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Nweke M, Mshunqane N. Characterization and stratification of risk factors of stroke in people living with HIV: A theory-informed systematic review. BMC Cardiovasc Disord 2025; 25:405. [PMID: 40426038 PMCID: PMC12107966 DOI: 10.1186/s12872-025-04833-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 05/07/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Identification and stratification of risk factors for stroke among individuals living with HIV (PLWH) will facilitate primary prevention and prognostication, as well as strategies aimed at optimizing neurorehabilitation. This review sought to characterize and stratify the risk factors associated with stroke in PLWH. METHODS The review was structured in accordance with the preferred items for reporting systematic reviews and meta-analysis (PRISMA) checklist. The epidemiological triangle, Bradford criteria, and Rothman causality model further informed the review. The review outcomes encompassed cardiovascular factors, HIV-related factors, and personal and extrinsic factors associated with stroke in PLWH. We conducted searches in PubMed, Scopus, Medline, Web of Science, Cumulative Index for Nursing and Allied Health Literature, and African Journal (SABINET). Data screening and extraction were independently performed utilizing predefined eligibility criteria and a data-extraction template. Narrative synthesis and risk stratification were employed to analyze the results. RESULTS Thirty studies (22 cohorts and eight case-control) with a sample size of 353,995 participants were included in this review. The mean age of the participants was 45.1 ± 10.7 years. The majority of the participants (72.4%) were male. Risk factors for stroke in PLWH include cardiovascular factors (advanced age, tobacco use, hypertension, diabetes, atrial fibrillation, etc.), HIV-related factors (high viral load and low nadir CD4 count), personal factors (advanced age and female sex), and comorbidities (hepatitis C virus infection, chronic kidney disease, coronary artery disease, and liver fibrosis or cirrhosis). Diabetes, atrial fibrillation, smoking habits, hypertension, age, and viral load demonstrated a high likelihood of association with stroke in PLWH and should be prioritized when constructing clinical prediction algorithms for HIV-related stroke. CONCLUSIONS The most important factors were hypertension and chronic kidney disease, followed by smoking, dyslipidemia, diabetes, HCV, HBV, CD4 count, use of ART, TB, and substance use (cocaine). The least important factors were age, sex, ethnicity, obesity, alcohol use, ART duration, and viral load. The predictive significance of these factors is still evolving, given the average moderate certainty of evidence. Predictive and preventative models should target factors with a high causality index and low investigative costs. TRIAL REGISTRATION The review is part of a larger review registered with the PROSPERO (ID: CRD42024524494).
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Affiliation(s)
- Martins Nweke
- Department of Physiotherapy, School of Health Care Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
- Department of Physiotherapy, David Umahi Federal, University of Health Sciences, Ebonyi State, Uburu, Nigeria.
| | - Nombeko Mshunqane
- Department of Physiotherapy, School of Health Care Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
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Cascio Rizzo A, Schwarz G, Bonelli A, Ceresa C, De Chiara B, Moreo A, Sessa M. Sex Differences in Embolic Stroke of Undetermined Source: Echocardiographic Features and Clinical Outcomes. Eur J Neurol 2025; 32:e70133. [PMID: 40186421 PMCID: PMC11971535 DOI: 10.1111/ene.70133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 03/18/2025] [Accepted: 03/25/2025] [Indexed: 04/07/2025]
Abstract
BACKGROUND Sex differences in stroke are well-documented, but in embolic stroke of undetermined source (ESUS) remains underexplored. This study aims to investigate sex-related differences in clinical and cardiac features and stroke outcomes in ESUS. METHODS Retrospective observational single-center study including consecutive ESUS patients. Multivariate regression analyses evaluated the association between sex, echocardiographic features, and 90-day outcomes. Cox regression assessed the independent effect of sex on ischemic stroke recurrence, all-cause death, and atrial fibrillation detection after stroke (AFDAS). RESULTS Among 556 patients, 248 (44.6%) were women, who were older and had more severe strokes. Women exhibited larger left atria (LA) as evidenced by a higher LA volume index (adjusted β-coefficient = 2.59, 95% CI 0.53-4.65, p = 0.014) and more valve abnormalities, such as mitral annulus calcification (aOR 2.72; 95% CI 1.43-5.20, p = 0.002). Men showed more markers of left ventricular (LV) disease, including reduced ejection fraction < 50% (aOR 0.44; 95% CI 0.20-0.93, p = 0.033) and LV wall motion abnormalities (aOR 0.37; 95% CI 0.19-0.74, p = 0.005). In multivariate analyses, the female sex was independently associated with reduced all-cause death (aHR 0.59; 95% CI 0.38-0.91, p = 0.019) and showed a trend toward higher AFDAS risk (aHR 1.57; 95% CI 0.99-2.49, p = 0.053). No association was found with 90-day outcomes or stroke recurrence. CONCLUSION ESUS patients exhibit significant sex-based differences in echocardiographic features, with women showing larger LA and more valve abnormalities, while men present greater LV dysfunction. Female sex is independently associated with a lower risk of long-term mortality and a potentially higher risk of AFDAS. These findings underscore the need for individualized, sex-specific ESUS management strategies.
