1
|
Martinez-Majander N, Kutal S, Ylikotila P, Yesilot N, Tulkki L, Zedde M, Sarkanen T, Junttola U, Nordanstig A, Fromm A, Ryliskiene K, Licenik R, Ferdinand P, Jatuzis D, Kõrv L, Kõrv J, Pezzini A, Tuohinen S, Sinisalo J, Lehto M, Gerdts E, Ryödi E, Autere J, Hedman M, Fonseca AC, Waje-Andreassen U, von Sarnowski B, Redfors P, Sairanen T, Tatlisumak T, Roine RO, Huhtakangas J, Numminen H, Jäkälä P, Putaala J. Association between heavy alcohol consumption and cryptogenic ischaemic stroke in young adults: a case-control study. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333759. [PMID: 38906694 DOI: 10.1136/jnnp-2024-333759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/05/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND The underlying risk factors for young-onset cryptogenic ischaemic stroke (CIS) remain unclear. This multicentre study aimed to explore the association between heavy alcohol consumption and CIS with subgroup analyses stratified by sex and age. METHODS Altogether, 540 patients aged 18-49 years (median age 41; 47.2% women) with a recent CIS and 540 sex-matched and age-matched stroke-free controls were included. Heavy alcohol consumption was defined as >7 (women) and >14 (men) units per week or at least an average of two times per month ≥5 (women) and ≥7 (men) units per instance (binge drinking). A conditional logistic regression adjusting for age, sex, education, hypertension, cardiovascular diseases, diabetes, hypercholesterolaemia, current smoking, obesity, diet and physical inactivity was used to assess the independent association between alcohol consumption and CIS. RESULTS Patients were twice as more often heavy alcohol users compared with controls (13.7% vs 6.7%, p<0.001), were more likely to have hypertension and they were more often current smokers, overweight and physically inactive. In the entire study population, heavy alcohol consumption was independently associated with CIS (adjusted OR 2.11; 95% CI 1.22 to 3.63). In sex-specific analysis, heavy alcohol consumption was associated with CIS in men (2.72; 95% CI 1.25 to 5.92), but not in women (1.56; 95% CI 0.71 to 3.41). When exploring the association with binge drinking alone, a significant association was shown in the entire cohort (2.43; 95% CI 1.31 to 4.53) and in men (3.36; 95% CI 1.44 to 7.84), but not in women. CONCLUSIONS Heavy alcohol consumption, particularly binge drinking, appears to be an independent risk factor in young men with CIS.
Collapse
Affiliation(s)
| | - Shakar Kutal
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pauli Ylikotila
- Department of Neurology, Neurocenter, Turku University Hospital, University of Turku, Turku, Finland
| | - Nilufer Yesilot
- Department of Neurology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Lauri Tulkki
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marialuisa Zedde
- Neurology, Azienda Ospedaliera Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Tomi Sarkanen
- Department of Neurology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ulla Junttola
- Clinical Neuroscience Research Unit and Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Annika Nordanstig
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Radim Licenik
- Stroke, Peterborough City Hospital, Peterborough, UK
| | - Phillip Ferdinand
- Neurosciences, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Dalius Jatuzis
- Centre of Neurology, Vilnius University, Vilnius, Lithuania
| | - Liisa Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Alessandro Pezzini
- Department of Medicine and Surgery, University of Parma and Stroke Care Program, Department of Emergency, Parma University Hospital, Parma, Italy
| | - Suvi Tuohinen
- Department of Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Sinisalo
- Department of Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mika Lehto
- Department of Internal Medicine, Jorvi Hospital, HUS Helsinki University Hospital, Helsinki Finland, and University of Helsinki, Helsinki, Finland
| | - Eva Gerdts
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Essi Ryödi
- Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jaana Autere
- Neurocenter Neurology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Heart Centre, Kuopio University Hospital, Kuopio, Finland
| | - Ana Catarina Fonseca
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | | | | | - Petra Redfors
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tiina Sairanen
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Risto O Roine
- Department of Neurology, Neurocenter, Turku University Hospital, University of Turku, Turku, Finland
| | - Juha Huhtakangas
- Clinical Neuroscience Research Unit and Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Heikki Numminen
- Department of Neurology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Pekka Jäkälä
- Neurocenter Neurology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Jukka Putaala
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
2
|
Sun Z, Kleine-Borgmann J, Suh J, McDermott GC, Vishnevetsky A, Rist PM. Migraine and the risk of cervical artery dissection: A systematic review and meta-analysis. Eur Stroke J 2023; 8:904-914. [PMID: 37555306 PMCID: PMC10683742 DOI: 10.1177/23969873231191860] [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: 06/01/2023] [Accepted: 07/18/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Migraine is a common, disabling chronic pain condition possibly related to changes in endothelial and vascular structure and function. Several observational studies have suggested an elevated risk of cervical artery dissection (CeAD) in patients with a history of migraine. We aimed to investigate this potential association using systematic review and meta-analytic methods. PATIENTS AND METHODS We utilized a pre-defined search protocol to identify and screen studies related to migraine and CeAD in PubMed, Embase, and the Web of Science Core Collection. We assessed the risk of bias and performed a meta-analysis of selected studies to assess the association between migraine and CeAD. We also performed subgroup analyses by migraine subtype, biological sex, and the use of stroke versus non-stroke controls. RESULTS We identified 11 studies (N = 9857 patients) for inclusion in the meta-analysis. Meta-analysis showed an association between migraine and CeAD with an odds ratio of 1.74 (95%CI 1.38-2.19). There was high heterogeneity among the included studies (I2 = 61%). Publication bias was present but the Trim-Fill imputation suggested that the impact on results was likely minimal. Subgroup analyses revealed an association between migraine without aura and CeAD (OR 1.86, 95%CI 1.55-2.24) but not migraine with aura and CeAD (OR 1.15, 95%CI 0.71-1.88). There was no difference in the association between migraine and CeAD in men compared to women. DISCUSSION AND CONCLUSION A history of migraine is associated with an increased risk of CeAD. Further studies are needed to elucidate the potential pathophysiologic mechanisms underlying this association.
Collapse
Affiliation(s)
- Zihan Sun
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Julian Kleine-Borgmann
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Center for Translational Neuro- and Behavioral Sciences, Department of Neurology, University Medicine Essen, Essen, Germany
| | - Joome Suh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Neurology, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Gregory C McDermott
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Anastasia Vishnevetsky
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pamela M Rist
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Wen H, Wang N, Lv M, Yang Y, Liu H. The early predictive value of platelet-to-lymphocyte ratio to hemorrhagic transformation of young acute ischemic stroke. ASIAN BIOMED 2023; 17:267-272. [PMID: 38161346 PMCID: PMC10754501 DOI: 10.2478/abm-2023-0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Background The increasing incidence of acute ischemic stroke (AIS) necessitates a comprehensive understanding of the related factors. Hemorrhagic transformation (HT), a severe complication of AIS, is influenced by platelet-induced inflammation and lymphocyte levels. Objective To measure the predictive value of platelet-to-lymphocyte ratio (PLR) in the occurrence of HT in young AIS patients. Methods Data of young AIS patients (n = 157) admitted to the hospital for the first time were retrospectively collected. The patients were divided into HT (63 patients) and non-HT groups (94 patients) on the basis of whether HT had occurred after admission. The National Institute of Health stroke scale (NIHSS) score was used to determine the severity of clinical symptoms. The relationship between PLR and HT and NIHSS scores was analyzed to evaluate the predictive value of PLR in the occurrence of HT using receiver operating characteristic (ROC) and area under the curve (AUC). Results Multivariate analysis showed that PLR and NIHSS are independent risk factors of HT. The PLR value of the observation group was positively associated with the NIHSS score (r = 0.8075, P < 0.0001). According to the PLR prediction about the occurrence of HT, an AUC of 0.713 (95% CI, 0.652-0.781), a cut-off value of 109.073, and a sensitivity and specificity of 0.806 and 0.674, respectively, were obtained. Conclusions PLR value can predict the possibility of HT in young AIS patients to a certain extent. To take effective measures to prevent HT in advance has crucial clinical significance according to PLR value.
Collapse
Affiliation(s)
- Huijun Wen
- Department of Neurology, Baoji Central Hospital, Baoji, Shaanxi721008, China
| | - Ning Wang
- Department of Neurology, Baoji Central Hospital, Baoji, Shaanxi721008, China
| | - Min Lv
- Department of Rehabilitation Medicine, Baoji Traditional Chinese Medicine Hospital, Baoji, Shaanxi721008, China
| | - Yue Yang
- Department of Cardiology, Shangluo Beikuanping Central Hospital, Shangluo, Shaanxi726000, China
| | - Hongmei Liu
- Department of Neurology, Baoji Central Hospital, Baoji, Shaanxi721008, China
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Sakseranee J, Sethabouppha P, Pattarasakulchai T, Klaewkla T, Thiankhaw K. The diagnostic tests and functional outcomes of acute ischemic stroke or transient ischemic attack in young adults: A 4-year hospital-based observational study. PLoS One 2023; 18:e0292274. [PMID: 37792783 PMCID: PMC10550126 DOI: 10.1371/journal.pone.0292274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Ischemic strokes in young adults have been a significant concern due to various potential etiologies and had substantial clinical and public health impacts. We aimed to study the diagnostic tests, etiologies, and functional outcomes of acute ischemic stroke (AIS) and transient ischemic attack (TIA) in young adult patients. METHODS The data were retrieved from the Chiang Mai University Hospital Stroke Registry between January 2018 and December 2021. Consecutive AIS or TIA patients were included if they were 18-50 years and had no stroke mimics. Study outcomes were proportions of positive diagnostic tests, and 90-day modified Rankin Scale (mRS). RESULTS Of 244 enrolled patients, 59.0% (n = 144) were male, and 38.1% (n = 93) were aged 18-40, classified as the younger age group. There was a high incidence of diabetes (24.5%) and dyslipidemia (54.3%) among patients aged 41-50, associated with small-vessel occlusion and large-artery atherosclerosis stroke classification in this age group. Patients aged 18-40 years had more other determined etiologies (39.8%), with hypercoagulability (8.2%), arterial dissection (7.8%), and cardiac sources (6.6%) being the first three causes, which were associated with higher anticoagulant treatment. The cerebrovascular study, cardiac evaluation using echocardiography, and antiphospholipid syndrome testing were commonly performed, of which computed tomography angiography provided a high proportion of positive results (80.3%). 76.3% of young adult patients had excellent functional outcomes (mRS 0-1) with a median mRS of 0 (interquartile range 0-1) at 90-day follow-up. CONCLUSIONS Stroke of other determined etiology remained the common cause of stroke in young adults, and most affected individuals had excellent clinical outcomes. Blood tests for arterial hypercoagulability and noninvasive vascular and cardiac evaluations are encouraged in selected patients to determine the stroke etiology and guide for appropriate preventive strategies.
