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Eilertsen RK, Midtbø H, Sindre RB, Waje-Andreassen U, Gerdts E. Factors associated with progression of arterial stiffness in ischemic stroke survivors: the Norwegian Stroke in the Young Study. Blood Press 2024; 33:2298308. [PMID: 38185939 DOI: 10.1080/08037051.2023.2298308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Progressive arterial stiffening may increase the risk of recurrent cardiovascular events in ischemic stroke survivors. Information about factors associated with progressive arterial stiffening during the follow-up of young patients with ischemic stroke is lacking. METHODS Arterial stiffness by carotid-femoral pulse wave velocity (cf-PWV) and ambulatory 24-hour blood pressure (24hBP) were assessed in 81 women and 190 men ≤60 years of age included in the Norwegian Stroke in the Young (NOR-SYS) study 3 months and 5.5 years after the incident ischemic stroke, representing baseline and follow-up. Covariables of change in cf-PWV were identified using linear regression analysis. RESULTS At baseline, women had less prevalent hypertension (53% vs. 69%, p < 0.05), and lower clinic and 24hBP than men, whereas age, obesity, and prevalence of smoking and antihypertensive drug treatment did not differ. During follow-up, systolic 24hBP remained unchanged, while diastolic 24hBP fell significantly (p < 0.01). Cf-PWV was lower in women both at baseline (7.3 m/s vs. 8.1 m/s) and at follow-up (7.3 m/s vs. 8.0 m/s, both p < 0.001), but the average change during follow-up did not differ between genders. In linear regression analysis, an increase in cf-PWV at the 5-year follow-up was associated with the presence of hypertension and lower cf-PWV at baseline, and higher systolic 24hBP and lack of use of antihypertensive treatment at follow-up (all p < 0.05). CONCLUSION In ischemic stroke survivors participating in the NOR-SYS study, the 5-year increase in cf-PWV did not differ between genders and was associated with higher systolic 24hBP and lack of antihypertensive treatment.
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Affiliation(s)
- Rune Krogh Eilertsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Helga Midtbø
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | | | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Leppert MH, Poisson SN, Scarbro S, Suresh K, Lisabeth LD, Putaala J, Schwamm LH, Daugherty SL, Bradley CJ, Burke JF, Ho PM. Association of Traditional and Nontraditional Risk Factors in the Development of Strokes Among Young Adults by Sex and Age Group: A Retrospective Case-Control Study. Circ Cardiovasc Qual Outcomes 2024; 17:e010307. [PMID: 38529631 PMCID: PMC11021148 DOI: 10.1161/circoutcomes.123.010307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/11/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Despite women having fewer traditional risk factors (eg, hypertension, diabetes), strokes are more common in women than men aged ≤45 years. This study examined the contributions of traditional and nontraditional risk factors (eg, migraine, thrombophilia) in the development of strokes among young adults. METHODS This retrospective case-control study used Colorado's All Payer Claims Database (2012-2019). We identified index stroke events in young adults (aged 18-55 years), matched 1:3 to stroke-free controls, by (1) sex, (2) age±2 years, (3) insurance type, and (4) prestroke period. All traditional and nontraditional risk factors were identified from enrollment until a stroke or proxy-stroke date (defined as the prestroke period). Conditional logistic regression models stratified by sex and age group first assessed the association of stroke with counts of risk factors by type and then computed their individual and aggregated population attributable risks. RESULTS We included 2618 cases (52% women; 73.3% ischemic strokes) and 7827 controls. Each additional traditional and nontraditional risk factors were associated with an increased risk of stroke in all sex and age groups. In adults aged 18 to 34 years, more strokes were associated with nontraditional (population attributable risk: 31.4% men and 42.7% women) than traditional risk factors (25.3% men and 33.3% women). The contribution of nontraditional risk factors declined with age (19.4% men and 27.9% women aged 45-55 years). The contribution of traditional risk factors peaked among patients aged 35 to 44 years (32.8% men and 39.7% women). Hypertension was the most important traditional risk factor and increased in contribution with age (population attributable risk: 27.8% men and 26.7% women aged 45 to 55 years). Migraine was the most important nontraditional risk factor and decreased in contribution with age (population attributable risk: 20.1% men and 34.5% women aged 18-35 years). CONCLUSIONS Nontraditional risk factors were as important as traditional risk factors in the development of strokes for both young men and women and have a stronger association with the development of strokes in adults younger than 35 years of age.
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Affiliation(s)
- Michelle H. Leppert
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
- Colorado Cardiovascular Outcomes Research (CCOR) Group, Denver, Colorado
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO
| | - Sharon N. Poisson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - Sharon Scarbro
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO
- Rocky Mountain Prevention Research Center, Colorado School of Public Health, Aurora, CO
| | - Krithika Suresh
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Lynda D. Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Stacie L. Daugherty
- Colorado Cardiovascular Outcomes Research (CCOR) Group, Denver, Colorado
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Cathy J. Bradley
- Colorado Comprehensive Cancer Center, University of Colorado, Aurora, CO
| | - James F. Burke
- Department of Neurology, The Ohio State University, Columbus, OH
| | - P. Michael Ho
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora, CO
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Umeonwuka CI, Roos R, Ntsiea V. Clinical and demographic predictors of unilateral spatial neglect recovery after prism therapy among stroke survivors in the sub-acute phase of recovery. Neuropsychol Rehabil 2023; 33:1624-1649. [PMID: 36242544 DOI: 10.1080/09602011.2022.2131582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/28/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS: Unilateral Spatial Neglect (USN) affects the rehabilitation process and leads to poor outcomes after stroke. Factors that influence USN recovery following prism adaptation therapy have not been investigated. This study investigated predictors of USN recovery after prism therapy at the sub-acute phase of recovery. METHODS: This study was a randomized controlled trial. USN was assessed with the Behavioural Inattention Test and Catherine Bergego scale. Seventy-four patients with USN were divided into control and intervention group (prism). The prism group used 20 dioptre prism lenses for repeated aiming for 12 sessions while the control group used neutral lenses for aiming training. Regression analysis was conducted to establish clinical and sociodemographic factors that influence USN recovery. RESULTS: Gender, age, years of education, race, employment status, handedness, type of stroke, time since stroke and site of stroke (p > 0.005) showed no significant influence on USN recovery following PA treatment. Higher Cognitive function (OR = 1.52, CI = 1.08-2.14, p = 0.016) and group allocationng (being in the prism group) (OR = 63.10, CI = 9.70-410.59, P < 0.001) were found to significantly influence USN recovery following PA treatment session. CONCLUSIONS: A significant modulating effect on general cognitive ability was found in this study. This suggests that prism adaptation therapy's effect on neural activity and spatial neglect depends on the cognitive function of stroke survivors.Trial registration: Pan African Clinical Trial Registry identifier: PACTR201903732473573.
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Affiliation(s)
- Chuka Ifeanyi Umeonwuka
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Ronel Roos
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
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Nicolini E, Saia V, Lorenzano S, Pracucci G, Iacobucci M, De Michele M, Vallone S, Bergui M, Diomedi M, Nencini P, Tassi R, Saletti A, Puglielli E, Naldi A, Vinci SL, Giannini N, Malfatto L, Roberto M, Romano DG, Cappellari M, Zini A, Sallustio F, Casetta I, Fainardi E, Mangiafico S, Toni D. Mechanical thrombectomy in young patients with large vessel occlusion-related ischemic stroke: Data from the Italian Registry of Endovascular Treatment in Acute Stroke. Eur J Neurol 2023; 30:3751-3760. [PMID: 37565375 DOI: 10.1111/ene.16035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/28/2023] [Accepted: 08/08/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND PURPOSE The weight of outcome predictors in acute ischemic stroke (AIS) patients older than 60 years is not necessarily mirrored in the younger population, posing the question of whether outcome determinants specific for the latter might vary. Very few data are available on predictors of outcome in young AIS patients receiving endovascular treatment (EVT). METHODS We analyzed data for patients aged between 16 and 55 years from the Italian Registry of Endovascular Treatment in Acute Stroke. We divided our population into patients <45 years old and patients aged between 45 and 55 years. After testing the differences between groups in terms of 90-day modified Rankin Scale (mRS) 0-2, mortality, and symptomatic intracranial hemorrhage, we looked for predictors of poor outcome (mRS 3-6), death, and symptomatic intracerebral hemorrhage in the two groups. RESULTS A total of 438 patients younger than 45 years and 817 aged 45-55 years were included; 284 (34.8%) patients aged 45-55 years and 112 (25.6%) patients younger than 45 years old showed poor 90-day functional outcome (p = 0.001). Predictors of poor outcome in the older group were baseline National Institutes of Health Stroke Scale (NIHSS; p < 0.001), diabetes (p = 0.027), poor collateral status (p = 0.036), and groin puncture-to-recanalization time (p = 0.010), whereas Thrombolysis in Cerebral Infarction (TICI) 2b-3 had an inverse association (p < 0.001). Predictors of poor outcome in patients younger than 45 years were baseline NIHSS (p < 0.001) and groin puncture-to-recanalization time (p = 0.015), whereas an inverse association was found for baseline Alberta Stroke Program Early CT Score (p = 0.010) and TICI 2b-3 (p < 0.001). CONCLUSIONS Approximately one third of young adults treated with EVT do not reach a good functional outcome. Fast and successful recanalization, rather than common risk factors, has a major role in determining clinical outcome.
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Affiliation(s)
- Ettore Nicolini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Svetlana Lorenzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Marta Iacobucci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Manuela De Michele
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | - Rossana Tassi
- Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Andrea Saletti
- Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | | | | | | | | | - Laura Malfatto
- Istituti di Ricovero e Cura a Carattere Scientifico - IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Daniele G Romano
- Azienda Ospedaliera Universitaria S. Giovanni di Dio Ruggi D'Aragona, Salerno, Italy
| | | | - Andrea Zini
- Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Ilaria Casetta
- Clinical Neurology, University of Ferrara, Ferrara, Italy
| | | | - Salvatore Mangiafico
- Istituti di Ricovero e Cura a Carattere Scientifico - IRCCS Neuromed, Pozzilli, Italy
| | - Danilo Toni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Tan XM, Liao ZX, Zhao YY, Sun XC, Yi FL. Changes in depressive symptoms before and after the first stroke: A longitudinal study from China Family Panel Study (CFPS). J Affect Disord 2023; 340:567-574. [PMID: 37573890 DOI: 10.1016/j.jad.2023.08.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/27/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES The study sought to examine the impact of longitudinal changes in depressive symptoms in middle-aged adults before and after their first stroke, and the impact of different ages. METHODS The study monitored middle-aged patients with a first stroke in the China Family Panel Study (CFPS) survey from 2016 to 2020. This study examined longitudinal changes in depressive symptoms in middle-aged adults and their controls before and after stroke using multilevel models, and also explored factors influencing middle-aged adults at the time of their respective stroke and depressive symptoms using conditional regression models and stepwise regression models, respectively. A chi-square test was used to determine whether long-term changes in depressive symptoms in patients before and after stroke could be attributed to changes in a single depressive symptom. RESULTS The study identified 582 first-time stroke patients and 5522 controls from a population of 17,588 participants. Middle-aged populations may have an increased risk of depressive symptoms after a first stroke compared to older populations. First-time stroke victims showed increased severity of depressive symptoms in both the two years before and the two years after stroke when depressive symptoms were assessed. Differences in the presentation of a single depressive symptom were most pronounced in sleep-related symptoms. CONCLUSIONS The link between first stroke and changes in the trajectory of increased depressive symptoms is complex and bidirectional. Age is an important factor influencing changes in depressive symptoms, some attention should be paid to the middle-aged population. Special attention should also be paid to sleep-related symptoms in the long-term care of patients.
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Affiliation(s)
- Xiao-Min Tan
- Guangdong Pharmaceutical University, Guangzhou, China
| | - Zi-Xuan Liao
- Guangdong Pharmaceutical University, Guangzhou, China
| | | | - Xiao-Cui Sun
- Guangdong Pharmaceutical University, Guangzhou, China; Engineering and Technology Research Center of Guangdong Universities-Real World Engineering and Technology Research Center of Medical Information, Guangzhou, China
| | - Fa-Ling Yi
- Guangdong Pharmaceutical University, Guangzhou, China; Engineering and Technology Research Center of Guangdong Universities-Real World Engineering and Technology Research Center of Medical Information, Guangzhou, China.
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Vítor J, Bonifácio GV, Fonseca AC. Diagnosis of atrial fibrillation in young patients with ischemic stroke: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2023; 32:107299. [PMID: 37657400 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/21/2023] [Accepted: 08/05/2023] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION The recommended cardiac rhythm evaluation to determine the etiology of ischemic stroke (IS) is similar in all patients regardless of their age and includes an electrocardiogram and at least a 24-hour heart rhythm monitoring. However, it is known that the main causes of IS vary according to patients' age. There is a higher preponderance of arterial dissections and patent foramen ovale in younger patients, while atrial fibrillation (AF) is more common in older patients. AIMS To determine the proportion of AF in young IS reported in the literature and determine if young IS patients found to have AF had known structural cardiac pathology. METHODS Systematic review of the literature searching PubMed and Embase for articles published since their inception to August 2020. Inclusion criteria were studies including at least 10 patients, aged 14-50 years-old, clinical or radiological diagnosis of IS and quantification of patients found to have AF. We conducted a meta-analysis using a random-effects model and calculated pooled proportions with 95% confidence intervals. RESULTS 8331 articles were screened, 154 were selected for full-text review. 43 studies were included in our final analysis (902800 patients). The proportion of AF in young IS overall was 3.1% [95%CI 2.4-3.7], I2 93.88%. Sub-analysis revealed a proportion of AF of 3.8% [95% CI 0.3-7.3] in lower-middle-income economies, versus 5.4% [95% CI 3-7.9] in upper-middle-income economies, and 2.2% [95% CI 1.6-2.8] in high-income economies. Only 3 studies mentioned the proportion of patients with AF that had structural cardiac pathology. CONCLUSION The proportion of AF in young IS was low. More studies are needed to better understand if young IS patients diagnosed with AF had a priori known structural cardiac pathology that could increase the probability of finding AF. This could lead to a reevaluation of the need for 24 hours cardiac rhythm evaluation in young patients without cardiac pathology.
