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Zheng X, Zeng N, Wang A, Zhu Z, Peng H, Zhong C, Xu T, Xu T, Peng Y, Li Q, Ju Z, Geng D, Zhang Y, He J. Family history of stroke and death or vascular events within one year after ischemic stroke. Neurol Res 2019; 41:466-472. [PMID: 30829563 DOI: 10.1080/01616412.2019.1577342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS The association between family history of stroke and clinical outcomes after ischemic stroke remains unclear. METHODS A total of 3878 acute ischemic stroke patients from CATIS were included. The participants with ischemic stroke were divided into groups according to types of family history of stroke, stroke onset age and stroke subtypes. The primary outcome was a composite outcome of death and vascular events within 1 year after stroke. Multivariable Cox proportional hazard models were used to analyze the association between family history of stroke and other variables and clinical outcomes. RESULTS Among 3878 ischemic stroke patients, 708 (18.26%) had a history of stroke in their first-degree relatives and 399 experienced a composite outcome (172 patients died and 227 experienced vascular events) within 1 year after stroke. Overall family history was not associated with the primary outcome (HR, 1.08; 95% CI, 0.37-3.19). However, the patients with maternal stroke history (HR, 1.87; 95% CI, 1.31-2.97), stroke onset age<55 years with family history (HR, 2.02; 95% CI, 1.08-3.80) and thrombotic stroke in the patients with family history (HR, 1.46; 95% CI, 1.00-2.12) were associated with primary outcome, death and vascular events, respectively. CONCLUSION This study suggests that maternal stroke history, age<55 years at stroke onset and thrombotic stroke in the patients with a family history are associated with poor outcomes after stroke. Further studies from other samples are needed to replicate our findings due to a reason for excluding some severe stroke patients in this study.
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Affiliation(s)
- Xiaowei Zheng
- a Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases , Medical College of Soochow University , Suzhou , China
| | - Nimei Zeng
- a Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases , Medical College of Soochow University , Suzhou , China
| | - Aili Wang
- a Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases , Medical College of Soochow University , Suzhou , China
| | - Zhengbao Zhu
- a Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases , Medical College of Soochow University , Suzhou , China.,b Department of Epidemiology , Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA
| | - Hao Peng
- a Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases , Medical College of Soochow University , Suzhou , China
| | - Chongke Zhong
- a Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases , Medical College of Soochow University , Suzhou , China.,b Department of Epidemiology , Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA
| | - Tan Xu
- a Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases , Medical College of Soochow University , Suzhou , China
| | - Tian Xu
- a Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases , Medical College of Soochow University , Suzhou , China.,c Department of Neurology , Affiliated Hospital of Nantong University , Nantong , China
| | - Yanbo Peng
- d Department of Neurology , Affiliated Hospital of North China University of Science and Technology , Hebei , China
| | - Qunwei Li
- e Department of Epidemiology, School of Public Health , Taishan Medical College , Shandong , China
| | - Zhong Ju
- f Department of Neurology , Kerqin District First People's Hospital of Tongliao City , Inner Mongolia , China
| | - Deqin Geng
- g Department of Neurology , Affiliated Hospital of Xuzhou Medical College , Jiangsu , China
| | - Yonghong Zhang
- a Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases , Medical College of Soochow University , Suzhou , China
| | - Jiang He
- b Department of Epidemiology , Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA
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Racial Differences in Outcomes after Acute Ischemic Stroke Hospitalization in the United States. J Stroke Cerebrovasc Dis 2016; 25:1970-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/22/2016] [Accepted: 03/27/2016] [Indexed: 11/20/2022] Open
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Duraski SA. Meeting the Needs of the Community: A Project to Prevent Stroke in Hispanics. Top Stroke Rehabil 2015; 9:46-56. [PMID: 14523699 DOI: 10.1310/qe87-btnd-6k03-fy9f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Hispanic population is the fastest growing minority population in the United States. Little research has been done to address the stroke risk in the Hispanic population that has a higher prevalence of diabetes, alcohol use, and physical inactivity. To change behavior and decrease the risk of stroke, a comprehensive program that combines education, risk identification, and follow-up is needed. The purpose of this article is to identify the increased risk factors of stroke in the Hispanic population, identify the barriers to health care, and outline the development of a stroke education and screening program for Hispanics.
