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Immens MH, Ekker MS, Verburgt E, Verhoeven JI, Schellekens MM, Hilkens NA, Boot EM, Van Alebeek ME, Brouwers PJ, Arntz RM, Van Dijk GW, Gons RA, Van Uden IW, den Heijer T, de Kort PL, de Laat KF, Van Norden AG, Vermeer SE, Van Zagten MS, Van Oostenbrugge RJ, Wermer MJ, Nederkoorn PJ, Kerkhoff H, Rooyer FA, Van Rooij FG, Van den Wijngaard IR, Klijn CJ, Tuladhar AM, Ten Cate TJ, de Leeuw FE. Trigger factors in patients with a patent foramen ovale-associated stroke: A case-crossover study. Int J Stroke 2024:17474930241242625. [PMID: 38497344 DOI: 10.1177/17474930241242625] [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: 03/19/2024]
Abstract
BACKGROUND Patent foramen ovale (PFO) is a congenital anatomical variant which is associated with strokes in young adults. Contrary to vascular risk factors and atherosclerosis, a PFO is present from birth. However, it is completely unknown how an anatomical structure that is already present at birth in a large proportion of the population can convert into a PFO that causes stroke in a few. Recent studies reported a significant association between certain trigger factors and ischemic stroke in young adults. This study aims to investigate these triggers in PFO-associated stroke. METHODS The ODYSSEY study, a multicenter prospective cohort study between 2013 and 2021, included patients aged 18-49 years experiencing their first-ever ischemic event. Participants completed a questionnaire about exposure to potential trigger factors. A case-crossover design was used to assess the relative risks (RR) with 95% confidence intervals (95% CI). The primary outcome was the RR of potential trigger factors for PFO-associated stroke. RESULTS Overall, 1043 patients completed the questionnaire and had an ischemic stroke, of which 124 patients had a PFO-associated stroke (median age 42.1 years, 45.2% men). For patients with PFO-associated stroke, the RR was 26.0 (95% CI 8.0-128.2) for fever, 24.2 (95% CI 8.5-68.7) for flu-like disease, and 3.31 (95% CI 2.2-5.1) for vigorous exercise. CONCLUSION In conclusion, flu-like disease, fever, and vigorous exercise may convert an asymptomatic PFO into a stroke-causing PFO in young adults. DATA ACCESS STATEMENT The raw and anonymized data used in this study can be made available to other researchers on request. Written proposals can be addressed to the corresponding author and will be assessed by the ODYSSEY investigators for appropriateness of use, and a data sharing agreement in accordance with Dutch regulations will be put in place before data are shared.
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Affiliation(s)
- Maikel Hm Immens
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Merel S Ekker
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esmee Verburgt
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jamie I Verhoeven
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mijntje Mi Schellekens
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nina A Hilkens
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther M Boot
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Paul Jam Brouwers
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gert W Van Dijk
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Rob Ar Gons
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Inge Wm Van Uden
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Tom den Heijer
- Department of Neurology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Paul Lm de Kort
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - K F de Laat
- Department of Neurology, Haga Hospital, The Hague, The Netherlands
| | | | - Sarah E Vermeer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marian Sg Van Zagten
- Department of Neurology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Marieke Jh Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Henk Kerkhoff
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - F A Rooyer
- Department of Neurology, Zuyderland Hospital, Sittard-Geleen, The Netherlands
| | - Frank G Van Rooij
- Department of Neurology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | - Catharina Jm Klijn
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Jf Ten Cate
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Rashmi R, Mohanty SK. Examining chronic disease onset across varying age groups of Indian adults using competing risk analysis. Sci Rep 2023; 13:5848. [PMID: 37037884 PMCID: PMC10086019 DOI: 10.1038/s41598-023-32861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/04/2023] [Indexed: 04/12/2023] Open
Abstract
In low-and-middle-income countries, people develop chronic diseases at a younger age, leading to health-and-economic loss. Estimates of the age of onset of chronic disease provide evidence for policy intervention, but in the Indian context, evidence is limited. The present study aims to explore the onset of seven chronic diseases across adults and the elderly, along with the prognostic factors of chronic disease onset. Using Wave 1 data of the Longitudinal Ageing Study in India (LASI), we estimated the statistical distributions, the median age at onset, and Loglogistic and Weibull accelerated failure time model to understand the onset of seven medically diagnosed self-reported chronic diseases across age groups. We also obtained the sub-distribution hazard ratio (SHR) from the Fine-Gray model to determine the risk of contracting selected chronic diseases in a competing risk setup. The seven chronic diseases- hypertension, diabetes, lung disease, heart disease/stroke, arthritis, neurological disease, and cancer- were developing early, especially in individuals aged 45-54 and 55-64. Arthritis risk was higher in rural areas, and physically active adults and elderly were 1.32 times (95% CI 1.12-1.56) more likely to develop heart disease/stroke. The emerging evidence of the early onset of neurological diseases in middle-aged adults (i.e., among the 45-54 age group) reminds us of the need to reinforce a balance between the physical and mental life of individuals. The early onset of chronic diseases in the independent and working-age category (45-54 years) can have many social and economic implications. For instance, it can create a greater healthcare burden when these individuals grow older with these diseases. Further, disease-specific interventions would be helpful in reducing future chronic disease burden.
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Affiliation(s)
- Rashmi Rashmi
- Department of Population and Development, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Sanjay K Mohanty
- Department of Population and Development, International Institute for Population Sciences, Mumbai, 400088, India
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Matsukawa K, Iwamoto GA, Mitchell JH, Mizuno M, Kim HK, Williamson JW, Smith SA. Exaggerated renal sympathetic nerve and pressor responses during spontaneously occurring motor activity in hypertensive rats. Am J Physiol Regul Integr Comp Physiol 2023; 324:R497-R512. [PMID: 36779670 DOI: 10.1152/ajpregu.00271.2022] [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: 02/14/2023]
Abstract
Stimulation of the mesencephalic locomotor region elicits exaggerated sympathetic nerve and pressor responses in spontaneously hypertensive rats (SHR) as compared with normotensive Wistar-Kyoto rats (WKY). This suggests that central command or its influence on vasomotor centers is augmented in hypertension. The decerebrate animal model possesses an ability to evoke intermittent bouts of spontaneously occurring motor activity (SpMA) and generates cardiovascular responses associated with the SpMA. It remains unknown whether the changes in sympathetic nerve activity and hemodynamics during SpMA are altered by hypertension. To test the hypothesis that the responses in renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) during SpMA are exaggerated with hypertension, this study aimed to compare the responses in decerebrate, paralyzed SHR, WKY, and normotensive Sprague-Dawley (SD) rats. In all strains, an abrupt increase in RSNA occurred in synchronization with tibial motor discharge (an index of motor activity) and was followed by rises in MAP and heart rate. The centrally evoked increase in RSNA and MAP during SpMA was much greater (306 ± 110%) in SHR than WKY (187 ± 146%) and SD (165 ± 44%). Although resting baroreflex-mediated changes in RSNA were not different across strains, mechanically or pharmacologically induced elevations in MAP attenuated or abolished the RSNA increase during SpMA in WKY and SD but had no effect in SHR. It is likely that the exaggerated sympathetic nerve and pressor responses during SpMA in SHR are induced along a central command pathway independent of the arterial baroreflex and/or result from central command-induced inhibition of the baroreflex.
