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Woo HG, Chang Y, Ryu DR, Song TJ. Plasma Klotho concentration is associated with the presence, burden and progression of cerebral small vessel disease in patients with acute ischaemic stroke. PLoS One 2019; 14:e0220796. [PMID: 31398214 PMCID: PMC6688787 DOI: 10.1371/journal.pone.0220796] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 07/23/2019] [Indexed: 12/26/2022] Open
Abstract
Klotho is a soluble or membrane-bound anti-aging protein, whose protective actions are important for a prudential function of many organs. Because Klotho and cerebral small vessel disease (SVD) are associated with ageing process and endothelial dysfunction, it is possible that Klotho has an association with cerebral SVD. We aimed to investigate the association of plasma Klotho concentration with the presence, burden and progression of cerebral SVD. We prospectively enrolled 262 patients with first-ever acute cerebral infarction, performed brain MRI and collected their blood samples within 24 hours of admission. An enzyme-linked immunosorbent assay was used for evaluating plasma Klotho concentration. We estimated the total SVD score of each patient after determining the presence and burden of high-grade white matter hyperintensities (HWMHs), cerebral microbleeds (CMBs), high-grade perivascular spaces (HPVSs) and asymptomatic lacunar infarctions (ALIs). Univariate and multivariate analyses were conducted to investigate association of Klotho with cerebral SVD and the total SVD score. Of the 262 patients, 152 (58.0%) were men. The mean age of these patients was 64.7 years. The mean ± standard deviation of plasma Klotho concentration was 329.8 ± 194.1 pg/mL. In multivariate analysis, plasma Klotho concentration was negatively associated with the presence of HWMHs [Odds ratio (OR): 0.13, p = 0.047], HPVSs (OR: 0.22, p = 0.024) and ALIs (OR: 0.53, p = 0.021) but not associated with the presence of CMBs (OR: 0.39, p = 0.404). Plasma Klotho concentration was also negatively related to the total SVD score (unstandardized coefficients beta: −0.895, standard error = 0.317, p = 0.005, R2 = 0.239). Furthermore, plasma Klotho concentration was negatively related to the presence (OR: 0.75, 95% CI: 0.59–0.96, p = 0.025) and severity of cerebral SVD progression (OR: 0.72, 95% CI: 0.56–0.92, p = 0.009). In conclusion, plasma Klotho concentration was negatively associated with the presence, burden and progression of cerebral SVD.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yoonkyung Chang
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Dong-Ryeol Ryu
- Department of Nephrology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
- * E-mail:
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Chang Y, Lee SA, Lee SH, Lee EH, Kim YJ, Song TJ. Interarm Blood Pressure Difference has Various Associations with the Presence and Burden of Cerebral Small-Vessel Diseases in Noncardioembolic Stroke Patients. J Clin Neurol 2019; 15:159-167. [PMID: 30877693 PMCID: PMC6444144 DOI: 10.3988/jcn.2019.15.2.159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose An interarm blood pressure difference (IABD) is independently related to the occurrence of cardiovascular disease and mortality. Cerebral small-vessel diseases (SVDs) are important risk factors for stroke, cognitive dysfunction, and mortality. We aimed to determine whether IABD is related to cerebral SVDs. Methods This study included 1,205 consecutive noncardioembolic ischemic stroke patients as confirmed by brain MRI and simultaneously measured the bilateral brachial blood pressures. We investigated cerebral SVDs based on high-grade white-matter hyperintensities (HWHs), presence of cerebral microbleeds (CMBs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs) on brain MRI. Results In multivariate logistic regression, an interarm systolic blood pressure difference (IASBD) ≥10 mm Hg was independently related to the existence of HWHs [odds ratio (OR)=1.94, 95% CI=1.32–2.84, p=0.011] and had a tendency to be associated with the presence of HPVSs (OR=1.45, 95% CI=0.49–2.23, p=0.089) and ALIs (OR=1.42, 95% CI=0.96–2.11, p=0.052), but not with the presence of CMBs (OR=1.09, 95% CI=0.73–1.61, p=0.634). In multivariate linear regression adjusted for age, sex, and variables with p<0.1 in the univariate analysis, IASBD ≥10 mm Hg and interarm diastolic blood pressure difference ≥10 mm Hg were significantly correlated with an increased total burden of SVDs (β=0.080 and p=0.006, and β=0.065 and p=0.023, respectively). Conclusions This study found that IABD ≥10 mm Hg was associated with the presence and increased burden of cerebral SVDs in noncardioembolic stroke patients. This suggests that IABD ≥10 mm Hg could be a useful indicator of the presence and burden of cerebral SVDs in stroke patients.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, College of Medicine, Ewha Womans University, Seoul, Korea.,Departent of Neurology, College of Medicine, Korea University Guro Hostpital, Seoul, Korea
| | - Seung Ah Lee
- Department of Neurology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sue Hyun Lee
- Department of Neurology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Eun Hye Lee
- Department of Neurology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yong Jae Kim
- Department of Neurology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Tae Jin Song
- Department of Neurology, College of Medicine, Ewha Womans University, Seoul, Korea.
