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Lowry CA, Jin AY. Improving the Social Relevance of Experimental Stroke Models: Social Isolation, Social Defeat Stress and Stroke Outcome in Animals and Humans. Front Neurol 2020; 11:427. [PMID: 32477259 PMCID: PMC7240068 DOI: 10.3389/fneur.2020.00427] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023] Open
Abstract
The outcome of ischemic stroke varies across socioeconomic strata, even among countries with universal health care. Emerging evidence suggests that psychosocial aspects of low socioeconomic status such as social isolation and social defeat stress interact with, and contribute to, stroke pathophysiology. However, experimental investigations of stroke rarely account for such socioeconomic influences. Social isolation in stroke survivors is associated with increased infarction volume, increased risk of post-stroke depression, and worse long-term functional outcome. Social defeat is thought to contribute significantly to chronic stress in low socioeconomic status groups and is associated with poor health outcomes. Chronic stress is also associated with worse post-stroke functional outcome and greater disability even after accounting for stroke severity, vascular risk factors, and access to acute stroke care. Experimental stroke studies which incorporate social isolation or social defeat stress have shown that both tissue and functional stroke outcome is affected by the increased expression of TNF-α and IL-6, increased glucocorticoid production, and suppression of the protooncogene bcl-2. This review explores the consequences of social isolation and social defeat stress on stroke, preclinical stroke models that have been used to investigate these factors, and possible molecular mechanisms underlying the influence of socioeconomic disparities on stroke outcome.
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Affiliation(s)
- Chloe A Lowry
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Albert Y Jin
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the Global Burden of Disease Study 2017. BMC Med 2019; 17:191. [PMID: 31647003 PMCID: PMC6813111 DOI: 10.1186/s12916-019-1397-3] [Citation(s) in RCA: 281] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/25/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Socioeconomic status (SES) is associated with stroke incidence and mortality. Distribution of stroke risk factors is changing worldwide; evidence on these trends is crucial to the allocation of resources for prevention strategies to tackle major modifiable risk factors with the highest impact on stroke burden. METHODS We extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. We analysed trends in global and SES-specific age-standardised stroke incidence, prevalence, mortality, and disability-adjusted life years (DALYs) lost from 1990 to 2017. We also estimated the age-standardised attributable risk of stroke mortality associated with common risk factors in low-, low-middle-, upper-middle-, and high-income countries. Further, we explored the effect of age and sex on associations of risk factors with stroke mortality from 1990 to 2017. RESULTS Despite a growth in crude number of stroke events from 1990 to 2017, there has been an 11.3% decrease in age-standardised stroke incidence rate worldwide (150.5, 95% uncertainty interval [UI] 140.3-161.8 per 100,000 in 2017). This has been accompanied by an overall 3.1% increase in age-standardised stroke prevalence rate (1300.6, UI 1229.0-1374.7 per 100,000 in 2017) and a 33.4% decrease in age-standardised stroke mortality rate (80.5, UI 78.9-82.6 per 100,000 in 2017) over the same time period. The rising trends in age-standardised stroke prevalence have been observed only in middle-income countries, despite declining trends in age-standardised stroke incidence and mortality in all income categories since 2005. Further, there has been almost a 34% reduction in stroke death rate (67.8, UI 64.1-71.1 per 100,000 in 2017) attributable to modifiable risk factors, more prominently in wealthier countries. CONCLUSIONS Almost half of stroke-related deaths are attributable to poor management of modifiable risk factors, and thus potentially preventable. We should appreciate societal barriers in lower-SES groups to design tailored preventive strategies. Despite improvements in general health knowledge, access to healthcare, and preventative strategies, SES is still strongly associated with modifiable risk factors and stroke burden; thus, screening of people from low SES at higher stroke risk is crucial.
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Yao BC, Meng LB, Hao ML, Zhang YM, Gong T, Guo ZG. Chronic stress: a critical risk factor for atherosclerosis. J Int Med Res 2019; 47:1429-1440. [PMID: 30799666 PMCID: PMC6460614 DOI: 10.1177/0300060519826820] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chronic stress refers to the non-specific systemic reaction that occurs when the body is stimulated by various internal and external negative factors over a long time. The physiological response to chronic stress exposure has long been recognized as a potent modulator in the occurrence of atherosclerosis. Furthermore, research has confirmed the correlation between atherosclerosis and cardiovascular events. Chronic stress is pervasive during negative life events and may lead to the formation of plaque. Several epidemiological studies have shown that chronic stress is an independent risk factor for the development of vascular disease and for increased morbidity and mortality in patients with pre-existing coronary artery disease. One possible mechanism for this process is that chronic stress causes endothelial injury, directly activating macrophages, promoting foam cell formation and generating the formation of atherosclerotic plaque. This mechanism involves numerous variables, including inflammation, signal pathways, lipid metabolism and endothelial function. The mechanism of chronic stress in atherosclerosis should be further investigated to provide a theoretical basis for efforts to eliminate the effect of chronic stress on the cardiocerebral vascular system.