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Affiliation(s)
- Joana Vítor
- Neurology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Ana Catarina Fonseca
- Stroke Unit, Neurology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa 1640-035, Portugal; Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Portugal; Instituto de Medicina Molecular, Lisboa, Portugal.
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Rhiner N, Thut MZ, Thurner P, Madjidyar J, Schubert T, Globas C, Wegener S, Luft AR, Michels L, Kulcsar Z. Impact of age on mechanical thrombectomy and clinical outcome in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2023; 32:107248. [PMID: 37441892 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy is less effective in patients aged 80 years or older. Our goal was to better understand the impact of age in general on recanalization rates and clinical outcome. METHODS We performed a retrospective analysis of our prospective database of adult patients with acute ischemic stroke due to large vessel occlusions, who had undergone mechanical thrombectomy between 2019 and mid-2021. The cohort was categorized into five age groups: 18 - 49, 50 - 59, 60 - 69, 70 - 79 and ≥ 80 years. Our primary outcome measure was clinical outcome at three months after mechanical thrombectomy, measured by the mRS score. Secondary outcomes were procedure times and rates of successful recanalization, defined by mTICI ≥ 2b. RESULTS Data of 264 patients were analyzed. There were no significant differences in procedure times (p = 0.46) or in rates of successful recanalization (p = 0.49) between age groups. There was a significant association of age and mRS score at three months (p < 0.0001): From youngest to oldest group, odds of functional independence (mRS ≤ 2) decreased (80.0% vs. 21.3%) and odds of death (mRS 6) increased (13.3% vs. 57.3%). Increasing age was significantly associated with lower rates of functional independence (OR 0.93; [95% CI 0.90 - 0.95]), higher rates of care dependency (OR 1.04; [95% CI 1.01 - 1.07]) and higher mortality rates (OR 1.06; [95% CI 1.04 - 1.09]). CONCLUSION Higher age had no significant impact on recanalization times or recanalization rates but was strongly associated with worse clinical outcome after mechanical thrombectomy.
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Affiliation(s)
- Nadine Rhiner
- Faculty of Medicine, University of Zurich, Raemistrasse 71, Zurich 8006, Switzerland
| | - Mara Z Thut
- Faculty of Medicine, University of Zurich, Raemistrasse 71, Zurich 8006, Switzerland
| | - Patrick Thurner
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland
| | - Jawid Madjidyar
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland
| | - Tilman Schubert
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland
| | - Christoph Globas
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland
| | - Susanne Wegener
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland
| | - Andreas R Luft
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland; Cereneo Center of Neurology and Rehabilitation, Seestrasse 18, Vitznau 6354, Switzerland
| | - Lars Michels
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland.
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Ciplak S, Adiguzel A, Deniz YZ, Aba M, Ozturk U. The Role of the Low-Density Lipoprotein/High-Density Lipoprotein Cholesterol Ratio as an Atherogenic Risk Factor in Young Adults with Ischemic Stroke: A Case-Control Study. Brain Sci 2023; 13:1180. [PMID: 37626536 PMCID: PMC10452716 DOI: 10.3390/brainsci13081180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Dyslipidemia is a major atherogenic risk factor for ischemic stroke. Stroke patients tend to have high levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) and low levels of high-density lipoprotein cholesterol (HDL-C). Therefore, it is noteworthy that there has been an increase in ischemic stroke cases in young and elderly individuals in recent years. This study investigated the TC/HDL-C ratio and the LDL-C/HDL-C ratio, which may be more specific and common lipid parameters in young patients with ischemic stroke. This study aimed to demonstrate the sensitivity and specificity of TC/HDL-C and LDL-C/HDL-C ratios as atherogenic markers for young adult ischemic strokes. This trial was conducted as a retrospective case-control study. A total of 123 patients (patient group) and 86 healthy individuals (control group) aged 18-50 years were randomly selected from four different hospitals. Lipid parameters and TC/HDL-C and LDL-C/HDL-C ratios were compared between these two groups. The mean age was 38.8 ± 7.3 years in patients and 37.7 ± 9 years in controls (p > 005). The HDL-C levels were 39.1 ± 10.8 mg/dL in patients and 48.4 ± 13.8 mg/dL in controls (p < 0.001). LDL-C/HDL-C ratios were 3.23 ± 1.74 and 2.38 ± 0.87, and TC/HDL-C ratios were 5.24 ± 2.31 and 4.10 ± 1.25 in the patient and control groups, respectively (p < 0.001). The LDL-C/HDL-C and TC/HDL-C cutoff values in ROC analyses were 2.61 and 4.40 respectively; the AUCs (95% CI) were determined to be 0.680 (0.608-0.753) and 0.683 (0.610-0.755) (p < 0.001), respectively. An increased risk of stroke was observed in those with a high LDL-C/HDL-C ratio (OR = 1.827; 95% CI = 1.341-2.488; p < 0.001). Our study obtained similar results when we compared the mean TC and LDL-C levels between the two groups. However, considering the TC/HDL-C and LDL-C/HDL-C ratios, it is noteworthy that there was a significant difference between the patient and control groups.
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Affiliation(s)
- Sibel Ciplak
- Department of Neurology, Turgut Ozal University Faculty of Medicine, Malatya 44090, Turkey
| | - Ahmet Adiguzel
- Department of Neurology, Inonu University Faculty of Medicine, Malatya 44210, Turkey
| | - Yusuf Ziya Deniz
- Department of Neurology, Siirt Education and Research Hospital, Siirt 56000, Turkey
| | - Melike Aba
- Department of Neurology, Mehmet Akif Inan Education and Research Hospital, Sanliurfa 63330, Turkey
| | - Unal Ozturk
- Department of Neurology, University of Health Sciences, Gazi Yasargil Education and Research Hospital, Diyarbakir 21070, Turkey;
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Alkutbi A, Binmahfooz S, AlSaidlani RH, Albeirouti RB, Kamal O, Alalawi H, Aljehani MN, Khared M, Ayoub OA. Clinical Characteristics of Ischemic Stroke Patients <50 Years Old at a University Hospital: A Retrospective Descriptive Study. Cureus 2023; 15:e43752. [PMID: 37746368 PMCID: PMC10511827 DOI: 10.7759/cureus.43752] [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] [Accepted: 08/19/2023] [Indexed: 09/26/2023] Open
Abstract
Background Stroke is a leading cause of mortality and disability around the world. It is responsible for 10% of all fatalities and about 5% of all disabilities. Risk factors include age, hypertension (HTN), dyslipidemia, and atrial fibrillation. The incidence of acute ischemic stroke (AIS) is increasing among young adults compared to older ones. It has a direct impact on their quality of life and working activities while also burdening the healthcare system. Aim The aim of this study is to investigate the possible risk factors for ischemic stroke in patients who are under 50 years old. Methods This is a single-center retrospective record review of patients with ischemic stroke from 2010 to 2022. Eighty patients who had an ischemic stroke at an age below 50 were included in the analysis. Patients above or equal to 50 years old who had ischemic stroke and all patients with hemorrhagic stroke were excluded. Baseline characteristics, length of hospitalization, and in-hospital mortality were compared with different comorbidities. Results The mean age was 36.65 among males and females who had an ischemic stroke. 56.8% of them were non-Saudi, while 43.2% were Saudis. Diabetes, hypertension, and dyslipidemia were among the most frequent comorbidities among patients who had ischemic stroke, with a percentage of 82.7%. Other comorbidities, such as autoimmune disease, thrombophilia, and heart failure, were present. Conclusion There are different comorbidities found in patients who have had an ischemic stroke and are under 50 years old. However, diabetes and hypertension remain the most common risk factors.
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Affiliation(s)
- Abdullah Alkutbi
- Department of Internal Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
- Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Saleh Binmahfooz
- Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
- Department of Internal Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Rawan H AlSaidlani
- Deparmtent of Internal Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Rasana B Albeirouti
- Department of Internal Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Omar Kamal
- Department of Internal Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Hassan Alalawi
- Department of Internal Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Mohammed N Aljehani
- Department of Internal Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Mohsin Khared
- Department of Internal Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Omar A Ayoub
- Department of Internal Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Amaya Pascasio L, Blanco Ruiz M, Milán Pinilla R, García Torrecillas JM, Arjona Padillo A, Del Toro Pérez C, Martínez-Sánchez P. Stroke in Young Adults in Spain: Epidemiology and Risk Factors by Age. J Pers Med 2023; 13:jpm13050768. [PMID: 37240938 DOI: 10.3390/jpm13050768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/16/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Recent research has highlighted an increased incidence of ischemic stroke (IS) in young adults, along with a higher percentage of vascular risk factors at younger ages. This study aimed to estimate the in-hospital incidence of IS and associated comorbidities by sex and age group in Spain. METHODS A retrospective analysis of the Spain Nationwide Inpatient Sample database from 2016 to 2019 was conducted, which included adult patients with IS. In-hospital incidence and mortality rates were estimated, and a descriptive analysis of the main comorbidities was performed, stratified by sex and age groups. RESULTS A total of 186,487 patients were included, with a median age of 77 (IQR 66-85) years and 53.3% were male. Of these, 9162 (5%) were aged between 18 and 50 years. The estimated incidence of IS in adults younger than 50 years ranged from 11.9 to 13.5 per 100,000 inhabitants during the study period, with a higher incidence in men. The overall in-hospital mortality was 12.6%. Young adults with IS had a higher prevalence of most vascular risk factors compared to the general Spanish population, with a specific distribution according to sex and age. CONCLUSIONS This study provides estimates of the incidence of IS and the prevalence of vascular risk factors and comorbidities associated with IS in Spain, stratified by sex and age, using a national registry of hospital admissions. These findings should be considered in terms of both primary and secondary prevention strategies.
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Affiliation(s)
- Laura Amaya Pascasio
- Stroke Centre, Department of Neurology, Torrecárdenas University Hospital, 04009 Almería, Spain
| | - Marina Blanco Ruiz
- Stroke Centre, Department of Neurology, Torrecárdenas University Hospital, 04009 Almería, Spain
| | - Rodrigo Milán Pinilla
- Stroke Centre, Department of Neurology, Torrecárdenas University Hospital, 04009 Almería, Spain
| | - Juan Manuel García Torrecillas
- Department of Emergency Medicine, Torrecárdenas University Hospital, 04009 Almería, Spain
- Biomedical Research Unit, Torrecárdenas University Hospital, 04009 Almería, Spain
- Instituto de Investigación Biomédica Ibs. Granada, 18012 Grranada, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Antonio Arjona Padillo
- Stroke Centre, Department of Neurology, Torrecárdenas University Hospital, 04009 Almería, Spain
| | - Cristina Del Toro Pérez
- Stroke Centre, Department of Neurology, Torrecárdenas University Hospital, 04009 Almería, Spain
| | - Patricia Martínez-Sánchez
- Stroke Centre, Department of Neurology, Torrecárdenas University Hospital, 04009 Almería, Spain
- Biomedical Research Unit, Torrecárdenas University Hospital, 04009 Almería, Spain
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Abedi V, Lambert C, Chaudhary D, Rieder E, Avula V, Hwang W, Li J, Zand R. Defining the Age of Young Ischemic Stroke Using Data-Driven Approaches. J Clin Med 2023; 12:jcm12072600. [PMID: 37048683 PMCID: PMC10095415 DOI: 10.3390/jcm12072600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction: The cut-point for defining the age of young ischemic stroke (IS) is clinically and epidemiologically important, yet it is arbitrary and differs across studies. In this study, we leveraged electronic health records (EHRs) and data science techniques to estimate an optimal cut-point for defining the age of young IS. Methods: Patient-level EHRs were extracted from 13 hospitals in Pennsylvania, and used in two parallel approaches. The first approach included ICD9/10, from IS patients to group comorbidities, and computed similarity scores between every patient pair. We determined the optimal age of young IS by analyzing the trend of patient similarity with respect to their clinical profile for different ages of index IS. The second approach used the IS cohort and control (without IS), and built three sets of machine-learning models—generalized linear regression (GLM), random forest (RF), and XGBoost (XGB)—to classify patients for seventeen age groups. After extracting feature importance from the models, we determined the optimal age of young IS by analyzing the pattern of comorbidity with respect to the age of index IS. Both approaches were completed separately for male and female patients. Results: The stroke cohort contained 7555 ISs, and the control included 31,067 patients. In the first approach, the optimal age of young stroke was 53.7 and 51.0 years in female and male patients, respectively. In the second approach, we created 102 models, based on three algorithms, 17 age brackets, and two sexes. The optimal age was 53 (GLM), 52 (RF), and 54 (XGB) for female, and 52 (GLM and RF) and 53 (RF) for male patients. Different age and sex groups exhibited different comorbidity patterns. Discussion: Using a data-driven approach, we determined the age of young stroke to be 54 years for women and 52 years for men in our mainly rural population, in central Pennsylvania. Future validation studies should include more diverse populations.