Collapse
Affiliation(s)
| | | | | | | | - Kitti Thiankhaw
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- The Northern Neuroscience Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
6
|
Naknoi S, Li J, Ramasoota P, Liu X, Chen L, Phuanukoonnon S, Soonthornworasiri N, Kaewboonchoo O. Associations of effort-reward imbalance at work and quality of life among workers after stroke: a one-year longitudinal study in Thailand. BMC Public Health 2023; 23:1910. [PMID: 37789277 PMCID: PMC10548574 DOI: 10.1186/s12889-023-16784-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Abstract
Stroke incidence is increasing among working-age population, but the role of psychosocial stress in the workplace in predicting quality of life (QoL) after stroke onset is understudied. This longitudinal study aimed to investigate the relationship between work stress, measured by the effort-reward imbalance (ERI) model, and QoL over one-year period among 103 Thai workers who had experienced a stroke. The study evaluated the effort (E)-reward (R) ratio and over-commitment, the extrinsic and intrinsic components of the ERI model, before discharge; QoL was repeatedly measured at baseline, six months, and 12 months after discharge, respectively, using the Short Form Version 2 (SF-12v2) indicators of physical and mental health composite scores. Generalized estimating equations were used to examine longitudinal relationships between work stress at baseline and QoL over one year by testing the hypotheses that E-R ratio and over-commitment would have direct effects on QoL, and potential moderating effects of over-commitment on E-R ratio and QoL. The results supported the ERI model partially, as over-commitment was significantly associated with poor mental health (coefficient - 8.50; 95% CI: -13.79, -3.20) after adjusting baseline sociodemographic, behavioral, and clinical characteristics, while the E-R ratio was not significantly associated with physical or mental health; the interaction between the E-R ratio and over-commitment was also not significant. These findings suggest that more attention should be paid to workers' personal coping skills and ability to handle work-related problems and prioritize interventions that address over-commitment to promote long-term mental health among workers with stroke.
Collapse
Affiliation(s)
- Siripan Naknoi
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Department of Public health Nursing, Faculty of Public health, Mahidol University, Bangkok, 10400, Thailand
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Pongrama Ramasoota
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Xinyue Liu
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Suparat Phuanukoonnon
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Ngamphol Soonthornworasiri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Orawan Kaewboonchoo
- Department of Public health Nursing, Faculty of Public health, Mahidol University, Bangkok, 10400, Thailand.
| |
Collapse
|
7
|
Di Carlo A, Baldereschi M, Bovis F, Piccardi B, Linoli G, Orlandi G, Volpi G, Chiti A, Tassi R, Brescia A, Inzitari D. Effect of an educational intervention to increase stroke awareness among Italian high school students: A prospective study in Tuscany. Eur Stroke J 2023; 8:769-776. [PMID: 37641553 PMCID: PMC10472968 DOI: 10.1177/23969873231175405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/25/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Stroke in young people shares traditional modifiable risk factors with older groups, and greatly affects quality of life. However, evidence on the effectiveness of educational interventions in young populations, aiming at spreading stroke knowledge and enhancing prevention, is still scarce. We evaluated baseline knowledge of stroke and possible improvements after an educational intervention among Italian high school students, also considering differences related to sex and type of school. SUBJECTS AND METHODS Using a mixed educational strategy, a prospective evaluation of stroke knowledge was performed in five humanities and sciences (lyceums) and five vocational high schools of Tuscany (students of the 12th and 13th grade). A baseline assessment with a structured questionnaire (21 questions) was followed by a standardized oral presentation, using audiovisual materials. After 3 months, the same questionnaire was re-administered to evaluate the long-term impact of the educational intervention. RESULTS Overall, 573 students (50.8% males; age range, 17-19 years) were enrolled; 288 (50.3%) were from lyceums and 285 (49.7%) from vocational schools. Follow-up participation was 97.2%. Baseline performances were comparable between groups for most variables examined. At 3 months, all groups showed a significant improvement from baseline regarding reaction to a stroke event, identification of stroke risk factors, such as smoking (from 62.9% to 83.7%; p < 0.001) and alcohol abuse (from 49.6% to 67.2%; p < 0.001), and symptoms. Knowledge of the existence of stroke units and thrombolysis increased from 25.4% to 60.7% (p < 0.001) and from 35.8% to 84.0% (p < 0.001), respectively. CONCLUSIONS Our educational intervention improved stroke awareness in high school students. The effects persisted after 3 months. Improved knowledge in young populations may reduce stroke burden in adult life, increase timely access to therapies, and spread knowledge across families.
Collapse
Affiliation(s)
- Antonio Di Carlo
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
| | - Marzia Baldereschi
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
| | - Francesca Bovis
- Department of Health Sciences, University of Genoa, Genova, Liguria, Italy
| | | | - Giovanni Linoli
- Neurology Unit, San Donato Hospital, South-East Tuscany Local Health Authority, Arezzo, Italy
| | - Giovanni Orlandi
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Gino Volpi
- Neurology and Neurophysiopathology Unit, San Iacopo and SS Cosma e Damiano Hospitals, Central Tuscany Local Health Authority, Pistoia and Pescia, Italy
| | - Alberto Chiti
- Neurology Unit, Apuane Hospital, North-West Tuscany Local Health Authority, Massa, Italy
| | - Rossana Tassi
- Stroke Unit, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Alfonso Brescia
- Scientific Committee Stroke Patients Association ALICe, Grosseto, Italy
| | - Domenico Inzitari
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
- Department of Neurofarba, University of Florence, Firenze, Italy
| |
Collapse
|
8
|
Guo X, Li J, Yin X, Zhang Z, Zhong Q, Zhu F. Trends in deaths and disability-adjusted life-years of stroke attributable to high body-mass index worldwide, 1990-2019. Front Neurol 2023; 14:1211642. [PMID: 37456638 PMCID: PMC10348385 DOI: 10.3389/fneur.2023.1211642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Background High body mass index (HBMI) is an independent risk factor for stroke. Previous studies on the incremental burden of the rapid growth of stroke attributable to HBMI are incomplete and lag behind. We aim to assess the global burden of stroke attributable to HBMI based on a public database online. Materials and methods Study data were taken from the Global Burden of Disease, Injuries, and Risk Factors Study; deaths, the Disability-Adjusted Life-Years (DALYs), and their age-standardized rates were screened. The join point regression was used, wherein age-standardized rates were referred to as temporal trends in disease burden. Results Deaths from stroke attributable to HBMI worldwide were on the rise during 1990-2019, with an increase of 88.75%. Age-standardized DALYs were on the rise during 1990-2003 but declined during 2003-2013, with a turning point in 2013 and an increasing trend since then [the Annual Percentage Change (APC) = 0.30%, p < 0.05]. China, India, Indonesia, the Russian Federation, and the United States of America shared in sequence the rate of leading deaths and DALYs in 2019. The Socio-Demographic Index (SDI) was associated with an increasing trend in age-standardized deaths (R = -0.24, p < 0.001) and age-standardized DALYs (R = -0.22, p = 0.0018). Conclusion A range of indicators for the global burden of stroke attributable to HBMI have been on the rise for the past three decades. Tremendous efforts worldwide should be in place to control and treat stroke attributable to HBMI, especially in regions with high-middle and middle SDIs and among middle-aged and aged populations.
Collapse
Affiliation(s)
- Xiucai Guo
- Pharmaceutical Department and Central Laboratory, Guangzhou Twelfth People’s Hospital, Guangzhou, China
| | - Junxiao Li
- Pharmaceutical Department and Central Laboratory, Guangzhou Twelfth People’s Hospital, Guangzhou, China
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xueyan Yin
- Pharmaceutical Department and Central Laboratory, Guangzhou Twelfth People’s Hospital, Guangzhou, China
| | - Ziping Zhang
- Pharmaceutical Department and Central Laboratory, Guangzhou Twelfth People’s Hospital, Guangzhou, China
| | - Qiongqiong Zhong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Feng Zhu
- Pharmaceutical Department and Central Laboratory, Guangzhou Twelfth People’s Hospital, Guangzhou, China
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| |
Collapse
|
9
|
Moosa A, Osama D, Alnidawi F, Algillidary S, Hussein A, Das P. Risk Factors, Incidence, and Outcome of Stroke: A Retrospective Cross-Sectional Hospital-Based Study Comparing Young Adults and Elderly. Cureus 2023; 15:e40614. [PMID: 37476123 PMCID: PMC10354461 DOI: 10.7759/cureus.40614] [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: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
A noticeable increase of up to 40% in the incidence of stroke among young population over the past decade has been noted. This study aimed to investigate the incidence, risk factors, and outcomes of stroke and its subtypes in young adults compared to older population. A retrospective study of patients which included patients with confirmed diagnosis of stroke based on the International Classification of Diseases 10th Revision (ICD-10) classification between the years 2018 and 2020 was conducted. The results indicated that patients less than 45 years of age had a higher incidence of hemorrhagic stroke as compared to the other age groups (p=0.011). Hypertension leading to hemorrhagic stroke was higher in patients less than 45 years of age as compared to other groups (18 years {19.4%} versus 33 years {7.5%}, p=0.001). Hypertension was noted to be the leading risk factor for stroke among the younger population.