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Affiliation(s)
- Kanji Matsukawa
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Department of Integrative Physiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Gary A Iwamoto
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jere H Mitchell
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Masaki Mizuno
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Han-Kyul Kim
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jon W Williamson
- Department of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Scott A Smith
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Impact of Preexisting Alcohol Use Disorder, Bipolar Disorder, and Schizophrenia on Ischemic Stroke Risk and Severity: A Lebanese Case-Control Study. Healthcare (Basel) 2023; 11:healthcare11040538. [PMID: 36833072 PMCID: PMC9957385 DOI: 10.3390/healthcare11040538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Stroke remains a major leading cause of morbidity and death globally. For ischemic stroke, the most frequent type of stroke, there are numerous risk models and risk assessments offered. Further research into potential risk factors or triggers is being sought to improve stroke risk models. Schizophrenia, bipolar disorder, and alcohol use disorder are all common causes of serious mental illnesses in the general population. Due to the tangled relationship between stroke and many chronic illnesses, lifestyle factors, and diet that may be present in a patient with a mental disease, the relationship between mental diseases and stroke requires further validation. Consequently, the purpose of this study is to assess the potential influence of bipolar disorder, schizophrenia, and alcohol use disorder on stroke patients as compared to non-stroke participants, after controlling for demographic, physical, and medical conditions. We aimed, as a secondary objective, to evaluate the impact of these pre-existing disorders on stroke severity levels. METHODS This research is a case-control survey study involving 113 Lebanese patients with a clinical diagnosis of ischemic stroke and 451 gender-matched volunteers without clinical signs of stroke as controls recruited from several hospitals in Lebanon (April 2020-April 2021). Based on the participant's consent, data was collected by filling out an anonymous paper-based questionnaire. RESULTS All of the odds ratios (ORs) generated by our regression model were greater than 1, indicating that the factors studied were associated with an increased risk of ischemic stroke. As such having schizophrenia (adjusted OR [aOR]: 6.162, 95% confidence interval [CI]: 1.136-33.423), bipolar disorder (aOR: 4.653, 95% CI: 1.214-17.834), alcohol use disorder (aOR: 3.918, 95% CI: 1.584-9.689), atrial fibrillation (aOR: 2.415, 95% CI: 1.235-4.721), diabetes (aOR: 1.865, 95% CI: 1.117-3.115), heart diseases (aOR: 9.890, 95% CI: 5.099-19.184), and asthma-COPD (aOR: 1.971, 95% CI: 1.190-3.263) were all involved with a high risk of developing an ischemic stroke. Moreover, obesity (aOR: 1.732, 95% CI: 1.049-2.861) and vigorous physical activity (aOR: 4.614, 95% CI: 2.669-7.978) were also linked to an increased risk of stroke. Moreover, our multinomial regression model revealed that the odds of moderate to severe/severe stroke were significantly higher in people with pre-stroke alcohol use disorder (aOR: 1.719, 95% CI: 1.385-2.133), bipolar disorder (aOR: 1.656, 95% CI: 1.281-2.141), and schizophrenia (aOR: 6.884, 95% CI: 3.294-11.492) compared to people who had never had a stroke. CONCLUSION The findings in our study suggest that individuals with schizophrenia, bipolar disorder, and alcohol use disorder may be at a higher risk for ischemic stroke and exhibit more severe symptoms. We believe that the first step toward creating beneficial preventative and treatment interventions is determining individuals with schizophrenia, bipolar disorder, or alcohol use disorder, assessing their risk of ischemic stroke, developing more integrated treatments, and closely monitoring the long-term outcome in the event of an ischemic stroke.
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Maalouf E, Hallit S, Salameh P, Hosseini H. Eating Behaviors, Lifestyle, and Ischemic Stroke: A Lebanese Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1487. [PMID: 36674240 PMCID: PMC9864864 DOI: 10.3390/ijerph20021487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Stroke is the second leading cause of death and the third leading cause of disability on a global scale. Most clinicians tend to underestimate the importance of diet and inadequate or dysfunctional eating attitudes in patients with a complicated relationship with food. Concerned about the potential of an independent Lebanese approach, and also because prior international research has revealed a link between eating intake or choice and ischemic stroke risk, it was considered vital to broaden the scope of the literature and evaluate further the association of disordered eating attitudes and focus on the distinct relationship with food in the case of orthorexia nervosa (ON) in the Lebanese community. Consequently, the purpose of the present study is to investigate the potential association between pre-existing disordered eating attitudes, specifically ON, and ischemic stroke risk, with an emphasis on the evidence supporting a Mediterranean-style diet. METHODS This research is a case-control survey study involving 113 Lebanese individuals with ischemic stroke and 451 age-(within 5 years) and sex-matched controls recruited from several hospitals in Lebanon (April 2020-April 2021). RESULTS According to the findings of our first regression model, living 100 m from a crowded road (adjusted odds ratio [aOR]: 3.421, 95% confidence interval [CI]: 1.585-7.387), living 100 m from an electricity generator (aOR: 3.686, 95% CI: 1.681-8.085), higher waterpipe dependence (aOR: 1.204, 95% CI: 1.117-1.297), higher exposure to passive smoking (aOR: 2.651, 95% CI: 2.051-3.426), being married (aOR: 3.545, 95% CI: 1.297-9.689), having a low educational attainment (aOR: 0.239, 95% CI: 0.084-0.679), vigorous physical activity (aOR: 1.003, 95% CI: 1.001-1.006), and having more inappropriate eating (aOR: 1.040, 95% CI: 1.006-1.074) were all associated with higher odds of having ischemic stroke. Furthermore, atrial fibrillation (aOR: 2.945, 95% CI: 1.010-8.585), diabetes (aOR: 2.550, 95% CI: 1.169-5.561), heart diseases (aOR: 6.193, 95% CI: 2.196-17.463), and hypertension (aOR: 2.744, 95% CI: 1.049-7.180) were also linked to an increased risk of stroke. Moreover, having more orthorexia nervosa tendencies (aOR: 1.123, 95% CI: 1.021-1.235) was related to a higher odds of having an ischemic stroke, whereas better adherence to the MeD was significantly linked (aOR: 0.691, 95% CI: 0.583-0.819) to lower odds of ischemic stroke. CONCLUSIONS Ischemic stroke patients were more likely to have disordered eating attitudes and orthorexic behaviors. Furthermore, the MeD has been found to be beneficial in reducing ischemic stroke risk. Despite the study's focus, outdoor pollution, waterpipe dependence, and passive smoking were linked to ischemic stroke. In summary, this review suggests that improving one's nutritional status and making a few lifestyle changes are key stroke prevention and treatment methods.