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Affiliation(s)
- Vida Abedi
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Clare Lambert
- Department of Neurology, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Durgesh Chaudhary
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA
- Department of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Emily Rieder
- Geisinger Commonwealth, School of Medicine, Scranton, PA 18509, USA
| | - Venkatesh Avula
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA
| | - Wenke Hwang
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Jiang Li
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA
| | - Ramin Zand
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA
- Department of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
- Correspondence: ; Tel.: +1-(717)-531-1804; Fax: +1-(717)-531-0384
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12
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Verified Parental Cardiovascular Events for Young and Middle-Aged Ischaemic Stroke Patients and Controls. Acta Neurol Scand 2023. [DOI: 10.1155/2023/3864506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Introduction. Nonmodifiable cardiovascular risk factors, like age and sex, are easily quantifiable. Due to immense technical progress in diagnostics and medical data storage, the aim of this study was to quantify, verify, and to compare parental cardiovascular events (CVE) as an additional nonmodifiable risk factor for young and middle-aged ischaemic stroke patients and controls. Methods. Information about parental CVE was first obtained by standardized questionnaires answered by 385 acute ischaemic stroke patients (15-60 years of age) and 260 controls. After consent to contact living and include deceased parents, patients and controls provided necessary personal identification of their parents. Thereafter, CVE were verified by standardized questionnaires answered by parents or medical records in case of deceased parents. Results. One hundred-and-nine (14.2%) of 770 patient parents vs. 128 (24.6%) of 520 control parents were not available for verification. Active participation was obtained for 229 (73.9%) of 310 patient parents vs.113 (58.2%) of 194 control parents. Medical record verification was obtained for 192 (54.7%) of 351 deceased patient parents, vs.103 (52.0%) of 198 deceased control parents. This study showed highest death rates of fathers (65.3% patient fathers and 57.6% control fathers) and highest numbers of CVE, especially myocardial infarction among patient fathers of patients aged 50-60 years. Discussion and Conclusion. Obtaining verified parental CVE as a nonmodifiable risk factor is still challenging, despite widely available digital medical information. To attain more accurate information on parental CVE, we recommend active involvement of family members in addition to medical record verification, especially for patients aged <50 years. Trial Registration. This trial is registered with NCT01597453
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13
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Ekker MS, Verhoeven JI, Schellekens MM, 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, Zonneveld TP, Kerkhoff H, Rooyer FA, van Rooij FG, van den Wijngaard IR, Klijn CJ, Tuladhar AM, de Leeuw FE. Risk Factors and Causes of Ischemic Stroke in 1322 Young Adults. Stroke 2023; 54:439-447. [PMID: 36511150 PMCID: PMC9855752 DOI: 10.1161/strokeaha.122.040524] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Identification of risk factors and causes of stroke is key to optimize treatment and prevent recurrence. Up to one-third of young patients with stroke have a cryptogenic stroke according to current classification systems (Trial of ORG 10172 in Acute Stroke Treatment [TOAST] and atherosclerosis, small vessel disease, cardiac pathology, other causes, dissection [ASCOD]). The aim was to identify risk factors and leads for (new) causes of cryptogenic ischemic stroke in young adults, using the pediatric classification system from the IPSS study (International Pediatric Stroke Study). METHODS This is a multicenter prospective cohort study conducted in 17 hospitals in the Netherlands, consisting of 1322 patients aged 18 to 49 years with first-ever, imaging confirmed, ischemic stroke between 2013 and 2021. The main outcome was distribution of risk factors according to IPSS classification in patients with cryptogenic and noncryptogenic stroke according to the TOAST and ASCOD classification. RESULTS The median age was 44.2 years, and 697 (52.7%) were men. Of these 1322 patients, 333 (25.2%) had a cryptogenic stroke according to the TOAST classification. Additional classification using the ASCOD criteria reduced the number patients with cryptogenic stroke from 333 to 260 (19.7%). When risk factors according to the IPSS were taken into account, the number of patients with no potential cause or risk factor for stroke reduced to 10 (0.8%). CONCLUSIONS Among young adults aged 18 to 49 years with a cryptogenic ischemic stroke according to the TOAST classification, risk factors for stroke are highly prevalent. Using a pediatric classification system provides new leads for the possible causes in cryptogenic stroke, and could potentially lead to more tailored treatment for young individuals with stroke.
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Affiliation(s)
- Merel S. Ekker
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (M.S.E., J.I.V., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.d.L.)
| | - Jamie I. Verhoeven
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (M.S.E., J.I.V., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.d.L.)
| | - Mijntje M.I. Schellekens
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (M.S.E., J.I.V., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.d.L.)
| | - Esther M. Boot
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (M.S.E., J.I.V., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.d.L.)
| | - Mayte E. van Alebeek
- Department of Neurology, Amphia Hospital, Breda, the Netherlands (M.E.v.A., A.G.W.v.N)
| | - Paul J.A.M. Brouwers
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands (P.J.A.M.B., R.M.A.)
| | - Renate M. Arntz
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands (P.J.A.M.B., R.M.A.)
| | - Gert W. van Dijk
- Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands (G.W.v.D.)
| | - Rob A.R. Gons
- Department of Neurology, Catharina Hospital, Eindhoven, the Netherlands (R.A.R.G., I.W.M.v.U)
| | - Inge W.M. van Uden
- Department of Neurology, Catharina Hospital, Eindhoven, the Netherlands (R.A.R.G., I.W.M.v.U)
| | - Tom den Heijer
- Department of Neurology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands (T.d.H.)
| | - Paul L.M. de Kort
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg (P.L.M.d.K.)
| | - Karlijn F. de Laat
- Department of Neurology, Haga Hospital, The Hague, Netherlands (K.F.d.L.)
| | - Anouk G.W. van Norden
- Department of Neurology, Amphia Hospital, Breda, the Netherlands (M.E.v.A., A.G.W.v.N)
| | - Sarah E. Vermeer
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands (S.E.V.)
| | - Marian S.G. van Zagten
- Department of Neurology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands (M.S.G.v.Z.)
| | | | - Marieke J.H. Wermer
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands (M.J.H.W.)
| | - Paul J. Nederkoorn
- Department of Neurology, Amsterdam University Medical Centres, Amsterdam, the Netherlands (P.J.N., T.P.Z.)
| | - Thomas P. Zonneveld
- Department of Neurology, Amsterdam University Medical Centres, Amsterdam, the Netherlands (P.J.N., T.P.Z.)
| | - Henk Kerkhoff
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (Henk Kerkhoff, MD, PhD)
| | - Fergus A. Rooyer
- Department of Neurology, Zuyderland Hospital, Sittard-Geleen, the Netherlands (F.A.R.)
| | - Frank G. van Rooij
- Department of Neurology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (F.G.v.R.)
| | | | - Catharina J.M. Klijn
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (M.S.E., J.I.V., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.d.L.)
| | - Anil M. Tuladhar
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (M.S.E., J.I.V., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.d.L.)
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (M.S.E., J.I.V., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.d.L.)
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Gurková E, Štureková L, Mandysová P, Šaňák D. Factors affecting the quality of life after ischemic stroke in young adults: a scoping review. Health Qual Life Outcomes 2023; 21:4. [PMID: 36653785 PMCID: PMC9850784 DOI: 10.1186/s12955-023-02090-5] [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: 05/31/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To synthesize the body of knowledge on the factors influencing the quality of life (QoL) after ischemic stroke (IS) in young adults. METHODS Guidelines regarding the scoping review methodology developed by the Joanna Briggs Institute, and the PRISMA-ScR checklist for a scoping review was used in this paper. A total of 1197 studies were identified through a bibliographic search in Web of Science, MEDLINE, PsycInfo, ScienceDirect, Scopus, and ProQuest Science Database. Articles published between the years 2000-2021 were included. RESULTS A total of nine papers were finally selected to respond to the research question. Three studies were prospective longitudinal studies compared QoL between young stroke and age-matched controls from the general population. Across all the analysed studies, 14 variables potentially associated with QoL were identified. QoL in young patients is mainly affected by clinical outcomes after IS (scored by the modified Rankin scale and the Barthel index-favourable initial functional status and higher independence in ADL leads to higher QoL) and psychological factors (post-stroke fatigue and depression-higher levels of fatigue and depression lead to lower QoL). The reviewed studies emphasized the importance of functional outcomes, post-stroke depression, fatigue and anxiety and early return to work. CONCLUSION Further longitudinal studies are needed to identify the trajectory of post-stroke psychosocial symptoms over time and other potential predictors of unfavourable long-term QoL, thus specific young stroke rehabilitation and stroke self-management support programmes should be developed (address physical, psychological factors which influence the psychosocial adaptation post-stroke and the perception of the QoL).
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Affiliation(s)
- Elena Gurková
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Lenka Štureková
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Petra Mandysová
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Daniel Šaňák
- grid.10979.360000 0001 1245 3953Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
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15
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Lee YT, Tsai CF, Yen YC, Huang LK, Chao SP, Hu LY, Shen CC, Lee HC. Periodontitis is a potential risk factor for transient ischemic attack and minor ischemic stroke in young adults: A nationwide population-based cohort study. J Periodontol 2022; 93:1848-1856. [PMID: 35297043 DOI: 10.1002/jper.21-0528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/26/2021] [Accepted: 01/09/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aims to determine whether periodontitis is a risk factor for transient ischemic attack (TIA) in young adults. METHODS The National Health Insurance (NHI) Research Database in Taiwan was the source of the data used in this retrospective cohort study. Individuals aged 20 to 53 years with periodontitis in 2001 and 2002 (n = 792,426) and an age- and sex-matched control group (n = 792,426) were selected. All participants were followed up until TIA diagnosis, 55 years of age, removal from the NHI program, death, or December 31, 2016. The incidence density and hazard ratio (HR) of new-onset TIA were compared between individuals with periodontitis and controls. Periodontitis was defined by dentists according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 523.3-5 with concurrent antibiotic prescription or periodontal treatment excluding scaling performed by certified dentists. TIA was defined according to the ICD-9-CM code 435.x at hospital discharge. RESULTS After adjustment for confounding factors, the risk of developing TIA/minor ischemic stroke was calculated to be higher in participants with periodontitis (HR, 1.24; 95% confidence interval, 1.15-1.32; P <0.001) than in those without. The HR was slightly higher among people aged 20 to 40 years than among those aged 40 to 53 years. CONCLUSION Periodontitis is associated with an increased risk of developing TIA/minor ischemic stroke. Periodontitis might be a modifiable risk factor for stroke in young adults. Clinicians must devote greater attention to this potential association to develop new preventive and therapeutic strategies for stroke in young adults.
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Affiliation(s)
- Yao-Tung Lee
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Center of Dementia, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chia-Fen Tsai
- Department of Psychiatry, Neurological Institute, Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chun Yen
- Biostatistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Li-Kai Huang
- Center of Dementia, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shu-Ping Chao
- Center of Dementia, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Li-Yu Hu
- Division of Psychiatry, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Che Shen
- Division of Psychiatry, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry & Sleep Center, Taipei Medical University Hospital, Taipei, Taiwan
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16
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Ramírez-Moreno J, Rebollo B, Macías-Sedas P, Valverde N, Parejo A, Felix Redondo F, Roa Montero A, Constantino A, Gómez Baquero M, Ceberino-Muñoz D, Fernández-Bergés D. Fuerza de asociación de factores de riesgo vascular clásicos en pacientes jóvenes con ictus isquémico: un estudio de casos y controles. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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Ramírez-Moreno JM, Rebollo B, Macías-Sedas P, Valverde N, Parejo A, Felix-Redondo FJ, Roa Montero AM, Constantino AB, Gómez Baquero MJ, Ceberino-Muñoz D, Fernández-Bergés D. Strength of association of classical vascular risk factors in young patients with ischaemic stroke: a case-control study. Neurologia 2022:S2173-5808(22)00142-0. [PMID: 36309160 DOI: 10.1016/j.nrleng.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/24/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Recent studies have reported an increasing incidence of ischaemic stroke among young adults. However, the strength of the association between traditional vascular risk factors has not been fully established. METHODS We compared 120 patients with a first ischaemic stroke before the age of 55 years admitted to the stroke unit of our centre with 600 healthy non-stroke controls from a population-based cohort study (HERMEX), matched for sex. Risk factors assessed included: hypertension, obesity, auricular fibrillation, current smoking, estimated glomerular filtration rate (eGFR), total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, high-density lipoprotein cholesterol (HDL-C) and diabetes mellitus. We used logistic regression analysis and calculated population attributable risk. We performed an overall analysis, by sex and aetiological subgroup. RESULTS Using logistic regression analysis, we found that overall, the significant risk factors were: hypertension (OR: 1.58; 95%CI: 1.01-2.50), atrial fibrillation (OR: 4.77; 95%CI: 1.20-19.00), low eGFR (OR: 4.74; 95%CI: 1.3-21.94) and low HDL-C (OR: 5.20; 95%CI: 3.29-8.21), as well as smoking for males (OR: 1.86; 95%CI: 1.14-3.03). LDL-C showed an inverse association with stroke. The population attributable risk for HDL-C was 37.8% and for hypertension 21.1%. In terms of aetiological subgroups, only low HDL-C was associated with stroke of undetermined aetiology. CONCLUSIONS Hypertension, auricular fibrillation, low eGFR, and low HDL-C, plus tobacco use in men, are the main risk factors among patients under 55 years of age with a first ischaemic stroke. We believe that it would be of particular interest to further explore the management of low HDL-C levels as part of preventive strategies in young stroke patients.