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Russo V, Santarelli S, Magrini L, Moscatelli P, Altomonte F, Cremonesi G, Battista S, Maggiorotto M, Pinto N, Maroccia A, Glorioso N, Sircana A, Moro M, Pugliese FR, Revello A, Di Somma S. Multicentre Italian analysis on cardiovascular diseases: impact of immigrants' referral to emergency department. J Cardiovasc Med (Hagerstown) 2014; 18:136-143. [PMID: 25333377 DOI: 10.2459/jcm.0000000000000221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During the recent years, immigration in Italy has increased. There are few data on the health status of immigrants and there is a need to improve their healthcare. Cardiovascular disorders account for 7.6% of immigrants' diseases and cause 3.6% of the total deaths. Lack of healthcare services to general medicine support and prescriptions leads immigrants to contact the Emergency Department (ED) to receive medical assistance. Primary endpoints of this study were to assess the use of national healthcare system by immigrants and to determine the incidence of cardiovascular diseases, and the frequency and type of risk factors for cardiovascular diseases in these patients. A no-profit, observational, multicentre study was conducted from April to September 2012. We studied 642 foreign patients referring to the ED for various symptoms/signs. One hundred and fourteen patients referred for suspected cardiovascular disease and 105 had a confirmed final diagnosis of cardiovascular disease. The more represented ethnic origin was Caucasian (59%), whereas the most represented country was Romania (24%). The main symptom recorded at ED arrival was chest pain (37.1%). Final cardiovascular diagnoses were represented by: hypertensive crisis (28.5%), acute coronary syndrome (20%), acute heart failure (12.3%), atrial fibrillation (10.4%) and chest pain (10.4%). Past medical history of cardiovascular disease, hypertension, obesity and male sex showed independent significant predictive value for cardiovascular disease diagnosis.Our study provides support for the development of specific primary prevention of cardiovascular risk factors in immigrants with the important role of culturally competent education of individuals and families. Better outpatient management seems to be needed in order to limit the need for emergency room referral.
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Affiliation(s)
- Veronica Russo
- aEmergency Department, Sant'Andrea Hospital, School of Medicine and Psychology 'Sapienza' University, Rome bEmergency Medicine Department, San Martino Teaching Hospital, Genova University, Genoa cEmergency Medicine Department, Città della Scienza e della Salute Hospital, Turin dEmergency Medicine Department, Bari Teaching Hospital, Bari eEmergency Medicine Department, Sassari Teaching Hospital, Sassari fEmergency Medicine Department, Sandro Pertini Hospital, Rome, Italy
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Lower stroke mortality among Hispanics: an exploration of potential methodological confounders. Med Care 2010; 48:534-9. [PMID: 20473209 DOI: 10.1097/mlr.0b013e3181d686cf] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Stroke mortality rates are reported to be lower for Hispanics than non-Hispanic Whites. We investigate the degree to which this lower reported mortality is explained by inaccuracies introduced through omission of nativity, imprecise measurement of cause of death, and under-ascertainment of Hispanic ethnicity on death certificates. We used national vital registration data for the years 1989-1991 and 1999-2002, including foreign- and US-born Hispanics and non-Hispanic Whites. Hispanic deaths were adjusted for misclassification of ethnicity on the death certificate. Denominators for the rates were derived from census estimates. RESULTS Adjustment for nativity and death certificate misclassification removes the stroke mortality advantage for US-born Hispanic men, but not women. After adjustment, US-born Hispanic men and women have higher rates of mortality from subarachnoid hemorrhage than non-Hispanic Whites (RR: 1.23 and 1.23, respectively), but lower rates of mortality from Ischemic (RR: 0.76 and 0.73, respectively) and chronic effects of stroke (RR: 0.87 and 0.73, respectively). CONCLUSIONS When adjusted for misclassification the lower stroke mortality remains for Hispanic men and women at older ages. Part of the previously reported advantage is a combination of imprecise measurement and data quality.
