagiologia
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Ji X, Wang A, Trandafir CC, Kurahashi K. Influence of experimental subarachnoid hemorrhage on nicotine-induced contraction of the rat basilar artery in relation to arachidonic acid metabolites signaling pathway. J Stroke Cerebrovasc Dis 2011; 22:951-8. [PMID: 22209310 DOI: 10.1016/j.jstrokecerebrovasdis.2011.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 11/23/2011] [Accepted: 12/01/2011] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Smoking is one of the most important risk factors for cerebral circulatory disorders. The purpose of this study was to investigate the influence of experimental subarachnoid hemorrhage (SAH) on nicotine-induced contraction (arachidonic acid metabolites) in the basilar arteries of rats. METHODS Rats were killed at 1 hour and 1 week after blood injection, and the basilar artery was isolated and cut into a spiral strip. RESULTS Testing of cyclooxygenase-1 (COX-1) and 5-lipoxygenase (5-LOX) inhibitors revealed no significant differences in their effects on normal and SAH (1 hour and 1 week). Phospholipase C (PLC) inhibitor (1-(6-((17beta-3-methoxyestra-1,3,5(10)-trien-17yl)amino)hexyl)-1H-pyrrole-2,5,-dione [U-73122]) slightly inhibited contraction of SAH (1 hour and 1 week) when compared to controls. Phospholipase A2 (PLA2) inhibitor (manoalide) and cytosolic PLA2 (cPLA2) inhibitor (arachidonyltrifluoromenthylketone [AACOCF3]) more strongly attenuated contraction in SAH (1 hour and 1 week) than in controls. Secreted PLA2 (sPLA2) inhibitor (indoxam), PLC inhibitor (2-nitro-4-carboxyphenyl N, N-diphenylcarbamate [NCDC]), and COX-2 inhibitors (nimesulide, (5-methanesulfonamido-6-(2,4-difluorothiophenyl)-1-indanone) [L-745337], and celecoxib) only slightly inhibited contraction of SAH (1 week) when compared to normal and SAH (1 hour). The calcium-independent PLA2 (iPLA2) inhibitor bromoenol lactone (BEL) showed greater inhibition of contraction in SAH (1 hour) when compared to normal and SAH (1 week). CONCLUSIONS One week after exposure to SAH, PLC, sPLA2, and COX-2 activity were enhanced and cPLA2 activity was inhibited. One hour after exposure to SAH, PLC activity was enhanced and cPLA2 and iPLA2 activity was inhibited. Such changes of inflammatory arachidonic acid metabolites by smoking after SAH may play important roles in fatal cerebral circulatory disorders, suggesting important implications for the etiology and pathogenesis of SAH.
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Affiliation(s)
- Xu Ji
- Pharmacology Division, Radioisotope Research Center, Kyoto University, Kyoto, Japan.
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Wajima D, Nakamura M, Horiuchi K, Takeshima Y, Nishimura F, Nakase H. Cilostazol minimizes venous ischemic injury in diabetic and normal rats. J Cereb Blood Flow Metab 2011; 31:2030-40. [PMID: 21505475 PMCID: PMC3208148 DOI: 10.1038/jcbfm.2011.47] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We evaluated the effects of cilostazol on venous infarction produced by a photothrombotic two-vein occlusion (2VO) model in diabetic and control rats. The cerebral blood flow (CBF) between the occluded veins was measured by laser Doppler flowmetry for 4 hours after 2VO. Infarct size and immunohistochemistry were evaluated 24, 48, 96, and 168 hours after 2VO. Cilostazol was administered 1 hour after 2VO, and thereafter at a continuous oral dose of 60 mg/kg per day. Cilostazol reduced the infarct size, and the number of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL)-positive apoptotic and B-cell lymphoma 2-associated X protein (Bax)-positive cells, and improved the CBF in control rats. In diabetic rats, cilostazol reduced the infarct size, and the number of TUNEL-positive apoptotic and Bax-positive cells, 96 and 168 hours after 2VO, but did not improve the CBF 4 hours after 2VO. Cilostazol increased the number of B-cell lymphoma 2 (Bcl-2)-positive cells in both strains 48, 96, and 168 hours after 2VO, but did not improve vessel wall thickness or collagen deposits. Cilostazol appeared to limit venous infarcts by improving the penumbral CBF in nondiabetic rats, and inhibited pro-apoptotic changes through Bcl-2 overexpression, without improving the CBF in diabetic rats.
