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Ramírez-Moreno JM, Rebollo B, Macías-Sedas P, Valverde N, Parejo A, Felix-Redondo FJ, Roa Montero AM, Constantino AB, Gómez Baquero MJ, Ceberino-Muñoz D, Fernández-Bergés D. Strength of association of classical vascular risk factors in young patients with ischaemic stroke: a case-control study. Neurologia 2024; 39:604-613. [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/24/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Recent studies have reported an increasing incidence of ischaemic stroke among young adults. However, the strength of the association between traditional vascular risk factors has not been fully established. METHODS We compared 120 patients with a first ischaemic stroke before the age of 55 years admitted to the stroke unit of our centre with 600 healthy non-stroke controls from a population-based cohort study (HERMEX), matched for sex. Risk factors assessed included: hypertension, obesity, auricular fibrillation, current smoking, estimated glomerular filtration rate (eGFR), total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, high-density lipoprotein cholesterol (HDL-C) and diabetes mellitus. We used logistic regression analysis and calculated population attributable risk. We performed an overall analysis, by sex and aetiological subgroup. RESULTS Using logistic regression analysis, we found that overall, the significant risk factors were: hypertension (OR: 1.58; 95%CI: 1.01-2.50), atrial fibrillation (OR: 4.77; 95%CI: 1.20-19.00), low eGFR (OR: 4.74; 95%CI: 1.3-21.94) and low HDL-C (OR: 5.20; 95%CI: 3.29-8.21), as well as smoking for males (OR: 1.86; 95%CI: 1.14-3.03). LDL-C showed an inverse association with stroke. The population attributable risk for HDL-C was 37.8% and for hypertension 21.1%. In terms of aetiological subgroups, only low HDL-C was associated with stroke of undetermined aetiology. CONCLUSIONS Hypertension, auricular fibrillation, low eGFR, and low HDL-C, plus tobacco use in men, are the main risk factors among patients under 55 years of age with a first ischaemic stroke. We believe that it would be of particular interest to further explore the management of low HDL-C levels as part of preventive strategies in young stroke patients.
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Affiliation(s)
- J M Ramírez-Moreno
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain; Departamento de Ciencias Biomédicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, Badajoz, Spain; Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE).
| | - B Rebollo
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - P Macías-Sedas
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - N Valverde
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - A Parejo
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - F J Felix-Redondo
- Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE); Servicio Extremeño de Salud, Spain
| | - A M Roa Montero
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - A B Constantino
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - M J Gómez Baquero
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - D Ceberino-Muñoz
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - D Fernández-Bergés
- Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE); Servicio Extremeño de Salud, Spain
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Kelly DM, Engelbertz C, Rothwell PM, Anderson CD, Reinecke H, Koeppe J. Age- and Sex-Specific Analysis of Stroke Hospitalization Rates, Risk Factors, and Outcomes From German Nationwide Data. Stroke 2024; 55:2284-2294. [PMID: 39145389 PMCID: PMC11346720 DOI: 10.1161/strokeaha.123.046118] [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: 12/06/2023] [Revised: 06/23/2024] [Accepted: 07/18/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Significant age and sex differences have been reported at each stage of the stroke pathway, from risk factors to outcomes. However, there is some uncertainty in previous studies with regard to the role of potential confounders and selection bias. Therefore, using German nationwide administrative data, we aimed to determine the magnitude and direction of trends in age- or sex-specific differences with respect to admission rates, risk factors, and acute treatments of ischemic and hemorrhagic stroke. METHODS We obtained and analyzed data from the Research Data Centres of the Federal Statistical Office for the years 2010 to 2020 with regard to all acute stroke hospitalizations, risk factors, treatments, and in-hospital mortality, stratified by sex and stroke subtype. This database provides a complete national-level census of stroke hospitalizations combined with population census counts. All hospitalized patients ≥15 years with an acute stroke (diagnosis code: I60-64) were included in the analysis. RESULTS Over the 11-year study period, there were 3 375 157 stroke events; 51.2% (n=1 728 954) occurred in men. There were higher rates of stroke admissions in men compared with women for both ischemic (378.1 versus 346.7/100 000 population) and hemorrhagic subtypes (75.6 versus 65.5/100 000 population) across all age groups. The incidence of ischemic stroke admissions peaked in 2016 among women (354.0/100 000 population) and in 2017 among men (395.8/100 000 population), followed by a consistent decline from 2018 onward. There was a recent decline in hemorrhagic stroke admissions observed for both sexes, reaching its nadir in 2020 (68.9/100 000 for men; 59.5/100 000 for women). Female sex was associated with in-hospital mortality for both ischemic (adjusted odds ratio, 1.11 [1.09-1.12]; P<0.001) and hemorrhagic stroke (adjusted odds ratio, 1.18 [95% CI, 1.16-1.20]; P<0.001). CONCLUSIONS Despite improvements in stroke prevention and treatment pathways in the past decade, sex-specific differences remain with regard to hospitalization rates, risk factors, and mortality. Better understanding the mechanisms for these differences may allow us to develop a sex-stratified approach to stroke care.
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Affiliation(s)
- Dearbhla M. Kelly
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom (D.M.K., P.M.R.)
| | - Christiane Engelbertz
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Germany (C.E., H.R.)
| | - Peter M. Rothwell
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom (D.M.K., P.M.R.)
| | - Christopher D. Anderson
- Program in Medical and Population Genetics, Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston (C.D.A.)
- McCance Center for Brain Health, Massachusetts General Hospital, Boston (C.D.A.)
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA (C.D.A.)
| | - Holger Reinecke
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Germany (C.E., H.R.)
| | - Jeanette Koeppe
- Institute of Biostatistics and Clinical Research, University of Muenster, Germany (J.K.)
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Lee H, Rhee TM, Park HE, Han K, Choi SY. Association between cumulative metabolic risk exposure and cardiovascular disease: a nationwide cohort of over 3.6 million young adults. Eur J Prev Cardiol 2024; 31:1288-1300. [PMID: 38421612 DOI: 10.1093/eurjpc/zwae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
AIMS As lifetime accumulation of cardiovascular risk factors is gaining importance, early identification and management of risk factors are being emphasized. The global prevalence of metabolic syndrome (MetS), a constellation of these risk factors, is increasing, particularly among young adults. In this study, we aim to investigate the association between cumulative exposure to metabolic risk and cardiovascular disease (CVD) in young adults. METHODS AND RESULTS In this nationwide population-based cohort, we analysed 3 688 787 young adults (<40 years) with 2 biennial National Health Screening examinations from 2009 to 2012. Participants were categorized into MetS-free, MetS-developed, MetS-recovered, or MetS-persistent group, based on MetS presence at each examination. The endpoint was new CVD development, including myocardial infarction (MI) and ischaemic stroke. During follow-up (median, 7.7 years), CVD occurred in 19 219 individuals (0.5%). The incidence rates of CVD were 0.58, 1.17, 1.20, and 1.83 (1000 person-years) in the MetS-free, MetS-developed, MetS-recovered, and MetS-persistent groups, respectively. The CVD risk was proportionally associated with cumulative metabolic risk exposure, with a maximum two-fold increase in the MetS-persistent group [adjusted hazard ratio (aHR) 1.94, 95% confidence interval (CI) 1.84-2.04], followed by the MetS-recovered and the MetS-developed groups with similar risks. Among the MetS components, persistent exposure to elevated blood pressure (BP) had the greatest association with CVD risk (aHR 1.69, 95% CI 1.63-1.76). This tendency was consistent in the separate analyses of the risk of MI and ischaemic stroke. CONCLUSION The risk of CVD increased in an exposure-dependent manner among young adults. Efforts to optimize the cardiometabolic profile, particularly BP, even after the establishment of MetS, might help promote long-term cardiovascular prognosis.
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Affiliation(s)
- Heesun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Centre, 39th Floor, Gangnam Finance Centre, 152, Teheran-ro, Gangnam-gu, Seoul 06236, Republic of Korea
| | - Tae-Min Rhee
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Centre, 39th Floor, Gangnam Finance Centre, 152, Teheran-ro, Gangnam-gu, Seoul 06236, Republic of Korea
| | - Hyo Eun Park
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Centre, 39th Floor, Gangnam Finance Centre, 152, Teheran-ro, Gangnam-gu, Seoul 06236, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-ro, Dongjak-gu, Seoul 06978, Republic of Korea
| | - Su-Yeon Choi
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Centre, 39th Floor, Gangnam Finance Centre, 152, Teheran-ro, Gangnam-gu, Seoul 06236, Republic of Korea
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Bardugo A, Bendor CD, Libruder C, Lutski M, Zucker I, Tsur AM, Derazne E, Yaniv G, Gardner RC, Gerstein HC, Cukierman-Yaffe T, Lebenthal Y, Batty D, Tanne D, Furer A, Afek A, Twig G. Cognitive function in adolescence and the risk of early-onset stroke. J Epidemiol Community Health 2024; 78:570-577. [PMID: 38937113 DOI: 10.1136/jech-2024-222114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/11/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Stroke is increasingly prevalent at younger ages but the risk factors are uncertain. We examined the association between adolescent cognitive function and early-onset stroke. METHODS This was a nationwide population-based cohort study of 1 741 345 Israeli adolescents (42% women) who underwent comprehensive cognitive function tests at age 16-20 years, before mandatory military service, during 1987-2012. Cognitive function (range: 1-9) was categorised as low (1-3, corresponding to IQ score below 89), medium (4-7, IQ score range: 89-118), or high (8-9, IQ score above 118). Participant data were linked to the Israeli National Stroke Registry. Cox proportional hazard models were used to estimate risks for the first occurrence of ischaemic stroke during 2014-2018. RESULTS During 8 689 329 person-years of follow-up, up to a maximum age of 50 years, 908 first stroke events occurred (767 ischaemic and 141 haemorrhagic). Compared with a reference group of people with high cognitive function, body mass index-adjusted and sociodemographic-adjusted HRs (95% CIs) for early-onset stroke were 1.78 (1.33-2.38) in medium and 2.68 (1.96-3.67) in low cognitive function groups. There was evidence of a dose-response relationship (P for trend <0.0001) such that one-unit of lower cognitive function z-score was associated with a 33% increased risk of stroke (1.33; 1.23-1.42). These associations were similar for ischaemic stroke but lower for haemorrhagic stroke; persisted in sensitivity analyses that accounted for diabetes status and hypertension; and were evident before age 40 years. CONCLUSIONS Alongside adolescent obesity and hypertension, lower cognitive function may be a risk factor for early-onset stroke.