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Cohuet G, Struijker-Boudier H. Mechanisms of target organ damage caused by hypertension: therapeutic potential. Pharmacol Ther 2005; 111:81-98. [PMID: 16288809 DOI: 10.1016/j.pharmthera.2005.09.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 09/14/2005] [Indexed: 12/24/2022]
Abstract
Hypertension is a major risk factor for cardiovascular mortality and morbidity through its effects on target organs like the brain, heart, and kidney. Structural alterations in the microcirculation form a major link between hypertension and target organ damage. In this review, we describe damages related to hypertension in these target organs and the mechanisms involved in the pathogenesis of hypertension-induced cardiovascular diseases such as dementia, cardiac ischemia and remodeling, or nephropathy. We also focus on the therapeutical potential on the basis of such mechanisms. Several antihypertensive agents like diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin II (Ang II) receptor antagonists, beta-blockers, or calcium channel blockers (CCBs) have been shown to reduce effectively hypertension associated cardiovascular events and to improve end organ damage. More recently, aldosterone antagonism has also shown beneficial effects. Part of the favorable effects of these agents is due to blood pressure lowering as such. Other mechanisms such as oxidative stress, inflammation, or endothelial dysfunction have appeared to play a key role in the pathogenesis of target organ damage and therefore represent another important pathway for therapy. In this review, we discuss the different therapeutic approaches aiming at reducing cardiovascular events and damages induced by hypertension.
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Affiliation(s)
- G Cohuet
- Cardiovascular Research Institute of Maastricht, Pharmacology and Toxicology, Universiteitssingel 50, PO BOX 616, 6200 MD Maastricht, The Netherlands
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Lavados PM, Sacks C, Prina L, Escobar A, Tossi C, Araya F, Feuerhake W, Galvez M, Salinas R, Alvarez G. Incidence, 30-day case-fatality rate, and prognosis of stroke in Iquique, Chile: a 2-year community-based prospective study (PISCIS project). Lancet 2005; 365:2206-15. [PMID: 15978929 DOI: 10.1016/s0140-6736(05)66779-7] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The epidemiology of stroke in Latin-American populations and variation of subtypes between communities are unclear. Our aim was to ascertain prospectively the incidence of first-ever stroke in the predominantly Hispanic-Mestizo population of Iquique, a city in the northern desert region of Chile. METHODS We prospectively identified all possible cases of stroke and transient ischaemic attacks between July 1, 2000, and June 30, 2002, from several overlapping sources. Patients were rapidly assessed by two field neurologists. Standard definitions for incident cases, stroke, transient ischaemic attack, pathological type, and infarction subtype were used. All cases identified were adjudicated by at least two stroke neurologists and followed up at 6 months. Incidence rates of first-ever strokes were calculated from the population of Iquique (214 526) according to the national census of 2002. FINDINGS Of 380 cases of stroke identified, 292 were incident. CT scans were done in 267 (91%) patients and the mean time to scan was 2.2 days. The hospital admission rate was 71% (207/292). The overall age-adjusted incidence rate of first-ever stroke was 140.1 per 100,000 (95% CI 124.0-156.2). The incidence rates per 100,000 according to pathological type were: infarcts 87.3, intracerebral haemorrhage 27.6, and subarachnoid haemorrhage 6.2. The 30 day and 6-month case-fatality rates were 23.3% and 33.0%, respectively. INTERPRETATION Our results show incidence rates of stroke similar to those reported in other community studies. Although the proportion of intracerebral haemorrhages was higher than reported in previous studies, the overall incidence was not, which could indicate a slightly lower incidence of ischaemic strokes in this population than in other countries. The prognosis was similar to that found in other population-based studies.
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Affiliation(s)
- Pablo M Lavados
- Departamento de Medicina, Clínica Alemana de Santiago, Instituto de Neurocirugía, Servicio de Salud Metropolitano Oriente, Santiago, Chile.