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Affiliation(s)
- Daisuke Wajima
- Department of Neurosurgery, Nara Medical University School of Medicine, Nara, Japan
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Bentley RT, March PA. Recurrent vestibular paroxysms associated with systemic hypertension in a dog. J Am Vet Med Assoc 2011; 239:652-5. [DOI: 10.2460/javma.239.5.652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Garg N, Rajpurohit N, Flaker G. Clopidogrel hydrogen sulphate for atrial fibrillation. Expert Opin Pharmacother 2011; 12:1781-7. [PMID: 21663525 DOI: 10.1517/14656566.2011.587118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Atrial fibrillation is a common cardiac rhythm abnormality with a considerable cardiovascular disease burden worldwide. It is an independent major risk factor for stroke. Stroke prevention with anticoagulation or antiplatelet agents has been an important area of clinical research. Warfarin is the most widely used antithrombotic therapy for stroke prophylaxis for last several years, and now dabigatran (150 mg b.i.d.) is more effective than warfarin in stroke prevention in individuals at increased of stroke. In addition, several studies have evaluated the efficacy of clopidogrel for stroke prophylaxis either alone or in combination with aspirin. AREAS COVERED This review summarizes the key findings of the trials looking at the efficacy of clopidogrel in stroke prevention. A literature search was performed using PubMed and Google Scholar. The trials that evaluated the efficacy of clopidogrel in preventing atherothrombotic events or stroke were also included. EXPERT OPINION Clopidogrel prevents more vascular events, including stroke, in patients with a recent myocardial infarction, stroke or peripheral vascular disease than aspirin. Combination of clopidogrel and aspirin provides a greater reduction of stroke than aspirin or clopidogrel monotherapy, but at an increased risk of bleeding. Dual antiplatelet therapy (clopidogrel and aspirin) is inferior to warfarin in primary stroke prevention for patient with atrial fibrillation and thus should be considered for stroke prophylaxis only in patients ineligible for warfarin. However, with the advent of newer agents, like direct thrombin inhibitors and Factor Xa inhibitors, the role of antiplatelet therapy for stroke prevention in atrial fibrillation remains unclear.
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Affiliation(s)
- Nadish Garg
- University of Missouri-Columbia, Division of Cardiovascular Medicine, Five Hospital Drive, CE306, Columbia, MO 65212, USA
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Sergeev AV, Carpenter DO. Geospatial patterns of hospitalization rates for stroke with comorbid hypertension in relation to environmental sources of persistent organic pollutants: results from a 12-year population-based study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2011; 18:576-585. [PMID: 20938749 DOI: 10.1007/s11356-010-0399-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Accepted: 09/27/2010] [Indexed: 05/30/2023]
Abstract
PURPOSE Recent evidence indicates that exposure to persistent organic pollutants (POPs) is emerging as an important risk factor for atherosclerosis-related diseases, including stroke. Hypertension (HTN) is a major risk factor for stroke, and some studies suggest that exposure to POPs is also a risk factor for HTN. We hypothesized that POPs increase the environmental burden of stroke with comorbid HTN. METHODS A population-based study of hospitalization rates for stroke with comorbid HTN in populations presumably exposed to POPs, based on the zip code of residence, was conducted. Data on hospitalizations for stroke with comorbid HTN were obtained from the New York Statewide Planning and Research Cooperative System for 1993-2004. Relative risks, with 95% confidence intervals (RR, 95% CI), of hospitalization were estimated by multiple Poisson regression analysis. RESULTS RR of hospitalization for stroke with comorbid HTN was 13.4% higher in populations residing in zip codes containing or abutting environmental sources of POPs (RR = 1.134; 95% CI, 1.036-1.241; p = 0.006). Also, hospitalization rates were significantly higher in males than in females (RR = 1.397; 95% CI, 1.357-1.437; p < 0.001), in African Americans than in Caucasians (RR = 3.902; 95% CI, 3.617-4.208; p < 0.001), and in older age groups (p for trend < 0.001). These statistically significant findings of the effect of demographic factors are highly consistent with the current knowledge of stroke and serve as indirect quality indicators for our model. CONCLUSIONS Results of our study support the hypothesis that exposure to POPs increases the environmental burden of both stroke and HTN.