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Affiliation(s)
- Aya Bardugo
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cole D Bendor
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carmit Libruder
- Israel Center for Disease Control, State of Israel Ministry of Health, Ramat Gan, Israel
| | - Miri Lutski
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel Center for Disease Control, State of Israel Ministry of Health, Ramat Gan, Israel
| | - Inbar Zucker
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel Center for Disease Control, State of Israel Ministry of Health, Ramat Gan, Israel
| | - Avishai M Tsur
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Estela Derazne
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Yaniv
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
| | - Raquel C Gardner
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Tali Cukierman-Yaffe
- Department of Preventive Medicine and Epidemiology, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
| | - Yael Lebenthal
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| | - David Tanne
- Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ariel Furer
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | | | - Gilad Twig
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
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Ma Z, He W, Zhou Y, Mai L, Xu L, Li C, Li M. Global burden of stroke in adolescents and young adults (aged 15-39 years) from 1990 to 2019: a comprehensive trend analysis based on the global burden of disease study 2019. BMC Public Health 2024; 24:2042. [PMID: 39080669 PMCID: PMC11289945 DOI: 10.1186/s12889-024-19551-1] [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: 08/28/2023] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION The incidence of stroke is rising among individuals aged 15-39. Insufficient research targeting this age group hampers the development of effective strategies. This study analyzes data from the Global Burden of Disease Study 2019 (GBD 2019) to examine trends from 1990 to 2019 and propose future interventions. METHODS Data on ischemic strokes, intracerebral hemorrhage, and subarachnoid hemorrhage from 1990 to 2019 was collected from the Global Health Data Exchange (GHDx) platform. We used the Annual Average Percentage Change (AAPC) to assess global trends in incidence, prevalence, Disability-Adjusted Life Years (DALYs), and mortality rates across various stroke categories. Joinpoint models identified significant years of trend inflection. Trend analyses were segmented by age, gender, and Sociodemographic Index (SDI). FINDINGS From 1990 to 2019, the global incidence of ischemic stroke within the adolescents and young adults (AYAs) cohort declined from 1990 to 1999, further decreased from 2000 to 2009, and then increased from 2010 to 2019. The overall AAPC p-value showed no significant difference. Mortality rates for ischemic strokes were consistently reduced during this period. The overall incidence rate of intracerebral hemorrhage has exhibited a downward trend. Meanwhile, the incidence rate of subarachnoid hemorrhage decreased from 1990 to 2009, yet saw a resurgence from 2010 to 2019. Male ischemic stroke incidence grew more than female incidence, but both absolute incidence and rates were higher for females. Differences in SDI levels were observed, with the fastest increase in incidence occurring in low-middle SDI regions, followed by high SDI regions, and the smallest increase in low SDI regions. Conversely, the most rapid decline was noted in high-middle SDI regions, with no significant change observed in middle SDI regions. CONCLUSION A concerning trend of increasing ischemic stroke incidence, DALYs, and prevalence rates has emerged in the global 15-39 age group, especially among those aged 30-39. This increase is evident across regions with varying SDI classifications. To combat this alarming trend among adolescents and young adults, enhancing preventive efforts, promoting healthier lifestyles, strengthening the healthcare system's responsiveness, and maintaining vigilant epidemiological monitoring is essential.
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Affiliation(s)
- Zixuan Ma
- The Second School of Clinical Medicine, Guangzhou Medical University, Guangdong, China
| | - Wenkai He
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuanxin Zhou
- The Second School of Clinical Medicine, Guangzhou Medical University, Guangdong, China
| | - Li Mai
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lifeng Xu
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Can Li
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingyan Li
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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Bekmez H, Kocak MN, Tavaci T, Halici H, Toktay E, Celik M, Bagci HH. Inflammation in cerebral ischemia reperfusion improved by avanafil via nod-like receptor protein-3 inflammasome: an experimental study in rats. Brain Inj 2024; 38:708-715. [PMID: 38676710 DOI: 10.1080/02699052.2024.2346147] [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: 04/16/2023] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE The aim of study was to investigate the effect of avanafil, a second-generation phosphodiesterase-5 (PDE5) inhibitor, on cerebral ischemia reperfusion (CI/R) model. METHODS 32 male albino Wistar rats were used. Four groups were constituted, as I: the healthy (sham), II: the CI/R group, III: the CI/R +I 10 mg/kg avanafil group, and IV: the CI/R + 20 mg/kg avanafil group. Avanafil was administered twice via oral gavage, first shortly after ischemia reperfusion and once more after 12 h. The rats were euthanized after 24 h. Histopathological and Real Time PCR analyzes were performed on cerebral tissues. RESULTS IL-1β, NLRP3 and TNF-α mRNA expressions were statistically higher in the CI/R group when compared to healthy (sham) group. Conversely, the IL-1β, NLRP3, and TNF-α mRNA expressions were significantly decreased in both of the avanafil-treated groups when compared to CI/R group. Histopathological results showed that both doses of avanafil also decreased cellular damage in cerebral tissue that occurred after CI/R. CONCLUSION Avanafil, was found to have ameliorated inflammatory response and cellular injury caused by CI/R. The mRNA expression of IL-1β, NLRP3, and TNF-α decreased in the I/R groups and approached the control group levels with a high dose of avanafil.
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Affiliation(s)
- Huseyin Bekmez
- Faculty of Medicine, Department of Pharmacology, Ataturk University, Erzurum, Turkey
| | - Mehmet Nuri Kocak
- Faculty of Medicine, Department of Neurology, Ataturk University, Erzurum, Turkey
| | - Taha Tavaci
- Faculty of Medicine, Department of Pharmacology, Ataturk University, Erzurum, Turkey
| | - Hamza Halici
- Faculty of Medicine, Department of Pharmacology, Ataturk University, Erzurum, Turkey
- Department of Hınıs Vocational Training School, Ataturk University, Erzurum, Turkey
| | - Erdem Toktay
- Faculty of Medicine, Department of Embryology and Histology, Kafkas University, Kars, Turkey
| | - Muhammet Celik
- Department of Medical Biochemistry, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Hamit Harun Bagci
- General Directorate of Administrative Services, Republic of Türkiye Ministry of Health, Ankara, Turkey
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Joynt Maddox KE, Elkind MSV, Aparicio HJ, Commodore-Mensah Y, de Ferranti SD, Dowd WN, Hernandez AF, Khavjou O, Michos ED, Palaniappan L, Penko J, Poudel R, Roger VL, Kazi DS. Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050-Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association. Circulation 2024; 150:e65-e88. [PMID: 38832505 DOI: 10.1161/cir.0000000000001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Cardiovascular disease and stroke are common and costly, and their prevalence is rising. Forecasts on the prevalence of risk factors and clinical events are crucial. METHODS Using the 2015 to March 2020 National Health and Nutrition Examination Survey and 2015 to 2019 Medical Expenditure Panel Survey, we estimated trends in prevalence for cardiovascular risk factors based on adverse levels of Life's Essential 8 and clinical cardiovascular disease and stroke. We projected through 2050, overall and by age and race and ethnicity, accounting for changes in disease prevalence and demographics. RESULTS We estimate that among adults, prevalence of hypertension will increase from 51.2% in 2020 to 61.0% in 2050. Diabetes (16.3% to 26.8%) and obesity (43.1% to 60.6%) will increase, whereas hypercholesterolemia will decline (45.8% to 24.0%). The prevalences of poor diet, inadequate physical activity, and smoking are estimated to improve over time, whereas inadequate sleep will worsen. Prevalences of coronary disease (7.8% to 9.2%), heart failure (2.7% to 3.8%), stroke (3.9% to 6.4%), atrial fibrillation (1.7% to 2.4%), and total cardiovascular disease (11.3% to 15.0%) will rise. Clinical CVD will affect 45 million adults, and CVD including hypertension will affect more than 184 million adults by 2050 (>61%). Similar trends are projected in children. Most adverse trends are projected to be worse among people identifying as American Indian/Alaska Native or multiracial, Black, or Hispanic. CONCLUSIONS The prevalence of many cardiovascular risk factors and most established diseases will increase over the next 30 years. Clinical and public health interventions are needed to effectively manage, stem, and even reverse these adverse trends.
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Imeshtari V, Imeshtari A, La Torre G. Cardiovascular risk in young healthcare professionals: A cross-sectional study. Work 2024:WOR220701. [PMID: 38995743 DOI: 10.3233/wor-220701] [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: 07/14/2024] Open
Abstract
BACKGROUND In the last years cardiovascular risk has decreased in grown adults and elderly while it seems to be rising among young adults. OBJECTIVE to assess the 10-year cardiovascular risk (CVR) in young healthcare professionals at the teaching hospital in Rome, using two scores, and identify possible determinants in order to design and implement preventive strategies. METHODS A cross-sectional study was carried out between January 2019 and July 2020. Participants underwent medical history collection, physical examination, and blood tests. CVR was calculated using CUORE and Framingham Risk Scores. A multiple linear regression analysis was conducted having the scores as dependent variables. Diagnostic tests were used for checking model assumptions. RESULTS The study was carried out including 525 participants, 58.5% physicians and 32.1% nurses. Multivariate analysis was carried out only for men, since the pp plot for the whole population and for females for the dependent variables showed some evidence of non-normality, and the residual plot shows variance of the residuals was not constant across the range of fitted values. CVR, using the Framingham equation, directly correlated with age (β = 0.260; p < 0.001). Using the CUORE score, qualification as a physician (p < 0.001) is associated with a lower risk of having a CVR, while age (p < 0.001) is directly proportional to this risk. CONCLUSIONS Increasing age consistently emerges as a prominent factor, positively influencing both the Framingham risk score and CUORE score, but this association was found only for men. Being a doctor is a protective factor for the CUORE score.