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Affiliation(s)
- Elise Maalouf
- Life and Health Sciences Department, Paris-Est University, 94000 Creteil, France
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman 11931, Jordan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib P.O. Box 60096, Lebanon
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos 5053, Lebanon
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut 1103, Lebanon
- Medical School, University of Nicosia, Nicosia 2417, Cyprus
- Faculty of Pharmacy, Lebanese University, Beirut 1103, Lebanon
| | - Hassan Hosseini
- UPE-C, Université Paris-Est Créteil, Faculté de Santé, INSERM U955-E01, IMRB, 94000 Creteil, France
- Hopital Henri Mondor, APHP, 94000 Creteil, France
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Abstract
Ischemic heart disease and stroke are the number 1 and number 2 causes of death worldwide, respectively. A lifelong commitment to exercise reduces the risk of these adverse events and is also associated with several cardiometabolic improvements, including reductions in blood pressure, cholesterol, and inflammatory markers, as well as improved glucose control. Routine exercise also reduces the risk of developing comorbidities that increase the risk of cardiovascular or cerebrovascular disease. While the benefits of a lifelong commitment to exercise are well documented, there is a complex interaction between exercise and stroke risk, such that the risk of ischemic or hemorrhagic stroke may increase acutely during or immediately following exercise. In this article, we discuss the physiological responses to different types of exercise, as well as the determinants of resting and exertional cerebrovascular perfusion, and explore the complex interaction between atrial fibrillation, exercise, and stroke risk. Finally, we highlight the increased risk of stroke during different types of exercise, as well as factors that may alleviate this risk.
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Affiliation(s)
- Justin A Edward
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora. (J.A.E., W.K.C.)
| | - William K Cornwell
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora. (J.A.E., W.K.C.).,Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora. (W.K.C.)
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Rowland ST, Chillrud LG, Boehme AK, Wilson A, Rush J, Just AC, Kioumourtzoglou MA. Can weather help explain 'why now?': The potential role of hourly temperature as a stroke trigger. ENVIRONMENTAL RESEARCH 2022; 207:112229. [PMID: 34699760 PMCID: PMC8810591 DOI: 10.1016/j.envres.2021.112229] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/08/2021] [Accepted: 10/15/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND While evidence suggests that daily ambient temperature exposure influences stroke risk, little is known about the potential triggering role of ultra short-term temperature. METHODS We examined the association between hourly temperature and ischemic and hemorrhagic stroke, separately, and identified any relevant lags of exposure among adult New York State residents from 2000 to 2015. Cases were identified via ICD-9 codes from the New York Department of Health Statewide Planning and Reearch Cooperative System. We estimated ambient temperature up to 36 h prior to estimated stroke onset based on patient residential ZIP Code. We applied a time-stratified case-crossover study design; control periods were matched to case periods by year, month, day of week, and hour of day. Additionally, we assessed effect modification by leading stroke risk factors hypertension and atrial fibrillation. RESULTS We observed 578,181 ischemic and 164,755 hemorrhagic strokes. Among ischemic and hemorrhagic strokes respectively, the mean (standard deviation; SD) patient age was 71.8 (14.6) and 66.8 (17.4) years, with 55% and 49% female. Temperature ranged from -29.5 °C to 39.2 °C, with mean (SD) 10.9 °C (10.3 °C). We found linear relationships for both stroke types. Higher temperature was associated with ischemic stroke over the 7 h following exposure; a 10 °C increase over 7 h was associated with 5.1% (95% Confidence Interval [CI]: 3.8, 6.4%) increase in hourly stroke rate. In contrast, temperature was negatively associated with hemorrhagic stroke over 5 h, with a 5-h cumulative association of -6.2% (95% CI: 8.6, -3.7%). We observed suggestive evidence of a larger association with hemorrhagic stroke among patients with hypertension and a smaller association with ischemic stroke among those with atrial fibrillation. CONCLUSION Hourly temperature was positively associated with ischemic stroke and negatively associated with hemorrhagic stroke. Our results suggest that ultra short-term weather influences stroke risk and hypertension may confer vulnerability.
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Affiliation(s)
- Sebastian T Rowland
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States.
| | - Lawrence G Chillrud
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Amelia K Boehme
- Departments of Neurology, Columbia University Medical School and Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Ander Wilson
- Department of Statistics, Colorado State University, United States
| | - Johnathan Rush
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Allan C Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marianthi-Anna Kioumourtzoglou
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
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Polonikov A, Bocharova I, Azarova I, Klyosova E, Bykanova M, Bushueva O, Polonikova A, Churnosov M, Solodilova M. The Impact of Genetic Polymorphisms in Glutamate-Cysteine Ligase, a Key Enzyme of Glutathione Biosynthesis, on Ischemic Stroke Risk and Brain Infarct Size. Life (Basel) 2022; 12:life12040602. [PMID: 35455093 PMCID: PMC9032935 DOI: 10.3390/life12040602] [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: 04/07/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this pilot study was to explore whether polymorphisms in genes encoding the catalytic (GCLC) and modifier (GCLM) subunits of glutamate-cysteine ligase, a rate-limiting enzyme in glutathione synthesis, play a role in the development of ischemic stroke (IS) and the extent of brain damage. A total of 1288 unrelated Russians, including 600 IS patients and 688 age- and sex-matched healthy subjects, were enrolled for the study. Nine common single nucleotide polymorphisms (SNPs) of the GCLC and GCLM genes were genotyped using the MassArray-4 system. SNP rs2301022 of GCLM was strongly associated with a decreased risk of ischemic stroke regardless of sex and age (OR = 0.39, 95%CI 0.24−0.62, p < 0.0001). Two common haplotypes of GCLM possessed protective effects against ischemic stroke risk (p < 0.01), but exclusively in nonsmoker patients. Infarct size was increased by polymorphisms rs636933 and rs761142 of GCLC. The mbmdr method enabled identifying epistatic interactions of GCLC and GCLM gene polymorphisms with known IS susceptibility genes that, along with environmental risk factors, jointly contribute to the disease risk and brain infarct size. Understanding the impact of genes and environmental factors on glutathione metabolism will allow the development of effective strategies for the treatment of ischemic stroke and disease prevention.
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Affiliation(s)
- Alexey Polonikov
- Laboratory of Statistical Genetics and Bioinformatics, Research Institute for Genetic and Molecular Epidemiology, Kursk State Medical University, 18 Yamskaya Street, 305041 Kursk, Russia
- Department of Biology, Medical Genetics and Ecology, Kursk State Medical University, 3 Karl Marx Street, 305041 Kursk, Russia; (E.K.); (M.B.); (O.B.); (A.P.); (M.S.)