Collapse
Affiliation(s)
- Ameena Moosa
- Internal Medicine, King Hamad University Hospital, Muharraq, BHR
| | - Dana Osama
- Internal Medicine, King Hamad University Hospital, Muharraq, BHR
| | - Firas Alnidawi
- Neurology, King Hamad University Hospital, Muharraq, BHR
| | | | - Ali Hussein
- Internal Medicine, King Hamad University Hospital, Muharraq, BHR
| | - Priya Das
- Scientific Research and Development, King Hamad University Hospital, Muharraq, BHR
| |
Collapse
|
10
|
Reverté-Villarroya S, Suñer-Soler R, Sauras-Colón E, Zaragoza-Brunet J, Fernández-Sáez J, Lopez-Espuela F. [Ischemic stroke and vascular risk factors in young and older adults. Community-based retrospective study (2011-2020)]. Aten Primaria 2023; 55:102623. [PMID: 37086593 PMCID: PMC10148073 DOI: 10.1016/j.aprim.2023.102623] [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: 12/10/2022] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 04/24/2023] Open
Abstract
OBJECTIVE To analyze the presence of vascular risk factors (VRF) among young adult and older adult patients with ischemic stroke, with and without follow-up in primary care after hospital discharge. DESIGN Observational, retrospective, multicenter study. SETTING Primary care health centers and Hospital Verge de la Cinta, Tortosa, Spain. PARTICIPANTS Patients with ischemic stroke of two age groups (≤55 and ≥65years) distributed in two groups (GroupA: without follow-up in primary care; and GroupB: with follow-up in primary care), between 2011-2020. MAIN MEASUREMENTS Sociodemographic, clinical, and VRF data coded according to the International Classification of Diseases (ICD-10). Descriptive, and inferential statistics. RESULTS Data from 2054 participants were analyzed. In the young adult group, 94.9% of the participants in groupA had between 1-2VRFs, compared to 60% in groupB. In the older adult group, 84.4% of groupA had between 1-2VRFs, compared to 43,9% of groupB. The most frequent VRFs among younger and older adult patients with ischemic stroke were hypertension and dyslipidemia in both follow-up groups. There were no records of obesity, smoking, or alcohol consumption in groupA. There was a significant association between being followed up in primary care after stroke and being a young adult and presenting between 3-4 VRFs (P<0.001). CONCLUSIONS The results reinforce the need for continuity of care and follow-up in people with acute stroke in primary care and the need to improve the quality of registries.
Collapse
Affiliation(s)
- Silvia Reverté-Villarroya
- Departamento de Enfermería, Campus Terres de l'Ebre, Universitat Rovira i Virgili, Tortosa, Tarragona, España; Grupo de Investigación Avanzada en Enfermería, Universitat Rovira i Virgili, Tarragona, España
| | - Rosa Suñer-Soler
- Grupo de Investigación Salud y Atención Sanitaria, Facultad de Enfermería, Universidad de Girona, Girona, España.
| | - Esther Sauras-Colón
- Hospital de Tortosa Verge de la Cinta, Unidad de Estudios Clínicos, Institut d'Investigació Sanitària Pere i Virgili, Tortosa, Tarragona, España
| | - Josep Zaragoza-Brunet
- Hospital de Tortosa Verge de la Cinta, Unidad de Estudios Clínicos, Institut d'Investigació Sanitària Pere i Virgili, Tortosa, Tarragona, España
| | - José Fernández-Sáez
- Departamento de Enfermería, Campus Terres de l'Ebre, Universitat Rovira i Virgili, Tortosa, Tarragona, España; Unitat de Support a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Tarragona, España
| | - Fidel Lopez-Espuela
- Grupo de Investigación en Enfermedades Metabólicas Óseas, Departamento de Enfermería, Universidad de Extremadura, Cáceres, España; Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, España
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Saapar M, Vibo R, Schneider S, Kõrv L, Mallene S, Kõrv J. Health behavior of young patients with ischemic stroke in Estonia: A score of five factors. Brain Behav 2023; 13:e2908. [PMID: 36788655 PMCID: PMC10013939 DOI: 10.1002/brb3.2908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/11/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Behavioral risk factors are common among young patients with stroke. This study aimed to compare the health behavior of patients and healthy controls and develop a combined risk score of health behavior. METHODS The health behavior of patients aged 18-54 years who suffered an ischemic stroke from 2013 to 2020 in Estonia was compared to the Health Behavior among Estonian Adult Population 2014 study sample. We chose five risk factors for comparison: smoking status, body mass index, physical exercise, diet (salt use and vegetable consumption), alcohol intake (quantity and frequency), and composed a summary score. RESULTS Comparing 342 patients and 1789 controls, daily smoking (49.0% vs. 22.7%), obesity (33.4% vs. 15.9%), low physical activity (< twice/week) (72.2% vs. 60.5%), excessive salt use (8.6% vs. 4.5%), and frequent alcohol use (≥ weekly) (39.9% vs. 34.0%) were more prevalent among patients. The differences in infrequent vegetable consumption (<6 days/week) and excessive alcohol consumption (7 days, >8 units/females, >16 units/males) were not significant. The observed differences were similar for age groups 18-44 years and 45-54 years. The average Health Behavior Stroke Risk Score (0-10) was 4.6 points (CI 4.4-4.8, SD ± 1.97) for patients and 3.5 points (CI 3.4-3.6, SD ± 1.90) for controls. CONCLUSIONS Before stroke, young patients displayed significantly worse health behavior than the general population. The largest differences were found for smoking and obesity, and a cumulation of risk factors was observed via the HBSR score.
Collapse
Affiliation(s)
- Minni Saapar
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Riina Vibo
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Siim Schneider
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.,Department of Neurology, North Estonia Medical Centre, Tallinn, Estonia
| | - Liisa Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.,Department of Neurology, North Estonia Medical Centre, Tallinn, Estonia
| | - Sandra Mallene
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| |
Collapse
|
13
|
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
Collapse
|
14
|
Valera RJ, Botero-Fonnegra C, Cogollo VJ, Sarmiento-Cobos M, Montorfano L, Rivera C, Hong L, Lo Menzo E, Szomstein S, Rosenthal RJ. Does bariatric surgery change the risk of acute ischemic stroke in patients with a history of transient ischemic attack? A nationwide analysis. Surg Obes Relat Dis 2022; 19:548-554. [PMID: 36581552 DOI: 10.1016/j.soard.2022.11.013] [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: 08/29/2022] [Revised: 11/12/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stroke is the second leading cause of death worldwide and fifth in the United States, and it represents the major cause of disability in older adults. OBJECTIVE We aimed to determine the risk of acute ischemic stroke (AIS) in individuals with obesity with a history of transient ischemic attack (TIA) compared with patients with a history of bariatric surgery. SETTING Academic hospital, United States. METHODS Using the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, we retrospectively identified patients with obesity and past medical history of TIA and divided them into 2 groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity. We compared incidence of new AIS in both groups using a univariate analysis and multivariate regression model. Covariates included were lifestyle (smoking status, alcohol habits, cocaine use), family history of stroke, co-morbidities (diabetes, hypertension, hyperlipidemia, atrial fibrillation) and long-term medical treatment (antiplatelet/antithrombotic treatment). RESULTS A total of 91,640 patients met inclusion criteria, of which treatment patients were 12.3% (n = 11,284) and control patients 87.6% (n = 80,356). The average age of the treatment group was 62.9 ± 17.08 years, and the average of the control was 59.6 ± 12.74 years. The rate of AIS in the treatment group was significantly lower compared with the control group (2.8% versus 4.2%, P < .0001). After adjusting for covariables, the risk difference of AIS was still significant between groups (odds ratio = 1.33, P < .0001), showing that patients in the treatment group were less likely to have AIS compared with the control group. CONCLUSIONS After analyzing nationwide information, we conclude bariatric surgery helps decrease risk of AIS in patients with a history of TIA. However, this comparison is limited by the nature of the database; further studies are needed to better understand these results.
Collapse
Affiliation(s)
- Roberto J Valera
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Cristina Botero-Fonnegra
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Vicente J Cogollo
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Mauricio Sarmiento-Cobos
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Lisandro Montorfano
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Carlos Rivera
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Liang Hong
- Biostatistics Section, Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
| |
Collapse
|
15
|
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
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Jo YJ, Kim DH, Sohn MK, Lee J, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Chang WH, Kim YH, Kim DY. Clinical Characteristics and Risk Factors of First-Ever Stroke in Young Adults: A Multicenter, Prospective Cohort Study. J Pers Med 2022; 12:jpm12091505. [PMID: 36143290 PMCID: PMC9504439 DOI: 10.3390/jpm12091505] [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] [Received: 08/22/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 01/10/2023] Open
Abstract
Stroke in young adults has catastrophic consequences and has increased in prevalence, contrary to the trends of most other diseases. This study aimed to determine the major characteristics and risk factors for stroke in younger adults compared with older adults. From the Korean Stroke Cohort for Functioning and Rehabilitation, 10,584 patients with first-ever stroke between August 2012 and March 2015 were enrolled retrospectively and divided into younger (age ≤ 45) and older groups (age > 45). The clinical characteristics and risk factors of stroke were compared between the younger and older groups. The younger group comprised 915 patients (8.6%). The proportion of hemorrhage strokes in the younger group (42.3%) was significantly higher than in the older group (20.0%) (p < 0.001). Obesity, current smoking, and heavy alcohol consumption were significantly more common risk factors in the younger group than in the older group for all stroke types, whereas hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, and coronary heart disease were significantly more frequent in the older group (both p < 0.001). The major risk factors in the younger group may be lifestyle-related. Therefore, increasing awareness of lifestyle-related risk factors may be necessary to prevent stroke in young adults.
Collapse
Affiliation(s)
- Yea Jin Jo
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dae Hyun Kim
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejon 34134, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan 46241, Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan 51538, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu 41566, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan 51538, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju 63243, Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Kwangju 61186, Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chunchon 24252, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University, Seoul 03063, Korea
- Correspondence: (Y.-H.K.); (D.Y.K.)
| | - Deog Young Kim
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: (Y.-H.K.); (D.Y.K.)
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
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.
Collapse
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
| | | |
Collapse
|
20
|
Fruhwirth V, Berger L, Gattringer T, Fandler-Höfler S, Kneihsl M, Schwerdtfeger A, Weiss EM, Enzinger C, Pinter D. Evaluation of a Newly Developed Smartphone App for Risk Factor Management in Young Patients With Ischemic Stroke: A Pilot Study. Front Neurol 2022; 12:791545. [PMID: 35069420 PMCID: PMC8766760 DOI: 10.3389/fneur.2021.791545] [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] [Received: 10/08/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Efficient treatment of modifiable vascular risk factors decreases reoccurrence of ischemic stroke, which is of uttermost importance in younger patients. In this longitudinal pilot study, we thus assessed the effect of a newly developed smartphone app for risk factor management in such a cohort. Methods: The app conveys key facts about stroke, provides motivational support for a healthy lifestyle, and a reminder function for medication intake and blood pressure measurement. Between January 2019 and February 2020, we consecutively invited patients with ischemic stroke aged between 18 and 55 years to participate. Patients in the intervention group used the app between hospital discharge and 3-month follow-up. The control group received standard clinical care. Modifiable risk factors (physical activity, nutrition, alcohol consumption, smoking behavior, obesity, and hypertension) were assessed during the initial hospital stay and at a dedicated stroke outpatient department three months post-stroke. Results: The study cohort comprised 21 patients in the app intervention group (62% male; age = 41 ± 11 years; education = 12 ± 3 years) and 21 sex-, age- and education-matched control patients with a comparable stroke risk factor profile. Baseline stroke severity was comparable between groups (intervention: median NIHSS = 3; control: median NIHSS = 4; p = 0.604). Three months post-stroke, patients in the intervention group reported to be physically almost twice as active (13 ± 9 h/week) compared to controls (7 ± 5 h/week; p = 0.022). More intense app usage was strongly associated with higher physical activity (r = 0.60, p = 0.005) and lower consumption of unhealthy food (r = -0.51, p = 0.023). Smoking behavior (p = 0.001) and hypertension (p = 0.003) improved in all patients. Patients in the intervention group described better self-reported health-related quality of life three months post-stroke (p = 0.003). Conclusions: Specifically designed app interventions can be an easily to implement and cost-efficient approach to promote a healthier lifestyle in younger patients with a stroke.