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Affiliation(s)
- Valentin Imeshtari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Anila Imeshtari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
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Goldstein LB. Weighing the Effect of Overweight/Obesity on Stroke Risk. Stroke 2024; 55:1866-1868. [PMID: 38841832 DOI: 10.1161/strokeaha.124.047353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
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Nguyen KT, Xu H, Gaynor B, Adebamowo SN, McArdle PF, O'Connor T, Worrall B, Malik R, Boncoraglio GB, Zand R, Kittner SJ, Mitchell BD. The Impact of Conventional Stroke Risk Factors on Early and Late Onset Ischemic Stroke: a Mendelian Randomization Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.31.24308308. [PMID: 38853993 PMCID: PMC11160856 DOI: 10.1101/2024.05.31.24308308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Objective Although stroke incidence is decreasing in older ages, it is increasing in young adults. While these divergent trends in stroke incidence are at least partially attributable to diverging prevalence trends in stoke risk factors, age-dependent differences in the impact of stroke risk factors on stroke may also contribute. To address this issue, we utilized Mendelian Randomization (MR) to assess differences in the association of stroke risk factors between early onset ischemic stroke (EOS) and late onset ischemic stroke (LOS). Methods We employed a two-sample MR design with inverse variance weighting as the primary method of analysis. Using large publicly available genome-wide association summary results, we calculated MR estimates for conventional stroke risk factors (body mass index, total, HDL-and LDL-cholesterol, triglycerides, type 2 diabetes, systolic and diastolic blood pressure, and smoking) in EOS cases (onset 18-59 years, n = 6,728) and controls from the Early Onset Stroke Consortium and in LOS cases (onset ≥ 60 years, n = 9,272) and controls from the Stroke Genetics Network. We then compared odds ratios between EOS and LOS, stratified by TOAST subtypes, to determine if any differences observed between effect sizes could be attributed to differences in the distribution of stroke subtypes. Results EOS was significantly associated with all risk factors except for total cholesterol levels, and LOS was associated with all risk factors except for triglyceride and total cholesterol levels. The associations of BMI, DBP, SBP, and HDL-cholesterol were significantly stronger in EOS than LOS (all p < 0.004). The differential distribution of stroke subtypes could not explain the difference in effect size observed between EOS and LOS. Conclusion These results suggest that interventions targeted at lowering body mass index and blood pressure may be particularly important for reducing stroke risk in young adults.
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Wang C, Li B, Zhu Q, Zhang Q, Xie Z, Xie H, Li X. Dietary vitamin B6 intake and stroke are negatively associated in adults: A cross-sectional study from the NHANES. Heliyon 2024; 10:e31125. [PMID: 38778939 PMCID: PMC11109891 DOI: 10.1016/j.heliyon.2024.e31125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Background The relationship between dietary vitamin B6 and stroke risk is controversial; thus, we analyzed their correlation using data from the National Health and Nutrition Examination Survey (NHANES). Method Data from 2005 to 2018 were collected from the NHANES database. Two 24-h dietary recalls and a standard questionnaire were used to evaluate vitamin B6 intake and stroke prevalence. We used logistic regression models to estimate the association between dietary vitamin B6 intake and stroke risk and investigated the nonlinear relationship between them using a restricted cubic spline (RCS). Sensitivity analysis was conducted using propensity score matching (PSM). Results Among 24,214 participants, 921 were patients diagnosed with stroke, while 23,293 were without stroke. The multivariate logistic regression model revealed that individuals in the highest quartile of vitamin B6 consumption had a significantly lower stroke risk than those in the lowest quartile under the fully adjusted model (OR: 0.48, 95 % CI: 0.35-0.66, P < 0.001). Subgroup analyses showed that dietary intake of vitamin B6 was a significant protective factor against stroke risk in different populations, with the most pronounced effect in the population engaging in moderate-intensity physical activity (OR: 0.34, 95%CI: 0.20-0.57). The RCS models revealed a non-linear L-shaped relationship (P for nonlinearity = 0.006) between stroke and dietary intake of vitamin B6. Conclusions Our study shows that an increased intake of vitamin B6 could be an effective strategy in reducing the risk of stroke.
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Affiliation(s)
- Chao Wang
- Department of Neurosurgery, Huizhou Third People's Hospital, Huizhou Hospital Affiliated to Guangzhou Medical University, Huizhou, China
| | - Bo Li
- Department of Neurosurgery, Huizhou Third People's Hospital, Huizhou Hospital Affiliated to Guangzhou Medical University, Huizhou, China
| | - Qian Zhu
- Department of Neurosurgery, Huizhou Third People's Hospital, Huizhou Hospital Affiliated to Guangzhou Medical University, Huizhou, China
| | - Qikeng Zhang
- Department of Neurosurgery, Huizhou Third People's Hospital, Huizhou Hospital Affiliated to Guangzhou Medical University, Huizhou, China
| | - Zhenyan Xie
- Department of Neurosurgery, Huizhou Third People's Hospital, Huizhou Hospital Affiliated to Guangzhou Medical University, Huizhou, China
| | - Huixi Xie
- Department of Neurosurgery, The First Clinical Medical College, Guangdong Medical University, Zhanjiang, China
| | - Xuesong Li
- Department of Neurosurgery, The First Clinical Medical College, Guangdong Medical University, Zhanjiang, China
- Department of Neurosurgery, Huizhou Third People's Hospital, Huizhou Hospital Affiliated to Guangzhou Medical University, Huizhou, China
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Iskandar K, Rahme D, Salameh P, Haddad C, Sacre H, Bahlol M, Darwish RM, El Khatib S, Safwan J, Sakr F, Rahhal M, Hosseini H, Cherfane M. Evaluating the influence of a 3-min online video on the community knowledge of stroke in four Arab countries. Front Public Health 2024; 12:1342490. [PMID: 38841682 PMCID: PMC11151891 DOI: 10.3389/fpubh.2024.1342490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Studies from developed and developing countries showed that the knowledge levels of stroke need improvement. Educational campaigns varied and were of limited influence predominantly because of their short duration and the need for financial support. The study aims to test the impact of a 3-min online video on the knowledge of stroke and factors influencing the knowledge score in four Arab countries. Methods A cross-sectional web-based pre-post study was conducted in Egypt, Jordan, Lebanon, and the United Arab Emirates. The data were collected using the snowball technique. Participants were adults aged 18 years and above. The questionnaire sequence was conducting a pretest, followed by the educational video explaining stroke occurrence, types, risks, warning signs, preventive measures, and treatment, and finally, a posttest to evaluate the differences in knowledge from baseline. Statistical analysis included paired t-tests comparing pre-post-education stroke knowledge scores, while repeated measures ANOVA, adjusting for covariates, assessed mean changes. Results The total number of participants was 2,721, mainly younger than 55 years. The majority had a university degree and were not healthcare professionals. A significant improvement was noted in the total knowledge score in all countries from a mean average (Mpretest = 21.11; Mposttest = 23.70) with p < 0.001. Identification of the stroke risks (Mpretest = 7.40; Mposttest = 8.75) and warning signs (Mpretest = 4.19; Mposttest = 4.94), understanding the preventive measures (Mpretest = 5.27; Mposttest = 5.39) and the importance of acting fast (Mpretest = 0.82; Mposttest = 0.85) improved from baseline with (p < 0.001) for all score components. Conclusion The educational tool successfully enhanced public understanding of stroke risks, the identification of stroke signs, and the critical need for emergency action. The advantages of this video include its short length, free online access, use of evidence-based content in lay language, and reflective images. The ultimate goal remains the long-term improvement of sustainability by mandating full-scale trials.
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Affiliation(s)
- Katia Iskandar
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Health and Social Work, School of Public Health, Lebanese University, Fanar, Lebanon
- Higher Institute of Public Health (ISSP), Saint Joseph University of Beirut, Beirut, Lebanon
| | - Deema Rahme
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Pharmacy Practice, School of Pharmacy, Beirut Arab University, Beirut, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Chadia Haddad
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Egypt
- Department of Pharmaceutical management and economics, Department Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Egyptian Russian University, Badr city, Cairo governorate, Egypt
| | - Mohamed Bahlol
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Rula M. Darwish
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
| | - Sarah El Khatib
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Health and Social Work, School of Public Health, Lebanese University, Fanar, Lebanon
| | - Jihan Safwan
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
- UMR U955 INSERM, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, Paris, France
| | - Mohamad Rahhal
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Hassan Hosseini
- INSERM U955-E01, IMRB, Henri Mondor Hospital, Créteil, France
- Department of Neurology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Michelle Cherfane
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Environmental and Public Health Department, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
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Manja V, Phibbs CS, Ananth L, Saechao F, Frayne SM. Lower Oral Anticoagulant Prescribing for Atrial Fibrillation in Women Compared With Men. Am J Cardiol 2024; 219:44-46. [PMID: 38548010 DOI: 10.1016/j.amjcard.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Veena Manja
- VA Northern California Healthcare System, Mather, California; Department of Medicine, University of California Davis, Sacramento, California.
| | - Ciaran S Phibbs
- VA Health Economics Resource Center (HERC), Menlo Park, California; VA Palo Alto Health Care System, Palo Alto, California; Department of Pediatrics, Stanford University, Stanford, California
| | - Lakshmi Ananth
- VA Health Economics Resource Center (HERC), Menlo Park, California; VA Palo Alto Health Care System, Palo Alto, California
| | - Fay Saechao
- VA Palo Alto Health Care System, Palo Alto, California; VA Health Services Research and Development Center for Innovation to Implementation (Ci2i), Menlo Park, California
| | - Susan M Frayne
- VA Health Economics Resource Center (HERC), Menlo Park, California; VA Palo Alto Health Care System, Palo Alto, California; VA Health Services Research and Development Center for Innovation to Implementation (Ci2i), Menlo Park, California; Division of Primary Care and Population Health, School of Medicine, Stanford University, Stanford, California
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Leppert MH, Poisson SN, Scarbro S, Suresh K, Lisabeth LD, Putaala J, Schwamm LH, Daugherty SL, Bradley CJ, Burke JF, Ho PM. Association of Traditional and Nontraditional Risk Factors in the Development of Strokes Among Young Adults by Sex and Age Group: A Retrospective Case-Control Study. Circ Cardiovasc Qual Outcomes 2024; 17:e010307. [PMID: 38529631 PMCID: PMC11021148 DOI: 10.1161/circoutcomes.123.010307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/11/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Despite women having fewer traditional risk factors (eg, hypertension, diabetes), strokes are more common in women than men aged ≤45 years. This study examined the contributions of traditional and nontraditional risk factors (eg, migraine, thrombophilia) in the development of strokes among young adults. METHODS This retrospective case-control study used Colorado's All Payer Claims Database (2012-2019). We identified index stroke events in young adults (aged 18-55 years), matched 1:3 to stroke-free controls, by (1) sex, (2) age±2 years, (3) insurance type, and (4) prestroke period. All traditional and nontraditional risk factors were identified from enrollment until a stroke or proxy-stroke date (defined as the prestroke period). Conditional logistic regression models stratified by sex and age group first assessed the association of stroke with counts of risk factors by type and then computed their individual and aggregated population attributable risks. RESULTS We included 2618 cases (52% women; 73.3% ischemic strokes) and 7827 controls. Each additional traditional and nontraditional risk factors were associated with an increased risk of stroke in all sex and age groups. In adults aged 18 to 34 years, more strokes were associated with nontraditional (population attributable risk: 31.4% men and 42.7% women) than traditional risk factors (25.3% men and 33.3% women). The contribution of nontraditional risk factors declined with age (19.4% men and 27.9% women aged 45-55 years). The contribution of traditional risk factors peaked among patients aged 35 to 44 years (32.8% men and 39.7% women). Hypertension was the most important traditional risk factor and increased in contribution with age (population attributable risk: 27.8% men and 26.7% women aged 45 to 55 years). Migraine was the most important nontraditional risk factor and decreased in contribution with age (population attributable risk: 20.1% men and 34.5% women aged 18-35 years). CONCLUSIONS Nontraditional risk factors were as important as traditional risk factors in the development of strokes for both young men and women and have a stronger association with the development of strokes in adults younger than 35 years of age.
