Cumulative Alcohol Consumption Burden and the Risk of Stroke in Young Adults: A Nationwide Population-Based Study

The impact of gut microbiota on the occurrence, treatment, and prognosis of ischemic stroke

Ischemic stroke (IS) is a cerebrovascular disease that predominantly affects middle-aged and elderly populations, exhibiting high mortality and disability rates. At present, the incidence of IS is increasing annually, with a notable trend towards younger affected individuals. Recent discoveries concerning the "gut-brain axis" have established a connection between the gut and the brain. Numerous studies have revealed that intestinal microbes play a crucial role in the onset, progression, and outcomes of IS. They are involved in the entire pathophysiological process of IS through mechanisms such as chronic inflammation, neural regulation, and metabolic processes. Although numerous studies have explored the relationship between IS and intestinal microbiota, comprehensive analyses of specific microbiota is relatively scarce. Therefore, this paper provides an overview of the typical changes in gut microbiota following IS and investigates the role of specific microorganisms in this context. Additionally, it presents a comprehensive analysis of post-stroke microbiological therapy and the relationship between IS and diet. The aim is to identify potential microbial targets for therapeutic intervention, as well as to highlight the benefits of microbiological therapies and the significance of dietary management. Overall, this paper seeks to provide key strategies for the treatment and management of IS, advocating for healthy diets and health programs for individuals. Meanwhile, it may offer a new perspective on the future interdisciplinary development of neurology, microbiology and nutrition.

Intracranial stenting with the Neuroform Atlas Stent for symptomatic intracranial atherosclerotic stenosis: a bi-center retrospective analysis including stroke recurrence nomogram

Background

Intracranial stenting with the Neuroform Atlas Stent is an emerging option for patients with symptomatic intracranial atherosclerotic stenosis (sICAS) who do not respond to intensive medical treatment. However, the efficacy, safety, and risk factors associated with postoperative stroke recurrence remain controversial.

Methods

A total of 326 consecutive patients with sICAS treated with intracranial stenting using the Neuroform Atlas Stent were retrospectively analyzed to evaluate the efficacy and safety of the procedure. Patients were randomly assigned to a training set and a validation set in a 7:3 ratio. Significant variables in the univariate logistic analyses were included in the final multivariate logistic regression analyses in the training set. Subsequently, we developed a predictive nomogram for sICAS treated with a Neuroform Atlas Stent to predict the likelihood of stroke recurrence at 6 months.

Results

The overall mean stenosis rate of the target artery was 88.85% ± 6.53% before the stenting (T0), 47.58% ± 9.94% at the end of the procedure (T1), and 40.21% ± 7.77% at the 6-month follow-up (T2). The stenosis rate was statistically significant between T0 and T1 (p < 0.01) and between T0 and T2 (p < 0.01). At 6 months postoperatively, 36 patients had a stroke recurrence linked to the target artery. Diabetes, acute ischemic stroke (AIS), plaque burden on vessel wall MRI, enhancement ratio on vessel wall MRI, and stenosis (T1) were independent predictors of stroke recurrence. A predictive nomogram was developed, showing strong predictive capability with the area under the curve of 0.933 for the training set and 0.949 for the validation set.

Conclusion

Intracranial stenting with the Neuroform Atlas Stent is a potentially safe and effective treatment for sICAS. Risk factors for recurrent stroke post-procedure include diabetes, current smoker, current drinker, AIS, plaque burden, enhancement ratio, and stenosis (T1).

Alcohol Consumption and Cardiovascular Disease: A Narrative Review of Evolving Perspectives and Long-Term Implications

Cardiovascular illnesses remain the primary cause of death, accounting for at least 17.9 million fatalities per year and posing a significant public health problem because of its extensive predominance and effect on healthcare systems. The etiology of cardiovascular disease is complex and involves several environmental and lifestyle factors. Alcohol use is a highly important determinant because of its dual-edged effect on cardiovascular health. Multiple studies indicate that moderate alcohol consumption may have certain advantages, such as slight enhancements in lipid profiles. Conversely, excessive alcohol intake is associated with serious negative consequences, including cardiomyopathy, hypertension, arrhythmias, and even mortality. The aim of this study is to provide a comprehensive analysis of the several effects of alcohol on cardiovascular health and their understanding within the medical field over time. It uses an interpretative narrative review methodology and analyzes studies that focus on genetic risk factors, gender differences, and shifts in paradigms in recent years. This article highlights the need for obtaining a thorough understanding of the effects of alcohol on cardiovascular health to support public health guidelines and clinical practice, and it underscores the significance of including alcohol consumption into the broader context of cardiovascular risk management and identifies important subjects for further study.

County-Level Socio-Environmental Factors Associated With Stroke Mortality in the United States: A Cross-Sectional Study

We used machine learning methods to explore sociodemographic and environmental determinants of health (SEDH) associated with county-level stroke mortality in the USA. We conducted a cross-sectional analysis of individuals aged ≥15 years who died from all stroke subtypes between 2016 and 2020. We analyzed 54 county-level SEDH possibly associated with age-adjusted stroke mortality rates/100,000 people. Classification and Regression Tree (CART) was used to identify specific county-level clusters associated with stroke mortality. Variable importance was assessed using Random Forest analysis. A total of 501,391 decedents from 2397 counties were included. CART identified 10 clusters, with 77.5% relative increase in stroke mortality rates across the spectrum (28.5 vs 50.7 per 100,000 persons). CART identified 8 SEDH to guide the classification of the county clusters. Including, annual Median Household Income ($), live births with Low Birthweight (%), current adult Smokers (%), adults reporting Severe Housing Problems (%), adequate Access to Exercise (%), adults reporting Physical Inactivity (%), adults with diagnosed Diabetes (%), and adults reporting Excessive Drinking (%). In conclusion, SEDH exposures have a complex relationship with stroke. Machine learning approaches can help deconstruct this relationship and demonstrate associations that allow improved understanding of the socio-environmental drivers of stroke and development of targeted interventions.

