The contribution of potentially modifiable risk factors to acute ischemic stroke burden - Comparing young and older adults

Lipid-Lowering Therapy Use When Indicated and Subsequent Ischemic Stroke Severity

BACKGROUND

Elevated low-density lipoprotein cholesterol is a risk factor for atherosclerotic cardiovascular disease, including acute ischemic stroke (AIS), due to large- and small-vessel disease. Cholesterol management guidelines recommend lipid-lowering therapy (LLT) to prevent atherosclerotic cardiovascular disease events. This study assessed use of LLT at the time of AIS according to guideline recommendations and determined the association of prestroke LLT use with stroke severity.

METHODS AND RESULTS

We conducted a retrospective study of patients hospitalized with AIS from 2015 to 2020 at a large academic comprehensive stroke center. Patients with AIS secondary to either small-vessel disease or large-artery atherosclerosis recorded in the institutional Get With The Guidelines-Stroke registry and with a prestroke indication for LLT were included. Using propensity score subclassification, adjusted logistic regression models were built to explore the associations between LLT use before AIS when indicated and presenting National Institutes of Health Stroke Scale score >4. There were 384 patients with AIS who met guideline-recommended criteria for prestroke LLT (median age 70 years, 57% men), of whom only 207 patients (54%) were prescribed LLT before AIS. Not being prescribed LLT when indicated was associated with a significantly higher likelihood of a presenting with National Institutes of Health Stroke Scale score >4, even when adjusted for specific stroke cause (odds ratio, 1.13 [95% CI, 1.03-1.20]; P=0.006).

CONCLUSIONS

LLT is underused in patients who present with atherosclerosis-related AIS. Lack of prestroke LLT use was associated with more severe stroke symptoms upon presentation. These findings emphasize the need to prescribe LLT when indicated, because its use may mitigate poststroke disability.

Combined polygenic scores for ischemic stroke risk factors aid risk assessment of ischemic stroke

BACKGROUND

Current risk assessment for ischemic stroke (IS) is limited to clinical variables. We hypothesize that polygenic scores (PGS) of IS (PGSIS) and IS-associated diseases such as atrial fibrillation (AF), venous thromboembolism (VTE), coronary artery disease (CAD), hypertension (HTN), and Type 2 diabetes (T2D) may improve the performance of IS risk assessment.

METHODS

Incident IS was followed for 479,476 participants in the UK Biobank who did not have an IS diagnosis prior to the recruitment. Lifestyle variables (obesity, smoking and alcohol) at the time of study recruitment, clinical diagnoses of IS-associated diseases, PGSIS, and five PGSs for IS-associated diseases were tested using the Cox proportional-hazards model. Predictive performance was assessed using the C-statistic and net reclassification index (NRI).

RESULTS

During a median average 12.5-year follow-up, 8374 subjects were diagnosed with IS. Known clinical variables (age, gender, clinical diagnoses of IS-associated diseases, obesity, and smoking) and PGSIS were all independently associated with IS (P < 0.001). In addition, PGSIS and each PGS for IS-associated diseases was also independently associated with IS (P < 0.001). Compared to the clinical model, a joint clinical/PGS model improved the C-statistic for predicting IS from 0.71 to 0.73 (P < 0.001) and significantly reclassified IS risk (NRI = 0.017, P < 0.001), and 6.48% of subjects were upgraded from low to high risk.

CONCLUSIONS

Adding PGSs of IS and IS-associated diseases to known clinical risk factors statistically improved risk assessment for IS, demonstrating the supplementary value of inherited susceptibility measurement . However, its clinical utility is likely limited due to modest improvements in predictive values.

Knowledge of stroke risk factors and warning symptoms among adults with type 2 diabetes in Addis Ababa, Ethiopia, 2021: an institution-Based cross-sectional study

BACKGROUND

Stroke is a global public health concern with type 2 diabetes being one of the common risk factors. Knowledge of stroke risk factors and warning symptoms among type 2 diabetes patients is largely unknown in developing countries like Ethiopia. The inability to recognize stroke warning symptoms accurately is an important cause of delay in seeking medical attention. We investigated knowledge of stroke risk factors and warning symptoms among adults with type 2 diabetes and the factors associated with these variables.

METHODS

This was an institution-based cross-sectional study. We enrolled 470 adult type 2 diabetes patients using a systematic random sampling method from four government-managed hospitals in Addis Ababa from 1 to 30 February 2021. The Stroke Recognition Questionnaire was adapted to measure the knowledge of stroke risk factors and warning symptoms. Sociodemographic characteristics, source of information, and reaction to stroke were also measured. Data were analyzed using SPSS version 25 and linear regression analysis was used to determine factors independently associated with knowledge of stroke risk factors and warning symptoms.

RESULT

The mean age of the participants was 50.6 ± 12.9 years. The mean score of knowledge of stroke risk factors and warning symptoms was 67.2% and 63.9%, respectively. Higher educational level (B = 2.007, 95% CI = 1.101, 2.914, P < 0.001), knowing someone diagnosed with stroke (B = 3.328, 95% CI = 2.734, 3.922, P < 0.001), and living with others (B = 2.28, 95% CI = 1.606, 2.954, P < 0.001) were independently associated with knowledge of stroke risk factors. Younger age (B = - 0.021, 95% CI= -0.038, 0.005, P = 0.01), higher educational level (B = 1.873, 95% CI = 1.017, 2.730, P < 0.001), and knowing someone diagnosed with stroke (B = 3.64, 95% CI = 3.079, 4.200, P < 0.001) were independently associated with knowledge of warning symptoms of stroke.

CONCLUSION

The mean score of knowledge of stroke risk factors and warning symptoms was 67.2% and 63.9%, respectively. Younger age, higher educational level, and living with other people are predictors of better knowledge of stroke risk factors and warning symptoms in this study. Future educational interventions should target type 2 diabetes adults with advancing age and the involvement of their family members.