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Affiliation(s)
- Michelle H. Leppert
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
- Colorado Cardiovascular Outcomes Research (CCOR) Group, Denver, Colorado
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO
| | - Sharon N. Poisson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - Sharon Scarbro
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO
- Rocky Mountain Prevention Research Center, Colorado School of Public Health, Aurora, CO
| | - Krithika Suresh
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Lynda D. Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Stacie L. Daugherty
- Colorado Cardiovascular Outcomes Research (CCOR) Group, Denver, Colorado
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Cathy J. Bradley
- Colorado Comprehensive Cancer Center, University of Colorado, Aurora, CO
| | - James F. Burke
- Department of Neurology, The Ohio State University, Columbus, OH
| | - P. Michael Ho
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora, CO
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15
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Sindre RB, Gerdts E, Putaala J, Grymyr LM, Midtbø H, Almeida AG, Bech-Hanssen O, Busch R, Eilertsen RK, Fonseca AC, Hedman M, Huhtakangas J, Jäkälä P, Lautamäki R, Lehto M, Martinez-Majander N, Redfors P, Sarkanen T, von Sarnowski B, Sinisalo J, Virtanen M, Waje-Andreassen U, Yesilot N, Ylikotila P, Cramariuc D. Association of Left Atrial Stiffness With Risk of Cryptogenic Ischemic Stroke in Young Adults. JACC. ADVANCES 2024; 3:100903. [PMID: 38939654 PMCID: PMC11198254 DOI: 10.1016/j.jacadv.2024.100903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/01/2023] [Accepted: 01/02/2024] [Indexed: 06/29/2024]
Abstract
Background Incidence of cryptogenic ischemic stroke (CIS) in young adults is increasing. Early left atrial (LA) myopathy might be 1 of the underlying mechanisms, but this has only been scarcely explored. Objectives The purpose of this study was to assess the association between increased LA stiffness and CIS in young adults. Methods In the multicenter SECRETO (Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome) study, LA function was analyzed by speckle tracking echocardiography in 150 CIS patients (aged 18-49 years) and 150 age- and sex-matched controls. Minimum and maximum LA volumes, LA reservoir and contractile strain were measured. LA stiffness was calculated by the ratio: mitral peak E-wave velocity divided by mitral annular e' velocity (E/e')/LA reservoir strain and considered increased if ≥0.22. Increased LA volumes, LA stiffness, and/or reduced LA strain indicated LA myopathy. Logistic regression was used to determine the relation between LA stiffness and CIS and the clinical variables associated with LA stiffness. Results Increased LA stiffness was found in 36% of patients and in 18% of controls (P < 0.001). Increased LA stiffness was associated with a 2.4-fold (95% CI: 1.1-5.3) higher risk of CIS after adjustment for age, sex, comorbidities, and echocardiographic confounders (P = 0.03). In patients, obesity, pre-CIS antihypertensive treatment, older age, and lower LA contractile strain were all related to increased LA stiffness (all P < 0.05). Conclusions LA myopathy with increased LA stiffness and impaired LA mechanics more than doubles the risk of CIS in patients under the age of 50 years. This provides new insights into the link between LA dysfunction and CIS at young ages. (Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome [SECRETO]; NCT01934725).
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Affiliation(s)
| | - Eva Gerdts
- Department of Clinical Science, Center for Research on Cardiac Disease in Women, University of Bergen, Bergen, Norway
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Finland
| | - Lisa M.D. Grymyr
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Helga Midtbø
- Department of Clinical Science, Center for Research on Cardiac Disease in Women, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ana G. Almeida
- Cardiology, Heart and Vessels Department, Faculty of Medicine of Lisbon University, University Hospital Santa Maria, Lisbon, Portugal
| | - Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska University Hospital and Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Raila Busch
- Department of Internal Medicine B (Cardiology), University Medicine Greifswald, Greifswald, Germany
| | - Rune K. Eilertsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ana Catarina Fonseca
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Marja Hedman
- Heart Center and Clinical Imaging Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Juha Huhtakangas
- Department of Neurology, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Pekka Jäkälä
- Department of Neurology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Riikka Lautamäki
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Mika Lehto
- Department of Internal Medicine, Jorvi Hospital, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tomi Sarkanen
- Department of Neurology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marko Virtanen
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | | | - Nilufer Yesilot
- Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkiye
| | - Pauli Ylikotila
- Neurocenter, Turku University Hospital and Clinical Neurosciences, University of Turku, Turku, Finland
| | - Dana Cramariuc
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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16
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Hsu UH, Lin YT, Chiang BL. The characteristics and risk factors of cerebrovascular events in young systemic lupus erythematosus patients: A case-control study. J Formos Med Assoc 2024; 123:478-486. [PMID: 37813767 DOI: 10.1016/j.jfma.2023.09.018] [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: 04/28/2023] [Revised: 08/10/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVES We clarified the characteristics and risk factors of CVEs in young SLE patients. METHOD We retrospectively reviewed the medical records of patients younger than 50 years of age diagnosed with SLE and first CVEs from 1995 to 2020 in a tertiary medical center in Taiwan. We collected data on the patient characteristics before the CVE and reviewed the laboratory data obtained during the period. At a ratio of 1:3, cases and controls were matched with sex, SLE diagnosis age, diagnosis year, and SLE duration. RESULTS We enrolled 43 CVE SLE patients and matched 129 non-CVE SLE controls. The median age at the time of the CVE was 39 years. Around 70% of young-aged CVE involved the cerebral lobes of frontal (∼30%), parietal (∼20%), occipital (∼10%), and temporal (∼10%). The peak incidence period for hemorrhagic CVE was within 1st year of SLE diagnosis (37%); in contrast, during the 2nd to 5th year of SLE diagnosis (25%) for ischemia CVEs. Hyperlipidemia (odds ratio [OR] = 19.36, p = 0.002), anti-phospholipid syndrome (APS) (OR = 41.9, p = 0.0068), a lower hemoglobin level (OR = 0.66, p = 0.0192), and a higher SLE Disease Activity Index (SLEDAI-2k) score (OR = 1.22, p = 0.0019) were independent risk factors for CVEs in young SLE patients. CONCLUSION Hyperlipidemia, APS, low Hb level, and high SLEDAI-2k significantly increase the risk of young-aged SLE patients developing CVE.
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Affiliation(s)
- Uei-Hsiang Hsu
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Taiwan
| | - Yu-Tsan Lin
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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17
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Henry CM, Oseran AS, Zheng Z, Dong H, Wadhera RK. Cardiovascular hospitalizations and mortality among adults aged 25-64 years in the USA. Eur Heart J 2024; 45:1017-1026. [PMID: 37952173 PMCID: PMC10972685 DOI: 10.1093/eurheartj/ehad772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND AND AIMS Declines in cardiovascular mortality have stagnated in the USA since 2011. There is growing concern that these patterns reflect worsening cardiovascular health in younger adults. However, little is known about how the burden of acute cardiovascular hospitalizations and mortality has changed in this population. Changes in cardiovascular hospitalizations and mortality among adults aged 25-64 years were evaluated, overall and by community-level income. METHODS Using the National Inpatient Sample, age-standardized annual hospitalization and in-hospital mortality rates for acute myocardial infarction (AMI), heart failure, and ischaemic stroke were determined among adults aged 25-64 years. Quasi-Poisson and quasi-binominal regression models were fitted to compare outcomes between individuals residing in low- and higher-income communities. RESULTS Between 2008 and 2019, age-standardized hospitalization rates for AMI increased among younger adults from 155.0 (95% confidence interval: 154.6, 155.4) per 100 000 to 160.7 (160.3, 161.1) per 100 000 (absolute change +5.7 [5.0, 6.3], P < .001). Heart failure hospitalizations also increased (165.3 [164.8, 165.7] to 225.3 [224.8, 225.8], absolute change +60.0 (59.3, 60.6), P < .001), as ischaemic stroke hospitalizations (76.3 [76.1, 76.7] to 108.1 [107.8, 108.5], absolute change +31.7 (31.2, 32.2), P < .001). Across all conditions, hospitalizations rates were significantly higher among younger adults residing in low-income compared with higher-income communities, and disparities did not narrow between groups. In-hospital mortality decreased for all conditions over the study period. CONCLUSIONS There was an alarming increase in cardiovascular hospitalizations among younger adults in the USA from 2008 to 2019, and disparities between those residing in low- and higher-income communities did not narrow.
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Affiliation(s)
- Chantal M Henry
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
- Meharry Medical College, Nashville,
TN, USA
| | - Andrew S Oseran
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
- Division of Cardiology, Massachusetts General Hospital,
Boston, MA, USA
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard
Medical School, 330 Brookline Avenue, Boston, MA
02215, USA
| | - ZhaoNian Zheng
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
| | - Huaying Dong
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard
Medical School, 330 Brookline Avenue, Boston, MA
02215, USA
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Bugiardini R, Cenko E, Yoon J, Bergami M, Vasiljevic Z, Mendieta G, Zdravkovic M, Vavlukis M, Kedev S, Miličić D, Badimon L, Manfrini O. Traditional risk factors and premature acute coronary syndromes in South Eastern Europe: a multinational cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 38:100824. [PMID: 38476741 PMCID: PMC10928297 DOI: 10.1016/j.lanepe.2023.100824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 03/14/2024]
Abstract
Background The age-standardized death rates under 65 years from ischemic heart disease in South Eastern Europe are approximately twice as high than the Western Europe average, but the reasons are not completely recognized. The aim of the present study was to address this issue by collecting and analyzing data from a large, multinational cohort. Methods We enrolled 70,953 Caucasian patients with first acute coronary syndrome, from 36 urban hospital in 7 South Eastern European countries and assessed their life expectancy free of acute coronary syndrome and mortality within 30 days after hospital admission from acute coronary syndrome as estimated in relation to dichotomous categories of traditional risk factors (current smoking, hypertension, diabetes and hypercholesterolemia) stratified according to sex. Findings Compared with patients without any baseline traditional risk factors, the presence of all four risk factors was associated with a 5-year shorter life expectancy free of acute coronary syndrome (women: from 67.1 ± 12.0 to 61.9 ± 10.3 years; r = -0.089; p < 0.001 and men: from 62.8 ± 12.2 to 58.9 ± 9.9 years; r = -0.096; p < 0.001). Premature acute coronary syndrome (women <67 years and men <63 years) was remarkably related to current smoking and hypercholesterolemia among women (RRs: 3.96; 95% CI: 3.72-4.20 and 1.31; 95% CI: 1.25-1.38, respectively) and men (RRs: 2.82; 95% CI: 2.71-2.93 and 1.39; 95% CI: 1.34-1.45, respectively). Diabetes was most strongly associated with death from premature acute coronary syndrome either in women (RR: 1.52; 95% CI: 1.29-1.79) or men (RR: 1.63; 95% CI: 1.41-1.89). Interpretation Public health policies in South Eastern Europe should place significant emphasis on the four traditional risk factors and the associated lifestyle behaviors to reduce the epidemic of premature ischemic heart disease. Funding None.