Collapse
Affiliation(s)
- Viktoria Fruhwirth
- Department of Neurology, Medical University of Graz, Graz, Austria
- Research Unit for Neuronal Plasticity and Repair, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Lisa Berger
- Research Unit for Neuronal Plasticity and Repair, Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Neuropsychology - Neuroimaging, Institute of Psychology, University of Graz, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | | | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Andreas Schwerdtfeger
- Department of Health Psychology, Institute of Psychology, University of Graz, Graz, Austria
| | - Elisabeth Margarete Weiss
- Department of Clinical Psychology, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Research Unit for Neuronal Plasticity and Repair, Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria
- Research Unit for Neuronal Plasticity and Repair, Department of Neurology, Medical University of Graz, Graz, Austria
| |
Collapse
|
21
|
Ho HC, Guo H, Chan TC, Shi Y, Webster C, Fong KNK. Community planning for a "healthy built environment" via a human-environment nexus? A multifactorial assessment of environmental characteristics and age-specific stroke mortality in Hong Kong. CHEMOSPHERE 2022; 287:132043. [PMID: 34543905 DOI: 10.1016/j.chemosphere.2021.132043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/28/2021] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
With the prevalence of stroke rising due to both aging societies and more people getting strokes at a younger age, a comprehensive investigation into the relationship between urban characteristics and age-specific stroke mortality for the development of a healthy built environment is necessary. Specifically, assessment of various dimensions of urban characteristics (e.g. short-term environmental change, long-term environmental conditions) is needed for healthy built environment designs and protocols. A multifactorial assessment was conducted to evaluate associations between environmental and sociodemographic characteristics with age-stroke mortality in Hong Kong. We found that short-term (and temporally varying) daily PM10, older age and being female were more strongly associated with all types of stroke deaths compared to all-cause deaths in general. Colder days, being employed and being married were more strongly associated with hemorrhagic stroke deaths in general. Long-term (and spatially varying) regional-level air pollution were more strongly associated with non-hemorrhagic stroke deaths in general. These associations varied by age. Employment (manual workers) and low education were risk factors for stroke mortality at younger ages (age <65). Greenness and open space did not have a significant association with stroke mortality. Since a significant connection was expected, this leads to questions about the health-inducing efficacy of Hong Kong's compact open spaces (natural greenery being limited to steep slopes, and extensive impervious surfaces on public open spaces). In conclusion, urban plans and designs for stroke mortality prevention should implement age-specific health care to neighborhoods with particular population segments.
Collapse
Affiliation(s)
- Hung Chak Ho
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong.
| | - Huagui Guo
- School of Architecture and Urban-rural Planning, Fuzhou University, China
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taiwan
| | - Yuan Shi
- Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong
| | - Chris Webster
- Faculty of Architecture, The University of Hong Kong, Hong Kong
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| |
Collapse
|
22
|
Chouhdari A, Farahani HS, Pakdaman H, Heidari K, Ebrahimzadeh K. Lifestyle Assessment in Young Adults with Ischemic Stroke: One Cross-Sectional Study in Iran. Int J Prev Med 2021; 12:152. [PMID: 34912528 PMCID: PMC8631135 DOI: 10.4103/ijpvm.ijpvm_441_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aim Lifestyle changes are associated with an increased incidence of stroke especially in young adults. The purpose of this study was to investigate the lifestyle of ischemic stroke cases under the age of 50 years. Methods This descriptive cross-sectional study was conducted on young adults with ischemic stroke who were admitted to some hospitals, Tehran, Iran between 2018 and 2019. Total lifestyle information collected in the form then was compared in males and females. Results Totally 11% ischemic stroke was under age 50 years. 60.7% of young adult patients were men. There was significant difference between body mass index (BMI) (P = 0.03), type of job (P = 0.04), physical activity (P = 0.02), fruit and vegetables consumption, and gender of patients (P = 0.02). Conclusion According to the association between inappropriate lifestyle and ischemic stroke in young adults, it is recommended to set preventive medicine and health promotion units with insurance coverage in all clinics for risk assessment of stroke in healthy general population specialty young adults.
Collapse
Affiliation(s)
- Arezoo Chouhdari
- Social Determinants of Health Research Center, Amir-al-Momenin Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | | | - Hossein Pakdaman
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamran Heidari
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Ebrahimzadeh
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
23
|
Vibo R, Schneider S, Kõrv L, Mallene S, Torop LA, Kõrv J. Estonian young stroke registry: High burden of risk factors and high prevalence of cardiomebolic and large-artery stroke. Eur Stroke J 2021; 6:262-267. [PMID: 34746422 PMCID: PMC8564150 DOI: 10.1177/23969873211040990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background and aims The aim of the present study was to assess the risk factor burden and stroke etiology of young stroke patients in Estonia and to compare the results with similar cohorts from other countries. Methods This study includes ischemic stroke patients aged 18-54 years from the prospective Estonian Young Stroke Registry between 2013 and 2020. All patients were managed in a stroke unit following a prespecified detailed protocol. Data on stroke risk factors, etiology, and stroke severity were analyzed. Results A total of 437 patients (mean age 44.7 ± 8.3 years; 62% males) were included in the registry during the 8-year study period. A total of 50.2% of patients had ≥ 3 well-documented risk factors (higher for men: odds ratio (OR) 3.8; 95% cardiac index confidence interval (CI) 1.8-8.3; p < .001) and 6.2% of patients had ≥ 3 less well-documented risk factors. While 42% of patients had undetermined cause of stroke (34% of them cryptogenic), the second most frequent etiologies were large-artery atherosclerosis and cardioembolism (both 19%). 60 percent of cardioembolic strokes were due to high-risk causes. Large-artery atherosclerosis was more prevalent in men (OR 1.8; 95% CI 1-3.3; p = .05) and among older patients (OR 6.2; 95% CI 1.8-21.4; p = .008). The median National Institutes of Health Stroke Scale score on admission was 3 (interquartile ranges 2-6), stroke was more severe in men (p = .05). Conclusions Our study revealed that young patients with stroke in Estonia have higher burden of well-documented risk factors, higher prevalence of high-risk cardioembolic causes and higher prevalence of large-artery stroke compared to other young stroke cohorts.
Collapse
Affiliation(s)
- Riina Vibo
- Department of Neurology and Neurosurgery, University of Tartu, Estonia
| | - Siim Schneider
- Department of Neurology and Neurosurgery, University of Tartu, Estonia
| | - Liisa Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Estonia
| | - Sandra Mallene
- Department of Neurology and Neurosurgery, University of Tartu, Estonia
| | | | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Estonia
| |
Collapse
|
24
|
Franc D, Šaňák D, Divišová P, Lysková L, Bártková A, Zapletalová J, Král M, Dorňák T, Polidar P, Veverka T, Kaňovský P. Socioeconomic status and lifestyle in young ischaemic stroke patients: a possible relationship to stroke recovery and risk of recurrent event. Cent Eur J Public Health 2021; 29:223-229. [PMID: 34623123 DOI: 10.21101/cejph.a6697] [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: 01/04/2021] [Accepted: 08/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Socioeconomic status (SES) and lifestyle have impact on recovery after ischaemic stroke (IS) and on risk of recurrent ischaemic stroke (RIS) in elderly patients. With regard to currently available limited data on young people, we aimed to assess SES and parameters of lifestyle and evaluate their relationship to stroke recovery and risk of RIS in young patients. METHODS We analysed consecutive young IS patients < 50 years enrolled in the prospective HISTORY (Heart and Ischaemic STrOke Relationship studY) study registered on ClinicalTrials.gov (NCT01541163). Data were acquired from structured a self-evaluating multiple-choice questionnaire. Clinical outcome was assessed using the Modified Rankin Scale (MRS) after 3 months with score 0-1 for excellent outcome. RESULTS Data were obtained from 297 (163 males, mean age 39.6 ± 7.8 years) young patients. Patients with MRS 0-1 (237, 79.8%) did not differ in SES except university education (21.1 vs. 3.3%; p = 0.001), less smoked (16.5 vs. 58.3%; p < 0.001), more of them did regular sport activities (79.1 vs. 51.6%; p = 0.02) and passed regular preventive medical checks (45.6 vs. 24.2%; p = 0.01). Twelve (4%) patients suffered from RIS during a follow-up with median of 25 months. They did not differ in SES but had higher body mass index (31.6 vs. 26.7; p = 0.007), reported less regular sport activities (16.7 vs. 73.0%; p < 0.001) and less regular medical checks (8.3 vs. 40.0%; p = 0.001). CONCLUSION In young patients, SES had no relationship to clinical outcome after IS and to risk of RIS except education level. Some parameters of health lifestyle were presented more in patients with excellent outcome and without RIS during the follow-up.