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Affiliation(s)
- Alexander V Sergeev
- Department of Social and Public Health, Ohio University, Grover Center W343, Athens, OH 45701, USA.
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Maász A, Szolnoki Z, Balikó L, Melegh B. Genetics of ischemic stroke: where are we now? Orv Hetil 2011; 152:455-63. [DOI: 10.1556/oh.2011.29069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
As stroke is the third leading cause of death after heart failure and tumors worldwide, cerebrovascular diseases reached substantial attention. In the past few years, significant progression has been seen in identification of genetic variants in the background of stroke and other cerebrovascular and cardiovascular events. Examination of these variants is a new approach to recognize pathogenesis of disorders that hopefully helps in future prevention and prospects of screening and, optimistically, it contributes to special care of patients susceptible for stroke. In the background of ischemic stroke several genetic variants have been identified, which localize in genes encoding proteins involved in hemostasis, renin-angiotensin system and lipid metabolism. The number of these variants exponentially increases permanently due to rapid spreading of genome wide association studies. The goal of this review is to summarize the results of genetic studies on ischemic stroke. Here the authors focus on genetic variants which can have major role in personalized medicine and prevention of stroke. Orv. Hetil., 2011, 152, 455–463.
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Affiliation(s)
- Anita Maász
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Orvosi Genetikai Intézet Pécs Szigeti út 12. 7624
| | - Zoltán Szolnoki
- Pándy Kálmán Kórház Neurológia és Agyérbetegségek Osztály Gyula
| | - László Balikó
- Veszprém Megyei Cholnoky Ferenc Kórház Neurológiai Osztály Veszprém
| | - Béla Melegh
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Orvosi Genetikai Intézet Pécs Szigeti út 12. 7624
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Icks A, Scheer M, Genz J, Giani G, Glaeske G, Hoffmann F. Stroke in the diabetic and non-diabetic population in Germany: relative and attributable risks, 2005-2007. J Diabetes Complications 2011; 25:90-6. [PMID: 20619691 DOI: 10.1016/j.jdiacomp.2010.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 05/17/2010] [Accepted: 05/28/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Reduction of cardiovascular events has been declared to be a main objective in diabetes care. Little is known about incidences of stroke in the diabetic compared to the non-diabetic population and its trend. We evaluated nationwide incidence of stroke in the diabetic compared to the non-diabetic populations as well as relative and attributable stroke risks due to diabetes in Germany. METHODS Using data of a statutory health insurance (1.6 million members in Germany), we assessed all first strokes in 2005-2007. We estimated sex/age-specific and standardised incidence of strokes in the diabetic and non-diabetic populations and relative and attributable risks due to diabetes. RESULTS A total of 6160 subjects had a first stroke [66.6% male, mean age (S.D.)=67.0 (13.9) years]; 31.4% had diabetes. Incidence per 100,000 person years (standard: 2004 German population) in the diabetic and non-diabetic populations, respectively, is as follows: men: 476 [95% confidence interval (CI)=438-514] and 255 (95% CI=243-266); women: 342 (95% CI=305-378) and 173 (95% CI=163-182). Age-standardised relative risks are as follows: 1.9 (95% CI=1.7-2.0) in men and 2.0 (95% CI=1.8-2.2) in women. The following are attributable risks among exposed: 0.46 (95% CI=0.41-0.51) in men and 0.49 (95% CI=0.43-0.55) in women; population attributable risks are as follows: 0.14 (95% CI=0.11-0.16) in men and 0.14 (95% CI=0.11-0.17) in women. CONCLUSIONS In this nationwide study, we found the stroke risk in the diabetic population to be still significantly increased compared to the non-diabetic population. The risk increase seems to be as high as earlier observations in other countries, despite large efforts to improve diabetes care.