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Affiliation(s)
- Bo-Chen Yao
- 1 Graduate College, Tianjin Medical University, Tianjin, China.,2 Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Ling-Bing Meng
- 3 Neurology Department, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P. R. China
| | - Meng-Lei Hao
- 4 Department of geriatric medicine, Qinghai University, Xining, Qinghai, China
| | - Yuan-Meng Zhang
- 5 Internal medicine, Jinzhou Medical University, Linghe District, Jinzhou City, Liaoning Province, China
| | - Tao Gong
- 1 Graduate College, Tianjin Medical University, Tianjin, China
| | - Zhi-Gang Guo
- 2 Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
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Ma YH, Leng XY, Dong Y, Xu W, Cao XP, Ji X, Wang HF, Tan L, Yu JT. Risk factors for intracranial atherosclerosis: A systematic review and meta-analysis. Atherosclerosis 2018; 281:71-77. [PMID: 30658194 DOI: 10.1016/j.atherosclerosis.2018.12.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/13/2018] [Accepted: 12/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Intracranial atherosclerosis (ICAS) is a predictable and preventable condition, but existing evidence concerning its risk factors has not been quantitatively assessed. The aim of this meta-analysis is to identify the non-modifiable and modifiable risk factors for ICAS. METHODS PubMed and EMBASE were searched (1995-May 15, 2018) for cross-sectional and longitudinal studies exploring risk factors for ICAS. The risk estimates and 95% confidence intervals (CIs) in multivariate analysis were aggregated using random-effect models. RESULTS Thirty-four studies comprising 59,736 subjects met the inclusion criteria for the systematic review involving thirty-one risk or protective factors. Seven factors were associated with ICAS, as suggested by the meta-analysis, including advanced age (odds ratio (OR) 1.05, 95% CI 1.03-1.08), metabolic syndrome (OR 2.13, 95% CI 1.35-3.37), diabetes mellitus (OR 1.98, 95% CI 1.69-2.31), hypertension (OR 1.97, 95% CI 1.69-2.31), dyslipidemia (OR 1.29, 95% CI 1.04-1.59), high levels of low-density lipoprotein cholesterol (OR 1.06, 95% CI 1.00-1.12) and high levels of apolipoprotein A1 (OR 0.34, 95% CI 0.15-0.75). The subgroup analysis for study populations indicated advanced age, metabolic syndrome, diabetes mellitus and hypertension as an elevated risk of ICAS among community subjects and stroke patients; according to the subgroup analysis for ethnicity, similar associations remained in Asians, but only metabolic syndrome and diabetes mellitus were correlated with ICAS in Caucasians. CONCLUSIONS Individuals with advanced age, metabolic syndrome, diabetes mellitus, hypertension and dyslipidemia might have a higher risk of ICAS, whereas high levels of apolipoprotein A1 might protect against ICAS.
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Affiliation(s)
- Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China
| | - Xin-Yi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yi Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xi-Peng Cao
- Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xi Ji
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China
| | - Hui-Fu Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China; Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Jin-Tai Yu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
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Mai W, Liu H, Liu X, Chen L, Zhou W. Low HDL-C levels are associated with cervicocerebral atherosclerotic stenosis in Southern Chinese patients with large artery atherosclerotic ischemic stroke. Clin Neurol Neurosurg 2018; 171:79-84. [PMID: 29870886 DOI: 10.1016/j.clineuro.2018.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 02/08/2018] [Accepted: 05/28/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study is to investigate the association of HDL-C with CCAS, as well as its intracranial or extracranial location in the Southern Chinese population. PATIENTS AND METHODS 123 Southern Chinese patients with large-artery atherosclerotic(LAA) ischemic stroke were enrolled for the final analysis. Based on the stenosis severity defined by digital subtraction angiography, the patients were categorized into CCAS and non-CCAS groups. The degree of artery stenosis among patients of CCAS was classified into three grades. CCAS were further categorized into intracranial AS (ICAS), Extracranial AS (ECAS) and combined intra-/extra-cranial AS (IECAS). RESULTS It was showed that patients with CCAS had a lower HDL-C level compared to NCCAS, and HDL-C levels were correlated to the degree of artery stenosis among CCAS. After adjusting for multiple potential confounders, low HDL-C level remained independently associated with CCAS(adjusted OR = 2.860). Patients with the lowest HDL-C quartile had a significantly increased risk for CCAS(adjusted OR: 5.771), referred to the highest quartile. But HDL-C levels in patients with ICAS, ECAS and IECAS were not significantly different, and there was no significant correlation between HDL-C levels and ICAS. CONCLUSION Our data indicate that low HDL-C level is associated with CCAS in Southern Chinese patients with LAA ischemic stroke. But the effects of HDL-C on the distribution of CCAS is required to be further explored.
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Affiliation(s)
- Weihua Mai
- Department of Neurology, The Fifth Affiliated Hospital of Sun Yat-sen University, China.
| | - Hanwei Liu
- Department of Neurology, The Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Xingwei Liu
- Department of General Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Ling Chen
- Department of Medical Quality Control, The Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Wenying Zhou
- Department of Laboratory Science, The Fifth Affiliated Hospital of Sun Yat-sen University, China
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Barreto-Neto N, Barros AD, Jesus PAP, Reis CC, Jesus ML, Ferreira ILO, Fernandes RD, Resende LL, Andrade AL, Gonçalves BM, Ventura LMB, Jesus AA, Fonseca LF, Mueller MC, Oliveira-Filho J. Low Ankle-Brachial Index is a Simple Physical Exam Sign Predicting Intracranial Atherosclerotic Stenosis in Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2016; 25:1417-20. [PMID: 27021041 DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/29/2016] [Indexed: 02/06/2023] Open
Affiliation(s)
- Nestor Barreto-Neto
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
| | - Alexandre D Barros
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Pedro A P Jesus
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Carolina C Reis
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Morgana L Jesus
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Isadora L O Ferreira
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Rodrigo D Fernandes
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lucas L Resende
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Alisson L Andrade
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Beatriz M Gonçalves
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lais M B Ventura
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Adriano A Jesus
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Luana F Fonseca
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Mila C Mueller
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Jamary Oliveira-Filho
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
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