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Affiliation(s)
- Angelo Cascio Rizzo
- Neurology and Stroke UnitASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Ghil Schwarz
- Neurology and Stroke UnitASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Andrea Bonelli
- CardiologyDe Gasperis Cardio Center, ASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Chiara Ceresa
- Neurology and Stroke UnitASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Benedetta De Chiara
- CardiologyDe Gasperis Cardio Center, ASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Antonella Moreo
- CardiologyDe Gasperis Cardio Center, ASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Maria Sessa
- Neurology and Stroke UnitASST Grande Ospedale Metropolitano NiguardaMilanItaly
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Ali KA, Kerrigan DLG, Berkman JM. Influence of Primary Neurologic Disease on Cardiovascular Health in Females. Circ Res 2025; 136:618-627. [PMID: 40080534 DOI: 10.1161/circresaha.124.325545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 02/12/2025] [Accepted: 02/12/2025] [Indexed: 03/15/2025]
Abstract
Neurocardiology is an interdisciplinary field that examines the complex interactions between the nervous and the cardiovascular systems, exploring how neurological processes, such as autonomic nervous system regulation and brain-heart communication impact heart function and contribute to cardiovascular health and disease. Although much of the focus on cardiovascular health has centered on traditional risk factors, the influence of the nervous system, especially in females, is increasingly recognized as a key determinant of cardiovascular outcomes. This article reviews existing literature on the neurological mechanisms that impact cardiovascular function in females. Specifically, we analyze how primary neurological disorders including cerebrovascular disease, headache disorders, and multiple sclerosis have specific downstream effects on cardiac function. By understanding the complex relationship between neurological and cardiovascular health, this review highlights the need for sex-specific approaches to prevention, diagnosis, and treatment of cardiovascular disease in females, ultimately encouraging the discovery of more effective care strategies and improving health outcomes.
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Affiliation(s)
- Khadija Awais Ali
- Department of Neurology, Stroke Divison, Vanderbilt University Medical Center, Nashville, TN
| | - Deborah L G Kerrigan
- Department of Neurology, Stroke Divison, Vanderbilt University Medical Center, Nashville, TN
| | - Jillian Molli Berkman
- Department of Neurology, Stroke Divison, Vanderbilt University Medical Center, Nashville, TN
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Kühne Escolà J, Bozkurt B, Brune B, Milles LS, Pommeranz D, Dammann P, Li Y, Deuschl C, Forsting M, Kill C, Kleinschnitz C, Köhrmann M, Frank B. Sex Differences in Clinical Presentation of Women and Men Evaluated at a Comprehensive Stroke Center for Suspected Stroke. Cerebrovasc Dis Extra 2025; 15:110-117. [PMID: 39938494 DOI: 10.1159/000543835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 01/24/2025] [Indexed: 02/14/2025] Open
Abstract
INTRODUCTION Understanding sex differences in the clinical presentation of patients with suspected stroke is important to reduce sex-related disparities and improve care. We aimed to characterize presenting symptoms in women and men with suspected stroke evaluated at our comprehensive stroke center. METHODS This was a retrospective analysis of consecutive patients with suspected stroke treated at the University Hospital Essen between January 2017 and December 2021. Patient characteristics, signs and symptoms as well as final diagnoses in women and men were compared. Logistic regression analysis was performed to assess the association of individual symptoms with a diagnosis of cerebrovascular disease. RESULTS We included 6,069 patients in our analysis. Cerebrovascular disease was diagnosed in 85.2% (2,576/3,022) of women and 88.0% (2,681/3,047) of men (p = 0.002). Aphasia (31.4% vs. 27.7%, p = 0.002), neglect (15.5% vs. 12.8%, p = 0.003), gaze deviation (21.0% vs. 18.8%, p = 0.034), as well as nonfocal symptoms including impairments in consciousness (17.0% vs 14.6%, p = 0.012), orientation (42.5 vs. 36.4%, p < 0.001), and completion of tasks (31.2% vs. 26.0%, p < 0.001) were more common among women. Limb ataxia (8.1% vs. 11.2%, p < 0.001) and dysarthria (44.0% vs. 46.8%, p = 0.030) were less frequent in women. Neglect and gaze deviation were independent positive predictors of cerebrovascular disease in women but not in men. CONCLUSION Although clinical presentation was similar in both sexes, cortical and nonfocal symptoms were more common among women with suspected stroke. Awareness of sex differences and acknowledgment of the full clinical picture are important to ensure optimal management for women and men with suspected stroke. Our findings might serve as a target for educational programs in order to improve preclinical stroke detection in patients with predominantly nonfocal or subtle symptoms.