- Correspondence:
| | - Iuliia Bocharova
- Department of Medical Biological Disciplines, Belgorod State University, 85 Pobedy Street, 308015 Belgorod, Russia; (I.B.); (M.C.)
- Division of Neurosurgery, Kursk Regional Clinical Hospital, 45a Sumskaya, 305027 Kursk, Russia
| | - Iuliia Azarova
- Department of Biological Chemistry, Kursk State Medical University, 3 Karl Marx Street, 305041 Kursk, Russia;
- Laboratory of Biochemical Genetics and Metabolomics, Research Institute for Genetic and Molecular Epidemiology, Kursk State Medical University, 18 Yamskaya Street, 305041 Kursk, Russia
| | - Elena Klyosova
- Department of Biology, Medical Genetics and Ecology, Kursk State Medical University, 3 Karl Marx Street, 305041 Kursk, Russia; (E.K.); (M.B.); (O.B.); (A.P.); (M.S.)
- Laboratory of Biochemical Genetics and Metabolomics, Research Institute for Genetic and Molecular Epidemiology, Kursk State Medical University, 18 Yamskaya Street, 305041 Kursk, Russia
| | - Marina Bykanova
- Department of Biology, Medical Genetics and Ecology, Kursk State Medical University, 3 Karl Marx Street, 305041 Kursk, Russia; (E.K.); (M.B.); (O.B.); (A.P.); (M.S.)
- Laboratory of Genomic Research, Research Institute for Genetic and Molecular Epidemiology, Kursk State Medical University, 18 Yamskaya Street, 305041 Kursk, Russia
| | - Olga Bushueva
- Department of Biology, Medical Genetics and Ecology, Kursk State Medical University, 3 Karl Marx Street, 305041 Kursk, Russia; (E.K.); (M.B.); (O.B.); (A.P.); (M.S.)
- Laboratory of Genomic Research, Research Institute for Genetic and Molecular Epidemiology, Kursk State Medical University, 18 Yamskaya Street, 305041 Kursk, Russia
| | - Anna Polonikova
- Department of Biology, Medical Genetics and Ecology, Kursk State Medical University, 3 Karl Marx Street, 305041 Kursk, Russia; (E.K.); (M.B.); (O.B.); (A.P.); (M.S.)
| | - Mikhail Churnosov
- Department of Medical Biological Disciplines, Belgorod State University, 85 Pobedy Street, 308015 Belgorod, Russia; (I.B.); (M.C.)
| | - Maria Solodilova
- Department of Biology, Medical Genetics and Ecology, Kursk State Medical University, 3 Karl Marx Street, 305041 Kursk, Russia; (E.K.); (M.B.); (O.B.); (A.P.); (M.S.)
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Kim SR, Lee G, Choi S, Oh YH, Son JS, Park M, Park SM. Changes in predicted lean body mass, appendicular skeletal muscle mass, and body fat mass and cardiovascular disease. J Cachexia Sarcopenia Muscle 2022; 13:1113-1123. [PMID: 35212175 PMCID: PMC8978024 DOI: 10.1002/jcsm.12962] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 01/05/2022] [Accepted: 02/03/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Little is known about the association of changes in two body components, muscle and fat mass, with the risk of cardiovascular disease (CVD) among young adults. We investigated the association of changes in predicted lean body mass index (LBMI), appendicular skeletal muscle mass index (ASMI), and body fat mass index (BFMI) with the development of CVD among young adults. METHODS This nationwide, population-based cohort study included 3 727 738 young adults [2 406 046 (64.5%) men and 1 321 692 (35.5%) women] aged 20-39 years without a previous history of CVD who underwent two health screening examinations during 2009-2010 and 2011-2012. Using validated and robust prediction equations, we calculated the changes in predicted LBMI, ASMI, and BFMI from the first to the second examinations. RESULTS The mean (SD) age was 32.2 (4.9) years, and 2 406 046 (64.5%) of the participants were men. A total of 23 344 CVD events were detected during 22 257 632 person-years of follow-up. Each 1 kg/m2 increase in predicted LBMI and ASMI change was associated with a reduced risk of CVD among men [adjusted hazard ratio (aHR): 0.86, 95% confidence interval (CI) 0.82-0.91; aHR: 0.76, 95% CI 0.69-0.82, respectively] and women (aHR: 0.77, 95% CI 0.63-0.95; aHR: 0.75, 95% CI 0.59-0.96). Each 1 kg/m2 increase in predicted BFMI change was associated with an increased risk of CVD among men (aHR: 1.16, 95% CI 1.10-1.22) and women (aHR: 1.32, 95% CI 1.06-1.65). In both sexes, decreases in predicted LBMI and ASMI were associated with greater CVD risk, and decreased predicted BFMI was associated with a reduced CVD risk. Those who maintained their BMI between -1 and +1 kg/m2 also had a decreased risk of CVD per 1 kg/m2 increase in predicted LBMI and ASMI change among men (aHR: 0.86, 95% CI 0.80-0.92; aHR: 0.85, 95% CI 0.76-0.95) and women (aHR: 0.62, 95% CI 0.47-0.83; aHR: 0.59, 95% CI 0.44-0.80) and had a greater risk of CVD per 1 kg/m2 increase in predicted BFMI change among men (aHR: 1.17, 95% CI 1.10-1.25) and women (aHR: 1.64, 95% CI 1.20-2.23). Regardless of changes in weight, such as from normal to obese or vice versa, these results were consistent. CONCLUSIONS Among young adults, increased predicted muscle mass or decreased predicted fat mass were associated with a reduced risk of development of CVD. Decreased predicted muscle mass or increased predicted fat mass were associated with an elevated risk of development of CVD.