Collapse
Affiliation(s)
- David Franc
- Comprehensive Stroke Centre, Department of Neurology, Medical School, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Daniel Šaňák
- Comprehensive Stroke Centre, Department of Neurology, Medical School, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Petra Divišová
- Comprehensive Stroke Centre, Department of Neurology, Medical School, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Lucie Lysková
- Comprehensive Stroke Centre, Department of Neurology, Medical School, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Andrea Bártková
- Comprehensive Stroke Centre, Department of Neurology, Medical School, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Jana Zapletalová
- Department of Biophysics and Statistics, Medical School, Palacky University Olomouc, Olomouc, Czech Republic
| | - Michal Král
- Comprehensive Stroke Centre, Department of Neurology, Medical School, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Tomáš Dorňák
- Comprehensive Stroke Centre, Department of Neurology, Medical School, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Petr Polidar
- Comprehensive Stroke Centre, Department of Neurology, Medical School, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Tomáš Veverka
- Comprehensive Stroke Centre, Department of Neurology, Medical School, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Petr Kaňovský
- Comprehensive Stroke Centre, Department of Neurology, Medical School, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| |
Collapse
|
25
|
Apelin-13 attenuates injury following ischemic stroke by targeting matrix metalloproteinases (MMP), endothelin- B receptor, occludin/claudin-5 and oxidative stress. J Chem Neuroanat 2021; 118:102015. [PMID: 34454018 DOI: 10.1016/j.jchemneu.2021.102015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022]
Abstract
Oxidative stress, an adverse consequence of brain ischemia-reperfusion injury (IRI), activates matrix metalloproteinase enzymes which cause to destruction of extracellular matrix and tight junction proteins. Oxidative stress during stroke increases serum endothelin-1 and endothelin B receptor (ETBR) expression. Apelin-13, an endogenous peptide, is expressed in numerous tissues that regulate diverse physiological and pathological processes. This study aimed to investigate the effect of intravenous (IV) injection of apelin-13 on cerebral vasogenic edema due to brain IRI. Animals were divided into sham, ischemia, and treat groups. IRI model was induced by middle cerebral artery occlusion (MCAO) for 60 min followed by 23 h reperfusion. Apelin-13 was injected into the tail vein 5 min before reperfusion. Neurological defects were evaluated with longa test. Brain water content and BBB permeability were assessed according to cerebral dry-wet weight and brain Evans blue extraction. Malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) were measured using the colorimetric method. Expression of occludin and claudin-5, matrix metalloproteinase- 2 and 9 (MMP-2 & 9) and, ETBR were evaluated using Western blot. Brain IRI was associated with BBB breakdowns and vasogenic edema. Apelin-13 significantly reduced BBB permeability and vasogenic edema. Apelin-13 significantly attenuated IRI-related oxidative stress. Apelin-13 decreased expression of mmp-2, 9 and ETBR, prevented from decrement of occludin and claudin-5 expersion, which protected BBB integrity and reduced vasogenic edema. In conclusion, our results have suggested that an IV injection of apelin-13 could somehow reduce vasogenic edema via targeting oxidative stress and ETBR expression.
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Bardugo A, Fishman B, Libruder C, Tanne D, Ram A, Hershkovitz Y, Zucker I, Furer A, Gilon R, Chodick G, Tiosano S, Derazne E, Tzur D, Afek A, Pinhas-Hamiel O, Bendor CD, Yaniv G, Rotem RS, Twig G. Body Mass Index in 1.9 Million Adolescents and Stroke in Young Adulthood. Stroke 2021; 52:2043-2052. [PMID: 33980044 DOI: 10.1161/strokeaha.120.033595] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Aya Bardugo
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.)
| | - Boris Fishman
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.).,Hypertension Unit, Internal Medicine D (B.F.), Sheba Medical Center, Ramat Gan, Israel.,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program (B.F., G.Y., G.T.), Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| | - Carmit Libruder
- Israel Center for Disease Control, Ministry of Health, Ramat Gan (C.L., A.R., Y.H., I.Z.)
| | - David Tanne
- Rambam Health Care Campus and Rappaport Faculty of Medicine, Haifa, Israel (D. Tanne)
| | - Amit Ram
- Israel Center for Disease Control, Ministry of Health, Ramat Gan (C.L., A.R., Y.H., I.Z.)
| | - Yael Hershkovitz
- Israel Center for Disease Control, Ministry of Health, Ramat Gan (C.L., A.R., Y.H., I.Z.)
| | - Inbar Zucker
- Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.).,Israel Center for Disease Control, Ministry of Health, Ramat Gan (C.L., A.R., Y.H., I.Z.)
| | - Ariel Furer
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.)
| | - Roy Gilon
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.)
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.).,Maccabitech (G.C.), Maccabi Healthcare Services, Tel Aviv, Israel
| | - Shmuel Tiosano
- Division of Cardiology, Leviev Heart and Vascular Center (S.T.), Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| | - Estela Derazne
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| | - Dorit Tzur
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.)
| | - Arnon Afek
- Central Management (A.A.), Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| | - Orit Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital (O.P.-H.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| | - Cole Daniel Bendor
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.)
| | - Gal Yaniv
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program (B.F., G.Y., G.T.), Sheba Medical Center, Ramat Gan, Israel.,Department of Diagnostic Imaging (G.Y.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| | - Ran Shmuel Rotem
- Kahn-Sagol-Maccabi Research and Innovation Institute (R.S.R.), Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (R.S.R.)
| | - Gilad Twig
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.).,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program (B.F., G.Y., G.T.), Sheba Medical Center, Ramat Gan, Israel.,Institute of Endocrinology (G.T.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| |
Collapse
|
29
|
Predictors of Adherence to Lifestyle Recommendations in Stroke Secondary Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094666. [PMID: 33925718 PMCID: PMC8124907 DOI: 10.3390/ijerph18094666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/26/2022]
Abstract
The risk of recurrent vascular events is high following ischaemic stroke or transient ischaemic attack (TIA). Unmanaged modifiable risk factors present opportunities for enhanced secondary prevention. This cross-sectional study (n = 142 individuals post-ischaemic stroke/TIA; mean age 63 years, 70% male) describes adherence rates with risk-reducing behaviours and logistical regression models of behaviour adherence. Predictor variables used in the models com-prised age, sex, stroke/TIA status, aetiology (TOAST), modified Rankin Scale, cardiovascular fit-ness (VO2peak) measured as peak oxygen uptake during incremental exercise (L/min) and Hospital Anxiety and Depression Score (HADS). Of the study participants, 84% abstained from smoking; 54% consumed ≥ 5 portions of fruit and vegetables/day; 31% engaged in 30 min moderate-to-vigorous physical activity (MVPA) at least 3 times/week and 18% were adherent to all three behaviours. VO2peak was the only variable predictive of adherence to all three health behaviours (aOR 12.1; p = 0.01) and to MVPA participation (aOR 7.5; p = 0.01). Increased age (aOR 1.1; p = 0.03) and lower HADS scores (aOR 0.9; p = 0.02) were predictive of smoking abstinence. Men were less likely to consume fruit and vegetables (aOR 0.36; p = 0.04). Targeted secondary prevention interventions after stroke should address cardiovascular fitness training for MVPA and combined health behaviours; management of psychological distress in persistent smokers and consider environmental and social factors in dietary interventions, notably in men.
Collapse
|
30
|
Inflammatory Bowel Disease as a Precondition for Stroke or TIA: A Matter of Crohn's Disease Rather than Ulcerative Colitis. J Stroke Cerebrovasc Dis 2021; 30:105787. [PMID: 33865232 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105787] [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: 12/09/2020] [Revised: 03/02/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As a chronic systemic inflammation may be associated with an increased risk of vascular events, the aim of the present study was to assess the incidence of stroke and transient ischemic attack (TIA) in patients with inflammatory bowel disease over a period of 15 years. METHODS This cohort study included patients for whom the initial diagnosis of an inflammatory bowel disease (IBD) (Crohn's disease: CD and ulcerative colitis: UC) was documented anonymously between 2000 and 2015 in 1,262 general practices in Germany. IBD patients were matched to patients without IBD using propensity scores based on age, sex, physician, co-diagnoses and co-therapies. Cox regression models were used to study the incidence of stroke and TIA as a function of CD and UC. RESULTS Each of the matched groups included 11,947 participants. In the IBD group, 43.5% had CD and 56.5% UC respectively. Higher incidences of both stroke and TIA were detected for IBD (stroke: 279.0 versus 222.6 cases per 100,000 patient years, HR 1.30, p=0.011; TIA: 203.1 versus 141.1 cases per 100,000 patient years, HR 1.42, p=0.006). Stroke and TIA incidences (cases per 100,000 patient years) were higher than in controls (stroke: 314.7 versus 204.5, HR: 1.50, p=0.013; TIA: 183.8 versus 95.3, HR: 1.93, p=0.004) in CD patients only. No relevant differences in incidences were found for patients with UC. CONCLUSION While CD turned out to be a relevant precondition for stroke or TIA, this was not the case for UC.
Collapse
|
31
|
Elhefnawy ME, Sheikh Ghadzi SM, Tangiisuran B, Zainal H, Looi I, Ibrahim KA, Sidek NN, Loo KW, Yee Lee K, Abdul Aziz Z, Harun SN. Population-based Study Comparing Predictors of Ischemic Stroke Recurrence After Index Ischemic Stroke in Non-elderly Adults with or without Diabetes. Int J Gen Med 2021; 14:1205-1212. [PMID: 33854362 PMCID: PMC8039196 DOI: 10.2147/ijgm.s303641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/08/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Factors associated with ischemic stroke (IS) recurrence and the contribution of pharmacological treatment as secondary preventions among nondiabetics especially in the non-elderly population are unclear and not widely investigated. This was a population-based study that aimed to identify recurrent IS predictors and to determine the possible impact of secondary preventive medications on the IS recurrence in non-elderly adults with or without diabetes. METHODS Data of 3386 patients <60 years old who had a history of index IS were extracted from the Malaysian National Neurology Registry (NNEUR) from 2009 to 2016. Recurrent IS was defined as any IS event recorded after the index IS in the NNEUR database. Multivariate logistic regression analysis was performed by using SPSS version 22. RESULTS Ischemic heart disease (IHD) was the significant predictor of IS recurrence in non-elderly adults both with or without diabetes (adjusted odds ratio (AOR) of 3.210; 95%CI: 1.909-5.398 and 2.989; 95%CI: 1.515-5.894) respectively). Receiving antiplatelet as secondary stroke prevention (AOR: 0.194; 95%CI: 0.046-0.817) and continuation of antidiabetic medication after the index IS event (AOR: 0.510; 95%CI: 0.298-0.872) reduced the odds of IS recurrence only in non-elderly diabetic adults. Among non-elderly adults without diabetes, hyperlipidemia and every increased in 1 mmHg of systolic blood pressure significantly increased the odds of IS recurrence following the indexing event (AOR: 1.796; 95%CI: 1.058-3.051 and 1.009; 95%CI: 1.002-1.016 respectively). CONCLUSION IHD was found as the main predictor of IS recurrence regardless of diabetes status in non-elderly adults after the index IS event. Receiving antidiabetic and antiplatelet medications upon discharge after index IS were significant predictors of recurrent IS in non-elderly diabetic adults. A proper randomized clinical trial may be required to determine the impact of secondary preventive medication on IS recurrence, especially in non-elderly adults.