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Affiliation(s)
- Jordi Kühne Escolà
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany,
| | - Bessime Bozkurt
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Bastian Brune
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
- Medical Emergency Service of the City of Essen, Essen, Germany
| | - Lennart Steffen Milles
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Doreen Pommeranz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Clemens Kill
- Center of Emergency Medicine, University Hospital Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Martin Köhrmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Benedikt Frank
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
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Liu F, Chen J, Yao Y, Ren R, Yu Y, Hu Y. Sex-specific association of weight-adjusted waist index with mortality in stroke survivors: A national longitudinal cohort study. Nutr Metab Cardiovasc Dis 2025; 35:103743. [PMID: 39448313 DOI: 10.1016/j.numecd.2024.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 09/08/2024] [Accepted: 09/16/2024] [Indexed: 10/26/2024]
Abstract
BACKGROUND AND AIMS The weight-adjusted waist index (WWI) is a novel indicator of obesity, and its association with mortality in stroke patients remains unknown. We aimed to explore these associations through a national longitudinal cohort study. METHODS AND RESULTS We included stroke survivors from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 who were followed up until December 31, 2019. The study outcomes were all-cause and cardiovascular disease (CVD) mortality in stroke patients. A total of 1427 stroke patients were enrolled, and after a median follow-up duration of 83 months, 624 stroke patients died, including 251 from CVD. Kaplan‒Meier survival analyses indicated that WWI was significantly associated with the probability of survival over time in stroke patients (log-rank tests, both p < 0.0001). After adjusting for confounders, WWI was significantly and positively associated with all-cause and CVD mortality after stroke. Restricted cubic spline analysis revealed that WWI was linearly associated with all-cause mortality and nonlinearly associated with CVD mortality. Stratified analyses suggested that sex significantly influenced the effect of WWI on all-cause mortality in stroke patients. Additional body mass index (BMI) adjustments did not significantly change the results. CONCLUSION WWI was positively associated with all-cause and CVD mortality in stroke patients, independent of BMI. These effects were present only in men. These findings suggest that WWI is an independent prognostic factor in stroke patients and that maintaining appropriate WWI values can help improve the prognosis of stroke survivors.
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Affiliation(s)
- Fei Liu
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jiarui Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ying Yao
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Reng Ren
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yue Yu
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yinghong Hu
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
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Abdelhameed A, Abouslima A, Ghanem ASH, Ahmed S, Islam R, Sultana S, Khoudir MA. Propranolol as a Novel Therapeutic Approach for Post-Stroke Anxiety: A Clinical Review and Future Directions. Cureus 2024; 16:e76381. [PMID: 39867038 PMCID: PMC11760769 DOI: 10.7759/cureus.76381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2024] [Indexed: 01/28/2025] Open
Abstract
Stroke remains a leading cause of death globally, with survivors facing both physical and psychological challenges. While acute stroke treatment has improved, many patients develop post-stroke anxiety (PSA), particularly generalized anxiety disorder. PSA represents a significant clinical challenge as most stroke survivors suffer from it. Current management includes lifestyle changes, behavioral therapy, and medications like selective serotonin reuptake inhibitors (SSRIs). Propranolol, a non-selective beta-blocker, has shown promise in treating anxiety disorders by targeting physical symptoms through its effects on the sympathetic nervous system. Its dual benefits in managing both cardiovascular and psychiatric symptoms make it particularly relevant for stroke patients. We aim to evaluate the therapeutic potential of propranolol in managing PSA and to establish a framework for future clinical studies comparing its effectiveness with SSRIs in stroke patients. Propranolol presents a potentially advantageous therapeutic option for post-stroke patients due to its multifaceted clinical benefits. Its dual mechanism of action addresses both neuropsychiatric symptoms and cardiovascular complications, offering simultaneous management of anxiety, cardiac arrhythmias, and hypertension, conditions that frequently coexist in stroke patients. We recommend high-quality randomized trials to estimate the efficiency of propranolol in comparison to other interventions and to estimate the cost-effectiveness while taking into consideration the associated risk.