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Affiliation(s)
- Andrea Icks
- Department of Public Health, Center for Health and Society, Heinrich-Heine-University, Düsseldorf, Germany.
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Yau WY, Hankey GJ. Which dietary and lifestyle behaviours may be important in the aetiology (and prevention) of stroke? J Clin Neurosci 2010; 18:76-80. [PMID: 20851607 DOI: 10.1016/j.jocn.2010.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Revised: 04/22/2010] [Accepted: 05/29/2010] [Indexed: 11/25/2022]
Abstract
Prevention of stroke requires optimal control of causal risk factors. However, only three-quarters of all strokes can be attributable to known causal risk factors. We aimed to identify novel risk factors for acute stroke in 48 patients with acute (<1 week) stroke admitted to Royal Perth Hospital Stroke Unit and 47 controls matched for age and sex from the northeast Perth metropolitan area. Patients and controls were interviewed, and had physical measurements and blood taken. Multiple odds ratios (OR) for risk factors, with 95% confidence intervals (CI), were calculated by unconditional multiple logistic regression. Mediterranean diet (OR: 0.1; 95% CI, 0.02-0.4), increased waist-to-hip ratio (OR 4.0, 95% CI, 1.5-11), physical activity during leisure time (OR 0.2; 95% CI, 0.1-0.9), periodontal disease (OR 6.4; 95% CI, 1.5-27), and acute febrile illness (OR 14; 95% CI, 1.5-127) were associated significantly and independently with ischaemic stroke. These preliminary data suggest that certain dietary and lifestyle behaviours may play as important a role in the aetiology (and prevention) of stroke as other conventional causal risk factors for stroke. However, these associations need confirmation from larger randomised trials given the small sample size of the current study.
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Affiliation(s)
- W Y Yau
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
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Feigin VL, Krishnamurthi R. Public health strategies could reduce the global stroke epidemic. Lancet Neurol 2010; 9:847-8. [PMID: 20723839 DOI: 10.1016/s1474-4422(10)70190-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Khandanpour N, Jennings B, Armon MP, Wright A, Willis G, Clark A, Meyer FJ. Do Novel Risk Biomarkers Reflect the Severity of Peripheral Arterial Disease? Angiology 2010; 62:126-33. [DOI: 10.1177/0003319710380681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The association between novel atherosclerotic risk biomarkers and severity of peripheral arterial disease (PAD) was assessed. Patients (n = 133) with PAD were recruited. Established risk biomarkers including low- and high-density cholesterol, triglycerides, and blood pressure were measured. Novel risk biomarkers including plasma C-reactive protein, von Willebrand factor (vWF), interleukin 6, red cell folate (RCF), vitamin B12, total homocysteine (tHcy), and Hcy genotypes were also determined. The severity of PAD was evaluated, using ankle—brachial pressure index (ABPI), brachial—knee, and brachial—ankle pulse wave velocity (bk- and ba-PWV). Plasma tHcy and systolic blood pressure had a positive independent correlation with bk-PWV (β = +0.56, P = .02 and β = +0.38, P < .001, respectively). Red cell folate had an independent inverse correlation with bk-PWV (β = —0.01, P = .01). Systolic blood pressure showed an independent positive correlation with ba-PWV only after adjustment for other risk biomarkers (β = +0.1, P = .04). Novel markers, plasma tHcy, and RCF levels correlated with the severity of PAD.