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Otiniano ME, Du XL, Ottenbacher K, Markides KS. The effect of diabetes combined with stroke on disability, self-rated health, and mortality in older Mexican Americans: results from the Hispanic EPESE. Arch Phys Med Rehabil 2003; 84:725-30. [PMID: 12736889 DOI: 10.1016/s0003-9993(02)04941-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine how diabetes in combination with stroke affects functional activities of daily living (ADLs) and instrumental activities of daily living (IADLs), self-rated health, and 5-year mortality in elderly Mexican Americans with or without other comorbid conditions. DESIGN Longitudinal study. SETTING Five southwestern states. PARTICIPANTS A total of 3050 subjects of age 65 years or older, of whom 23% had diabetes and 6% had a stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES ADL and IADL disabilities, self-rated health, and 5-year mortality. RESULTS Subjects with both diabetes and stroke but without other comorbid conditions had almost 18 times higher risk of having any ADL disability (odds ratio [OR]=18.8; 95% confidence interval [CI], 3.3-105.2) and 10 times higher risk of having any IADL disability (OR=10.6; 95% CI, 1.1-101.5), compared with subjects without either of the 2 conditions. The risk of disability was further increased if the subject had a comorbid condition (hypertension, heart attack, cancer, hip fracture, arthritis). The risk of fair or poor self-rated health was 3.5 (95% CI, 1.4-8.6) and the hazard ratio for 5-year mortality was 2.4 (95% CI, 1.7-3.4) in people with both diseases. CONCLUSIONS Diabetes and stroke in combination is strongly associated with a higher risk of disabilities, poor self-rated health, and 5-year mortality in elderly Mexican Americans. The effect on outcomes appears to follow an additive model. Information on disability risk and morbidity and mortality should be useful to rehabilitation professionals in discharge planning and allocation of therapy resources.
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Affiliation(s)
- Max E Otiniano
- Department of Internal Medicine, Sealy Center on Aging, University of Texas Medical Branch, Galveston 77555-0460, USA
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Hartmann A, Rundek T, Mast H, Paik MC, Boden-Albala B, Mohr JP, Sacco RL. Mortality and causes of death after first ischemic stroke: the Northern Manhattan Stroke Study. Neurology 2001; 57:2000-5. [PMID: 11739816 DOI: 10.1212/wnl.57.11.2000] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the early and long-term causes of death after first ischemic stroke in the multiethnic northern Manhattan community. METHODS In the prospective, population-based Northern Manhattan Stroke Study, 980 patients with first ischemic stroke (mean age 70 years; 56% women; 49% Caribbean Hispanic, 31% black, 20% white) were followed for a mean of 3 years. Causes of death were classified as vascular (incident stroke, recurrent stroke, cardiac) or nonvascular. Life table analyses were used to assess mortality risks among different race-ethnic groups. Early (< or =1 month) vs long-term (> 1 month to 5 years) causes of death were compared. RESULTS Among the 980 patients followed, 278 (28%) died; 47 (5%) died during the first month. Cumulative mortality risk was 5% at 1 month, 16% after 1 year, 29% after 3 years, and 41% after 5 years. The proportion of vascular deaths among all deaths was 75% at 1 month and 43% thereafter (p = 0.001). Stroke, either incident (53%) or recurrent (4%), caused early deaths in 57% and long-term deaths in 14% (p = 0.001). Overall mortality risks did not differ significantly among race-ethnic groups. However, the proportion of incident stroke-related early deaths was 85% in Caribbean Hispanic patients, 33% in white patients, and 25% in black patients (p = 0.002). CONCLUSIONS Among patients with first ischemic stroke, incident stroke is the leading cause of early deaths. A large proportion of long-term deaths are nonvascular in origin. Despite similar overall mortality rates in race-ethnic groups, our data suggest a higher incident stroke-related early mortality among Caribbean Hispanics.
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Affiliation(s)
- A Hartmann
- Stroke Center, Department of Neurology, Columbia University College of Physicians and Surgeons and School of Public Health, New York, NY, USA.
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Morgenstern LB, Wein TH, Smith MA, Moyé LA, Pandey DK, Labarthe DR. Comparison of stroke hospitalization rates among Mexican-Americans and non-Hispanic whites. Neurology 2000; 54:2000-2. [PMID: 10822444 DOI: 10.1212/wnl.54.10.2000] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors performed a prospective, community-based pilot stroke surveillance project in Nueces County, TX. Mexican-Americans showed a trend toward higher completed ischemic stroke hospitalization rates compared with non-Hispanic whites. Mexican-Americans were more commonly uninsured (p = 0.007) and were less likely to receive neuroimaging (p = 0.001). Additional studies are needed to confirm this finding and to determine the role of stroke risk factors and access to care variables.
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Affiliation(s)
- L B Morgenstern
- Stroke Program, Department of Neurology, The University of Texas, Medical School, Houston, TX 77030, USA.
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