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Affiliation(s)
- J M Ramírez-Moreno
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain; Departamento de Ciencias Biomédicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, Badajoz, Spain; Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE).
| | - B Rebollo
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - P Macías-Sedas
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - N Valverde
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - A Parejo
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - F J Felix-Redondo
- Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE); Servicio Extremeño de Salud, Spain
| | - A M Roa Montero
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - A B Constantino
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - M J Gómez Baquero
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - D Ceberino-Muñoz
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - D Fernández-Bergés
- Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE); Servicio Extremeño de Salud, Spain
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18
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Aslam A, Khan U, Niazi F, Anwar I. Etiology and risk factors of stroke in young adults: A multicentric study. Ann Med Surg (Lond) 2022; 82:104647. [PMID: 36268321 PMCID: PMC9577644 DOI: 10.1016/j.amsu.2022.104647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 11/11/2022] Open
Abstract
Objective The main objective of this research was to assess the risk factors and causes of ischemic stroke in the young population (age less than 50 years). Methods This was a prospective multicenter study conducted at Pakistan Atomic Energy Commission General Hospital, Islamabad, and Mayo hospital Lahore from June 2019 to June 2020. In this research, patients with ischemic stroke, aged 15–50 years were included. Prior to noting demographics, each patient gave ethical approval via filling out consent forms. After that, all demographical details including residence, education, gender and age, and socioeconomic status were noted. Risk factors were evaluated on the questionnaire proforma. Outcomes were measured using the modified Rankin scale (MRS) score. Additionally, data were analyzed by using SPSS V26. A P-value of <0.05 was set as statistically significant. Results Out of 80 patients, 53 (66.25%) were male, while 27 (33.75%) were female. Six (7.5%) patients were between the ages of 15 and 25 years, 18 (22.5%) patients were between 26 and 35 years, 48 (60%) patients were between the ages of 36 and 45, and eight (10%) patients were between the ages of 46 and 50. According to this research, hypertension was found to be the most frequently occurring risk factor in 28 participants (35%), Diabetes mellitus in 23 patients (28.75%), dyslipidemia in 20 patients (22.5%), and smoking in 18 patients (22.5%). The etiology remained undetermined in 30 patients (37.5%). Most of the patients (87.5%) reported positive functional outcomes (MRS score 0–2). However, 3 (3.75%) patients died during the study period. Conclusion This research showed that common risk factors of ischemic stroke in the local young population included hypertension, diabetes mellitus, and smoking, whereas the etiology of stroke remained unidentified in the majority of patients. This study was conducted to evaluate causes and risk factors of ischemic stroke in young population (age less than 50 years). This was a prospective multicenter study conducted between June 2019 to June 2020. Patients with ischemic stroke, aged 15–50 years were included. Out of 80 patients, Hypertension was the most frequently found risk factor in 28 patients (35%), followed by Diabetes mellitus in 23 patients (28.75%), dyslipidemia in 20 patients (22.5%), and smoking in 18 patients (22.5%). The etiology remained undetermined in 30 patients (37.5%). This research showed that common risk factors of ischemic stroke in the local young population included hypertension, diabetes mellitus and smoking.
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19
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Vargas-Murcia JD, Isaza-Jaramillo SP, Vallejo-Mesa DM, Carvajal-Muñoz D. Ischemic stroke in young patients in Medellín, Colombia. BMC Neurol 2022; 22:363. [PMID: 36138366 PMCID: PMC9494873 DOI: 10.1186/s12883-022-02895-9] [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: 04/28/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is scarce information about ischemic stroke in young patients in Colombia. To get insights about this phenomenon, this study describes the etiologies and risk factors of ischemic stroke in young patients in a third level complexity referral hospital in Medellin, Colombia. Methods A retrospective observational cross-sectional study was carried out reviewing the medical records of patients between 18 to 49 years old admitted for the first time for ischemic stroke, from January 2009 to December 2019. The sociodemographic characteristics, risk factors, and etiological classification of ischemic stroke according to the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) were described. Results Two hundred thirty-seven cases were found. The most frequent risk factors were arterial hypertension (31.7%), smoking (29.5%) and alcohol intake (23.2%). There was a greater number of traditional cardiovascular risk factors at older ages. The TOAST classification was large-artery atherosclerosis (6.8%), cardioembolism (17.7%), small-vessel disease (7.6%), other determined etiology (25.7%) and undetermined (42.2%). Within cardioembolism, the most common high-risk source was valve replacement, and the most common moderate-risk source was patent foramen ovale. Craniocervical arterial dissection (11.4%) and substance abuse (2.9%) were the two most frequent sources within other determined etiologies. The most common compromised vascular territory was the anterior (55.7%). Conclusions The high frequency of traditional risk factors in young patients highlights the need to optimize primary and secondary prevention plans. This study provides new insights about the relevance of illicit substance abuse in Colombia as a cause of stroke in young patients, unlike the previous one conducted in Bogotá. Infectious causes were other peculiarities found. It is necessary to investigate the reasons for the high proportion of undetermined causes. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02895-9.
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20
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Okoth K, Crowe F, Marshall T, Thomas GN, Nirantharakumar K, Adderley NJ. Sex-specific temporal trends in the incidence and prevalence of cardiovascular disease in young adults: a population-based study using UK primary care data. Eur J Prev Cardiol 2022; 29:1387-1395. [PMID: 35139185 DOI: 10.1093/eurjpc/zwac024] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/15/2022] [Accepted: 02/02/2022] [Indexed: 11/13/2022]
Abstract
AIMS There is concern that cardiovascular disease (CVD) in young adults is rising. However, current trends in the UK are unknown. We investigated sex-specific trends in the incidence and prevalence of CVD in young UK adults. METHODS AND RESULTS A series of annual (1998-2017) cohort and cross-sectional studies were conducted to estimate incidence rates and prevalence in men and women aged 16-50. Joinpoint regression models were fitted to evaluate changes in trends. From 1998 to 2017, incidence and prevalence had an overall downward trend for ischaemic heart disease (IHD) and angina, while coronary revascularization, stroke/transient ischaemic attack (TIA), and heart failure (HF) had an upward trend in both sexes. Myocardial infarction (MI) trends were stable in men and increased in women. For incidence, the average annual percentage change (AAPC) for men vs. women, respectively, was IHD -2.6% vs. -3.4%; angina -7.0% vs. -7.3%; MI 0.01% vs. 2.3%; revascularization 1.1% vs. 3.9%; stroke/TIA 1.9% vs. 0.6%; HF 5.6% vs. 5.0% (P for trend <0.05 for all except MI and revascularization in men and stroke/TIA in women). For prevalence, AAPCs for men vs. women, respectively, were IHD -2.8% vs. -4.9%; angina -7.2% vs. -7.8%; MI -0.2% vs. 2.0; revascularization 3.2% vs. 4.1%; stroke/TIA 3.1% vs. 3.6%; HF 5.0% vs. 3.0% (P for trend <0.05 for all except MI in men). In recent years, IHD and revascularization trends levelled off, while stroke/TIA and HF trends increased in both sexes. CONCLUSION Overall trends in incidence and prevalence of CVD are worsening in young adults. Factors behind unfavourable trends warrant investigation and public health intervention.
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Affiliation(s)
- Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Francesca Crowe
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Institute of Metabolism and Systems Research, Edgbaston, Birmingham B15 2TT, UK
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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21
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Tejada Meza H, Artal Roy J, Pérez Lázaro C, Bestué Cardiel M, Alberti González O, Tejero Juste C, Hernando Quintana N, Jarauta Lahoz L, Giménez Muñoz A, Campello Morer I, Fernández Sanz A, Cruz Velásquez G, Latorre Jiménez A, Vinueza Buitrón P, Crespo Burillo JA, Palacín Larroy M, Millán García JR, Muñoz Farjas E, Oliván Usieto JA, Clavo Pérez LM, Marta Moreno J. Epidemiology and characteristics of ischaemic stroke in young adults in Aragon. Neurologia 2022; 37:434-440. [PMID: 31340903 DOI: 10.1016/j.nrl.2019.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 04/19/2019] [Accepted: 05/04/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Stroke affects around 15 million people per year, with 10%-15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. METHODS A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. RESULTS During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40-48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0-7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. CONCLUSIONS Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence.
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Affiliation(s)
- H Tejada Meza
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria (IIS), Aragón, Zaragoza, España.
| | - J Artal Roy
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - C Pérez Lázaro
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, España
| | - M Bestué Cardiel
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - C Tejero Juste
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, España
| | | | - L Jarauta Lahoz
- Servicio de Neurología, Hospital Obispo Polanco, Teruel, España
| | - A Giménez Muñoz
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, España
| | - I Campello Morer
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, España
| | - A Fernández Sanz
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - G Cruz Velásquez
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Latorre Jiménez
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - P Vinueza Buitrón
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, España
| | - J A Crespo Burillo
- Servicio de Neurología, Hospital Ernest Lluch, Calatayud, Zaragoza, España
| | - M Palacín Larroy
- Servicio de Neurología, Hospital Ernest Lluch, Calatayud, Zaragoza, España
| | - J R Millán García
- Servicio de Neurología, Hospital de Barbastro, Barbastro, Huesca, España
| | - E Muñoz Farjas
- Servicio de Neurología, Hospital de Alcañiz, Alcañiz, Teruel, España
| | - J A Oliván Usieto
- Servicio de Neurología, Hospital de Alcañiz, Alcañiz, Teruel, España
| | - L M Clavo Pérez
- Servicio de Neurología, Hospital de Barbastro, Barbastro, Huesca, España
| | - J Marta Moreno
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria (IIS), Aragón, Zaragoza, España
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22
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Sapuppo D, Bernhardt J, Carvalho LB, Churilov L, Thijs V. Self-evaluation of personal needs by community-living young stroke survivors using an online English language questionnaire. Disabil Rehabil 2022; 45:1830-1835. [PMID: 35617487 DOI: 10.1080/09638288.2022.2076935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Identifying personal needs of young stroke survivors is crucial for their recovery. PURPOSE Identify factors, burden, and significance of unmet needs of young community-living stroke survivors. MATERIALS AND METHODS We used online advertising and word-of-mouth snowballing to recruit participants for an English language online questionnaire constructed for this purpose. Eligible participants aged 18-55 at time of stroke. Needs were classified into seven domains: Healthcare Experience, Impairments from Stroke, Everyday Activities, Work/Study, Finances, Relationships, and Social Participation. Random-effects logistic regression was used to determine the probability of unmet needs and X2 test to determine significance of distribution across domains. RESULTS Out of 137 responses recorded: 32 did not meet inclusion criteria, 29 duplicates identified were discarded, and 76 eligible participants were analysed. Respondents were median 37 (IQR 32-47) years at time of stroke, and median 3 (1-5) years since stroke. Fifty-eight (76%) females. Modified Rankin Scale median score of 1 (1-3). Of 48 identified potential needs, 25 (IQR 19-30) were rated unmet. Twenty (IQR 15-25) considered of high significance. Unmet needs most frequently occurred in the domains: Impairments from Stroke, Finances, and Social Participation. CONCLUSIONS There is high burden of unmet needs in community-living young stroke survivors which are spread disproportionately across the identified domains.IMPLICATIONS FOR REHABILITATIONIdentifying personal needs of young stroke survivors is crucial for their recovery.Impairments after Stroke, Finances, and Social Participation were often selected as being high burden unmet needs for community-living young people after stroke.Employing a post-stroke checklist to guide exploration of needs in young stroke may better capture which needs are unmet.
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Affiliation(s)
- David Sapuppo
- Neurology Department, Austin Health, Melbourne, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Lilian B Carvalho
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonid Churilov
- Department of Medicine (Austin Health) and Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, University of Melbourne, Australia
| | - Vincent Thijs
- Neurology Department, Austin Health, Melbourne, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Nawaz B, Fromm A, Øygarden H, Eide GE, Saeed S, Meijer R, Bots ML, Sand KM, Thomassen L, Næss H, Waje-Andreassen U. Vascular risk factors and staging of atherosclerosis in patients and controls: The Norwegian Stroke in the Young Study. Eur Stroke J 2022; 7:289-298. [PMID: 36082261 PMCID: PMC9446327 DOI: 10.1177/23969873221098582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: We studied the prevalence of vascular risk factors (RFs) among 385 ischaemic
stroke patients ⩽60 years and 260 controls, and their association with
atherosclerosis in seven vascular areas. Methods: History of cardiovascular events (CVE), hypertension, diabetes mellitus (DM),
dyslipidaemia, pack-years of smoking (PYS), alcohol, and physical inactivity
were noted. Blood pressure, body mass index (BMI), waist-hip ratio (WHR),
lipid profile, epicardial adipose tissue (EAT), visceral abdominal adipose
tissue (VAT), and subcutaneous abdominal adipose tissue were measured.
Numeric staging of atherosclerosis was done by standardized examination of
seven vascular areas by right and left carotid and femoral intima-media
thickness, electrocardiogram, abdominal aorta plaques, and the ankle-arm
index. All results were age and sex-adjusted. Poisson regression analysis
was applied. Results: At age ⩽49 years at least one RF was present in 95.6% patients versus 90.0%
controls. Compared to controls, male patients and middle-aged female
patients showed no significant differences. Young female patients compared
to young female controls had a higher burden of RFs (94.3% vs 88.6%,
p = 0.049). Poisson regression analysis combined for
patients and controls, adjusted for age and sex, showed numeric staging of
atherosclerosis associated with age, prior CVE, hypertension, DM,
dyslipidaemia, PYS, alcohol, BMI, WHR, EAT, VAT, and an increased number of
risk factors. Adjusted for all risk factors, numeric staging of
atherosclerosis was associated with increasing age, hypertension, DM, PYS,
and BMI. Conclusion: Vascular risk factors are highly prevalent in young- and middle-aged patients
and controls, and are predictors of established atherosclerosis at study
inclusion. Focus on main modifiable vascular RFs in primary prevention, and
early and aggressive secondary treatment of patients are necessary to reduce
further progression of atherosclerosis.