Collapse
Affiliation(s)
| | | | | | - Hadzliana Zainal
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800, Malaysia
| | - Irene Looi
- Clinical Research Centre, Seberang Jaya Hospital, Penang, Malaysia
| | | | | | - Keat Wei Loo
- Department of Biological Science, Faculty of Science, Universiti Tunku Abdul Rahman (UTAR) Kampar Campus, Perak, Malaysia
| | - Keng Yee Lee
- National Clinical Research Centre, Kuala Lumpur, Malaysia
| | - Zariah Abdul Aziz
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia
| | - Sabariah Noor Harun
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800, Malaysia
| |
Collapse
|
32
|
Gerber Y, Rana JS, Jacobs DR, Yano Y, Levine DA, Nguyen-Huynh MN, Lima JAC, Reis JP, Zhao L, Liu K, Lewis CE, Sidney S. Blood Pressure Levels in Young Adulthood and Midlife Stroke Incidence in a Diverse Cohort. Hypertension 2021; 77:1683-1693. [PMID: 33775116 DOI: 10.1161/hypertensionaha.120.16535] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.G.).,Division of Research, Kaiser Permanente Northern California, Oakland (Y.G., J.S.R., M.N.N.-H., S.S.).,Division of Epidemiology, University of California Berkeley, CA (Y.G.)
| | - Jamal S Rana
- Division of Research, Kaiser Permanente Northern California, Oakland (Y.G., J.S.R., M.N.N.-H., S.S.).,Department of Medicine, University of California San Francisco (J.S.R.)
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.)
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.)
| | - Deborah A Levine
- Department of Internal Medicine, University of Michigan, Ann Arbor (D.A.L.)
| | - Mai N Nguyen-Huynh
- Division of Research, Kaiser Permanente Northern California, Oakland (Y.G., J.S.R., M.N.N.-H., S.S.)
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (J.A.C.L.)
| | - Jared P Reis
- National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.)
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University, Chicago, IL (L.Z., K.L.)
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Chicago, IL (L.Z., K.L.)
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham (C.E.L.)
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland (Y.G., J.S.R., M.N.N.-H., S.S.)
| |
Collapse
|
33
|
Nazarinia D, Dolatshahi M, Faezi M, Nasseri Maleki S, Aboutaleb N. TLR4 /NF-ĸB and JAK2/STAT3 signaling pathways: Cellular signaling pathways targeted by cell-conditioned medium therapy in protection against ischemic stroke. J Chem Neuroanat 2021; 113:101938. [PMID: 33636320 DOI: 10.1016/j.jchemneu.2021.101938] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/21/2022]
Abstract
Human amniotic membrane-derived mesenchymal stem cell-conditioned medium (hAMSC-CM) has been known to improve neuronal survival following ischemic stroke. The present study was designed to examine whether protective effects of hAMSC-CM against stroke can be linked to reducing neuroinflamation by targeting TLR4 /NF-ĸB and Jak2/Stat3 signaling pathways. Immunohistochemistry of hippocampus and western blot assay were performed to evaluate the expression of TLR4 /NF-ĸB and Jak2/Stat3, respectively. Real-time PCR assay was applied to investigate the mRNA levels of Jak2/Stat3. Hematoxylin and eosin (H&E) staining was used to investigate tissue damage and morphological changes in the CA1 region of hippocampus. Increased brain edema was seen in middle cerebral artery occlusion (MCAO) rats compared to sham. Post-treatment with hAMSC-CM markedly reduced brain edema in comparison with MCAO group (P < 0.05). Compared to sham, significantly increased levels of TLR4 /NF-ĸB and Jak2/Stat3 were seen in MCAO rats. Intravenous injection of hAMSC-CM after reperfusion markedly reduced levels of TLR4 /NF-ĸB and Jak2/Stat3 in hippocampus region (P < 0.05). Tissue damage and neuronal cell increased in the CA1 region of hippocampus that reversed by post-treatment by hAMSC-CM. Interestingly, our finding showed that hAMSC-CM can be considered as good candidate to reduce injury following ischemic stroke by decreasing activity of TLR4 /NF-ĸB and Jak2/Stat3 signaling pathways.
Collapse
Affiliation(s)
- Donya Nazarinia
- Department of Physiology, School of Paramedical Sciences, Dezful University of Medical Sciences, Dezful, Iran.
| | - Mojtaba Dolatshahi
- Department of Physiology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran.
| | - Masoumeh Faezi
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Solmaz Nasseri Maleki
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Nahid Aboutaleb
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
34
|
Lee MT, Mahtta D, Alam M, Ullah W, Nasir K, Hanif B, Virani SS. Contemporary outcomes studies to identify and mitigate the risk in patients with premature cardiovascular disease. Expert Rev Pharmacoecon Outcomes Res 2021; 21:559-570. [DOI: 10.1080/14737167.2021.1888718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Michelle T. Lee
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
| | - Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, USA
| | - Mahboob Alam
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, USA
| | - Waqas Ullah
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Khurram Nasir
- Department of Cardiology, Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
- Division of Cardiovascular Prevention and Wellness, Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Bashir Hanif
- Section of Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Salim S. Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, USA
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, USA
| |
Collapse
|
35
|
Alsaeiti K, Ibrahim Hamedh M. Pattern of admission of stroke in Benghazi Medical Center: A cross-sectional study. APOLLO MEDICINE 2021. [DOI: 10.4103/am.am_21_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
36
|
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.
Collapse
|
37
|
Tong X, Yang Q, George MG, Gillespie C, Merritt RK. Trends of risk profile among middle-aged adults hospitalized for acute ischemic stroke in United States 2006-2017. Int J Stroke 2020; 16:855-862. [PMID: 33308104 DOI: 10.1177/1747493020979379] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent studies reported increasing trends in hospitalization of stroke patients aged 35-64 years. AIM To examine changes in risk factor profiles among patients aged 35-64 years hospitalized with acute ischemic stroke between 2006 and 2017 in the United States. METHODS We used data from the National Inpatient Sample of the Healthcare Cost and Utilization Project from 2006 through 2017. Principal ICD-9-CM/ICD-10-CM codes were used to identify acute ischemic stroke hospitalizations, and secondary codes were used to identify the presence of four major stroke risk factors: hypertension, diabetes, lipid disorders, and tobacco use. We used the relative percent change to assess the changes in the prevalence of risk profile between 2006-2007 and 2016-2017 and linear regression models to obtain the p values for the overall trends across six time periods. RESULTS Approximately 1.5 million acute ischemic stroke hospitalizations occurred during 2006-2017. The prevalence of having all four risk factors increased from 4.1% in 2006-2007 to 9.1% in 2016-2017 (relative percent change 122.0%, p < 0.001 for trend), prevalence of any three risk factors increased from 24.5% to 33.8% (relative percent change 38.0%, p < 0.001). Prevalence of only two risk factors decreased from 36.1% to 32.7% (p < 0.001), only one risk factor decreased from 25.2% to 18.1% (p < 0.001), and absence of risk factors decreased from 10.1% to 6.2% (p < 0.001). The most prevalent triad of risk factors was hypertension, diabetes, and lipid disorders (14.3% in 2006-2007 and 19.8% in 2016-2017), and the most common dyad risk factors was hypertension and lipid disorders (12.6% in 2006-2007 and 11.9% in 2016-2017). CONCLUSIONS The prevalence of hospitalized acute ischemic stroke patients aged 35-64 years with all four or any three of four major stroke risk factors increased by 122% and 38%, while those with only one risk factor or no risk factor has declined by 28% and 39%, respectively, from 2006 to 2017. Younger adults are increasingly at higher risk for stroke from preventable and treatable risk factors. This growing public health problem will require clinicians, healthcare systems, and public health efforts to implement more effective prevention strategies among this population.
Collapse
Affiliation(s)
- Xin Tong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert K Merritt
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
38
|
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.
Collapse
|
39
|
Martinez-Majander N, Artto V, Ylikotila P, von Sarnowski B, Waje-Andreassen U, Yesilot N, Zedde M, Huhtakangas J, Numminen H, Jäkälä P, Fonseca AC, Redfors P, Wermer MJH, Pezzini A, Putaala J. Association between Migraine and Cryptogenic Ischemic Stroke in Young Adults. Ann Neurol 2020; 89:242-253. [PMID: 33078475 DOI: 10.1002/ana.25937] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/26/2020] [Accepted: 10/11/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the association between migraine and cryptogenic ischemic stroke (CIS) in young adults, with subgroup analyses stratified by sex and presence of patent foramen ovale (PFO). METHODS We prospectively enrolled 347 consecutive patients aged 18 to 49 years with a recent CIS and 347 age- and sex-matched (±5 years) stroke-free controls. Any migraine and migraine with (MA) and migraine without aura (MO) were identified by a screener, which we validated against a headache neurologist. We used conditional logistic regression adjusting for age, education, hypertension, diabetes, waist-to-hip ratio, physical inactivity, current smoking, heavy drinking, and oral estrogen use to assess independent association between migraine and CIS. The effect of PFO on the association between migraine and CIS was analyzed with logistic regression in a subgroup investigated with transcranial Doppler bubble screen. RESULTS The screener performance was excellent (Cohen kappa > 0.75) in patients and controls. Compared with nonmigraineurs, any migraine (odds ratio [OR] = 2.48, 95% confidence interval [CI] = 1.63-3.76) and MA (OR = 3.50, 95% CI = 2.19-5.61) were associated with CIS, whereas MO was not. The association emerged in both women (OR = 2.97 for any migraine, 95% CI = 1.61-5.47; OR = 4.32 for MA, 95% CI = 2.16-8.65) and men (OR = 2.47 for any migraine, 95% CI = 1.32-4.61; OR = 3.61 for MA, 95% CI = 1.75-7.45). Specifically for MA, the association with CIS remained significant irrespective of PFO. MA prevalence increased with increasing magnitude of the right-to-left shunt in patients with PFO. INTERPRETATION MA has a strong association with CIS in young patients, independent of vascular risk factors and presence of PFO. ANN NEUROL 2021;89:242-253.