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Affiliation(s)
- Raffaele Bugiardini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Edina Cenko
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Maria Bergami
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Guiomar Mendieta
- Servei de Cardiologia, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain & Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marija Zdravkovic
- Faculty of Medicine, Clinical Hospital Center Bezanijska Kosa, University of Belgrade, Belgrade, Serbia
| | - Marija Vavlukis
- University Clinic for Cardiology, Skopje 1000, Republic of North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje 1000, Republic of North Macedonia
| | - Sasko Kedev
- University Clinic for Cardiology, Skopje 1000, Republic of North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje 1000, Republic of North Macedonia
| | - Davor Miličić
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Lina Badimon
- Cardiovascular Research Program ICCC, IR-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, CiberCV-Institute Carlos III, Barcelona, Spain
| | - Olivia Manfrini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Sant’Orsola Hospital, Bologna, Italy
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Ding Y, Zhou Y, Han H, Chen C, Tarasenko Y. Risk Factors of Premature Atherosclerotic Cardiovascular Disease in China: A Longitudinal Analysis of the China Health and Nutrition Survey Cohort. Asia Pac J Public Health 2024; 36:192-201. [PMID: 38247055 DOI: 10.1177/10105395241226525] [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] [Indexed: 01/23/2024]
Abstract
The burden of premature atherosclerotic cardiovascular disease (ASCVD) has increased rapidly in China. Using the China Health and Nutrition Survey (CHNS) data, we assessed the risk factors of premature ASCVD (age of diagnosis: <55 years for men and <65 years for women). Propensity score matching was used to reduce selection bias. Multivariable Cox proportional-hazards analyses indicated that factors associated with increased risk of premature ASCVD included hypertension (adjusted hazard ratio [HRadj.] = 1.68), obesity (HRadj. = 1.64), and high carbohydrate intake (HRadj. = 1.46). Conversely, participants with medical insurance (HRadj. = 0.42), high urbanization index (HRadj. = 0.53), and high household income (HRadj. = 0.48) had lower risk of premature ASCVD. When comparing premature vs non-premature ASCVD participants, those who were obese (HRadj. = 2.08) or living in more urbanized areas had higher hazards of early onset (HRadj. = 2.29).
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Affiliation(s)
- Yihong Ding
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
| | - Yifan Zhou
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
| | - Hui Han
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
| | - Chen Chen
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
- Center for Biostatistics, Bioinformatics, and Big Data, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yelena Tarasenko
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
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20
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Zhang Z, Zhang Y, Liu M, Su H, He Y, Zheng Q, Xu Z, Tang J. Paternal preconception alcohol consumption increased Angiotensin II-mediated vasoconstriction in male offspring cerebral arteries via oxidative stress-AT1R pathway. Addict Biol 2024; 29:e13385. [PMID: 38488472 PMCID: PMC11061854 DOI: 10.1111/adb.13385] [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: 10/25/2023] [Revised: 12/25/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024]
Abstract
Alcohol consumption is popular worldwidely and closely associated with cardiovascular diseases. Influences of paternal preconception alcohol consumption on offspring cerebral arteries are largely unknown. Male rats were randomly given alcohol or water before being mated with alcohol-naive females to produce alcohol- and control-sired offspring. Middle cerebral artery (MCA) was tested with a Danish Myo Technology wire myograph, patch-clamp, IONOPTIX, immunofluorescence and quantitative PCR. Alcohol consumption enhanced angiotensin II (AngII)-mediated constriction in male offspring MCA mainly via AT1R. PD123,319 only augmented AngII-induced constriction in control offspring. AngII and Bay K8644 induced stronger intracellular calcium transient in vascular smooth muscle cells (VSMCs) from MCA of alcohol offspring. L-type voltage-dependent calcium channel (L-Ca2+ ) current at baseline and after AngII-stimulation was higher in VSMCs. Influence of large-conductance calcium-activated potassium channel (BKC a ) was lower. Caffeine induced stronger constriction and intracellular calcium release in alcohol offspring. Superoxide anion was higher in alcohol MCA than control. Tempol and thenoyltrifluoroacetone alleviated AngII-mediated contractions, while inhibition was significantly higher in alcohol group. The mitochondria were swollen in alcohol MCA. Despite lower Kcnma1 and Prkce expression, many genes expressions were higher in alcohol group. Hypoxia induced reactive oxygen species production and increased AT1R expression in control MCA and rat aorta smooth muscle cell line. In conclusion, this study firstly demonstrated paternal preconception alcohol potentiated AngII-mediated vasoconstriction in offspring MCA via ROS-AT1R. Alcohol consumption increased intracellular calcium via L-Ca2+ channel and endoplasmic reticulum and decreased BKCa function. The present study provided new information for male reproductive health and developmental origin of cerebrovascular diseases.
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Affiliation(s)
- Ze Zhang
- Institute for FetologyFirst Hospital of Soochow UniversitySuzhouChina
| | - Yumeng Zhang
- Institute for FetologyFirst Hospital of Soochow UniversitySuzhouChina
| | - Mingxing Liu
- Infection Management DepartmentFirst Hospital of Soochow UniversitySuzhouChina
| | - Hongyu Su
- Institute for FetologyFirst Hospital of Soochow UniversitySuzhouChina
| | - Yun He
- Taixing People's HospitalTaixingChina
| | - Qiutong Zheng
- Institute for FetologyFirst Hospital of Soochow UniversitySuzhouChina
| | - Zhice Xu
- Institute for FetologyFirst Hospital of Soochow UniversitySuzhouChina
- Wuxi Maternily and Child Health HospitalWuxiChina
| | - Jiaqi Tang
- Institute for FetologyFirst Hospital of Soochow UniversitySuzhouChina
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21
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Castillo-García A, Valenzuela PL, Saco-Ledo G, Carrera-Bastos P, Ruilope LM, Santos-Lozano A, Lucia A. Lifestyle and cardiovascular risk in working young adults: insights from a nationwide Spanish cohort. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00069-0. [PMID: 38423178 DOI: 10.1016/j.rec.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION AND OBJECTIVES This study aimed to describe the cardiovascular risk profile of working young adults from Spain and its association with lifestyle. METHODS Participants (18-30 years) were recruited from a nationwide cohort of economically active adults insured by a large occupational risk prevention company, with data obtained from routine medical assessments. The participants were categorized as having an "unhealthy" cardiovascular risk profile based on the presence of prediabetes/diabetes, prehypertension/hypertension, or hypercholesterolemia, or a "healthy" profile if these conditions were completely absent. The association with lifestyle factors (weight, physical activity, sleeping characteristics, alcohol consumption, smoking) was assessed. RESULTS A total of 78 421 young adults (27±2 years, 36% female) were evaluated at baseline. The "unhealthy" cardiovascular risk profile was prevalent (18%) and inversely associated (OR, 0.64; 95%CI, 0.57-0.80) with an optimal lifestyle (normal weight, regular physical activity, no drinking/smoking, and good sleep). The latter condition was found in only 3.5% of the participants. On the other hand, prospective analyses in 44 776 participants (median follow-up=2 [range 2-5] years) showed that 2.0% transitioned from a "healthy" to an "unhealthy" profile. Being physically active (OR, 0.95; 95%CI, 0.81-0.99) and having a normal weight (OR, 0.61; 95%CI, 0.51-0.70) were associated with a lower likelihood of this transition. No consistent associations were found for other lifestyle factors. CONCLUSIONS The prevalence of cardiovascular risk factors is high in economically active young Spanish adults. An unhealthy cardiovascular risk profile is inversely associated with an optimal lifestyle, but the latter is highly infrequent in this population.
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Affiliation(s)
- Adrián Castillo-García
- Departamento de Biología de Sistemas, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain. https://twitter.com/@adrian_science
| | - Pedro L Valenzuela
- Departamento de Biología de Sistemas, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Physical Activity and Health Research Group (PaHerg), Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain.
| | - Gonzalo Saco-Ledo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Pedro Carrera-Bastos
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain; Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Luis M Ruilope
- Grupo de Investigación Traslacional en Hipertensión y Enfermedad Cardiorrenal, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Alejandro Santos-Lozano
- Physical Activity and Health Research Group (PaHerg), Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain; i+HeALTH Strategic Research Group, Universidad Europea Miguel de Cervantes, Valladolid, Spain
| | - Alejandro Lucia
- Physical Activity and Health Research Group (PaHerg), Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain; Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
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22
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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23
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Shareef MAH, Narasimhalu K, Saffari SE, Woon FP, De Silva DA. Recurrent vascular events partially explain association between diabetes and poor prognosis in young ischemic stroke patients. J Neurol Sci 2024; 457:122881. [PMID: 38219383 DOI: 10.1016/j.jns.2024.122881] [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: 07/30/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND AND AIMS Stroke is the second leading cause of death and third leading cause of disability worldwide. There is an increasing incidence of stroke among the young. In this study, we aimed to identify factors associated with poor long-term prognosis in young stroke patients. METHODS In this longitudinal observational study, we recruited 147 young ischemic stroke patients within one week of ischemic stroke and followed them up for functional outcome (modified Rankin score (mRS)), recurrent vascular events, and recurrent hospitalisation. Poor function was labelled as mRS score of 3 and above. We performed univariate and multivariable logistic regression analyses to determine factors associated with poor long term functional outcome. RESULTS At a median follow-up of 7-years, 32 (22%) of the 147 patients had poor functional outcome. In multivariable analyses, diabetes mellitus (OR = 9.01, CI 3.15 to 26.92), was the only independent predictor of poor function. In analyses stratified by diabetic status, recurrent vascular events (OR = 4.47, CI 1.40 to 14.28) were associated with poor functional outcome within young diabetic patients but not in non-diabetic patients. CONCLUSIONS Our findings suggest that diabetes mellitus affects long-term functional outcome in young ischemic stroke and that its effect is mediated partly by recurrent vascular events. DATA ACCESS STATEMENT Data obtained from Multi-Centre Retinal study (MCRS), Singapore site. Data cannot be made publicly available due to potentially identifiable research participant information.