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Affiliation(s)
- Beenish Nawaz
- Department of Clinical Medicine 1, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Halvor Øygarden
- Department of Neurology, Sørlandet Hospital, Kristiansand, Norway
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sahrai Saeed
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | - Rudy Meijer
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kristin Modalsli Sand
- Department of Medicine, Sørlandet Hospital, Flekkefjord, Norway
- The Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Thomassen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Halvor Næss
- Department of Clinical Medicine 1, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
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24
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da Silva Paiva L, de Alcantara Sousa LV, Oliveira FR, de Carvalho LEW, Raimundo RD, Correa JA, de Abreu LC, Adami F. Temporal Trend of the Prevalence of Modifiable Risk Factors of Stroke: An Ecological Study of Brazilians between 2006 and 2012. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095651. [PMID: 35565046 PMCID: PMC9103657 DOI: 10.3390/ijerph19095651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 02/05/2023]
Abstract
Stroke is one of the leading causes of death worldwide, including in Brazil. This study aimed to analyze the temporal trend of the prevalence of modifiable risk factors of stroke from 2006 to 2012. This ecological study was conducted by secondary analysis in May 2018, using data from the surveillance of risk factors and protection for chronic diseases by telephone inquiry (VIGITEL) available in the Department of Informatics of the Unified Health System (DATASUS). The modifiable risk factors of stroke in Brazilians were systemic arterial hypertension, diabetes mellitus, abusive alcohol consumption, overweight, and obesity. Overall, there was a significant increase in the risk factors of diabetes (β = 0.30, P = 0.001, r2 = 0.99), overweight (β = 0.50, P = 0.002, r2 = 0.98), and obesity (β = 0.88, P < 0.001, r2 = 0.96). However, there was a stability in the prevalence of hypertension (β = 0.25, P = 0.320, r2 = 0.88) and alcohol abuse (β = 0.32, P = 0.116, r2 = 0.49). There was an increase in the prevalence of diabetes mellitus, overweight, and obesity, but stability in systemic arterial hypertension and abusive alcohol consumption in the Brazilian population.
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Affiliation(s)
- Laércio da Silva Paiva
- Laboratório de Epidemiologia e Análise de Dados, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André 09060-870, Brazil; (L.V.d.A.S.); (F.A.)
- Correspondence:
| | - Luiz Vinicius de Alcantara Sousa
- Laboratório de Epidemiologia e Análise de Dados, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André 09060-870, Brazil; (L.V.d.A.S.); (F.A.)
| | - Fernando Rocha Oliveira
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo 01246-904, Brazil;
| | | | - Rodrigo Daminello Raimundo
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André 09060-870, Brazil;
| | - João Antonio Correa
- Disciplina de Angiologia e Cirurgia Vascular, Centro Universitário FMABC, Santo André 09060-870, Brazil;
| | - Luiz Carlos de Abreu
- Departamento de Saúde Integrada em Saúde, Universidade Federal do Espirito Santo—UFES, Vitoria 29075-910, Brazil;
| | - Fernando Adami
- Laboratório de Epidemiologia e Análise de Dados, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André 09060-870, Brazil; (L.V.d.A.S.); (F.A.)
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25
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Nawaz B, Fromm A, Øygarden H, Eide GE, Saeed S, Meijer R, Bots ML, Sand KM, Thomassen L, Næss H, Waje-Andreassen U. Prevalence of atherosclerosis and association with 5-year outcome: The Norwegian Stroke in the Young Study. Eur Stroke J 2022; 6:374-384. [PMID: 35342817 PMCID: PMC8948509 DOI: 10.1177/23969873211059472] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/20/2021] [Indexed: 01/05/2023] Open
Abstract
Objectives: We studied the prevalence of atherosclerosis among ischaemic stroke patients ≤60 years and controls at the time of the index stroke, and its association with occurrence of new cardiovascular events (CVEs) and mortality at a 5-year follow-up. Methods: Prevalent atherosclerosis was assessed for 385 patients and 260 controls in seven vascular areas by electrocardiogram (ECG), ankle–arm index (AAI) and measurement of right and left carotid and femoral intima-media thickness (cIMT and fIMT) and abdominal aorta plaques (AAP). Clinical end-points were any new CVE (stroke, angina, myocardial infarction or peripheral arterial disease) or death from any cause at 5-year follow-up. All results were sex- and age-adjusted; logistic regression and Cox proportional hazards models were applied. Results: Young patients ≤49 years had prevalent atherosclerosis in 1/2 of males and 1/3 of females. Compared with controls, young female patients showed significantly higher prevalent atherosclerosis, p = 0.024. Ischaemic ECG and mean cIMT were higher in young and middle-aged female patients (p = 0.044, p = 0.020, p = 0.023 and p <0.001, respectively). Mean fIMT was higher in middle-aged female patients (p <0.001). Cardiovascular events were associated with ischaemic ECG; AAI ≤0.9, fIMT ≥0.9 mm and increased number of areas with atherosclerosis (NAA) among patients, and with AAP, cIMT ≥0.9 mm, fIMT ≥0.9 mm and NAA among controls. Mortality was associated with higher age, ischaemic ECG and NAA among patients, and cIMT ≥0.9 mm among controls. Conclusion: Atherosclerosis is highly prevalent even in young stroke patients. Some areas and increasing NAA are associated with CVEs and death.
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Affiliation(s)
- Beenish Nawaz
- Department of Clinical Medicine 1, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Halvor Øygarden
- Department of Neurology, Sørlandet Hospital, Kristiansand, Norway.,Department of Health and Nursing Sciences, Univeristy of Agder, Kristiansand, Norway
| | - Geir E Eide
- Centre of Clinical Research, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sahrai Saeed
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | - Rudy Meijer
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kristin M Sand
- Department of Medicine, Sørlandet Hospital, Flekkefjord, Norway.,The Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Thomassen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Halvor Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.,SESAM, Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway
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26
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Chaudhary D, Anyaehie M, Demiraj F, Bavishi S, Shahjouei S, Li J, Abedi V, Zand R. Comparison of Long-Term Outcomes and Associated Factors between Younger and Older Rural Ischemic Stroke Patients. J Clin Med 2022; 11:jcm11051430. [PMID: 35268521 PMCID: PMC8911514 DOI: 10.3390/jcm11051430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/16/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The rise of ischemic stroke among young adults has stressed the need to understand their risk profiles and outcomes better. This study aimed to examine the five-year ischemic stroke recurrence and survival probability among young patients in rural Pennsylvania. Methods: This retrospective cohort study included first-time ischemic stroke patients from the Geisinger Health System between September 2003 and May 2014. The outcomes included all-cause mortality and ischemic stroke recurrence at five years. Kaplan-Meier estimator, cumulative incidence function, Cox proportional hazards model, and Cause-specific hazard model were used to examine the association of independent variables with the outcomes. Results: A total of 4459 first-time ischemic stroke patients were included in the study, with 664 (14.9%) patients in the 18−55 age group and 3795 (85.1%) patients in the >55 age group. In the 18−55 age group, the five-year survival probability was 87.2%, and the cumulative incidence of recurrence was 8%. Patients in the 18−55 age group had significantly lower hazard for all-cause mortality (HR = 0.37, 95% CI 0.29−0.46, p < 0.001), and non-significant hazard for five-year recurrence (HR = 0.81, 95% CI 0.58−1.12, p = 0.193) compared to the >55 age group. Chronic kidney disease was found to be associated with increased mortality in the 18−55 age group. Conclusion: In our rural population, younger ischemic stroke patients were at the same risk of long-term ischemic stroke recurrence as the older ischemic stroke patients. Identifying the factors and optimizing adequate long-term secondary prevention may reduce the risk of poor outcomes among younger ischemic stroke patients.
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Affiliation(s)
- Durgesh Chaudhary
- Department of Neurology, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (D.C.); (S.S.)
| | - Michelle Anyaehie
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18510, USA;
| | - Francis Demiraj
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL 33314, USA;
| | - Shreya Bavishi
- Cell and Molecular Biology Department, Tulane University, New Orleans, LA 70118, USA;
| | - Shima Shahjouei
- Department of Neurology, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (D.C.); (S.S.)
| | - Jiang Li
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA;
| | - Vida Abedi
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA;
| | - Ramin Zand
- Department of Neurology, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (D.C.); (S.S.)
- Neuroscience Institute, The Pennsylvania State University, Hershey, PA 17033, USA
- Correspondence:
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Swetlik C, Migdady I, Hasan LZ, Buletko AB, Price C, Cho SM. Cannabis Use and Stroke: Does a Risk Exist? J Addict Med 2022; 16:208-215. [PMID: 34001774 DOI: 10.1097/adm.0000000000000870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS Cannabis use has been reported as a risk factor for stroke. We systematically review the prevalence and outcomes of stroke in people with cannabis use. METHODS We searched MEDLINE and 6 other databases from inception to January 2020 for studies on the relationship between cannabis use and stroke. We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations. Two independent reviewers extracted the data. Study quality was assessed by the Newcastle-Ottawa Scale for cohort and case-control studies. RESULTS Seventeen studies involving 3,185,560 people with cannabis use were included. Descriptive statistics demonstrated 18,676 (median 1.1%, interquartile range [IQR] 0.3%-1.3%) experienced stroke compared with 0.8% of those without use (Odds Ratio 1.17, 95% CI 1.10-1.25). Among people with cannabis use, median age was 26.2 years (IQR 25.2-34.3 years) and mostly male (median 57.8%). Of stroke subtypes, ischemic stroke was most prevalent (median 1.2%, IQR 0.4%-1.9%), followed by undefined stroke subtype (median 1.2%, IQR 1.1%-1.2%) and hemorrhagic stroke (median 0.3%, IQR 0.1%-0.6%). The majority of people with cannabis use who experienced stroke survived (median: 85.1%, IQR 83%-87.5%) and 64.0% of people experienced a good neurologic outcome, defined as modified Rankin Scale of 0 to 3. Few studies included outcomes of vasospasm or seizure. CONCLUSIONS In people with cannabis use, the prevalence of ischemic stroke and hemorrhagic stroke was 1.2% and 0.3%, respectively, higher than the prevalence of people without use (0.8% and 0.2%). There is insufficient information on timing, exposure, duration, and dose-responsive relationship.
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Affiliation(s)
- Carol Swetlik
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH (CS, IM, ABB), Department of Medicine, University of Connecticut School of Medicine, Hartford, CT (LZH), Welch Medical Library, Johns Hopkins University, Baltimore, MD (CP), Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (MC)
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Leopold JA, Antman EM. Ideal Cardiovascular Health in Young Adults With Established Cardiovascular Diseases. Front Cardiovasc Med 2022; 9:814610. [PMID: 35252395 PMCID: PMC8893279 DOI: 10.3389/fcvm.2022.814610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
There has been an increase in the prevalence of cardiovascular diseases among young adults in the United States that has been attributed, in part, to a rise in overweight and obesity, use of combustible tobacco and unhealthy diet and exercise patterns. These factors are influenced further by socioeconomic status and other social determinants of health. In the My Research Legacy study, we examined ideal cardiovascular health in young adults aged 18– <50 years with cardiovascular disease using the Life's Simple 7 survey and data from digital health devices. Young adults with cardiovascular disease (n = 349) were older, had a lower socioeconomic status, a higher prevalence of risk factors, and lower Life's Simple 7 Health Scores (6.4 ± 1.5 vs. 7.1 ± 1.5, p < 0.01) compared to young adults without cardiovascular disease (n = 696). Analysis of digital health device data revealed that young adults with cardiovascular disease performed a similar number of weekly minutes of moderate and vigorous exercise as those without disease leading to similar ideal activity scores. Young adults with cardiovascular disease also shared similarities in modifiable risk factors with adults aged ≥50 years with cardiovascular disease (n = 217), including weight, dietary habits, and weekly minutes of exercise. Latent class analysis identified two phenogroups of young adults with cardiovascular disease: phenogroup 1 was characterized by more advantageous cardiovascular health factors and behaviors resulting in higher Life's Simple 7 Health Scores than phenogroup 2 (7.4 ± 1.2 vs. 5.5 ± 1.1, p < 0.01). These findings in young adults with cardiovascular disease may inform the design of behavioral and therapeutic interventions in the future to decrease cardiovascular morbidity and mortality.