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Affiliation(s)
- Seong Rae Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Yun Hwan Oh
- Department of Family Medicine, Jeju National University School of Medicine, Jeju, South Korea.,Department of Family Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Joung Sik Son
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Minseon Park
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
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10
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van Etten ES, Kaushik K, Jolink WMT, Koemans EA, Ekker MS, Rasing I, Voigt S, Schreuder FHBM, Cannegieter SC, Rinkel GJE, Lijfering WM, Klijn CJM, Wermer MJH. Trigger Factors for Spontaneous Intracerebral Hemorrhage: A Case-Crossover Study. Stroke 2021; 53:1692-1699. [PMID: 34911344 DOI: 10.1161/strokeaha.121.036233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Whether certain activities can trigger spontaneous intracerebral hemorrhage (ICH) remains unknown. Insights into factors that trigger vessel rupture resulting in ICH improves knowledge on the pathophysiology of ICH. We assessed potential trigger factors and their risk for ICH onset. METHODS We included consecutive patients diagnosed with ICH between July 1, 2013, and December 31, 2019. We interviewed patients on their exposure to 12 potential trigger factors (eg, Valsalva maneuvers) in the (hazard) period soon before onset of ICH and their normal exposure to these trigger factors in the year before the ICH. We used the case-crossover design to calculate relative risks (RR) for potential trigger factors. RESULTS We interviewed 149 patients (mean age 64, 66% male) with ICH. Sixty-seven (45%) had a lobar hemorrhage, 60 (40%) had a deep hemorrhage, 19 (13%) had a cerebellar hemorrhage, and 3 (2%) had an intraventricular hemorrhage. For ICH in general, there was an increased risk within an hour after caffeine consumption (RR=2.5 [95% CI=1.8-3.6]), within an hour after coffee consumption alone (RR=4.8 [95% CI=3.3-6.9]), within an hour after lifting >25 kg (RR=6.6 [95% CI=2.2-19.9]), within an hour after minor head trauma (RR=10.1 [95% CI=1.7-60.2]), within an hour after sexual activity (RR=30.4 [95% CI=16.8-55.0]), within an hour after straining for defecation (RR=37.6 [95% CI=22.4-63.4]), and within an hour after vigorous exercise (RR=21.8 [95% CI=12.6-37.8]). Within 24 hours after flu-like disease or fever, the risk for ICH was also increased (RR=50.7 [95% CI=27.1-95.1]). Within an hour after Valsalva maneuvers, the RR for deep ICH was 3.5 (95% CI=1.7-6.9) and for lobar ICH the RR was 2.0 (95% CI=0.9-4.2). CONCLUSIONS We identified one infection and several blood pressure related trigger factors for ICH onset, providing new insights into the pathophysiology of vessel rupture resulting in ICH.
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Affiliation(s)
- Ellis S van Etten
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Kanishk Kaushik
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Wilmar M T Jolink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (W.M.T.J., G.J.E.R., C.J.M.K.)
| | - Emma A Koemans
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Merel S Ekker
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (M.S.E., F.H.B.M.S., C.J.M.K.)
| | - Ingeborg Rasing
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Sabine Voigt
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (M.S.E., F.H.B.M.S., C.J.M.K.)
| | - Suzanne C Cannegieter
- Department of Epidemiology, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.).,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.).,Department of Internal Medicine, Section Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands. (S.C.C.)
| | - Gabriël J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (W.M.T.J., G.J.E.R., C.J.M.K.)
| | - Willem M Lijfering
- Department of Epidemiology, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.).,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.)
| | - Catharina J M Klijn
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (W.M.T.J., G.J.E.R., C.J.M.K.).,Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (M.S.E., F.H.B.M.S., C.J.M.K.)
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
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Neurologic complications of cardiac disease in athletes. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:269-274. [PMID: 33632446 DOI: 10.1016/b978-0-12-819814-8.00031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Athletic participation at all levels of proficiency is an encouraged activity. Physicians evaluating athletes are tasked with assessing the benefits and risks of participating in vigorous physical activity and should engage in shared decision making with the athlete. Identifying the neurologic sequelae is an essential part of the assessment that is often not covered. This chapter will review the association of a wide range of cardiac disorders that can be related to or associated with subsequent neurologic sequelae, along with a brief overview of recommendations for management. Prevalent neurological complications of cardiac disease in athletes include stroke and seizures. There are also certain channelopathies that result in concurrent cardiac dysrhythmias and epilepsy. In addition, physiologic cardiac rhythm changes and the athlete's heart are discussed in the context of the differential diagnoses of subsequent cardiac and neurologic disease. The primary objective of this chapter is to prepare the physician for accurate recognition of cardiac disease in athletes that could result in neurologic complications if not diagnosed and managed early on.
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12
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Triggering factors in non-traumatic intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2020; 29:104921. [PMID: 32689642 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/08/2020] [Accepted: 04/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In ischemic stroke and subarachnoid hemorrhage, there are known preceding triggering events that predispose to the stroke by, for example, abruptly raising blood pressure. We explored, whether triggering events can be identified in non-traumatic intracerebral hemorrhage (ICH). METHODS We used structured questionnaires to interview consented patients with ICH treated in a tertiary teaching hospital, between 2014 and 2016. We asked of possible trigger factors, including Valsalva-inducing activity, heavy physical exertion, sexual activity, abrupt change in position, a heavy meal, a sudden change in temperature, exposure to traffic jam, and the combination of the first three (any physical trigger) during the hazard period of 0-2 h prior to ICH. The ratio of the reported trigger during the hazard period was compared to the same 2-h period the previous day (control period) to calculate the relative risks for each factor (case-crossover design). RESULTS Of our 216 consented ICH patients, 97 (35.0%) could be interviewed for trigger questions. Reasons for not able to provide consistent and reliable responses included lowered level of consciousness, delirium, impaired memory, and aphasia. None of the studied possible triggers alone were more frequent during the hazard period compared to the control period. However, when all physical triggers were combined, we found an association with the triggering event and onset of ICH (risk ratio 1.32, 95% confidence interval 1.01-1.73). CONCLUSIONS Obtaining reliable information on the preceding events before ICH onset was challenging. However, we found that physical triggers as a group were associated with the onset of ICH.
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13
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Abstract
Stroke is a leading cause of mortality and morbidity all around the world. Identification of stroke risk factors and protective lifestyles is necessary for optimizing personalized treatment and reducing mortality. Sedentary lifestyle is a well-known modifiable risk factor in primary and secondary stroke prevention. Also, in recent years, exercise has been described as a neuroprotective and neuroreparative factor. Here we summarized the existing available evidence of the relationship between physical activity and stroke.
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14
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Neutrophil-to-lymphocyte ratio and exercise intensity are associated with cardiac-troponin levels after prolonged cycling: the Indonesian North Coast and Tour de Borobudur 2017 Troponin Study. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-019-00556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Saeed M, Naveed M, BiBi J, Ali Kamboh A, Phil L, Chao S. Potential nutraceutical and food additive properties and risks of coffee: a comprehensive overview. Crit Rev Food Sci Nutr 2019; 59:3293-3319. [PMID: 30614268 DOI: 10.1080/10408398.2018.1489368] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Coffee is a composite mixture of more than a thousand diverse phytochemicals like alkaloids, phenolic compounds, vitamins, carbohydrates, lipids, minerals and nitrogenous compounds. Coffee has multifunctional properties as a food additive and nutraceutical. As a nutraceutical, coffee has anti-inflammatory, anti-oxidant, antidyslipidemic, anti-obesity, type-2 diabetes mellitus (DM), and cardiovascular diseases (CVD), which can serve for the treatment and prevention of metabolic syndrome and associated disorders. On the other hand, as a food additive, coffee has antimicrobial activity against a wide range of microorganisms, inhibits lipid peroxidation (LPO), and can function as a prebiotic. The outcomes of different studies also revealed that coffee intake may reduce the incidence of numerous chronic diseases, like liver disease, mental health, and it also overcomes the all-cause mortality, and suicidal risks. In some studies, high intake of coffee is linked to increase CVD risk factors, like cholesterol, plasma homocysteine and blood pressure (BP). There is also a little evidence that associated the coffee consumption with increased risk of lung tumors in smokers. Among adults who consume the moderate amount of coffee, there is slight indication of health hazards with strong indicators of health benefits. Moreover, existing literature suggests that it may be cautious for pregnant women to eliminate the chances of miscarriages and impaired fetal growth. The primary purpose of this narrative review is to provide an overview of the findings of the positive impacts and risks of coffee consumption on human health. In conclusion, to date, the best available evidence from research indicates that drinking coffee up to 3-4 cups/day provides health benefits for most people.