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Affiliation(s)
| | - Kaavya Narasimhalu
- Duke-NUS Medical School, Singapore; National Neuroscience Institute (Singapore General Hospital Campus), Department of Neurology, Singapore.
| | | | - Fung Peng Woon
- Singapore General Hospital, Department of Neurology, Singapore
| | - Deidre Anne De Silva
- Duke-NUS Medical School, Singapore; National Neuroscience Institute (Singapore General Hospital Campus), Department of Neurology, Singapore
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24
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Aguilar-Palacio I, Rabanaque M, Castel S, Maldonado L, González-García J, Compés L, Malo S. Cohort Profile: The CArdiovascular Risk factors for hEalth Services research (CARhES) cohort study. Int J Epidemiol 2024; 53:dyae015. [PMID: 38380446 PMCID: PMC10879753 DOI: 10.1093/ije/dyae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/24/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Isabel Aguilar-Palacio
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - MªJosé Rabanaque
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Sara Castel
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Lina Maldonado
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Department of Applied Economics, University of Zaragoza, Zaragoza, Spain
| | - Juan González-García
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Biocomputing Unit, Aragón Health Sciences Institute (IACS), Zaragoza, Spain
- Data Science for Health Services and Policy Research Group, Aragón Health Sciences Institute (IACS), Zaragoza, Spain
| | - Luisa Compés
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Departamento de Sanidad de Aragón, Dirección General de Asistencia Sanitaria, Zaragoza, Spain
| | - Sara Malo
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
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Stein LK, Maillie L, Erdman J, Loebel E, Mayman N, Sharma A, Wolmer S, Tuhrim S, Fifi JT, Jette N, Mocco J, Dhamoon MS. Variation in US acute ischemic stroke treatment by hospital regions: limited endovascular access despite evidence. J Neurointerv Surg 2024; 16:151-155. [PMID: 37068938 PMCID: PMC11192062 DOI: 10.1136/jnis-2023-020128] [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: 02/28/2023] [Accepted: 04/02/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Although national organizations recognize the importance of regionalized acute ischemic stroke (AIS) care, data informing expansion are sparse. We assessed real-world regional variation in emergent AIS treatment, including growth in revascularization therapies and stroke center certification. We hypothesized that we would observe overall growth in revascularization therapy utilization, but observed differences would vary greatly regionally. METHODS A retrospective cross-sectional analysis was carried out of de-identified national inpatient Medicare Fee-for-Service datasets from 2016 to 2019. We identified AIS admissions and treatment with thrombolysis and endovascular thrombectomy (ET) with International Classification of Diseases, 10th Revision, Clinical Modification codes. We grouped hospitals in Dartmouth Atlas of Healthcare Hospital Referral Regions (HRR) and calculated hospital, demographic, and acute stroke treatment characteristics for each HRR. We calculated the percent of hospitals with stroke certification and AIS cases treated with thrombolysis or ET per HRR. RESULTS There were 957 958 AIS admissions. Relative mean (SD) growth in percent of AIS admissions receiving revascularization therapy per HRR from 2016 to 2019 was 13.4 (31.7)% (IQR -6.1-31.7%) for thrombolysis and 28.0 (72.0)% (IQR 0-56.0%) for ET. The proportion of HRRs with decreased or no difference in ET utilization was 38.9% and the proportion of HRRs with decreased or no difference in thrombolysis utilization was 32.7%. Mean (SD) stroke center certification proportion across HRRs was 45.3 (31.5)% and this varied widely (IQR 18.3-73.4%). CONCLUSIONS Overall growth in AIS treatment has been modest and, within HRRs, growth in AIS treatment and the proportion of centers with stroke certification varies dramatically.
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Affiliation(s)
- Laura K Stein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Luke Maillie
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Erdman
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Emma Loebel
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Naomi Mayman
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Akarsh Sharma
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Stanley Tuhrim
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mandip S Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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26
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Aliramezany M, Moazenzadeh M, Sayyadi A, Mohammadi K, Barzegar H, Aliramezany M. Atrial Septal Abnormalities and Cryptogenic Stroke: A Cross-Sectional Study. Cardiovasc Hematol Disord Drug Targets 2024; 24:40-46. [PMID: 38685781 DOI: 10.2174/011871529x294809240415070950] [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: 12/31/2023] [Revised: 03/19/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Cryptogenic stroke, whose underlying pathology is unknown, accounts for 30-40% of all ischemic strokes. Studies have mentioned the association between atrial septal abnormalities and cryptogenic stroke, but there are still disparities in the results among different studies. OBJECTIVE We aimed to clarify the prevalence of atrial septal abnormalities in patients with cryptogenic stroke. METHODS We conducted a cross-sectional study on 91 patients with cryptogenic stroke/transient ischemic attack from March 2021 to March 2022. We evaluated the demographic data of the patients and also the existence of neurologic attacks. Furthermore, echocardiography was performed to determine the type of atrial septal abnormality. RESULTS Out of 91 patients with cryptogenic stroke/transient ischemic attack, 16 patients (17.5%) had patent foramen ovale, 1 man (1.1%) had atrial septal aneurysm, and 1 woman (1.1%) had an atrial septal defect. Patients with patent foramen ovale were significantly younger than those without. The size of patent foramen ovale in patients with cryptogenic stroke was larger than those with transient ischemic attack, but this difference was not significant. Also, the size of the patent foramen ovale (length and width) was not significantly related to any of the demographic variables (p-value = 0.544, 0.604). CONCLUSION Based on our results, the prevalence of atrial septal abnormalities was relatively high. Considering these issues and the importance of preventing neurological accidents in patients, especially young people, it is recommended to always consider atrial septal disorders and, if diagnosed, to carry out the necessary treatment in this field.
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Affiliation(s)
- Marzieh Aliramezany
- Department of Cardiology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansoor Moazenzadeh
- Department of Cardiology, Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Amin Sayyadi
- Department of Cardiology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Khadijeh Mohammadi
- Department of Cardiology, Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamidreza Barzegar
- Neurology Department, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Aliramezany
- Department of Cardiology, Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
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27
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Pizov NA, Baranova NS. [Ischemic stroke in men 18-50 years of age]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:5-11. [PMID: 38512088 DOI: 10.17116/jnevro20241240325] [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] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To evaluate the main modifiable risk factors for ischemic stroke (IS) and features of the course in atherothrombotic, cardioembolic, and lacunar subtypes of IS in men aged 18-50 years. MATERIAL AND METHODS The study included 125 men (the mean age was 42.6±5.3 years) who were admitted to the Vascular department before the COVID-19 pandemic and survived for the first 30 days after IS. Information on patients' baseline characteristics, traditional vascular risk factors, and lifestyle risk factors was systematically collected. Neuroimaging, ultrasound and laboratory tests were performed. RESULTS Atherothrombotic subtype was identified in 60 patients, lacunar subtype in 46 patients and cardioembolic subtype in 19 patients. In the group as a whole, major risk factors included arterial hypertension (83.2%), dyslipidemia (50.4%), smoking (67.2%), alcohol consumption (29.6%), obesity (16.8%), heart rhythm disorders (12%), and diabetes mellitus (8%). CONCLUSION The study revealed the main risk factors, the frequency of which differed depending on the stroke subtype and the age of the patients.
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Affiliation(s)
- N A Pizov
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - N S Baranova
- Yaroslavl State Medical University, Yaroslavl, Russia
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Zhu X, Gao J, Yuan K, Chen J, Wang H, Zhang X, Xie Y, Wu M, Xie M, Sun J, Fan X, Liu X, Ma M. Association between liver fibrosis and stroke recurrence in young patients with ischemic stroke. Nutr Metab Cardiovasc Dis 2024; 34:112-120. [PMID: 37798237 DOI: 10.1016/j.numecd.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIM Stroke incidence rates are rising among young adults. Liver fibrosis has recently been recognized as a risk factor for cardiovascular events and stroke in the general population. It remains unclear whether liver fibrosis influences the prognosis of stroke. We aimed to evaluate the association between liver fibrosis and stroke recurrence in young stroke patients. METHODS AND RESULTS Young adults with first-ever ischemic stroke were enrolled from a prospective stroke registry and were followed up for stroke recurrence. Liver fibrosis was evaluated by Fibrosis-4 (FIB-4) score and was stratified into three categories. Cox regression analysis was performed to assess the relationship between liver fibrosis and stroke recurrence. Over a median follow-up of 3.1 (1.7-4.6) years, 72 (11.6%) recurrent strokes occurred among 621 patients. According to the FIB-4 score, 73 (11.7%) patients had indeterminate fibrosis, while 11 (1.8%) had advanced fibrosis. Univariate Cox analysis revealed that patients with a high FIB-4 score were more likely to experience stroke recurrence than those with a low FIB-4 score (hazard ratio 3.748, 95% confidence interval 1.359-10.332, P = 0.011). After adjusting for potential confounders in the multivariate analysis, FIB-4 score remained an independent risk factor. CONCLUSIONS Young stroke patients with advanced liver fibrosis were at a greater risk of stroke recurrence. Evaluating liver fibrosis may provide valuable information for stroke risk stratification, and the FIB-4 score could serve as a useful tool.
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Affiliation(s)
- Xinyi Zhu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Jie Gao
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Kang Yuan
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Jingjing Chen
- Department of Neurology, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Huaiming Wang
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China; Department of Neurology, The 80th Group Army Hospital of The People's Liberation Army, Weifang, Shandong, 261021, China
| | - Xiaohao Zhang
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Yi Xie
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Min Wu
- Department of Neurology, Nanjing Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China
| | - Mengdi Xie
- Department of Neurology, Nanjing Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China
| | - Jinpeng Sun
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Xinying Fan
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China; Department of Neurology, Nanjing Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China.
| | - Xinfeng Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China; Department of Neurology, Nanjing Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China; Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Minmin Ma
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China; Department of Neurology, Nanjing Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China.
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Hao H, Yoo SR, Strickland MJ, Darrow LA, D'Souza RR, Warren JL, Moss S, Wang H, Zhang H, Chang HH. Effects of air pollution on adverse birth outcomes and pregnancy complications in the U.S. state of Kansas (2000-2015). Sci Rep 2023; 13:21476. [PMID: 38052850 PMCID: PMC10697947 DOI: 10.1038/s41598-023-48329-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023] Open
Abstract
Neonatal mortality and morbidity are often caused by preterm birth and lower birth weight. Gestational diabetes mellitus (GDM) and gestational hypertension (GH) are the most prevalent maternal medical complications during pregnancy. However, evidence on effects of air pollution on adverse birth outcomes and pregnancy complications is mixed. Singleton live births conceived between January 1st, 2000, and December 31st, 2015, and reached at least 27 weeks of pregnancy in Kansas were included in the study. Trimester-specific and total pregnancy exposures to nitrogen dioxide (NO2), particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5), and ozone (O3) were estimated using spatiotemporal ensemble models and assigned to maternal residential census tracts. Logistic regression, discrete-time survival, and linear models were applied to assess the associations. After adjustment for demographics and socio-economic status (SES) factors, we found increases in the second and third trimesters and total pregnancy O3 exposures were significantly linked to preterm birth. Exposure to the second and third trimesters O3 was significantly associated with lower birth weight, and exposure to NO2 during the first trimester was linked to an increased risk of GDM. O3 exposures in the first trimester were connected to an elevated risk of GH. We didn't observe consistent associations between adverse pregnancy and birth outcomes with PM2.5 exposure. Our findings indicate there is a positive link between increased O3 exposure during pregnancy and a higher risk of preterm birth, GH, and decreased birth weight. Our work supports limiting population exposure to air pollution, which may lower the likelihood of adverse birth and pregnancy outcomes.