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Song TJ, Chang Y, Kim AR, Kim Y, Kim YJ. High dietary glycemic load was associated with the presence and burden of cerebral small vessel diseases in acute ischemic stroke patients. Nutr Res 2018; 51:93-101. [DOI: 10.1016/j.nutres.2017.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 12/30/2022]
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Song TJ, Chang Y, Chun MY, Lee CY, Kim AR, Kim Y, Kim YJ. High Dietary Glycemic Load is Associated with Poor Functional Outcome in Patients with Acute Cerebral Infarction. J Clin Neurol 2018; 14:165-173. [PMID: 29629525 PMCID: PMC5897198 DOI: 10.3988/jcn.2018.14.2.165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/25/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022] Open
Abstract
Background and Purpose Elevated postprandial blood glucose is a critical risk factor for stroke. The dietary glycemic load (GL) and glycemic index (GI) are frequently used as markers of the postprandial blood glucose response to estimate the overall glycemic effect of diets. We hypothesized that high dietary GL, GI, or total carbohydrate intake is associated with a poor functional outcome in patients with acute ischemic stroke. Methods We prospectively included 263 first-ever ischemic stroke patients who completed a semiquantitative food-frequency questionnaire. The dietary GL, GI, and total carbohydrate intake were investigated by examining the average frequency of intake during the previous year based on reference amounts for various food items. Poor functional outcome was defined as a score on the modified Rankin Scale (mRS) of ≥3 at 3 months after stroke. Results The patients were aged 65.4±11.7 years (mean±standard deviation), and 58.2% of them were male. A multivariate analysis adjusted for age, sex, marital status, prestroke mRS score, diabetes mellitus, hyperlipidemia, body mass index, triglycerides, low-density lipoprotein, hemoglobin A1c, stroke classification, and National Institutes of Health Stroke Scale score, early neurological deterioration, and high-grade white-matter hyperintensities revealed that the dietary GL and total carbohydrate intake were associated with a poor functional outcome, with odds ratios for the top quartile relative to the bottom quartile of 28.93 (95% confidence interval=2.82–296.04) and 36.84 (95% confidence interval=2.99–453.42), respectively (p for trend=0.002 and 0.002, respectively). In contrast, high dietary GI was not associated with a poor functional outcome (p for trend=0.481). Conclusions Increased dietary GL and carbohydrate intake were associated with a poor short-term functional outcome after an acute ischemic stroke.
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Affiliation(s)
- Tae Jin Song
- Stroke Center, Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yoonkyung Chang
- Stroke Center, Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Min Young Chun
- Stroke Center, Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chan Young Lee
- Stroke Center, Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - A Ram Kim
- Department of Clinical Nutrition, The Graduate School of Converging Clinical & Public Health, Seoul, Korea
| | - Yuri Kim
- Department of Clinical Nutrition, The Graduate School of Converging Clinical & Public Health, Seoul, Korea.,Department of Nutritional Science and Food Management, Ewha Womans University, Seoul, Korea
| | - Yong Jae Kim
- Stroke Center, Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea.
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Song TJ, Kim J, Song D, Yoo J, Lee HS, Kim YJ, Nam HS, Heo JH, Kim YD. Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke. J Clin Neurol 2017; 13:187-195. [PMID: 28406586 PMCID: PMC5392462 DOI: 10.3988/jcn.2017.13.2.187] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/15/2017] [Accepted: 01/18/2017] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose The recently developed total cerebral small-vessel disease (CSVD) score might appropriately reflect the total burden or severity of CSVD. We investigated whether the total CSVD score is associated with long-term outcomes during follow-up in patients with acute ischemic stroke. Methods In total, 1,096 consecutive patients with acute ischemic stroke who underwent brain magnetic resonance imaging were enrolled. We calculated the total CSVD score for each patient after determining the burden of cerebral microbleeds (CMBs), high-grade white-matter hyperintensities (HWHs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs). We recorded the date and cause of death for all of the patients using data from the Korean National Statistical Office. We compared the long-term mortality rate with the total CSVD score using Cox proportional-hazards models. Results CMBs were found in 26.8% of the subjects (294/1,096), HWHs in 16.4% (180/1,096), HPVSs in 19.3% (211/1,096), and ALIs in 38.0% (416/1,096). After adjusting for age, sex, and variables that were significant at p<0.1 in the univariate analysis, the total CSVD score was independently associated with long-term death from all causes [hazard ratio (HR)=1.18 per point, 95% confidence interval (CI)=1.07–1.30], ischemic stroke (HR=1.20 per point, 95% CI=1.01–1.42), and hemorrhagic stroke (HR=2.05 per point, 95% CI=1.30–3.22), but not with fatal cardiovascular events (HR=1.17 per point, 95% CI=0.82–1.67). Conclusions The total CSVD score is a potential imaging biomarker for predicting mortality during follow-up in patients with acute ischemic stroke.
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Affiliation(s)
- Tae Jin Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jinkwon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dongbeom Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Jae Kim
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
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