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Roland M, Markaki I, Andersson T, Arnberg F, Sjöstrand C. Mechanical thrombectomy in stroke patients of working age: Real-world outcomes in Sweden. Eur Stroke J 2022; 7:41-47. [PMID: 35300257 PMCID: PMC8921781 DOI: 10.1177/23969873211067883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/02/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Outcomes after mechanical thrombectomy (MT) in young stroke patients remain elusive due to small patient cohorts. We sought to determine outcomes after MT in stroke patients between ages 18 and 64 years and compare with outcomes in older patients in a large national stroke cohort. Patients and methods We used the Swedish National Stroke Registry and the Swedish National Endovascular Thrombectomy Registry to identify all patients treated with MT for anterior circulation occlusions. We examined outcome measures in terms of functional independence at 90 days (modified Rankin Scale score of 0–2), symptomatic intracerebral hemorrhage (sICH), and mortality at 90 days with multivariable logistic regression analysis. Results Of 2143 patients, 565 were between 18 and 64 years (26.4%) and 1179 (55.0%) were males. Analysis showed that patient aged 18–64 achieved higher rate of functional independence at 90 days (46.2% vs 28.4%, p < .001), had less often sICH (5.5% vs 6.8%, p = .008), and lower 90-day mortality rate (6.9% vs 17.7%, p < .001). Increasing age was associated with a lesser probability of functional independence at 90 days (adjusted odds ratio (aOR), 0.94; [95% confidence intervals (CIs) 0.93–0.95]), higher odds of mortality at 90 days (aOR, 1.05; [95% CIs 1.03–1.06]), and of sICH (aOR 1.03; [95% CIs 1.01–1.05]). Conclusion Patients aged 18–64 years demonstrated better outcome after thrombectomy regarding functional independence, sICH, and mortality at 90 days when compared to older ages.
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Affiliation(s)
- Mihae Roland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ioanna Markaki
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center of Neurology, Academic Specialist Center, Stockholm, Sweden
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Fabian Arnberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christina Sjöstrand
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Singla M, Singh G, Kaur P, Pandian J. Epidemiology of young stroke in the ludhiana population-based stroke registry. Ann Indian Acad Neurol 2022; 25:114-119. [PMID: 35342262 PMCID: PMC8954304 DOI: 10.4103/aian.aian_711_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/12/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: The objective of the study was to determine incidence, risk factors, and short-term outcomes of young stroke in Ludhiana city, Northwest India. Methods: Data were collected on first-ever stroke in patients of age ≥18 years, from hospitals, diagnostic imaging centers, general practitioners, and municipal corporation during March 2011–March 2013 in Ludhiana city, using the World Health Organization Stepwise Approach to Surveillance (WHO STEPS). Outcome was documented using the modified Rankin Scale at 28 days. Results: Of 2948 patients, 700 (24%) were in the age group 18–49 years. Annual incidence in this age group was 46/100,000 person-years (95% confidence interval [CI], 41–51/100,000). Hypertension (84%), diabetes mellitus (48%), and atrial fibrillation (AF) (12%) were found more common in >49 years age group, as compared with 18–49 years age group. Drug abuse (8.7% vs. 6% in age >49 years; P = 0.04) and tobacco intake (8.7% vs. 5.6% in age >49 years; P = 0.02) was more common in young people, that is, 18–49 years age group in comparison to older patients, >49 years age group. Recovery was better in younger subjects (60% vs. 46% in age >49 years P < 0.001). In a multivariable analysis, younger people were more often literate (odds ratio [OR] 2.52; 95% CI, 1.68–3.77; P < 0.001), employed (OR 3.92; 95% CI, 2.20–5.21; P < 0.001), and 374 (60%) had good clinical outcome, modified Rankin Scale <2 at 28 days follow-up as compared with 938 (46%) older patients (OR 1.52; 95% CI, 1.15–2.00; P = 0.003). Conclusion: Hypertension, diabetes mellitus, drug addiction, and tobacco intake were significantly associated with young stroke. Outcome was also better in younger people.
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Krishnamurthi RV, Feigin VL. Global Burden of Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Premature Stroke. Curr Atheroscler Rep 2022; 24:939-948. [PMID: 36374365 PMCID: PMC9660017 DOI: 10.1007/s11883-022-01067-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW Recent data identifies increases in young ischemic and hemorrhagic strokes. We provide a contemporary overview of current literature on stroke among young patients or premature stroke along with directions for future investigation. RECENT FINDINGS Strokes in the young are highly heterogenous and often cryptogenic. Sex distribution and risk factors shift from women among the youngest age groups (< 35) to men over the age of 45, with a coinciding rise in traditional vascular risk factors. Incidence is higher in minority and socioeconomically disadvantaged populations, and the impact of stroke among these communities may be exaggerated by disparities in symptom recognition and access to care. Special diagnostic work-up may be needed, and a lower threshold for diagnosis is warranted as potential misdiagnosis is a concern and may preclude necessary triage and management. Although "premature strokes" form a relatively small proportion of total incidence, they vary greatly across subgroups and present an outsized impact on quality of life and productivity.
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Eltemamy MA, Tamayo A, Altarsha E, Sedghi A, Pallesen LP, Barlinn J, Puetz V, Illigens BMW, Barlinn K, Siepmann T. Cerebrovascular Risk Profiles in a Saudi Arabian Cohort of Young Stroke Patients. Front Neurol 2021; 12:736818. [PMID: 34867720 PMCID: PMC8632802 DOI: 10.3389/fneur.2021.736818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The constantly increasing incidence of stroke in younger individuals substantiates an urgent need for research to elucidate underlying risk factors and etiologies. Heretofore, the vast majority of studies on stroke in the young have been carried out in European and North American regions. We aimed to characterize cerebrovascular risk profiles in a Saudi Arabic cohort of consecutive young stroke patients. Methods: We retrospectively analyzed data from consecutive ischemic stroke patients aged 15 to 49 years who underwent detailed cardiocerebrovascular evaluation at a tertiary stroke care center in Makkah, Saudi Arabia. Distributions of risk factors and stroke etiologies were assessed in the entire cohort and in two strata of very young (15–40 years) and young to middle-aged patients (41–49) to account for variability in suggested age cutoffs. Results: In the entire cohort [n = 63, ages 44 (34–47) median, interquartile range], dyslipidemia (71.4%) and small vessel occlusion (31.7%) displayed highest prevalence followed by diabetes (52.4%) and cardioembolism (19%). In very young patients, cardioembolism was the most prevalent etiology (27.3%). Risk profiles were similar between both age strata except for a higher prevalence of diabetes among the older cohort (31.8 vs. 63.4%, p = 0.01). Logistic regression identified diabetes as strongest predictor for association to the older strata (odds ratio = 4.2, 95% confidence interval = 1.2–14.1, p = 0.02). Conclusion: Cerebrovascular risk profiles and stroke etiologies in our cohort of young stroke patients differ from those of previous cohorts, suggesting the need for tailored prevention strategies that take into account local epidemiological data on cerebrovascular health.
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Affiliation(s)
- Marwa Ahmed Eltemamy
- Department of Stroke Medicine, Fairfield General Hospital, Manchester, United Kingdom.,Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany.,Department of Neurology, King Abdullah Medical City, Mecca, Saudi Arabia
| | - Arturo Tamayo
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany.,Winnipeg Regional Health Authority (WRHA), Department of Medicine, Section of Neurology, The Max Rady Faculty of Health Sciences, Brandon Regional Health Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Eyad Altarsha
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Annahita Sedghi
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Kristian Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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Shihmanter R, Friedman J, Kushner N, Miller EB, Schattner A. Prospective observational study of young adult ischemic stroke patients. Brain Behav 2021; 11:e2283. [PMID: 34423914 PMCID: PMC8442588 DOI: 10.1002/brb3.2283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/07/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Ischemic stroke (IS) in young patients may differ in etiology and prognosis from later-life IS, which is much more common. A number of single-center and population-based cohorts of affected individuals have been published, but information on the long-term prognosis of these patients is limited. METHODS IS patients (≤55 years), discharged over a 10-year period, were evaluated and prospectively followed. Subgroups were evaluated for type of stroke, antecedent risk factors (RF), long-term outcomes, and occupational status over several years of follow-up. RESULTS 178 IS individuals from 2001-2010 were divided into older (46-55, n = 118) and younger (18-45, n = 60) age groups. Traditional RF-hypertension, diabetes mellitus, hyperlipidemia-were significantly associated with IS, and increased with age. The distribution and type of IS were similar in both groups, except for an increase in small vessel IS among the older subgroup (p = .003). Of the evaluable patients at 5.1 ± 2.5 years of follow-up (n = 138), a similar proportion of patients in both subgroups had a recurrent IS, but no significant differences were found in most disability indices. Approximately one third of patients suffered from moderate to severe disability, and were unable to return to their prior work. CONCLUSIONS Younger and older IS patients are generally predisposed from the same traditional RF which progress with age. Long-term disabilities tend to worsen over time due to recurrent vascular events. These data emphasize the need for a strategy for early identification of the already well-known stroke RF in younger stroke patients.
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Affiliation(s)
- Renata Shihmanter
- Department of Medicine, Kaplan Medical Center, Rehovot, Israel.,Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Joshua Friedman
- Department of Medicine, Kaplan Medical Center, Rehovot, Israel.,Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Natali Kushner
- Department of Medicine, Kaplan Medical Center, Rehovot, Israel.,Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Edward B Miller
- Department of Medicine, Kaplan Medical Center, Rehovot, Israel.,Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Ami Schattner
- Department of Medicine, Kaplan Medical Center, Rehovot, Israel.,Hebrew University Hadassah Medical School, Jerusalem, Israel
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Shang YX, Yan LF, Cornett EM, Kaye AD, Cui GB, Nan HY. Incidence of Cerebral Infarction in Northwest China From 2009 to 2018. Cureus 2021; 13:e17576. [PMID: 34646631 PMCID: PMC8480718 DOI: 10.7759/cureus.17576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a lack of epidemiological analysis of patients with cerebral infarction in northwest China. In the present investigation, we conducted a retrospective analysis to collect information on epidemiological characteristics of patients with cerebral infarction in five provinces of northwest China and the Shanxi Province of patients who were hospitalized in the Tangdu Hospital. This project should provide a scientific basis for active prevention and treatment of cerebral infarction. MATERIAL AND METHODS A retrospective analysis of patients with epidemic characteristics of cerebral infarction that were admitted to the Tangdu Hospital of northwest China from January 2009 to December 2018. RESULTS A total of 18,302 patients (aged 1-97 years) with confirmed cerebral infarction, including 12,201 males and 6,101 females, were retrospectively enrolled in this study. The most common lesion site was the cerebellum (51.5%). The incidence of cerebral infarction was slightly higher in workers and laborers, favoring male patients and those aged 40-70 years. The difference between men and women gradually increased after the age of 30. CONCLUSIONS In this study, 18,302 hospitalized patients with cerebral infarction from different occupations were included. Those engaged in physical labor were more likely to have a cerebral infarction. The incidence of cerebral infarction in males was higher than in females. Cerebellar and cerebral area infarctions were the most common.
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Affiliation(s)
- Yu-Xuan Shang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Fourth Military Medical University, Shaanxi, CHN
| | - Lin-Feng Yan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Fourth Military Medical University, Shaanxi, CHN
| | - Elyse M Cornett
- Department of Anaesthesiology, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | - Alan D Kaye
- Department of Anaesthesiology, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | - Guang-Bin Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Fourth Military Medical University, Shaanxi, CHN
| | - Hai-Yan Nan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Fourth Military Medical University, Shaanxi, CHN
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Choice of time-scale in time-to-event analysis: evaluating age-dependent associations. Ann Epidemiol 2021; 62:69-76. [PMID: 34174410 DOI: 10.1016/j.annepidem.2021.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare hazard ratios obtained by using time on study (conventional) versus biological age as the time-scale in survival analyses for a known age-dependent association between an exposure and outcome. METHODS We conducted a retrospective cohort study of 9 million people in Ontario, Canada who were followed from 2003 to 2018 to identify incident ischemic stroke using linked administrative health data. Using cause-specific hazards models, we calculated hazard ratios (HR) of ischemic stroke in women compared to men using the two different time scales. By using piecewise estimates and interaction terms, we evaluate the effect of sex on stroke incidence across age groups. RESULTS In unadjusted analyses, the reduction in the hazard of ischemic stroke in women compared to men was greater with age as time-scale (HR 0.77; 0.76-0.78) compared to conventional time-scale (HR 0.93; 0.92-0.93); however, the estimates were similar (HR 0.78 with age vs. 0.77 with conventional) in multivariable adjusted analyses. The estimates obtained by two methods across different age groups varied modestly, except in those under 30 years (HR 1.47; 1.19-1.83 with age vs. 1.08; 0.99-1.17 with conventional). CONCLUSIONS When evaluating age-dependent association between an exposure and outcome, estimates of association vary based on the time-scale used in survival analysis, requiring thoughtful consideration.
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Henriquez S, Legris N, Chrétien P, Hacein-Bey-Abina S, Henry J, Denier C, Noël N. Discovery of Anti-SS-A Antibodies during Stroke Investigations in Young Adults: What Impact? J Stroke Cerebrovasc Dis 2021; 30:105896. [PMID: 34144337 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES French national guidelines recommend searching for anti-SS-A antibodies during the second-line assessment of stroke in adults < 55 years of age in the absence of an identified etiology. We aimed to assess the impact of finding anti-SS-A antibodies during the etiological investigations of stroke in young adults. METHODS Medical files from all patients ≤ 55 years of age admitted to a single stroke unit during a five-year period and for whom anti-SS-A antibodies were positive were retrospectively analyzed. RESULTS Twelve patients were included (9 women; median age 48.5 years), with a rate of anti-SS-A antibody positivity of 1.6% (95% confidence interval [0.71-2.55] %; 12/735 admissions). The etiologies of the 12 ischemic events based on the TOAST classification were large-artery atherosclerosis (n = 1), cardioembolism (n = 1), small-vessel disease (n = 1), other determined etiology (n = 3), multiple etiology (n = 1), and no determined etiology (n = 5). A connective tissue disease (CTD) was discovered in 8/12 patients (1 primary Sjögren's Syndrome, 1 mixed CTD, 1 systemic sclerosis, 2 antiphospholipid syndromes, 1 undetermined CTD, 2 lupus). Anti-SSA antibodies were not directly responsible for the stroke in any of the 12 cases. A link between the autoimmune disease and the neurological vascular episode could be hypothesized for four patients, but it never influenced the therapeutic decision. CONCLUSIONS Finding anti-SS-A antibodies during the etiological assessment of a stroke of young adults is rare. However, it may be worthwhile to refer the patient to a rheumatologist/an internist because CTD may be discovered and may require specific follow-up.