Collapse
Affiliation(s)
| | - Ville Artto
- Neurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Pauli Ylikotila
- Neurocenter, Turku University Hospital, Clinical Neurosciences, Turku University, Turku, Finland
| | | | | | - Nilufer Yesilot
- Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey
| | - Marialuisa Zedde
- Neurology Unit, Company Local Health Unit-Reggio Emilia National Institute for Research and Treatment, Reggio Emilia, Italy
| | - Juha Huhtakangas
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Heikki Numminen
- Department of Neuroscience and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Pekka Jäkälä
- Kuopio University Hospital, Neurocenter Neurology, Finland and University of Eastern Finland, Kuopio, Finland
| | - Ana C Fonseca
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Jukka Putaala
- Neurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | |
Collapse
|
40
|
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.
Collapse
|
41
|
Use of mobile-stroke risk scale and lifestyle guidance promote healthy lifestyles and decrease stroke risk factors. Int J Nurs Sci 2020; 7:401-407. [PMID: 33195751 PMCID: PMC7644564 DOI: 10.1016/j.ijnss.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 07/24/2020] [Accepted: 08/02/2020] [Indexed: 12/04/2022] Open
Abstract
Objective The purpose of this study was to determine the effectiveness of Mobile-Stroke Risk Scale and Life Style Guidance (M-SRSguide) in promoting a healthy lifestyle and reducing stroke risk factors in at-risk persons. Methods This research was an clinical trial with a pre-test and post-test control group design. The accessible population is persons at risk of stroke in the community (West and East Kalimantan Province, Indonesia). Thirty-two participants in the intervention group and 32 participants in the control group participated in this study. The sampling method was systematic random sampling. We allocate the sample into the intervention and control groups using a randomized block design. The intervention group used the M-SRSguide. The control group used manual book for a self-assessment of stroke risk. The measurement of a healthy lifestyle and the stroke risk factors was performed before and six months after the intervention. Results There are no significant differences in healthy lifestyle and stroke risk factors between the two groups after the intervention (P > 0.05). Analysis of healthy lifestyle behavior assessment items in the intervention group showed an increase in healthy diets, activity patterns, and stress control after the use of the M-SRSguide (P < 0.01). Conclusion The use of M-SRSguide is effective in promoting a healthy lifestyle.
Collapse
|
42
|
Šaňák D, Divišová P, Hutyra M, Král M, Bártková A, Zapletalová J, Látal J, Dorňák T, Hudec Š, Franc D, Polidar P, Veverka T, Kaňovský P. Risk of recurrent ischemic stroke in young cryptogenic patients with embolic stroke of undetermined source. J Neurol Sci 2020; 416:116985. [PMID: 32563078 DOI: 10.1016/j.jns.2020.116985] [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: 04/23/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Elderly cryptogenic ischemic stroke (IS) patients with embolic stroke of undetermined source (ESUS) have a high risk of recurrent IS (RIS) compared to other stroke subtypes. In young ESUS patients, different sources of embolism may be a cause and the risk of RIS remains not enough established. The aim was to assess and compare risk of RIS between ESUS and non ESUS patients <50 years. METHODS The study set consisted of young acute IS patients <50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study registered on ClinicalTrials.gov (NCT01541163). In all analyzed patients, the brain ischemia was confirmed on CT or MRI. All patients underwent identical diagnostic protocol including TEE and long-term ECG-Holter. Cause of IS was assessed according to the ASCOD classification. RESULTS Of 320 enrolled patients <50 years, 219 (68.4%) were identified as cryptogenic (119 males, mean age 41.4 ± 7.2 years) and 122 (38.1%) patients fulfilled the ESUS criteria. During the follow-up with a median of 34 months, three (2.5%) ESUS and 5 (5.2%) non-ESUS patients suffered from RIS (p = .471). One-year risk of RIS was 0.008 (95% CI: 0-0.025) for ESUS and 0.036 (95% CI: 0-0.076) for non-ESUS patients (p = .262). CONCLUSION The risk of RIS was very low in ESUS patients and did not differ from those with non-ESUS. Our finding may indicate that antiplatelet therapy can be effective in the secondary prevention in young ESUS patients if high-risk sources of embolization are excluded extensively.
Collapse
Affiliation(s)
- Daniel Šaňák
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic.
| | - Petra Divišová
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Cardiology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Michal Král
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Andrea Bártková
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Jana Zapletalová
- Department of Biophysics and statistics, Palacký University Medical School, Olomouc, Czech Republic
| | - Jan Látal
- Department of Cardiology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Tomáš Dorňák
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Štěpán Hudec
- Department of Cardiology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - David Franc
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Petr Polidar
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Tomáš Veverka
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Petr Kaňovský
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| |
Collapse
|
43
|
Divišová P, Šaňák D, Král M, Bártková A, Hutyra M, Zapletalová J, Dorňák T, Špaček M, Franc D, Polidar P, Veverka T, Kaňovský P. Young cryptogenic ischemic stroke: A descriptive analysis of clinical and laboratory characteristics, outcomes and stroke recurrence. J Stroke Cerebrovasc Dis 2020; 29:105046. [PMID: 32807456 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105046] [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] [Received: 04/28/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Ischemic strokes (IS) occur also in young adults and despite an extensive work-up the cause of IS remains very often cryptogenic. Thus, effectiveness of secondary prevention may be unclear. We aimed to analyze a relationship among vascular risk factors (VRF), clinical and laboratory parameters, outcomes and recurrent IS (RIS) in young cryptogenic IS (CIS) patients. SUBJECTS AND METHODS The study set consisted of young acute IS patients < 50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study registered on ClinicalTrials.gov (NCT01541163). All analyzed patients underwent transesophageal echocardiography, 24-h and 3-week ECG-Holter to assess cause of IS according to the ASCOD classification. Recurrent IS (RIS) was recorded during a follow-up (FUP). RESULTS Out of 294 young enrolled patients, 208 (70.7%, 113 males, mean age 41.6 ± 7.2 years) were identified as cryptogenic. Hyperlipidemia (43.3%), smoking (40.6%) and arterial hypertension (37.0%) were the most frequent VRF. RIS occurred in 7 (3.4%) patients during a mean time of FUP 19 ± 23 months. One-year risk of RIS was 3.4% (95%CI: 1.4-6.8%). Patients with RIS were older (47.4 vs. 41.1 years, p = 0.007) and more often obese (71.4 vs. 19.7%, p = 0.006), and did not differ in any of other analyzed parameters and VRF. Multivariate logistic regression analysis showed obesity (OR: 9.527; 95%CI: 1.777-51.1) and the previous use of antiplatelets (OR: 15.68; 95%CI: 2.430-101.2) as predictors of recurrent IS. CONCLUSION Despite a higher presence of VRF in young CIS patients, the risk of RIS was very low. Obesity and previous use of antiplatelet therapy were found the only predictors of RIS.
Collapse
Affiliation(s)
- Petra Divišová
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Daniel Šaňák
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic.
| | - Michal Král
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Andrea Bártková
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Cardiology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Jana Zapletalová
- Department of Biophysics and Statistics, Palacký University Medical School, Olomouc, Czech Republic
| | - Tomáš Dorňák
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Miloslav Špaček
- Department of Cardiology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - David Franc
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Petr Polidar
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Tomáš Veverka
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Petr Kaňovský
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| |
Collapse
|
44
|
King TL, Tiong LL, Kaman Z, Zaw WM, Abdul Aziz Z, Chung LW. A hospital-based study on ischaemic stroke characteristics, management, and outcomes in Sarawak: Where do we stand? J Stroke Cerebrovasc Dis 2020; 29:105012. [PMID: 32807427 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105012] [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] [Received: 04/16/2020] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Located on the Borneo Island, Sarawak is the largest state of Malaysia and has a population distinctive from Peninsular Malaysia. The ischaemic stroke data in Sarawak had not been reported despite the growing number of patients annually. We aimed to investigate patient characteristics, management, and outcomes of ischaemic stroke in Sarawak and benchmark the results with national and international published data. METHODS We included ischaemic stroke cases admitted to Sarawak General Hospital between June 2013 and August 2018 from Malaysia National Stroke Registry. We performed descriptive analyses on patient demographics, cardiovascular risk factors, prior medications, smoking status, arrival time, thrombolysis rate, Get With The Guidelines (GWTG)-Stroke measures, and outcomes at discharge. We also numerically compared the results from Sarawak with the published data from selected national and international cohorts. RESULTS We analysed 1435 ischaemic stroke cases. The mean age was 60.1±13.2 years old; 64.9% were male; median baseline National Institute of Health Stroke Scale was seven points. Hypertension was the most prevalent risk factor of ischaemic stroke; 12.7% had recurrent stroke; 13.7% were active smokers. The intravenous thrombolysis rate was 18.8%. We achieved 80-90% in three GWTG-Stroke performance measures and 90-98% in four additional quality measures in our ischaemic stroke management. At discharge, 57% had modified Rankin Scale of 0-2; 6.7% died during hospitalisation. When compared with selected national and international data, patients in Sarawak were the youngest; Sarawak had more male and more first-ever stroke. Thrombolysis rate in Sarawak was higher compared with most studies in the comparison. Functional outcome at discharge in Sarawak was better than national cohort but still lagging behind when compared with the developed countries. In-hospital mortality rate in Sarawak was slightly lower than the national data but higher when compared with other countries. CONCLUSION Our study described characteristics, management, and outcomes of ischaemic stroke in Sarawak. We achieved high compliance with most of GTWG-Stroke performance and quality indicators. Sarawak had better outcomes than the national results on ischaemic stroke. However, there is still room for improvement when compared with other countries. Actions are needed to reduce the cardiovascular burdens for stroke prevention, enhance healthcare resources for stroke care, and improve intravenous thrombolysis treatment in Sarawak.