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Affiliation(s)
- Nader Khandanpour
- University of East Anglia, School of Medicine and Health Policy, Norwich, UK,
| | - Barbara Jennings
- University of East Anglia, School of Medicine and Health Policy, Norwich, UK
| | - Matthew P. Armon
- Norfolk and Norwich University Hospital NHS Trust, Vascular Unit, UK
| | - Anthony Wright
- Institute of Food Research (IFR), Norwich Research Park, Colney, Norwich, UK
| | - Gavin Willis
- Norfolk and Norwich University Hospital NHS Trust, Molecular Genetics Laboratory, UK
| | - Allan Clark
- University of East Anglia, School of Medicine and Health Policy, Norwich, UK
| | - Felicity J. Meyer
- Institute of Food Research (IFR), Norwich Research Park, Colney, Norwich, UK
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Genetics and genomics of stroke: novel approaches. J Am Coll Cardiol 2010; 56:245-53. [PMID: 20633816 DOI: 10.1016/j.jacc.2010.02.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Revised: 02/02/2010] [Accepted: 02/09/2010] [Indexed: 01/11/2023]
Abstract
Evidence for a genetic basis for stroke comes from twin and family studies and from the occurrence of a number of uncommon monogenic disorders, but the contribution of genetic factors identified for stroke so far is small. Advances in genetics and genomics may permit new insights. In recent genome-wide association studies, a number of single-nucleotide polymorphisms have been associated with specific stroke subtypes and major stroke risk factors such as diabetes and atrial fibrillation. These await replication. Studies of messenger ribonucleic acid expression have also shown promise for the development of genomic signatures for stroke classification. Stroke and coronary heart disease share some features of pathophysiology, risk, and treatment, and their genetic and genomic bases also appear to overlap.
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Bacigaluppi M, Comi G, Hermann DM. Animal models of ischemic stroke. Part one: modeling risk factors. Open Neurol J 2010; 4:26-33. [PMID: 20802809 PMCID: PMC2928914 DOI: 10.2174/1874205x01004020026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 12/16/2009] [Accepted: 12/22/2009] [Indexed: 12/14/2022] Open
Abstract
Ischemic stroke is one of the leading causes of long-term disability and death in developed and developing countries. As emerging disease, stroke related mortality and morbidity is going to step up in the next decades. This is both due to the poor identification of risk factors and persistence of unhealthy habits, as well as to the aging of the population. To counteract the estimated increase in stroke incidence, it is of primary importance to identify risk factors, study their effects, to promote primary and secondary prevention, and to extend the therapeutic repertoire that is currently limited to the very first hours after stroke. While epidemiologic studies in the human population are essential to identify emerging risk factors, adequate animal models represent a fundamental tool to dissect stroke risk factors to their molecular mechanism and to find efficacious therapeutic strategies for this complex multi- factorial disorder. The present review is organized into two parts: the first part deals with the animal models that have been developed to study stroke and its related risk factors and the second part analyzes the specific stroke models. These models represent an indispensable tool to investigate the mechanisms of cerebral injury and to develop novel therapies.