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Affiliation(s)
- Hua Hao
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd., NE, Atlanta, GA, 30322, USA.
| | - Sodahm R Yoo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Matthew J Strickland
- Depatment of Health Analytics and Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, NV, 89557, USA
| | - Lyndsey A Darrow
- Depatment of Health Analytics and Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, NV, 89557, USA
| | - Rohan R D'Souza
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Joshua L Warren
- Department of Biostatistics, School of Medicine, Yale University, New Haven, CT, 06510, USA
| | - Shannon Moss
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Huaqing Wang
- Department of Landscape Architecture and Environment Planning, College of Agriculture and Applied Sciences, Utah State University, Logan, UT, 84322, USA
| | - Haisu Zhang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd., NE, Atlanta, GA, 30322, USA
| | - Howard H Chang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd., NE, Atlanta, GA, 30322, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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Richards-Belle A, Poole N, Osborn DP, Bell V. Longitudinal associations between stroke and psychosis: a population-based study. Psychol Med 2023; 53:7698-7706. [PMID: 37272367 PMCID: PMC10755233 DOI: 10.1017/s0033291723001575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND The co-occurrence of stroke and psychosis is a serious neuropsychiatric condition but little is known about the course of this comorbidity. We aimed to estimate longitudinal associations between stroke and psychosis over 10 years. METHODS A 10-year population-based study using data from the English Longitudinal Study of Ageing. A structured health assessment recorded (i) first-occurrence stroke and (ii) psychosis, at each wave. Each were considered exposures and outcomes in separate analyses. Logistic and Cox proportional hazards regression and Kaplan-Meier methods were used. Models were adjusted for demographic and health behaviour covariates, with missing covariates imputed using random forest multiple imputation. RESULTS Of 19 808 participants, 24 reported both stroke and psychosis (median Wave 1 age 63, 71% female, 50% lowest quintile of net financial wealth) at any point during follow-up. By 10 years, the probability of an incident first stroke in participants with psychosis was 21.4% [95% confidence interval (CI) 12.1-29.6] compared to 8.3% (95% CI 7.8-8.8) in those without psychosis (absolute difference: 13.1%; 95% CI 20.8-4.3, log rank p < 0.001; fully-adjusted hazard ratio (HR): 3.57; 95% CI 2.18-5.84). The probability of reporting incident psychosis in participants with stroke was 2.3% (95% CI 1.4-3.2) compared to 0.9% (95% CI 0.7-1.1) in those without (absolute difference: 1.4%; 95% CI 0.7-2.1, log rank p < 0.001; fully-adjusted HR: 4.98; 95% CI 2.55-9.72). CONCLUSIONS Stroke is an independent predictor of psychosis (and vice versa), after adjustment for potential confounders.
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Affiliation(s)
- Alvin Richards-Belle
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Norman Poole
- Department of Neuropsychiatry, South West London and St George's Mental Health NHS Trust, London, UK
| | | | - Vaughan Bell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Nicolini E, Saia V, Lorenzano S, Pracucci G, Iacobucci M, De Michele M, Vallone S, Bergui M, Diomedi M, Nencini P, Tassi R, Saletti A, Puglielli E, Naldi A, Vinci SL, Giannini N, Malfatto L, Roberto M, Romano DG, Cappellari M, Zini A, Sallustio F, Casetta I, Fainardi E, Mangiafico S, Toni D. Mechanical thrombectomy in young patients with large vessel occlusion-related ischemic stroke: Data from the Italian Registry of Endovascular Treatment in Acute Stroke. Eur J Neurol 2023; 30:3751-3760. [PMID: 37565375 DOI: 10.1111/ene.16035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/28/2023] [Accepted: 08/08/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND PURPOSE The weight of outcome predictors in acute ischemic stroke (AIS) patients older than 60 years is not necessarily mirrored in the younger population, posing the question of whether outcome determinants specific for the latter might vary. Very few data are available on predictors of outcome in young AIS patients receiving endovascular treatment (EVT). METHODS We analyzed data for patients aged between 16 and 55 years from the Italian Registry of Endovascular Treatment in Acute Stroke. We divided our population into patients <45 years old and patients aged between 45 and 55 years. After testing the differences between groups in terms of 90-day modified Rankin Scale (mRS) 0-2, mortality, and symptomatic intracranial hemorrhage, we looked for predictors of poor outcome (mRS 3-6), death, and symptomatic intracerebral hemorrhage in the two groups. RESULTS A total of 438 patients younger than 45 years and 817 aged 45-55 years were included; 284 (34.8%) patients aged 45-55 years and 112 (25.6%) patients younger than 45 years old showed poor 90-day functional outcome (p = 0.001). Predictors of poor outcome in the older group were baseline National Institutes of Health Stroke Scale (NIHSS; p < 0.001), diabetes (p = 0.027), poor collateral status (p = 0.036), and groin puncture-to-recanalization time (p = 0.010), whereas Thrombolysis in Cerebral Infarction (TICI) 2b-3 had an inverse association (p < 0.001). Predictors of poor outcome in patients younger than 45 years were baseline NIHSS (p < 0.001) and groin puncture-to-recanalization time (p = 0.015), whereas an inverse association was found for baseline Alberta Stroke Program Early CT Score (p = 0.010) and TICI 2b-3 (p < 0.001). CONCLUSIONS Approximately one third of young adults treated with EVT do not reach a good functional outcome. Fast and successful recanalization, rather than common risk factors, has a major role in determining clinical outcome.
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Affiliation(s)
- Ettore Nicolini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Svetlana Lorenzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Marta Iacobucci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Manuela De Michele
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | - Rossana Tassi
- Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Andrea Saletti
- Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | | | | | | | | | - Laura Malfatto
- Istituti di Ricovero e Cura a Carattere Scientifico - IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Daniele G Romano
- Azienda Ospedaliera Universitaria S. Giovanni di Dio Ruggi D'Aragona, Salerno, Italy
| | | | - Andrea Zini
- Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Ilaria Casetta
- Clinical Neurology, University of Ferrara, Ferrara, Italy
| | | | - Salvatore Mangiafico
- Istituti di Ricovero e Cura a Carattere Scientifico - IRCCS Neuromed, Pozzilli, Italy
| | - Danilo Toni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Fortson K, Rajbhandari-Thapa J, Ingels J, Thapa K, Dube SR. Adverse childhood experiences, risk of opioid misuse and its pathway among students at a public university. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2859-2868. [PMID: 34788586 DOI: 10.1080/07448481.2021.2002336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 09/08/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We examine role of ACEs and pathways to risk of opioid misuse among young adults. Participants and Methods: A cross-sectional survey of validated measures of ACEs, risk of opioid misuse, and health conditions with a sample of 1,402 students from a large public university followed by multivariate logistic regression and pathway analysis. Results: Majority (61%) of participants reported at least one ACE. A dose-response relationship between numbers of ACEs with risk for opioid misuse was present. Compared to participants with no ACEs, participants with ≥4 ACEs and 0-3 ACEs were 2.93 (95% CI: 1.95, 4.39; p < 0.001) and 1.96 (95% CI: 1.46, 2.65; p < 0.001) times more likely to be at risk for opioid misuse, respectively. Having at least one existing or past health condition significantly mediated the association. Conclusions: Our findings suggest need to include assessment of ACEs as a screening criterion for opioid prescription and administration among college-aged individuals.
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Affiliation(s)
- Kennicia Fortson
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Janani Rajbhandari-Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Justin Ingels
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Kiran Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Shanta R Dube
- Department of Population Health Sciences, School of Public Health, Georgia State University, Athens, Georgia, USA
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Nampogo AM, Musubire AK, Bagasha P, Mbalinda S, Moore S, Katabira ET, Sajatovic M, Kaddumukasa M. Thirty-day mortality rates among young adult stroke patients and their characteristics at Kiruddu and Mulago hospitals in Uganda: A prospective observational cohort study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001892. [PMID: 37883355 PMCID: PMC10602322 DOI: 10.1371/journal.pgph.0001892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023]
Abstract
Stroke outcomes among young adults in Uganda are unclear. This study therefore determined the clinical characteristics and 30-day outcome among young adults with an acute stroke. In a prospective observational cohort study, 61 young adults with confirmed stroke were followed up for 30 days. Socio-demographic and clinical characteristics were collected using a study questionnaire. Kaplan-Meier curves, and modified Poisson regression were performed for factors associated with the 30-day mortality outcome. A third of the screened stroke survivors, (61/195) were young adults aged between 18 and 50 years. About two-thirds were male. More than half were diagnosed with ischaemic strokes while 42.6% had a haemorrhagic stroke. Nearly half (29/61) were known hypertensives, 43% (26/61) had a history of alcohol consumption with 95% classified as dependent on CAGE assessment. Ten percent had a prior smoking history while 29% of the female gender had a prior history of oral contraception use. Twenty-three percent (14/61) of the young stroke patients died within 30 days of stroke onset (95% CI: 0.01, 0. 901). A history of smoking (adjusted prevalence ratio: aPR;5. 094, 95% CI: 3.712, 6. 990) and stroke severity National Institutes of Health Stroke score (NIHSS) >16; Prevalence ratio (PR) -3. 301, 95%CI: 1. 395, 7. 808) and not drinking alcohol (aPR (adjusted prevalence ratio) -7. 247, 95% CI: 4. 491, 11.696) were associated with 30- day mortality. A third of all stroke survivors were young adults. About 23. 3% died within 30 days of stroke onset. Stroke severity and a history of smoking were associated with mortality. Identifying high risk patients and early outpatient follow up may help reduce the 30-day mortality in our settings.
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Affiliation(s)
- Adrian Mwota Nampogo
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Peace Bagasha
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Kiruddu National Referral Hospital, Kampala, Uganda
| | - Scovia Mbalinda
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Shirley Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States of America
| | - Elly. T. Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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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.
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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.