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Affiliation(s)
- Muhammad Saeed
- Department of Animal Nutrition, College of Animal Sciences and Technology, Northwest A & F University, Yangling, Shaanxi Province, P.R. China
| | - Muhammad Naveed
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China
| | - Jannat BiBi
- Department of Physical Education, Shaanxi Normal University, Xian, Shaanxi Province, P.R. China
| | - Asghar Ali Kamboh
- Department of Veterinary Microbiology, Faculty of Animal Husbandry and Veterinary Sciences, Sindh Agriculture University, Tandojam, Sindh Province, Pakistan
| | - Lucas Phil
- Department of Pharmaceutical Analysis, China Pharmaceutical University, School of Pharmacy, Nanjing, Jiangsu Province, P.R. China
| | - Sun Chao
- Department of Animal Nutrition, College of Animal Sciences and Technology, Northwest A & F University, Yangling, Shaanxi Province, P.R. China
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16
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Wee IJY, Choong AMTL. A systematic review of the impact of preoperative exercise for patients with abdominal aortic aneurysm. J Vasc Surg 2019; 71:2123-2131.e1. [PMID: 30606665 DOI: 10.1016/j.jvs.2018.09.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/20/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) surgery carries significant risk of morbidity and mortality. Preoperative exercise may improve the physical fitness capacity of patients with AAA as well as postoperative outcomes. METHODS A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search was performed on MEDLINE, Embase, and Cochrane Library for relevant studies. A methodologic assessment of included studies was conducted using the Physiotherapy Evidence Database (PEDro) scale. RESULTS Seven studies (six randomized controlled trials and one retrospective cohort study) were included. The overall quality of studies was assessed to range from fair to good. Three studies included AAA patients without indication for surgery, whereas four other studies included AAA patients awaiting surgical repair. One study implemented an inspiratory muscle training program; five studies implemented a continuous moderate-intensity exercise regimen; one study implemented a high-intensity interval training program. Overall compliance with the exercise regimen was high (94% in those not waiting for surgery; 75.8% to 82.3% in those waiting for surgery). In patients not awaiting surgery, preoperative exercise may improve physical fitness parameters including ventilatory threshold (P = .016 at 12 weeks; P = .09 at 12 months) and anaerobic threshold (10% increase; P = .007) but not peak oxygen consumption (P = .183 at 12 weeks; P = .29 at 12 months). In patients awaiting surgery, one study demonstrated a statistically significant improvement in peak oxygen consumption (difference, 1.6 mL/kg/min; P = .004) and anaerobic threshold (difference, 1.9 mL/kg/min; P = .012) for patients who exercised. In terms of postoperative outcomes, exercise may reduce the risk of cardiac, renal, and respiratory complications, although only in those who undergo open surgery. Only patients who underwent endovascular repair had a shorter length of hospital stay when preoperative exercise was conducted. CONCLUSIONS Despite the encouraging evidence of preoperative exercise for AAA patients, it remains premature to recommend it as a preoperative intervention. Given the heterogeneity of reported outcomes, future studies should consider conducting well-designed randomized controlled trials with standardized reporting outcomes and definitions.
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Affiliation(s)
- Ian J Y Wee
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrew M T L Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular Surgery, National University Heart Centre, Singapore.
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17
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Chahal HS, Gelaye B, Mostofsky E, Sanchez SE, Mittleman MA, Maclure M, Pacora P, Torres JA, Romero R, Ananth CV, Williams MA. Physical Exertion Immediately Prior to Placental Abruption: A Case-Crossover Study. Am J Epidemiol 2018; 187:2073-2079. [PMID: 29992226 PMCID: PMC6194205 DOI: 10.1093/aje/kwy138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 12/14/2022] Open
Abstract
While there is consistent evidence that episodes of physical exertion are associated with an immediately higher risk of acute ischemic vascular events, the risk of placental abruption immediately following episodes of physical exertion has not been studied. In a multicenter case-crossover study, we interviewed 663 women with placental abruption at 7 Peruvian hospitals between January 2013 and August 2015. We asked women about physical exertion in the hour before symptom onset and compared this with their frequency of physical exertion over the prior week. Compared with times with light or no exertion, the risk of placental abruption was 7.8 (95% confidence interval (CI): 5.5, 11.0) times greater in the hour following moderate or heavy physical exertion. The instantaneous incidence rate ratio of placental abruption within an hour of moderate or heavy physical exertion was lower for women who habitually engaged in moderate or heavy physical activity more than 3 times per week in the year before pregnancy (rate ratio (RR) = 3.0, 95% CI: 1.6, 5.9) compared with more sedentary women (RR = 17.3, 95% CI: 11.3, 26.7; P for homogeneity < 0.001), and the rate ratio was higher among women with preeclampsia/eclampsia (RR = 13.6, 95% CI: 7.0, 26.2) than among women without (RR = 6.7, 95% CI: 4.4, 10.0; P for homogeneity = 0.07).
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Affiliation(s)
- Harpreet S Chahal
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Mississauga Academy of Medicine, University of Toronto Mississauga, Mississauga, Canada
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Elizabeth Mostofsky
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sixto E Sanchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Asociación Civil Proyectos en Salud , Lima, Peru
| | - Murray A Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Malcolm Maclure
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Percy Pacora
- Department of Obstetrics and Gynecology, San Marcos University, Hospital Madre-Nino San Bartolome, Lima, Peru
| | - Jose A Torres
- Department of Obstetrics and Gynecology, San Marcos University, Hospital Madre-Nino San Bartolome, Lima, Peru
- Department of Obstetrics and Gynecology, San Marcos University, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Department of Obstetrics and Gynecology, University of Michigan Health System, University of Michigan, Ann Arbor, Michigan
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Lin WP, Kuan TS, Lin CI, Hsu LC, Lin YC. Spinal cord infarction during physical exertion due to polycythemia vera and aortoiliac occlusive disease: A case report. Medicine (Baltimore) 2018; 97:e12181. [PMID: 30170466 PMCID: PMC6392751 DOI: 10.1097/md.0000000000012181] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Spinal cord infarction is rarely caused by hypercoagulable states. Polycythemia vera (PV) is a myeloproliferative neoplasm that can contribute to thrombotic events due to increased blood viscosity. We report a case of spinal cord infarction due to extensive aortic thrombosis caused by PV. PATIENT CONCERNS A 56-year-old man presented with acute paraplegia and urinary retention during heavy physical exertion. DIAGNOSES Imaging studies revealed spinal cord infarction at the T9 to T12 levels and aortoiliac occlusive disease. PV was diagnosed during workup for elevated hemoglobin level INTERVENTIONS:: The patient received intravenous hydration and anticoagulation for spinal cord infarction. PV was managed with phlebotomy and hydroxyurea. Courses of inpatient and outpatient rehabilitation programs were also given. OUTCOMES The patient became urinary catheter-free 5 months after disease onset, and was able to walk with walker. The American Spinal Injury Association Impairment scale also improved from C at diagnosis to D during last follow-up. LESSONS Etiologic workup is important for patients with spinal cord infarction to direct specific treatment strategies. Physical exertion may act as a trigger for infarction in patients at risk for thrombotic events, and monitoring of neurologic status during and after periods of exercise is warranted.