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Affiliation(s)
| | - Aly Abouslima
- Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR
| | | | - Salma Ahmed
- Cardiology, Faculty of Medicine, Mansoura University, Mansoura, EGY
| | - Rajia Islam
- Neuroscience, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Shahida Sultana
- Neuroscience, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Mohamed A Khoudir
- Neuroscience, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
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7
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Eng PC, Tan LLY, Kimball TN, Prapiadou S, Tan BYQ. Ischemic Stroke in Women: Understanding Sex-Specific Risk Factors, Treatment Considerations, and Outcomes. J Cardiovasc Dev Dis 2024; 11:382. [PMID: 39728272 DOI: 10.3390/jcdd11120382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 11/07/2024] [Accepted: 11/26/2024] [Indexed: 12/28/2024] Open
Abstract
Ischemic stroke is a major cause of mortality and disability and has become a significant public health concern among women. Overall, women have more ischemic stroke events than men, in part due to their longer life span, and also suffer from more severe stroke-related disabilities compared to men. Women are also more likely than men to present with atypical non-focal neurological symptoms, potentially leading to delayed diagnosis and treatment. Female-specific risk factors, especially those related to pregnancy, are often under-recognized. A woman's risk for ischemic stroke evolves throughout her lifespan, influenced by various factors including the age of menarche, pregnancy and its complications (such as parity, pre-eclampsia/eclampsia, and preterm delivery), postpartum challenges, oral contraceptive use, and menopause. Additionally, vascular risk factors like hypertension, diabetes, and atrial fibrillation are more prevalent among older women. Despite comparable treatment efficacies, women generally experience poorer outcomes after stroke. They also face higher rates of post-stroke depression, further complicating recovery. Although significant strides have been made in reducing the incidence of ischemic stroke, our understanding of the unique risks, underlying causes, and long-term consequences for women remains limited. While sex hormones may explain some differences, a lack of awareness regarding sex-related disparities can result in suboptimal care. This review aims to illuminate the unique risks and burdens of ischemic stroke faced by women, advocating for a more nuanced understanding to enhance prevention and treatment strategies.
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Affiliation(s)
- Pei Chia Eng
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK
| | - Lyeann Li Ying Tan
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
| | - Tamara N Kimball
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Savvina Prapiadou
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Benjamin Y Q Tan
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
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Zheng R, Dong X, Wang T, Zhang H, Zhou Y, Wang D. Linear positive association of metabolic score for insulin resistance with stroke risk among American adults: a cross-sectional analysis of National Health and Nutrition Examination Survey datasets. J Stroke Cerebrovasc Dis 2024; 33:107994. [PMID: 39241846 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/24/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Insulin Resistance (IR) is associated with stroke. This study aimed to investigate the correlation between metabolic score for insulin resistance (METS-IR) level, a new biomarker for assessing IR, and stroke. METHODS This is a cross-sectional study based on data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020 and included participants aged ≥ 20 years. All participants provided complete stroke and METS-IR related data. The study employed statistical techniques, including multivariate logistic regression analysis, restricted cubic splines (RCS), and stratified analyses to evaluate the relationship between the amounts of METS-IR and the risk of stroke. RESULTS The study included 14,029 participants aged 20 years or older. The fully adjusted model revealed a statistically significant correlation between METS-IR and stroke (OR=1.21, 95% CI: 1.00, 1.46; P<0.05). Specifically, for every 10-unit increase in METS-IR, there was a 21% increase in the prevalence of stroke. The prevalence of stroke was 60% higher in the Q4 group compared to the Q1 group, as indicated by a significant association with METS-IR (OR=1.60, 95% CI: 1.01, 2.54; P<0.05). The RCS analysis revealed a strong linear correlation between METS-IR and the incidence of stroke (P<0.05). Subgroup analyses showed that gender, age, race, alcohol consumption, smoking, diabetes, and hypertension exhibited correlation with this positive association, and a significant interaction was observed in age (P for interaction < 0.05). CONCLUSIONS The findings of this study indicate that elevated METS-IR levels are strongly linked to a greater risk of stroke in adults.