Post-Stroke Brain Health Monitoring and Optimization: A Narrative Review

Significant advancements have been made in recent years in the acute treatment and secondary prevention of stroke. However, a large proportion of stroke survivors will go on to have enduring physical, cognitive, and psychological disabilities from suboptimal post-stroke brain health. Impaired brain health following stroke thus warrants increased attention from clinicians and researchers alike. In this narrative review based on an open timeframe search of the PubMed, Scopus, and Web of Science databases, we define post-stroke brain health and appraise the body of research focused on modifiable vascular, lifestyle, and psychosocial factors for optimizing post-stroke brain health. In addition, we make clinical recommendations for the monitoring and management of post-stroke brain health at major post-stroke transition points centered on four key intertwined domains: cognition, psychosocial health, physical functioning, and global vascular health. Finally, we discuss potential future work in the field of post-stroke brain health, including the use of remote monitoring and interventions, neuromodulation, multi-morbidity interventions, enriched environments, and the need to address inequities in post-stroke brain health. As post-stroke brain health is a relatively new, rapidly evolving, and broad clinical and research field, this narrative review aims to identify and summarize the evidence base to help clinicians and researchers tailor their own approach to integrating post-stroke brain health into their practices.

Cultural adaptation and validation of the Arabic version of the short 12-item stroke-specific quality of life scale

Background

Given the excessive length and inconsistent validity of the existing long stroke-specific quality of life (SS-QOL) scales, there is a need to validate a shorter measuring tool. The aim of this study was to validate the Arabic version of the short 12-item SS-QOL (SS-QOL-12-AR) and examine its validity measures and psychometric properties. Additionally, the study aimed to assess the QOL after stroke and identify the sociodemographic and clinical factors that influence it in Lebanon.

Methods

A cross-sectional study was conducted. The SS-QOL-12-AR structure was validated, and its reliability and internal consistency were assessed. The scale's specificity and sensitivity were evaluated and then compared with those of other SS-QOL scales. The correlation between each item and the overall scale were examined, and its convergent validity was evaluated.

Results

A total of 172 stroke survivors were included. The SS-QOL-12-AR structure was validated with a solution of two factors, with a Kaiser-Meyer-Olkin measure of sampling adequacy of 0.850 and a significant Bartlett's test of sphericity (p < 0.001). The Cronbach's alpha of the scale was 0.917. According to ROC curve analysis, the optimal cut-off point for distinguishing between lower and better QOL was 32.50. At this cut-off, the sensitivity and specificity were 70.0% and 71.2%, respectively. The area under the curve was 0.779 (95% CI 0.704-0.855, p < 0.001). The SS-QOL-12-AR demonstrated a strong and highly significant correlation with existing versions of the SS-QOL, confirming its convergent validity. 61.6% of stroke survivors had a lower QOL, which was significantly associated with poor stroke prognosis, increased physical dependence, current smoking, and alcohol abstinence.

Conclusion

The SS-QOL-12-AR exhibits strong validity and reliability, demonstrating excellent psychometric properties. The scale holds potential for application in clinical practice and research settings, enabling the measurement of stroke-related consequences and evaluation of management outcomes.

Improved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus: a nationwide cohort study

BACKGROUND

Patients with concurrent atrial fibrillation (AF) and diabetes mellitus (DM) [AF-DM] have a high risk of cardiovascular and diabetes-related complications, but are less engaged in a comprehensive treatment approach. We evaluated the association of early rhythm control (ERC), lifestyle modification (LSM), and a combination of ERC and LSM with cardiovascular or diabetes-related complication risk in patients with AF-DM (type 2).

METHODS

From the National Health Information Database, 47,940 patients diagnosed with AF-DM in 2009-2016 were included. We defined ERC as rhythm control therapy within two years of AF diagnosis and LSM as adherence to ≥ 2 of the healthy behaviors among non-current smoking, non-drinking, and regular exercise. We compared the primary (ischemic stroke) and secondary (macro- and microvascular complications, glycemic emergency, and all-cause death) outcomes in four groups: non-ERC and non-LSM (group 1), LSM only (group 2), ERC only (group 3), and both ERC and LSM (group 4).

RESULTS

Of total, 10,617 (22%), 26,730 (55.8%), 2,903 (6.1%), and 7,690 (16.0%) were classified into groups 1 to 4, in sequence. The mean duration from AF diagnosis to ERC was 25.6 ± 75.5 days. During 4.0 (interquartile range: 2.5-6.2) years' follow-up, groups 2 and 3 were associated with 23% and 33% lower risks of stroke than group 1, respectively. Group 4 was associated with the lowest risk of stroke: hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.51-0.67, p < 0.001. Regarding secondary outcomes, the lowest risks were also observed in group 4; macro- and microvascular complications, glycemic emergency, and all-cause death had HRs (95% CIs) of 0.63 (0.56-0.70), 0.88 (0.82-0.94), 0.72 (0.62-0.84), and 0.80 (0.73-0.87), respectively, all p < 0.001.

CONCLUSIONS

For AF-DM patients, ERC and LSM exert a synergistic effect in preventing cardiovascular and diabetes-related complications with the greatest lowered risk of stroke. A comprehensive treatment approach should be pursued in AF-DM patients.