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Affiliation(s)
- Marco Bacigaluppi
- Department of Neurology, University Hospital Zurich (USZ), Zurich, Switzerland
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Kumar G, Kalita J, Kumar B, Bansal V, Jain SK, Misra U. Magnetic resonance angiography findings in patients with ischemic stroke from North India. J Stroke Cerebrovasc Dis 2010; 19:146-52. [PMID: 20189091 DOI: 10.1016/j.jstrokecerebrovasdis.2009.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 03/13/2009] [Accepted: 03/17/2009] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND We sought to evaluate the magnetic resonance (MR) angiography (MRA) findings in patients with ischemic stroke (IS) from North India and correlate the changes with various conventional and nonconventional risk factors. METHODS The study took place at a tertiary care teaching hospital. The patients with IS were clinically evaluated including body mass index, dietary habits, and family history of stroke. MR imaging, MRA, and testing for blood sugar, lipid profile, B12, folic acid, and homocysteine were carried out. The MRA abnormalities were considered significant if stenosis was 50% or greater and these were categorized into extracranial (EC), intracranial (IC), or combined lesions. The location of infarct on MR imaging was also noted. RESULTS There were 151 patients whose median age was 60 (22-85) years. The EC MRA was abnormal in 56.3% and the IC MRA in 63.3% of patients, the internal carotid artery being the most common site. Corresponding infarct was present in 64.7% and noncorresponding in 45.3% of patients. The MRA abnormality positively correlated with hypertension and diabetes, and negatively with alcohol consumption. The EC MRA abnormality was more common in upper caste Hindus and Muslims and in the city dwellers. CONCLUSION In North Indian patients with IS, the frequency of EC and IC MRA abnormality lies between Whites and the Orientals.
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Affiliation(s)
- Gyanendra Kumar
- Department of Neurology, University of Missouri-Health Care Columbia, Columbia, MO, USA
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Abstract
Remarkable progress has occurred over the last two decades in stroke interventions. Many have been developed on the basis of their efficacy in other disorders. This "inheritance" approach should continue, but two areas where completely novel therapeutic targets might emerge are the stimulation of neuroplasticity and unraveling the genetic code of stroke heterogeneity (Table 2). For the former, the next steps are to identify small-molecule, nontoxic compounds that most effectively enhance plasticity in animal models, and then subject them to clinical trial in humans. For the latter, more and larger-scale cooperative GWASs in carefully phenotyped stroke populations are required to better understand the polygenic nature of cerebrovascular disease. Then, the physiological relevance of genetic abnormalities can be determined in in vitro and in vivo systems before candidate compounds are developed.
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Wajima D, Nakamura M, Horiuchi K, Miyake H, Takeshima Y, Tamura K, Motoyama Y, Konishi N, Nakase H. Enhanced cerebral ischemic lesions after two-vein occlusion in diabetic rats. Brain Res 2010; 1309:126-35. [DOI: 10.1016/j.brainres.2009.10.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 10/22/2009] [Accepted: 10/24/2009] [Indexed: 11/26/2022]
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Rezaii AA, Hoseinipanah SM, Hajilooi M, Rafiei AR, Shikh N, Haidari M. Interleukin-1 receptor antagonist gene polymorphism and susceptibility to ischemic stroke. Immunol Invest 2009; 38:220-30. [PMID: 19811433 DOI: 10.1080/08820130902745146] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cytokines gene polymorphisms have been implicated in susceptibility to ischemic stroke. This study aims to determine the influence of the polymorphism within the intron 2 of the interleukin- 1 receptor antagonist (IL-1Ra) gene on the susceptibility to stroke. A variable number of tandem repeats (VNTR) in intron 2 of the IL-1Ra gene was analyzed in 148 patients with stroke and 161 healthy volunteers from the same area. The carriage rate of allele 2 of IL-1Ra gene, low producer, was significantly higher in patients with stroke compared to the controls (29% vs 21% p = 0.02). Frequency of IL1RN1/IL1RN1 genotype in the patients was significantly lower than the controls (49% vs 66% p = 0.003). The distribution of homozygous genotypes of IL1RN2 was not different between the controls and stroke patients while the heterozygous genotype was more frequent among the patients. (39% vs 25%, respectively). Multiple logistic regression analysis demonstrated that individuals who carry allele 2 for IL-1Ra gene had a significantly higher risk for ischemic stroke with an odds ratio of 2.48 (95% CI, 1.67, 3.51, p = 0.006). These data suggest that allele 2 of the IL-1Ra intron 2 gene represents a susceptibility factor in the development of ischemic stroke.