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Affiliation(s)
- Ruwen Zheng
- Heilongjiang University of Chinese Medicine, Harbin 150040, China.
| | - Xu Dong
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150000, China.
| | - Tianyi Wang
- Heilongjiang University of Chinese Medicine, Harbin 150040, China.
| | - Hongyan Zhang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150000, China.
| | - Yihao Zhou
- Heilongjiang University of Chinese Medicine, Harbin 150040, China.
| | - Dongyan Wang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150000, China.
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Okobi OE, Nwogwugwu E, Ihezie CO, Olasupo OO, Emovon CI, Wambai-Sani H, Ezie OB, Afolabi AR, Erinne OC, O'dare RA. Cardiovascular Disease Patterns, Mortality, and Hospitalization Trends in Adults Over 18: Insights From the Behavioral Risk Factor Surveillance System Database. Cureus 2024; 16:e66604. [PMID: 39258090 PMCID: PMC11385429 DOI: 10.7759/cureus.66604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 09/12/2024] Open
Abstract
Background Cardiovascular diseases (CVDs), including coronary artery disease, heart attacks, strokes, and hypertension, are the leading cause of global morbidity and mortality. Despite advancements in diagnostic techniques, treatment protocols, and public health initiatives, the prevalence of CVD continues to rise. Hence, understanding trends of predisposing factors for CVD and current treatment modalities such as medication use and frequency of hospitalization is essential for developing effective interventions and improving public health strategies. This study leverages Behavioral Risk Factor Surveillance System (BRFSS) data to analyze these trends among adults older than 18 years. Methods Data were sourced from the BRFSS database, analyzing CVD patterns from 2019 to 2021. The study included adults with high cholesterol or blood pressure, coronary heart disease, stroke, and heart failure. Data analysis utilized age-adjusted prevalence, mortality, and hospitalization rates. Results The analysis of the BRFSS data revealed several key trends in CVD patterns from 2019 to 2021. There was a statistically significant increase (p<0.05) in the age-adjusted prevalence of adults taking medication for high cholesterol, rising from 28.9% to 31%, and for controlling high blood pressure, increasing from 57.7% to 60.4%. From 2019 to 2021, coronary heart disease mortality increased from 360,900 to 382,820, while stroke deaths rose from 150,005 to 162,890. Trends show rising mortality for both conditions despite missing data for some years. Mortality rates for coronary heart disease and stroke also rose and were statistically significant (p<0.05), with coronary heart disease mortality increasing from 88 to 92.8 cases per 100,000, and stroke mortality from 37 to 41.1 cases per 100,000. Hospitalization rates for heart failure among Medicare beneficiaries aged 65 and older initially decreased in 2020, likely due to the COVID-19 pandemic impacting hospital admissions, but rose again in 2021 as healthcare-seeking behaviors normalized. Significant gender and racial disparities were observed, with higher mortality rates among males (127.4 per 100,000) and Black, non-Hispanic individuals (110.5 per 100,000). Conclusions This study highlights the increasing medication use for cholesterol and blood pressure among adults older than 18 years, yet mortality rates for coronary heart disease and stroke persist. Significant gender and racial disparities in medication use and mortality rates were observed. These findings underscore the need for targeted public health intervention towards improving medication adherence and addressing social determinants of health, to reduce CVD burden and enhance health equity across diverse populations.
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Affiliation(s)
- Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Enyioma Nwogwugwu
- Internal Medicine, Lincoln Medical and Mental Health Center, New York, USA
| | - Cosmas O Ihezie
- Orthopedics, Federal University Teaching Hospital, Owerri, Owerri, NGA
| | - Olutayo O Olasupo
- Internal Medicine, Phoenix Rehabilitation and Nursing Center, New York, USA
| | | | | | | | - Akinbanji R Afolabi
- Medicine, Emory University, Atlanta, USA
- Endocrinology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Okechukwu C Erinne
- Epidemiology, University of Texas Health Science Center at Houston, Houston, USA
| | - Rachel A O'dare
- Nursing, South University, Savannah, Savannah, USA
- General Medicine, Medical University of Graz, Graz, AUT
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