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Affiliation(s)
- Soledad Henriquez
- Université Paris-Saclay, APHP, Service de Médecine Interne et Immunologie Clinique, CHU Bicêtre, 78 Rue du Général Leclerc, Le Kremlin Bicêtre 94270, France; Faculté de Médecine Paris Saclay, Le Kremlin Bicêtre, France
| | - Nicolas Legris
- Université Paris-Saclay, APHP, Service de Neurologie, CHU Bicêtre, Le Kremlin Bicêtre, France; Faculté de Médecine Paris Saclay, Le Kremlin Bicêtre, France
| | - Pascale Chrétien
- Université Paris-Saclay, APHP, Service d'Immunologie Biologique, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Salima Hacein-Bey-Abina
- Faculté de Médecine Paris Saclay, Le Kremlin Bicêtre, France; Université Paris-Saclay, APHP, Service d'Immunologie Biologique, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Julien Henry
- APHP, Service de Rhumatologie, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Christian Denier
- Université Paris-Saclay, APHP, Service de Neurologie, CHU Bicêtre, Le Kremlin Bicêtre, France; Faculté de Médecine Paris Saclay, Le Kremlin Bicêtre, France
| | - Nicolas Noël
- Université Paris-Saclay, APHP, Service de Médecine Interne et Immunologie Clinique, CHU Bicêtre, 78 Rue du Général Leclerc, Le Kremlin Bicêtre 94270, France; Faculté de Médecine Paris Saclay, Le Kremlin Bicêtre, France; UMR CEA/INSERM U1184/Université Paris-Saclay, Centre de recherche des maladies virales, autoimmunes, hématologiques et bactériennes (IMVA-HB), Le Kremlin Bicêtre, France.
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Barzegar M, Vital S, Stokes KY, Wang Y, Yun JW, White LA, Chernyshev O, Kelley RE, Alexander JS. Human placenta mesenchymal stem cell protection in ischemic stroke is angiotensin converting enzyme-2 and masR receptor-dependent. STEM CELLS (DAYTON, OHIO) 2021; 39:1335-1348. [PMID: 34124808 PMCID: PMC8881785 DOI: 10.1002/stem.3426] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/29/2021] [Indexed: 12/15/2022]
Abstract
Thromboembolic stroke remains a major cause of neurological disability and death. Current stroke treatments (aspirin, tissue plasminogen activator) are significantly limited by timing and risks for hemorrhage which have driven researchers to explore other approaches. Stem cell‐based therapy appears to be an effective option for ischemic stroke. Besides trans‐differentiation into neural cells, stem cells also provide acute protection via paracrine signaling pathways through which releasing neuroprotective factors. We previously reported that intraperitoneal administration of human placenta mesenchymal stem cell (hPMSC) therapy upon reperfusion significantly protected the brain against middle cerebral artery occlusion (MCAO)‐induced injury. In the present study, we specifically investigated the role of hPMSC‐derived angiotensin converting enzyme‐2 (ACE‐2) in protection of MCAO‐induced brain injury by measurement of brain tissue viability, cerebral blood flow, and neurological score. Here, we report for the first time that hPMSC expressing substantial amount of ACE‐2, which mediates hPMSC protection in the MCAO model. Strikingly, we found that the protective effects of hPMSC in MCAO‐induced brain injury could be attenuated by pretreatment of hPMSCs with MLN‐4760, a specific inhibitor of ACE‐2 activity, or by transfection of hPMSCs with ACE‐2‐shRNA‐lentivirus. The hPMSC‐derived ACE‐2 specific protective mechanism was further demonstrated by administration of PD123319, an Angiotensin type‐2 receptor antagonist, or A779, a MasR antagonist. Importantly, our study demonstrated that the protective effects of hPMSC in experimental stroke are ACE‐2/MasR dependent and this signaling pathway represents an innovative and highly promising approach for targeted stroke therapy.
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Affiliation(s)
- Mansoureh Barzegar
- Molecular and Cellular Physiology, Ochsner-LSU Health Sciences Center, Shreveport, Louisiana, USA
| | - Shantel Vital
- Molecular and Cellular Physiology, Ochsner-LSU Health Sciences Center, Shreveport, Louisiana, USA
| | - Karen Y Stokes
- Molecular and Cellular Physiology, Ochsner-LSU Health Sciences Center, Shreveport, Louisiana, USA
| | - Yuping Wang
- Obstetrics and Gynecology and Medicine, Ochsner-LSU Health Sciences Center, Shreveport, Louisiana, USA
| | - Jungmi Winny Yun
- Molecular and Cellular Physiology, Ochsner-LSU Health Sciences Center, Shreveport, Louisiana, USA
| | - Luke A White
- Molecular and Cellular Physiology, Ochsner-LSU Health Sciences Center, Shreveport, Louisiana, USA
| | - Oleg Chernyshev
- Neurology, Ochsner-LSU Health Sciences Center, Shreveport, Louisiana, USA
| | - Roger E Kelley
- Neurology, Ochsner-LSU Health Sciences Center, Shreveport, Louisiana, USA
| | - Jonathan S Alexander
- Molecular and Cellular Physiology, Ochsner-LSU Health Sciences Center, Shreveport, Louisiana, USA.,Neurology, Ochsner-LSU Health Sciences Center, Shreveport, Louisiana, USA
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Tejada Meza H, Artal Roy J, Pérez Lázaro C, Bestué Cardiel M, Alberti González O, Tejero Juste C, Hernando Quintana N, Jarauta Lahoz L, Giménez Muñoz A, Campello Morer I, Fernández Sanz A, Cruz Velásquez G, Latorre Jiménez A, Vinueza Buitrón P, Crespo Burillo JA, Palacín Larroy M, Millán García JR, Muñoz Farjas E, Oliván Usieto JA, Clavo Pérez LM, Marta Moreno J. Epidemiology and characteristics of ischaemic stroke in young adults in Aragon. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:434-440. [PMID: 34092536 DOI: 10.1016/j.nrleng.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/04/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Stroke affects around 15 million people per year, with 10%--15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. METHODS A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. RESULTS During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40--48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0--7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. CONCLUSIONS Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence.
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Affiliation(s)
- H Tejada Meza
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria (IIS), Aragón, Zaragoza, Spain.
| | - J Artal Roy
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - C Pérez Lázaro
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - M Bestué Cardiel
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - C Tejero Juste
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | | | - L Jarauta Lahoz
- Servicio de Neurología, Hospital Obispo Polanco, Teruel, Spain
| | - A Giménez Muñoz
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, Spain
| | - I Campello Morer
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, Spain
| | - A Fernández Sanz
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - G Cruz Velásquez
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Latorre Jiménez
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - P Vinueza Buitrón
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - J A Crespo Burillo
- Servicio de Neurología, Hospital Ernest Lluch, Calatayud, Zaragoza, Spain
| | - M Palacín Larroy
- Servicio de Neurología, Hospital Ernest Lluch, Calatayud, Zaragoza, Spain
| | - J R Millán García
- Servicio de Neurología, Hospital de Barbastro, Barbastro, Huesca, Spain
| | - E Muñoz Farjas
- Servicio de Neurología, Hospital de Alcañiz, Alcañiz, Teruel, Spain
| | | | - L M Clavo Pérez
- Servicio de Neurología, Hospital de Barbastro, Barbastro, Huesca, Spain
| | - J Marta Moreno
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria (IIS), Aragón, Zaragoza, Spain
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Norouzi S, Jafarabadi MA, Shamshirgaran SM, Farzipoor F, Fallah R. Modeling Survival in Patients With Brain Stroke in the Presence of Competing Risks. J Prev Med Public Health 2021; 54:55-62. [PMID: 33618500 PMCID: PMC7939750 DOI: 10.3961/jpmph.20.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives After heart disease, brain stroke (BS) is the second most common cause of death worldwide, underscoring the importance of understanding preventable and treatable risk factors for the outcomes of BS. This study aimed to model the survival of patients with BS in the presence of competing risks. Methods This longitudinal study was conducted on 332 patients with a definitive diagnosis of BS. Demographic characteristics and risk factors were collected by a validated checklist. Patients’ mortality status was investigated by telephone follow-up to identify deaths that may be have been caused by stroke or other factors (heart disease, diabetes, high cholesterol, etc.). Data were analyzed by the Lunn-McNeil approach at alpha=0.1. Results Older age at diagnosis (59–68 years: adjusted hazard ratio [aHR], 2.19; 90% confidence interval [CI], 1.38 to 3.48; 69–75 years: aHR, 5.04; 90% CI, 3.25 to 7.80; ≥76 years: aHR, 5.30; 90% CI, 3.40 to 8.44), having heart disease (aHR, 1.65; 90% CI, 1.23 to 2.23), oral contraceptive pill use (women only) (aHR, 0.44; 90% CI, 0.24 to 0.78) and ischemic stroke (aHR, 0.52; 90% CI, 0.36 to 0.74) were directly related to death from BS. Older age at diagnosis (59–68 years: aHR, 21.42; 90% CI, 3.52 to 130.39; 75–69 years: aHR, 16.48; 90% CI, 2.75 to 98.69; ≥76 years: aHR, 26.03; 90% CI, 4.06 to 166.93) and rural residence (aHR, 2.30; 90% CI, 1.15 to 4.60) were directly related to death from other causes. Significant risk factors were found for both causes of death. Conclusions BS-specific and non-BS-specific mortality had different risk factors. These findings could be utilized to prescribe optimal and specific treatment.
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Affiliation(s)
- Solmaz Norouzi
- Department of Statistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology and Road Traffic Injury Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Morteza Shamshirgaran
- Department of Statistics and Epidemiology, Faculty of Health Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Farshid Farzipoor
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramazan Fallah
- Department of Statistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Pirinen J, Kuusisto J, Martinez-Majander N, Sinisalo J, Pöyhönen P, Putaala J, Järvinen V. Evidence of subtle left ventricular systolic dysfunction in cryptogenic stroke in the young. Echocardiography 2021; 38:271-279. [PMID: 33484598 DOI: 10.1111/echo.14978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/30/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Ischemic stroke in young patients often remains cryptogenic, that is, no underlying reason can be found. Some of these strokes may originate in the heart. Left ventricular (LV) dynamic volumetry and strain analysis are relatively new and promising methods for evaluating LV function. METHODS In this pilot study, we recruited 30 young (18-50 years) patients with cryptogenic ischemic stroke and 30 age- and sex-matched controls from the SECRETO study (NCT01934725). The LV systolic function was assessed by LV volumetry (ejection fraction, peak emptying rate, and time to peak emptying rate). The longitudinal systolic function was assessed by speckle tracking strain and strain rate imaging, and by tissue velocity imaging derived MAD (mitral annular displacement) and septal S'. RESULTS Stroke patients had less vigorous global longitudinal strain (median -18.9, interquartile range 3.3), compared to healthy controls (median -20.0, interquartile range 2.8), P = .010. There was no statistically significant differences in septal S', MAD, global longitudinal strain rate, or dynamic volumetry-derived parameters between the two groups. CONCLUSIONS Young cryptogenic stroke patients have subtly altered systolic function compared to healthy controls, found merely with longitudinal strain analysis. This infers that the heart may play a role in the pathogenesis of cryptogenic ischemic stroke.
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Affiliation(s)
- Jani Pirinen
- HUS Medical Imaging Center, Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouni Kuusisto
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | | | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Pauli Pöyhönen
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jukka Putaala
- Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vesa Järvinen
- HUS Medical Imaging Center, Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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İNAN RA, ÖZER D, ÖZEN BARUT B. Üçüncü Basamak Sağlık Merkezinde Genç İskemik İnme Hastalarında Etiyolojik inceleme. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.735340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
PURPOSE OF REVIEW This article reviews current knowledge on epidemiology, risk factors and causes, diagnostic considerations, management, and prognosis of ischemic stroke in young adults (those 55 years old and younger). RECENT FINDINGS The incidence of ischemic stroke in young adults has been increasing since the 1980s, which has occurred in parallel with increasing prevalence of vascular risk factors and substance abuse among the younger population. Young adults have a considerably wider range of risk factors than older patients, including age-specific factors such as pregnancy/puerperium and oral contraceptive use. Behavioral risk factors such as low physical activity, excess alcohol consumption, and smoking are factors as well. More than 150 identified causes of early-onset ischemic stroke exist, including rare monogenic disorders. Several recent advances have been made in diagnosis and management of stroke in young adults, including molecular characterization of monogenic vasculitis due to deficiency of adenosine deaminase 2 and transcatheter closure of patent foramen ovale for secondary prevention. Compared with the background population of the same age and sex, long-term mortality in patients remains fourfold higher with cardiovascular causes underlying most of the deaths. The cumulative rate of recurrent stroke extends up to 15% at 10 years. Patients with atherosclerosis, high-risk sources of cardioembolism, and small vessel disease underlying their stroke seem to have the worst prognosis regarding survival and recurrent vascular events. Young stroke survivors also often have other adverse outcomes in the long term, including epilepsy, pain, cognitive problems, and depression. SUMMARY Systematic identification of risk factors and causes and the motivation of patients for long-term prevention and lifestyle changes are of utmost importance to improve the prognosis of early-onset ischemic stroke.