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Affiliation(s)
- Wei-Pin Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital
| | - Ta-Shen Kuan
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C
| | - Cho-I Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital
| | - Lin-Chieh Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C
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19
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The beneficial role of early exercise training following stroke and possible mechanisms. Life Sci 2018; 198:32-37. [DOI: 10.1016/j.lfs.2018.02.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 12/21/2022]
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20
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Shiraishi Y, Kohsaka S, Abe T, Harada K, Miyazaki T, Miyamoto T, Iida K, Tanimoto S, Yagawa M, Takei M, Nagatomo Y, Hosoda T, Yamamoto T, Nagao K, Takayama M. Impact of Triggering Events on Outcomes of Acute Heart Failure. Am J Med 2018; 131:156-164.e2. [PMID: 28941748 DOI: 10.1016/j.amjmed.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/26/2017] [Accepted: 09/04/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The onset of acute heart failure is known to be associated with increased physical activity and other specific behaviors that can trigger hemodynamic deterioration. This analysis aimed to describe the distribution of triggers in patients hospitalized for acute heart failure, and investigate their effects on in-hospital outcomes. METHODS Consecutive patients hospitalized for acute heart failure between 2010 and 2014 were registered in a multicenter data registration system (72 institutions within Tokyo, Japan). Baseline demographics and in-hospital mortality were extracted from 17,473 patients. Patients with a trigger were grouped based on their triggering event: those with onset during (a) physical activity; (b) sleeping; (c) eating or watching television; (d) bathing or excretion (use of restrooms); and (e) engaging in other activities. These patients were compared with patients without identifiable triggers. Multiple imputation was used for missing data. RESULTS Patients were predominantly men (57.1%), with a mean age of 76.0 ± 13.0 years; a triggering event was present in 49.1%. No significant difference in baseline characteristics was noted between groups except for younger age, higher blood pressure, and prevalence of signs of congestion in the trigger-positive group. In-hospital mortality rate was 7.9%. Presence of triggers was positively associated with a reduced risk of in-hospital mortality (adjusted odds ratio 0.79; 95% confidence interval, 0.70-0.90; P = .0003). In a delta-adjusted pattern mixture model, the effect of a triggering event on in-hospital mortality remained consistently significant. CONCLUSION Triggering events for acute heart failure can provide additional information for risk prediction. Efforts to identify the triggers should be made to classify patients according to risk group.
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Affiliation(s)
- Yasuyuki Shiraishi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Tokyo CCU Network Scientific Committee, Tokyo, Japan.
| | - Takayuki Abe
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | - Kiyoshi Iida
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Mayuko Yagawa
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Makoto Takei
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Yuji Nagatomo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Toru Hosoda
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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Adverse events among seniors receiving spinal manipulation and exercise in a randomized clinical trial. ACTA ACUST UNITED AC 2014; 20:335-41. [PMID: 25454683 DOI: 10.1016/j.math.2014.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 09/29/2014] [Accepted: 10/07/2014] [Indexed: 12/16/2022]
Abstract
Spinal manipulative therapy (SMT) and exercise have demonstrated effectiveness for neck pain (NP). Adverse events (AE) reporting in trials, particularly among elderly participants, is inconsistent and challenges informed clinical decision making. This paper provides a detailed report of AE experienced by elderly participants in a randomized comparative effectiveness trial of SMT and exercise for chronic NP. AE data, consistent with CONSORT recommendations, were collected on elderly participants who received 12 weeks of SMT with home exercise, supervised plus home exercise, or home exercise alone. Standardized questions were asked at each treatment; participants were additionally encouraged to report AE as they occurred. Qualitative interviews documented participants' experiences with AE. Descriptive statistics and content analysis were used to categorize and report these data. Compliance was high among the 241 randomized participants. Non-serious AE were reported by 130/194 participants. AE were reported by three times as many participants in supervised plus home exercise, and nearly twice as many as in SMT with home exercise, as in home exercise alone. The majority of AE were musculoskeletal in nature; several participants associated AE with specific exercises. One incapacitating AE occurred when a participant fell during supervised exercise session and fractured their arm. One serious adverse event of unknown relationship occurred to an individual who died from an aneurysm while at home. Eight serious, non-related AE also occurred. Musculoskeletal AE were common among elderly participants receiving SMT and exercise interventions for NP. As such, they should be expected and discussed when developing care plans.
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22
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Alexandrino GM, Damásio J, Canhão P, Geraldes R, Melo TP, Correia C, Ferro JM. Stroke in sports: a case series. J Neurol 2014; 261:1570-4. [PMID: 24888314 DOI: 10.1007/s00415-014-7383-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 11/25/2022]
Abstract
Regular physical activity decreases vascular risk. However, vascular events, including stroke, can occur while practicing physical activities. Stroke associated with sports is a rare clinical entity, whose risk factors and mechanisms are not fully understood. We report a case series of sports-related stroke, from tertiary care institutions. From the stroke registries of two University Neurology services and Stroke Units we retrieved all cases of stroke which occurred in temporal association with the practice of sports. Investigators had to fill a simple case report form, describing the demographic, clinical characteristics of the patients and the sport associated with the stroke. We included ten patients aged between 27 and 65 years, 8 being male. Only three subjects had vascular risk factors. Trauma to the head and/or neck was reported in two patients only. Cervicocerebral arterial dissection was the main cause of stroke, occurring in six of the ten cases. No patient died, but three were left disabled (modified Rankin Scale 3-5). This case series confirms that stroke associated with sport is very rare. The majority of the victims did not have vascular risk factors. Dissection was the most common cause of sport-associated stroke. Strokes were often disabling.