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Affiliation(s)
- Ali Akbar Rezaii
- Department of Neurology, Sina Hospital, Hamedan, Hamedan University of Medical Sciences, Iran
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Neau JP, Ingrand P, Godeneche G. Awareness within the French population concerning stroke signs, symptoms, and risk factors. Clin Neurol Neurosurg 2009; 111:659-64. [DOI: 10.1016/j.clineuro.2009.05.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 05/25/2009] [Accepted: 05/31/2009] [Indexed: 10/20/2022]
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Arboix A, García-Eroles L, Comes E, Oliveres M, Targa C, Balcells M, Pujadas R, Massons J. Importance of cardiovascular risk profile for in-hospital mortality due to cerebral infarction. Rev Esp Cardiol 2009. [PMID: 18817678 DOI: 10.1157/13126042] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND OBJECTIVES To investigate cardiovascular risk profiles and their prognostic implications in patients with different subtypes of cerebral infarction. METHODS The study involved the retrospective analysis of data from a hospital stroke registry on 2704 consecutive CI patients who were admitted between 1986 and 2004. Of the 2704 strokes recorded, 770 were classified as thrombotic, 763 as cardioembolic, 733 as lacunar, 324 as undetermined and 114 as atypical. Multivariate analysis was used to compare cardiovascular risk profiles in each subtype and their influence on inhospital mortality. RESULTS Arterial hypertension (AH) was present in 55.5%, atrial fibrillation (AF) in 29.8%, and diabetes mellitus in 23.4%. The in-hospital mortality rate was 12.9%, and in-hospital mortality was independently associated with AF (odds ratio [OR]=2.33; 95% confidence interval [CI], 1.84-2.96), and heart failure (HF) (OR=1.96; 95% CI, 1.33-2.89). In patients with thrombotic stroke, the cardiovascular risk factors associated with in-hospital mortality were HF (OR=2.87; 95% CI, 1.45-5.71), AF (OR=1.80; 95% CI, 1.09-2.96) and age (OR=1.06; 95% CI, 1.04-1.08). In patients with cardioembolic stroke, they were peripheral vascular disease (OR=2.18; 95% CI, 1.17-4.05), previous cerebral infarction (OR=1.75; 95% CI, 1.16-2.63), HF (OR=1.71; 95% CI, 1.01-2.90), and age (OR=1.06; 95% CI, 1.04-1.08). In those with undetermined stroke, they were AH (OR=3.68; 95% CI, 1.78-7.62) and age (OR=1.05; 95% CI, 1.01-1.09). CONCLUSIONS Each cerebral infarction etiologic subtype was associated with its own cardiovascular risk profile. Consequently, the cardiovascular risk factors associated with mortality were also different for each ischemic stroke subtype.
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Affiliation(s)
- Adrià Arboix
- Unidad de Enfermedades Vasculares Cerebrales, Servicio de Neurología, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain.
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Kim MK, Kim JT, Choi SM, Lee SH, Park MS, Cho KH. Phosphodiesterase 4D gene and risk of noncardiogenic ischemic stroke in a Korean population. J Korean Med Sci 2009; 24:307-10. [PMID: 19399275 PMCID: PMC2672133 DOI: 10.3346/jkms.2009.24.2.307] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2007] [Accepted: 06/09/2008] [Indexed: 11/20/2022] Open
Abstract
Recently published studies from different populations provide apparently conflicting evidence on the association between the phosphodiesterase 4D (PDE4D) gene and ischemic stroke. The relationship between a representative PDE4D genotype and ischemic stroke was explored in a case-control study of 205 consecutive Korean patients with noncardiogenic ischemic stroke and 103 healthy controls who were neurologically and radiologically proven to be stroke-free. We selected and genotyped a PDE4D single nucleotide polymorphism (SNP 41, rs152312) as a candidate marker for susceptibility to ischemic stroke because SNP 41 has shown the most significant association with stroke in both a meta-analysis and the original Icelandic study of the PDE4D gene. No significant difference was observed between the cases and controls in the distribution of the PDE4D SNP 41 genotypes. The results from the adjusted conditional logistic regression analysis (adjusted for age, hypertension, diabetes and smoking status) showed no significant association between PDE4D SNP 41 genotypes and an increased risk of noncardiogenic ischemic stroke. The PDE4D gene is not a major risk factor for noncardiogenic ischemic stroke in a Korean population, which supports the recent evidence suggesting that the causative genetic variants of ischemic stroke may differ across populations.