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Nagaraja N, Patel UK, Chaturvedi S. Age differences in utilization and outcomes of tissue-plasminogen activator and mechanical thrombectomy in acute ischemic stroke. J Neurol Sci 2020; 420:117262. [PMID: 33333325 DOI: 10.1016/j.jns.2020.117262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/21/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE U.S. demographics is shifting towards older population. Older stroke patients likely receive less tissue-plasminogen activator (t-PA) and mechanical thrombectomy (MT) compared to younger patients. The objective of this study is to evaluate extent of difference in utilization of t-PA and MT and outcomes of stroke between three age groups -18-45 (young adults), 46-80 (middle/old), and > 80 (oldest old) years. METHODS It is a retrospective cross-sectional observational study. Primary outcomes were rates of stroke intervention and effect of age on stroke intervention. Secondary outcomes were in-hospital mortality, discharge to home, and prolonged length of stay. Multivariate survey-logistic regression was performed to evaluate outcomes. RESULTS Among 487,105 patients in the study 4.8% were young adults, 66.6% middle/old, and 28.6% oldest old. Compared to young adults, middle/old received 19% (OR = 0.81; 95%CI = 0.72-0.91) less t-PA alone; and 33% (OR = 0.67; 95%CI = 0.53-0.83) less MT alone; oldest old received 25% less t-PA alone (OR = 0.75; 95%CI = 0.66-0.86) and 51% (OR = 0.49; 95%CI = 0.38-0.63) less MT alone. Compared to young adults, in-hospital mortality was three-fold higher among middle/old (OR = 3.5; 95%CI = 1.3-9.6), and seven-fold higher among oldest old (OR = 7.5; 95%CI = 2.8-20.5) for t-PA alone; discharge to home reduced by 40% in middle/old (OR = 0.6; 95%CI = 0.4-0.7) and by 80% in oldest old (OR = 0.2; 95%CI = 0.1-0.2) for t-PA alone and similarly for MT alone. CONCLUSIONS Oldest old receive one-fourth less t-PA and half less MT compared to young adults. Oldest old patients who received t-PA alone or MT alone had remarkably worse outcomes for in-hospital mortality and discharge to home than young adults did.
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Affiliation(s)
- Nandakumar Nagaraja
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Urvish K Patel
- Department of Neurology and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, USA
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Characterisation of recent trends in cardiovascular risk factors in young and middle-aged patients with ischaemic stroke and/or transient ischaemic attack. J Neurol Sci 2020; 418:117115. [PMID: 32916515 DOI: 10.1016/j.jns.2020.117115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Strokes in the young and middle-aged are associated with a disproportionately large economic and social impact in addition to their clinical effects. Standard Modifiable Cardiovascular Risk Factors (SMuRFs; hypercholesterolaemia, hypertension, diabetes mellitus and smoking) are key drivers of cardiovascular disease including strokes, however recent temporal trends in the younger stroke population have not been well characterised. We aimed to evaluate recent trends of SMuRFs in a cohort of younger patients with ischaemic stroke. METHODS Consecutive patients aged <65 years with clinical and/or radiological diagnosis of ischaemic stroke or transient ischaemic attack in a tertiary referral centre (2013-2017) were retrospectively appraised. The demographic and clinical comorbidities of these patients were assessed including their SMuRF profile. The prevalence over time and clinical associations of patients with no SMuRFs were studied and compared to patients with SMuRFs. RESULTS Of 487 patients (53.49 ± 9.13 yrs., 60% men) analysed, 23% did not have SMuRFs. The proportion of "non-SMuRF" patients increased over time (p < 0.01) and this trend was not influenced by age (p = 0.48) or gender (p = 0.68). The presence of SMuRFs was not associated with in-hospital outcomes, however patients without SMuRFs were significantly less likely to be discharged on blood pressure (p < 0.01) and lipid-lowering therapies (p = 0.03). CONCLUSIONS The proportion of younger stroke patients without SMuRFs is substantial and has increased over time. Our findings highlight the need for further research to better understand the mechanisms underlying stroke development in this population and whether less risk factor treatment in this population could impact longer term outcomes.
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Annus Á, Juhász LÁ, Szabó E, Rárosi F, Szpisjak L, Vécsei L, Klivényi P. Connection between small vessel disease related stroke and the MTHFR C677T polymorphism in a Hungarian population. Heliyon 2020; 6:e05305. [PMID: 33163671 PMCID: PMC7609446 DOI: 10.1016/j.heliyon.2020.e05305] [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: 06/11/2020] [Revised: 08/06/2020] [Accepted: 10/15/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction There are conflicting results in the literature regarding the connection between thrombophilias and ischaemic stroke. However, most of the clinical studies have not differentiated between various ischaemic stroke subtypes. Our aim was to investigate whether there is an association between the methylene tetrahydrofolate reductase (MTHFR) C677T polymorphism and ischaemic stroke due to small vessel disease (SVD) in patients ≤50 years of age. Patients and methods We performed a retrospective search in the database used at our Health Centre. Our study population consisted of 100 ischaemic stroke patients. 65 patients had MTHFR C677T variants: 21 were homozygous (TT allele), 45 were heterozygous (CT). 35 stroke patients did not carry MTHFR C677T polymorphism (wild genotype, CC). Stroke subtypes were determined according to the TOAST classification. Pearson's chi-squared test of independence was used to evaluate differences between subgroups and multivariate logistic regression was also performed. Results More than half of our study population (52.00%) had lacunar strokes. The ratio of SVD in patients ≤50 years of age with TT homozygous variant was significantly higher compared to heterozygous and wild type subjects (p = 0.032 and p = 0.03 respectively). Multivariate logistic regression also showed, that apart from hypertension, only TT homozygosity was a predictive factor for SVD related stroke (p = 0.014, OR 1.619, 95% CI 1.390–18.338). Conclusion Our results demonstrate that in a Hungarian population of ischaemic stroke patients ≤50 years of age, SVD is the most common stroke subtype. In addition, we found association of SVD stroke with hypertension and MTHFR 677TT homozygous polymorphism.
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Affiliation(s)
- Ádám Annus
- University of Szeged, Albert Szent-Györgyi Health Centre, Department of Neurology, H-6725, Szeged, Semmelweis u. 6, Hungary
| | - Lilla Ágnes Juhász
- University of Szeged, Albert Szent-Györgyi Health Centre, Department of Neurology, H-6725, Szeged, Semmelweis u. 6, Hungary
| | - Elza Szabó
- University of Szeged, Albert Szent-Györgyi Health Centre, Department of Neurology, H-6725, Szeged, Semmelweis u. 6, Hungary
| | - Ferenc Rárosi
- Universtiy of Szeged, Department of Medical Physics and Informatics, H-6720, Szeged, Korányi fasor 9, Hungary
| | - László Szpisjak
- University of Szeged, Albert Szent-Györgyi Health Centre, Department of Neurology, H-6725, Szeged, Semmelweis u. 6, Hungary
| | - László Vécsei
- University of Szeged, Albert Szent-Györgyi Health Centre, Department of Neurology, H-6725, Szeged, Semmelweis u. 6, Hungary.,MTA-SZTE Neuroscience Research Group, H-6725, Szeged, Semmelweis u. 6, Hungary
| | - Péter Klivényi
- University of Szeged, Albert Szent-Györgyi Health Centre, Department of Neurology, H-6725, Szeged, Semmelweis u. 6, Hungary
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Risk factors, etiology, and outcome of ischemic stroke in young adults: A Japanese multicenter prospective study. J Neurol Sci 2020; 417:117068. [PMID: 32745720 DOI: 10.1016/j.jns.2020.117068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE This study aimed to evaluate the risk factors, etiology, and outcomes of ischemic stroke (IS) in Japanese young adults. METHODS This was a prospective multicenter study. We enrolled patients aged 16 to 55 years with IS within seven days of the onset of symptoms. We assessed the demographic data, risk factors, stroke etiology, and outcome at discharge. The clinical characteristics were compared between sexes and among age groups. RESULTS We prospectively enrolled 519 patients (median age, 48 years: 139 females). The mean National Institute of Health Stroke Scale score was 3.6 ± 0.2. The most common risk factors were hypertension (HT) (55%), dyslipidemia (DL) (47%), and current smoking (42%). Body mass index, incidence of current smoking, and heavy alcohol consumption were higher in males. The prevalence of current smoking, HT, DL, and diabetes mellitus increased with aging. The most common etiologic subgroup of IS was small vessel disease (145/510, 28%). Intracranial arterial dissection (IAD) was the most common among the other determined causes (56/115, 49%). The outcome at discharge was relatively good (mRS 0-1, 71.7%); however, poor outcome (mRS ≥ 4) was observed at an incidence of 9.5%. CONCLUSIONS Most young adults with IS had modifiable risk factors, of which prevalence increased with age. This emphasizes lifestyle improvement to prevent IS in the young population. Furthermore, we indicated that the incidence rate of IAD was high among the other determined causes.
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Ekker MS, de Leeuw FE. Higher Incidence of Ischemic Stroke in Young Women Than in Young Men: Mind the Gap. Stroke 2020; 51:3195-3196. [PMID: 32942968 DOI: 10.1161/strokeaha.120.032062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Merel S Ekker
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
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Leppert MH, Ho PM, Burke J, Madsen TE, Kleindorfer D, Sillau S, Daugherty S, Bradley CJ, Poisson SN. Young Women Had More Strokes Than Young Men in a Large, United States Claims Sample. Stroke 2020; 51:3352-3355. [PMID: 32942966 DOI: 10.1161/strokeaha.120.030803] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cardiovascular risk factors, which are overall more prevalent in men, are considered the major risk factors for strokes among young adults. However, recent European data found the incidence of strokes to be higher in young women. Using a large US claims sample, we examined sex differences in the index stroke rate of young adults. METHODS We performed a retrospective cohort study of enrollees in a 10% random sample of PharMetrics, a nationally representative claims database of insured Americans from 2001 to 2014. Outcomes were index ischemic stroke events, based on inpatient admissions using International Classification of Diseases-Ninth Revision codes. The index stroke rate was estimated from Poisson rate models with time varying covariates for 2-year periods, stratified by sex and age groups. RESULTS We identified 20 554 index strokes (50.4% women; mean age 63) including 5198 in young adults ages 15 to 54. There was no difference by sex in the index stroke rate in the extremes of age groups 15 to 24 and ≥75 years old. However, in the 25 to 34 and 35 to 44 year age groups, more women had strokes than men (incidence rate ratio: men:women, 0.70 [95% CI, 0.57-0.86]; 0.87 [95% CI, 0.78-0.98], respectively). In contrast, in the 45 to 54, 55 to 64, and 65 to 74 year age groups, more men had strokes (incidence rate ratio, 1.25 [95% CI, 1.16-1.33]; 1.41 [95% CI, 1.18-1.34]; 1.18 [95% CI, 1.12-125], respectively). CONCLUSIONS More young women than men have strokes, suggesting possible importance of sex-mediated etiologies of stroke. Understanding these drivers is critical to stroke treatment and prevention efforts in young adults.
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Affiliation(s)
- Michelle H Leppert
- Department of Neurology, University of Colorado School of Medicine, Aurora (M.H.L., S.S., S.N.P.)
| | - P Michael Ho
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora (P.M.H.).,Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (P.M.H., S.D.)
| | - James Burke
- Department of Neurology, University of Michigan Health System, Ann Arbor (J.B., D.K.)
| | - Tracy E Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.)
| | - Dawn Kleindorfer
- Department of Neurology, University of Michigan Health System, Ann Arbor (J.B., D.K.)
| | - Stefan Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora (M.H.L., S.S., S.N.P.)
| | - Stacie Daugherty
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (P.M.H., S.D.)
| | - Cathy J Bradley
- Colorado Comprehensive Cancer Center, University of Colorado, Aurora (C.J.B.)
| | - Sharon N Poisson
- Department of Neurology, University of Colorado School of Medicine, Aurora (M.H.L., S.S., S.N.P.)
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Arterial Hypertension and Risk of Recurrent Event in Young Ischemic Stroke Patients. Can J Neurol Sci 2020; 48:358-364. [PMID: 32912364 DOI: 10.1017/cjn.2020.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION In young patients, the cause of ischemic stroke (IS) remains often cryptogenic despite presence of traditional vascular risk factors (VRFs). Since arterial hypertension (AH) is considered the most important one, we aimed to evaluate the impact of AH and blood pressure (BP) levels after discharge on risk of recurrent IS (RIS) in young patients. METHODS The study set consisted of acute IS patients < 50 years of age enrolled in the prospective Heart and Ischemic STrOke Relationship studY registered on ClinicalTrials.gov (NCT01541163). Cause of IS was assessed according to the ASCOD classification. RESULTS Out of 319 enrolled patients <50 years of age (179 males, mean age 41.1 ± 7.8 years), AH was present in 120 (37.6%) of them. No difference was found in the rates of etiological subtypes of IS between patients with and without AH. Patients with AH were older, had more VRF, used more frequently antiplatelets prior IS, and had more RIS (10 vs. 1%, p = 0.002) during a follow-up (FUP) with median of 25 months. Multivariate logistic regression stepwise model showed the prior use of antiplatelets as only predictor of RIS (p = 0.011, OR: 6.125; 95% CI: 1.510-24.837). Patients with elevated BP levels on BP Holter 1 month after discharge did not have increased rate of RIS during FUP (3.8 vs. 1.7%, p = 1.000). CONCLUSION AH occurred in 37.6% of young IS patients. Patients with AH had more frequently RIS. Prior use of antiplatelets was found only predictor of RIS in young IS patients with AH.
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