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Affiliation(s)
- Gonçalo M Alexandrino
- Serviço de Neurologia, Department of Neurosciences, Hospital de Santa Maria, Universidade de Lisboa, Lisbon, Portugal
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23
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Ricciardi AC, López-Cancio E, Pérez de la Ossa N, Sobrino T, Hernández-Pérez M, Gomis M, Munuera J, Muñoz L, Dorado L, Millán M, Dávalos A, Arenillas JF. Prestroke physical activity is associated with good functional outcome and arterial recanalization after stroke due to a large vessel occlusion. Cerebrovasc Dis 2014; 37:304-11. [PMID: 24851928 DOI: 10.1159/000360809] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although multiple studies and meta-analyses have consistently suggested that regular physical activity (PhA) is associated with a decreased stroke risk and recurrence, there is limited data on the possible preconditioning effect of prestroke PhA on stroke severity and prognosis. We aimed to study the association of prestroke PhA with different outcome variables in patients with acute ischemic stroke due to an anterior large vessel occlusion. METHODS The Prestroke Physical Activity and Functional Recovery in Patients with Ischemic Stroke and Arterial Occlusion trial is an observational and longitudinal study that included consecutive patients with acute ischemic stroke admitted to a single tertiary stroke center. Main inclusion criteria were: anterior circulation ischemic stroke within 12 h from symptom onset; presence of a confirmed anterior large vessel occlusion, and functional independence previous to stroke. Prestroke PhA was evaluated with the International Physical Activity Questionnaire and categorized into mild, moderate and high levels by means of metabolic equivalent (MET) minutes per week thresholds. The primary outcome measure was good functional outcome at 3 months (modified Rankin scale ≤2). Secondary outcomes were severity of stroke at admission, complete early recanalization, early dramatic neurological improvement and final infarct volume. RESULTS During the study period, 159 patients fulfilled the above criteria. The mean age was 68 years, 62% were men and the baseline NIHSS score was 17. Patients with high levels of prestroke PhA were younger, had more frequently distal occlusions and had lower levels of blood glucose and fibrinogen at admission. After multivariate analysis, a high level of prestroke PhA was associated with a good functional outcome at 3 months. Regarding secondary outcome variables and after adjustment for relevant factors, a high level of prestroke PhA was independently associated with milder stroke severity at admission, early dramatic improvement, early arterial recanalization after intravenous thrombolysis and lower final infarct volume. The beneficial association of prestroke PhA with stroke outcomes was already present with a cutoff point of 1,000 MET min/week, a level of PhA easily achieved by walking 1 h/day during 5 days or by doing a vigorous aerobic activity 1 h/day twice a week. CONCLUSIONS Prestroke PhA is independently associated with favorable stroke outcomes after a large vessel occlusion. Future research on the underlying mechanisms is needed to understand this neuroprotective effect of PhA.
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Affiliation(s)
- Ana Clara Ricciardi
- Stroke Unit, Department of Neurosciences, Germans Trias i Pujol University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
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24
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The Impact of World and European Football Cups on Stroke in the Population of Dijon, France: A Longitudinal Study from 1986 to 2006. J Stroke Cerebrovasc Dis 2014; 23:e229-35. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 10/12/2013] [Indexed: 11/20/2022] Open
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25
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Breslow RA. Measuring the burden--current and future research trends: results from the NIAAA Expert Panel on Alcohol and Chronic Disease Epidemiology. Alcohol Res 2014; 35:250-9. [PMID: 24881334 PMCID: PMC3908717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Alcohol has a significant impact on health and well-being, from the beneficial aspects of moderate drinking to the detrimental effects of alcoholism. The broad implications of alcohol use on public health have been addressed through a wide range of epidemiological and clinical studies, many of which are described in this issue of Alcohol Research: Current Reviews. Where chronic disease is involved, alcohol use can be a risk factor that not only affects the onset of various chronic diseases but also exacerbates the ongoing extent and severity of those diseases. Lifestyle choices and genetic influences also contribute to, or help to alleviate, that risk.
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26
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Affiliation(s)
- Armin J. Grau
- From the Department of Neurology (A.J.G.), Klinikum Ludwigshafen aRh, Germany; and the Department of Biostatistics (G.H.), University of Alabama School of Public Health, Birmingham, AL
| | - George Howard
- From the Department of Neurology (A.J.G.), Klinikum Ludwigshafen aRh, Germany; and the Department of Biostatistics (G.H.), University of Alabama School of Public Health, Birmingham, AL
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27
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Mittleman MA, Mostofsky E. Physical, psychological and chemical triggers of acute cardiovascular events: preventive strategies. Circulation 2011; 124:346-54. [PMID: 21768552 DOI: 10.1161/circulationaha.110.968776] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Murray A Mittleman
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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28
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Previous leisure-time physical activity dose dependently decreases ischemic stroke severity. Stroke Res Treat 2011; 2012:614925. [PMID: 21912754 PMCID: PMC3168295 DOI: 10.1155/2012/614925] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 06/30/2011] [Accepted: 07/07/2011] [Indexed: 11/17/2022] Open
Abstract
In the present subanalysis of a cross-sectional study showing the favorable effect of prior transient ischemia, leisure-time physical activity, and lipid-lowering drug therapy on stroke severity, we aimed to evaluate whether previous physical activity was dose dependently associated to minor stroke (NIHSS 0-3) and to identify possible underlying factors. Among 362 consecutive patients, less severe stroke was related to weekly exercise duration prior to stroke (no exercise: 36.1%; <2 hours: 49.3%; 2-5 hours: 58.8%; >5 hours: 64.0%; P = 0.003). Only weak and moderate exercise practices were protective (weak: 50.0%; moderate: 79.3%; heavy: 22.2%; P < 0.0001). Such a beneficial effect was observed independently of age and was associated with a trend to a lower frequency of arterial hypertension, alcohol abuse, and a better metabolic profile. Besides other therapeutic approaches, physical activity may be a simple way to decrease cerebral ischemia severity.
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Abstract
Much of the decline in stroke incidence and mortality for the past several decades in Western countries has been attributed to better treatment of risk factors. Many epidemiological studies and clinical trials confirmed the importance of managing hypertension. Comparative trials of anti-hypertensive drugs or drug classes have not yielded clear results, but blood pressure variability may play an important role beyond the absolute value of blood pressure. Diabetes therapy remains a conundrum. Although diabetes is clearly a risk factor for ischemic stroke, treatment trials targeting different glycemic goals have not indicated that glucose lowering results in stroke prevention. Trials focused on insulin resistance are ongoing and they may be able to help establish the management of diabetes/impaired glucose tolerance. Evidence for treatment of dyslipidemia has contrasted science to diabetes mellitus. Dyslipidemia has not been strongly or consistently linked to ischemic stroke but the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial showed the impact of statin treatment in stroke prevention. The results of clinical trials investigating dabigatran and rivaroxaban clearly indicate alternative strategies to vitamin K antagonists in stroke prevention for persons with atrial fibrillation. Evidence for stroke prevention by life style modification, treating metabolic syndrome, sleep disordered breathing, lipoprotein (a), hyperhomocysteinemia, and coagulation disorders are also discussed.
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Affiliation(s)
- Junya Aoki
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama 701–0192 Japan
| | - Ken Uchino
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH 44195 USA
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