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Affiliation(s)
- Myeong-Kyu Kim
- Department of Neurology, Chonnam National University Medical School and Research Institute of Medical Science, Gwangju, Korea
| | - Jun-Tae Kim
- Department of Neurology, Chonnam National University Medical School and Research Institute of Medical Science, Gwangju, Korea
| | - Sung-Min Choi
- Department of Neurology, Chonnam National University Medical School and Research Institute of Medical Science, Gwangju, Korea
| | - Seung-Han Lee
- Department of Neurology, Chonnam National University Medical School and Research Institute of Medical Science, Gwangju, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School and Research Institute of Medical Science, Gwangju, Korea
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School and Research Institute of Medical Science, Gwangju, Korea
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Abstract
Clinical trials and observational studies provide evidence for a wide range of interventions of proven value for preventing a first or recurrent stroke. The available data indicate that strategies for primordial, primary and secondary stroke prevention are not being optimally implemented. Although specific estimates are difficult to calculate, the impact of improving the use of the wide array of effective stroke preventive interventions would be substantial.
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Affiliation(s)
- Larry B Goldstein
- Department of Medicine Neurology, Center for Cerebrovascular Disease, Center for Clinical Health Policy Research, Duke University and Durham VA Medical Center, Durham, NC 27710, USA.
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Nadareishvili Z, Michaud K, Hallenbeck JM, Wolfe F. Cardiovascular, rheumatologic, and pharmacologic predictors of stroke in patients with rheumatoid arthritis: a nested, case-control study. ACTA ACUST UNITED AC 2008; 59:1090-6. [PMID: 18668583 DOI: 10.1002/art.23935] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the risk of stroke in patients with rheumatoid arthritis (RA) and risk factors associated with stroke. METHODS We performed nested case-control analyses within a longitudinal databank, matching up to 20 controls for age, sex, and time of cohort entry to each patient with stroke. Conditional logistic regression was performed as an estimate of the relative risk of stroke in RA patients compared with those with noninflammatory rheumatic disorders, and to examine severity and anti-tumor necrosis factor (anti-TNF) treatment effects in RA. RESULTS We identified 269 patients with first-ever all-category strokes and 67 with ischemic stroke, including 41 in RA patients. The odds ratio (OR) for the risk of all-category stroke in RA was 1.64 (95% confidence interval [95% CI] 1.16-2.30, P = 0.005), and for ischemic stroke was 2.66 (95% CI 1.24-5.70, P = 0.012). Ischemic stroke was predicted by hypertension, myocardial infarction, low-dose aspirin, comorbidity score, Health Assessment Questionnaire score, and presence of total joint replacement, but not by diabetes, smoking, exercise, or body mass index. Adjusted for cardiovascular and RA risk factors, ischemic stroke was associated with rofecoxib (P = 0.060, OR 2.27 [95% CI 0.97-5.28]), and possibly with corticosteroid use. Anti-TNF therapy was not associated with ischemic stroke (P = 0.584, OR 0.80 [95% CI 0.34-1.82]). CONCLUSION RA is associated with increased risk of stroke, particularly ischemic stroke. Stroke is predicted by RA severity, certain cardiovascular risk factors, and comorbidity. Except for rofecoxib, RA treatment does not appear to be associated with stroke, although the effect of corticosteroids remains uncertain.
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