Collapse
Affiliation(s)
- Teck Long King
- Pharmacy Department, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia; Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia.
| | - Lee Len Tiong
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Zurainah Kaman
- Neurology Unit, Department of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Win Moe Zaw
- Neurology Department, Salford Royal Foundation NHS Trust, Salford, Greater Manchester, UK
| | - Zariah Abdul Aziz
- Department of Medicine, Hospital Sultanah Nur Zahirah, Ministry of Health, Kuala Terengganu, Terengganu, Malaysia
| | - Law Wan Chung
- Neurology Unit, Department of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| |
Collapse
|
45
|
Mahtta D, Khalid U, Misra A, Samad Z, Nasir K, Virani SS. Premature Atherosclerotic Cardiovascular Disease: What Have We Learned Recently? Curr Atheroscler Rep 2020; 22:44. [PMID: 32671484 DOI: 10.1007/s11883-020-00862-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW In contrast to patients with non-premature atherosclerotic cardiovascular disease (ASCVD), patients with premature ASCVD have not observed a similar decline in cardiovascular mortality and recurrent adverse events. We sought to review the underlying risk factors, potential gaps in medical management, associated outcomes, and tools for risk prognostication among patients with premature ASCVD. RECENT FINDINGS In addition to traditional cardiovascular risk factors (i.e., diabetes, familial hypercholesterolemia), non-traditional risk factors such as chronic inflammatory conditions, recreational drug use, genetics, and pregnancy-related complications play a key role in development and progression of premature ASCVD. Patients with premature ASCVD, and especially women, receive less optimal medical management as compared to their non-premature counterparts. There is an increasing prevalence of cardiovascular risk factors among young adults. Hence, this population remains at an elevated risk for premature ASCVD and subsequent adverse cardiovascular events. Future studies evaluating different risk assessment tools and focusing on young patients across all three major domains of ASCVD are needed.
Collapse
Affiliation(s)
- Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA.,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Umair Khalid
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Arunima Misra
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Zainab Samad
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Khurram Nasir
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA. .,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. .,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.
| |
Collapse
|
46
|
Age-Related Risk Factors at the First Stroke Event. J Clin Med 2020; 9:jcm9072233. [PMID: 32674391 PMCID: PMC7408897 DOI: 10.3390/jcm9072233] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 01/11/2023] Open
Abstract
(1) Background: Stroke is a multifactorial disease, which can affect individuals at any age. Risk factors (RFs) associated with the first stroke event have been well identified; however, the influence of these RFs on the patient’s age needs to be studied. (2) Objective: This study aimed to examine the effect of modifiable RFs on the age at which a stroke occurs. (3) Methods: A cross-sectional study was conducted on patients admitted consecutively with a first-ever acute stroke at the Burgos University Hospital (Spain). Data on sociodemographic and clinical parameters were collected (high blood pressure (HBP), smoking habit, diabetes mellitus (DM), dyslipemia, abdominal obesity, sedentary lifestyle, alcohol consumption, and cardiovascular diseases). The possible associations between RFs and age were studied using univariate and multivariate regression analyses and a decision tree. (4) Results: A total of 436 patients with a mean age of 75.39 years (standard deviation (SD) ± 12.67) were included. HBP and overweight/obesity were the most prevalent stroke RFs. Being an active smoker (OR 21.48; 95% confidence interval (CI) 8.80–52.41), having a sedentary lifestyle (OR 3.24; 95% CI 1.97–5.31), being an excessive alcohol drinker (OR 2.36; 95% CI 1.45–3.84), or being overweight or obese (OR 1.95; 95% CI 1.14–3.34) increased the risk of having an acute cerebrovascular event in individuals aged 75 years or below. However, a personal history of HBP (OR 0.40; 95% CI 0.24–0.67) was significantly associated with a greater likelihood of having an acute stroke in individuals aged more than 75 years. (5) Conclusions: This study showed that the modifiable RFs strongly influence the first stroke event in patients aged below 75 years, which will be useful in guiding different prevention strategies.
Collapse
|
47
|
Doneen AL, Bale BF, Vigerust DJ, Leimgruber PP. Cardiovascular Prevention: Migrating From a Binary to a Ternary Classification. Front Cardiovasc Med 2020; 7:92. [PMID: 32528979 PMCID: PMC7256212 DOI: 10.3389/fcvm.2020.00092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/29/2020] [Indexed: 12/21/2022] Open
Abstract
Migrating from a binary approach to risk assessment to a ternary model of disease identification allows for individualized, optimal disease management. Redefining the disease/inflammatory approach has been proven to identify, stabilize, and regress atherosclerosis while adding understanding to the progression of vascular disease. Our previously published results show the beneficial effect of comprehensive, evidence-based management on subclinical atherosclerosis and vulnerable plaque. We argue that this approach does not mitigate the value of utilizing standard risk factor identification, but rather augments it for the benefit of the individual patient.
Collapse
Affiliation(s)
- Amy Lynn Doneen
- College of Medicine, Washington State University, Spokane, WA, United States
| | - Bradley Field Bale
- College of Medicine, Washington State University, Spokane, WA, United States
| | | | | |
Collapse
|
48
|
Zhao Z, Zhao Z, Zheng X, Li X, Li X, Huang C, Shan Y, Nyame L, Ibrahim M, Gao X, Liang H, Hu J, Zou J. The association between smoking and unfavorable outcomes in
acute ischemic stroke patients with mechanical thrombectomy. Tob Induc Dis 2020; 18:31. [PMID: 32336969 PMCID: PMC7177386 DOI: 10.18332/tid/119229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Little is known about the relationship between smoking and clinical outcomes in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). The outcomes could depend on different stroke subtypes. The aim of this study was to investigate whether smoking affected differently the outcomes in patients with different stroke subtypes who received MT. METHODS AIS patients who underwent MT were prospectively enrolled from three hospitals between January 2014 and December 2018. Smokers were defined as current users of cigarettes. The stroke subtypes were classified according to TOAST criteria. Outcome measurements included treatment effects, intracerebral hemorrhage (ICH), and functional outcomes at 3 months. The effects of smoking on outcomes were assessed by logistic regression analysis. RESULTS A total of 128 AIS patients with MT were enrolled, including 64 smokers and 64 non-smokers. Logistic regression analysis indicated that smoking was related to higher risk of In-hospital ICH (OR=4.31; 95% CI: 1.10–16.96; p=0.036) in patients with cardioembolism subtype. Furthermore, smoking was also associated with lower rates of mild stroke at discharge (OR=0.07; 95% CI: 0.02–0.31; p<0.001) and functional independence (OR=0.13; 95% CI: 0.03–0.56; p=0.006) in patients with cardioembolism subtype. CONCLUSIONS In AIS patients undergoing MT, smoking could be related to a higher risk of In-hospital ICH and lower rates of mild stroke at discharge and functional independence if their stroke subtype is cardioembolism.
Collapse
Affiliation(s)
- Zhihong Zhao
- Department of Neurology, The First Affiliated Hospital (People’s Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Zheng Zhao
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiaohan Zheng
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiang Li
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xuemei Li
- Department of Neurology, The First Affiliated Hospital (People’s Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Chaoping Huang
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Yajie Shan
- Department of Neurology, The First Affiliated Hospital (People’s Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Linda Nyame
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Mako Ibrahim
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiaoping Gao
- Department of Neurology, The First Affiliated Hospital (People’s Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Hui Liang
- Department of Neurology, The First Affiliated Hospital (People’s Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Jue Hu
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - JianJun Zou
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| |
Collapse
|
49
|
Boot E, Ekker MS, Putaala J, Kittner S, De Leeuw FE, Tuladhar AM. Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry 2020; 91:411-417. [PMID: 32015089 DOI: 10.1136/jnnp-2019-322424] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/04/2022]
Abstract
Ischaemic stroke at young age is an increasing problem in both developing and developed countries due to rising incidence, high morbidity and mortality and long-term psychological, physical and social consequences. Compared with stroke in older adults, stroke in young adults is more heterogeneous due to the wide variety of possible underlying risk factors and aetiologies. In this review, we will provide an overview of the global variation in the epidemiology of stroke in young adults, with special attention to differences in geography, ethnicity/race and sex, as well as traditional and novel risk factors for early-onset ischaemic stroke, such as air pollution. Understanding global differences is an important prerequisite for better region-specific prevention and treatment of this devastating condition.
Collapse
Affiliation(s)
- Esther Boot
- Department of Neurology, Radboud Univerisity Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Merel Sanne Ekker
- Department of Neurology, Radboud Univerisity Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Steven Kittner
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Frank-Erik De Leeuw
- Department of Neurology, Radboud Univerisity Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Radboud Univerisity Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| |
Collapse
|
50
|
Sun ZG, Tian G, Zheng XC, Liu WY, Luo XT, Xiao J, Song H, Xu X. AMPKα2 Deficiency Does Not Affect the Exercise-Induced Improvements in Glucose Tolerance and Metabolic Disorders in Mice Fed a High-Fat Diet. J Nutr Sci Vitaminol (Tokyo) 2020; 65:491-497. [PMID: 31902862 DOI: 10.3177/jnsv.65.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Exercise can improve obesity and metabolic disorders in mice fed a high-fat diet (HFD), but the role of AMPKα2 in the process remains unclear. The aim of this study was to investigate the role of AMPKα2 in the exercise-induced improvements in glucose tolerance and metabolic turnover in obesity mice. Male wild-type mice (n=12) and AMPKα2 knockout (AMPKα2 KO) mice (n=12) were fed a HFD for 16 wk and were then randomly divided into four groups: WT HFD group (WT HF), AMPKα2 KO HFD group (AMPKα2 KO HF), WT HFD exercise group (WT HE), and AMPK HFD exercise group (AMPKα2 KO HE). The HF groups continue to be fed a HFD from 16 wk to 24 wk, and the HE groups were fed a HFD and performed exercise training. After 8 wk of exercise, all mice were placed in an energy metabolism chamber to test their metabolic turnover, include locomotor activity, food intake, oxygen consumption (VO2), carbon dioxide production (VCO2), energy expenditure (EE) and respiratory exchange ratio (RER), over a period of 3 d. Exercise improved glucose tolerance, VO2, VCO2 and EE in mice fed a HFD (p<0.05). The VO2, VCO2 and EE in AMPKα2 KO HE group were lower than these in WT HE group (p<0.05). Our findings revealed exercise improved glucose tolerance and metabolic disorders in C57 and AMPKα2 KO mice fed a HFD. AMPKα2 is not essential for exercise-induced improvements in glucose tolerance and metabolic disorders.
Collapse
Affiliation(s)
- Zhong-Guang Sun
- Department of Exercise Rehabilitation, Shanghai University of Sport
| | - Ge Tian
- Beijing Xian Nong Tan Sports Technical College
| | - Xiao-Ci Zheng
- Department of Exercise Rehabilitation, Shanghai University of Sport
| | - Wen-Ying Liu
- Department of Exercise Rehabilitation, Shanghai University of Sport
| | - Xue-Ting Luo
- Department of Exercise Rehabilitation, Shanghai University of Sport
| | - Jing Xiao
- Department of Exercise Rehabilitation, Shanghai University of Sport
| | - Hui Song
- Department of Exercise Rehabilitation, Shanghai University of Sport
| | - Xin Xu
- Department of Exercise Rehabilitation, Shanghai University of Sport
| |
Collapse
|