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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.
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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
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de Havenon A, Zhou LW, Johnston KC, Dangayach NS, Ney J, Yaghi S, Sharma R, Abbasi M, Delic A, Majersik JJ, Anadani M, Tirschwell DL, Sheth KN. Twenty-Year Disparity Trends in United States Stroke Death Rate by Age, Race/Ethnicity, Geography, and Socioeconomic Status. Neurology 2023; 101:e464-e474. [PMID: 37258298 PMCID: PMC10401675 DOI: 10.1212/wnl.0000000000207446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/07/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In 2017, the Centers for Disease Control and Prevention (CDC) issued an alert that, after decades of consistent decline, the stroke death rate levelled off in 2013, particularly in younger individuals and without clear origin. The objective of this analysis was to understand whether social determinants of health have influenced trends in stroke mortality. METHODS We performed a longitudinal analysis of county-level ischemic and hemorrhagic stroke death rate per 100,000 adults from 1999 to 2018 using a Bayesian spatiotemporally smoothed CDC dataset stratified by age (35-64 years [younger] and 65 years or older [older]) and then by county-level social determinants of health. We reported stroke death rate by county and the percentage change in stroke death rate during 2014-2018 compared with that during 2009-2013. RESULTS We included data from 3,082 counties for younger individuals and 3,019 counties for older individuals. The stroke death rate began to increase for younger individuals in 2013 (p < 0.001), and the slope of the decrease in stroke death rate tapered for older individuals (p < 0.001). During the 20-year period of our study, counties with a high social deprivation index and ≥10% Black residents consistently had the highest rates of stroke death in both age groups. Comparing stroke death rate during 2014-2018 with that during 2009-2013, larger increases in younger individuals' stroke death rate were seen in counties with ≥90% (vs <90%) non-Hispanic White individuals (3.2% mean death rate change vs 1.7%, p < 0.001), rural (vs urban) populations (2.6% vs 2.0%, p = 0.019), low (vs high) proportion of medical insurance coverage (2.9% vs 1.9%, p = 0.002), and high (vs low) substance abuse and suicide mortality (2.8 vs 1.9%, p = 0.008; 3.3% vs 1.5%, p < 0.001). In contrast to the younger individuals, in older individuals, the associations with increased death rates were with more traditional social determinants of health such as the social deprivation index, urban location, unemployment rate, and proportion of Black race and Hispanic ethnicity residents. DISCUSSION Improvements in the stroke death rate in the United States are slowing and even reversing in younger individuals and many US counties. County-level increases in stroke death rate were associated with distinct social determinants of health for younger vs older individuals. These findings may inform targeted public health strategies.
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Affiliation(s)
- Adam de Havenon
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle.
| | - Lily W Zhou
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Karen C Johnston
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Neha S Dangayach
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - John Ney
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Shadi Yaghi
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Richa Sharma
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Mehdi Abbasi
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Alen Delic
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Jennifer Juhl Majersik
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Mohammad Anadani
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - David L Tirschwell
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Kevin Navin Sheth
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
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Inam SHA, Chaychi MTM, Mannan MS, Hanson JE, Ferguson P, Nolte J. Cerebellar Stroke in a Young Adult Following an Amusement Park Ride. Cureus 2023; 15:e44165. [PMID: 37753051 PMCID: PMC10519367 DOI: 10.7759/cureus.44165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
The incidence of stroke in young individuals has been showing an increasing trend. In such cases, atypical mechanisms of stroke should be considered. Here, we report a case of a 37-year-old healthy female who presented with complaints of right-sided ataxia and clumsiness that started after an amusement park ride where she was swung rapidly. Imaging revealed an infarct in the right cerebellar hemisphere. This case report highlights certain mechanisms that can cause a stroke in this situation, with special emphasis on recognition, timely medical management, public awareness of such risk factors, and the prevention of complications.
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Affiliation(s)
- Syed Hashim Ali Inam
- Neurology, Joan C. Edwards School of Medicine, Marshall University, Huntington, USA
| | | | | | - Jonathan E Hanson
- Neurology, Joan C. Edwards School of Medicine, Marshall University, Huntington, USA
| | - Paul Ferguson
- Neurology, Joan C. Edwards School of Medicine, Marshall University, Huntington, USA
| | - Justin Nolte
- Neurology, Joan C. Edwards School of Medicine, Marshall University, Huntington, USA
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Bukhari S, Yaghi S, Bashir Z. Stroke in Young Adults. J Clin Med 2023; 12:4999. [PMID: 37568401 PMCID: PMC10420127 DOI: 10.3390/jcm12154999] [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: 05/20/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Stroke in young adults is associated with significant morbidity, and its prevalence is rising in the United States. This is partly attributed to a rise in the prevalence of traditional risk factors including hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease. In addition, there are non-modifiable risk factors comprising migraine, pregnancy and postpartum state, illicit drug use, oral contraceptives and hypercoagulable state. The mechanisms causing stroke in young adults are unique and include cervical dissection, cardioembolic phenomenon, vasculitis and vasculopathy, connective tissue disease, patent foramen ovale and cerebral venous thrombosis. The diagnosis of stroke in the young population can be challenging given its myriad clinical presentations. In this document, we provide an overview of the epidemiology of stroke in young adults, explore mechanisms that may explain increasing rates of stroke in this population, and provide a critical updated overview of the existing literature on the management and prevention of stroke in young adults.
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Affiliation(s)
- Syed Bukhari
- Temple University Hospital, Philadelphia, PA 19140, USA
| | - Shadi Yaghi
- Department of Medicine, Brown University, Providence, RI 02912, USA; (S.Y.); (Z.B.)
| | - Zubair Bashir
- Department of Medicine, Brown University, Providence, RI 02912, USA; (S.Y.); (Z.B.)
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39
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Pearce G, O’Donnell J, Pimentel R, Blake E, Mackenzie L. Interventions to Facilitate Return to Work after Stroke: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6469. [PMID: 37569011 PMCID: PMC10418317 DOI: 10.3390/ijerph20156469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To gather knowledge about effective return to work interventions for survivors of stroke. METHODS A database search was conducted in MEDLINE, CINAHL, PsycINFO, Scopus, and Web of Science using keywords and medical subject headings. Studies were included if they met the following criteria: (i) studies published in English since the year 2000; (ii) adult patients aged 18-65 with a primary diagnosis of stroke; (iii) working pre-stroke; and (iv) intervention in which one of the primary outcomes is return to work. The methodological quality of included studies was assessed and the evidence synthesised. RESULTS Twelve studies were included, of which three were randomised controlled trials, four were retrospective studies, one was a cohort study, one was an explorative longitudinal study, one was a pre-post treatment observation study and two were pilot studies. The employment rate at follow-up ranged from 7% to 75.6%. Overall, there was limited published evidence regarding the effectiveness of interventions to promote return to work for this population, and it was unclear if return to pre-stroke work was the goal. CONCLUSION A lack of large, controlled trials, variations in follow-up time and the definitions of return to work accounted for the large range of employment rates at follow-up. There is limited published high-quality evidence regarding the effectiveness of interventions to promote return to work in working-age survivors of stroke.
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Affiliation(s)
- Gemma Pearce
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Occupational Therapy Department, Concord Repatriation General Hospital, Concord, NSW 2139, Australia
| | - Joan O’Donnell
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Rebecca Pimentel
- Occupational Therapy Helping Children, Frenchs Forest, NSW 2086, Australia
| | - Elizabeth Blake
- Occupational Therapy Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Lynette Mackenzie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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Diniz MS, Grilo LF, Tocantins C, Falcão-Pires I, Pereira SP. Made in the Womb: Maternal Programming of Offspring Cardiovascular Function by an Obesogenic Womb. Metabolites 2023; 13:845. [PMID: 37512552 PMCID: PMC10386510 DOI: 10.3390/metabo13070845] [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: 05/31/2023] [Revised: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Obesity incidence has been increasing at an alarming rate, especially in women of reproductive age. It is estimated that 50% of pregnancies occur in overweight or obese women. It has been described that maternal obesity (MO) predisposes the offspring to an increased risk of developing many chronic diseases in an early stage of life, including obesity, type 2 diabetes, and cardiovascular disease (CVD). CVD is the main cause of death worldwide among men and women, and it is manifested in a sex-divergent way. Maternal nutrition and MO during gestation could prompt CVD development in the offspring through adaptations of the offspring's cardiovascular system in the womb, including cardiac epigenetic and persistent metabolic programming of signaling pathways and modulation of mitochondrial metabolic function. Currently, despite diet supplementation, effective therapeutical solutions to prevent the deleterious cardiac offspring function programming by an obesogenic womb are lacking. In this review, we discuss the mechanisms by which an obesogenic intrauterine environment could program the offspring's cardiovascular metabolism in a sex-divergent way, with a special focus on cardiac mitochondrial function, and debate possible strategies to implement during MO pregnancy that could ameliorate, revert, or even prevent deleterious effects of MO on the offspring's cardiovascular system. The impact of maternal physical exercise during an obesogenic pregnancy, nutritional interventions, and supplementation on offspring's cardiac metabolism are discussed, highlighting changes that may be favorable to MO offspring's cardiovascular health, which might result in the attenuation or even prevention of the development of CVD in MO offspring. The objectives of this manuscript are to comprehensively examine the various aspects of MO during pregnancy and explore the underlying mechanisms that contribute to an increased CVD risk in the offspring. We review the current literature on MO and its impact on the offspring's cardiometabolic health. Furthermore, we discuss the potential long-term consequences for the offspring. Understanding the multifaceted effects of MO on the offspring's health is crucial for healthcare providers, researchers, and policymakers to develop effective strategies for prevention and intervention to improve care.
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Affiliation(s)
- Mariana S Diniz
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-531 Coimbra, Portugal
- Ph.D. Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, 3004-531 Coimbra, Portugal
| | - Luís F Grilo
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-531 Coimbra, Portugal
- Ph.D. Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, 3004-531 Coimbra, Portugal
| | - Carolina Tocantins
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-531 Coimbra, Portugal
- Ph.D. Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, 3004-531 Coimbra, Portugal
| | - Inês Falcão-Pires
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
| | - Susana P Pereira
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-531 Coimbra, Portugal
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, 4200-450 Porto, Portugal
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Urner TM, Cowdrick KR, Brothers RO, Boodooram T, Zhao H, Goyal V, Sathialingam E, Quadri A, Turrentine K, Akbar MM, Triplett SE, Bai S, Buckley EM. Normative cerebral microvascular blood flow waveform morphology assessed with diffuse correlation spectroscopy. BIOMEDICAL OPTICS EXPRESS 2023; 14:3635-3653. [PMID: 37497521 PMCID: PMC10368026 DOI: 10.1364/boe.489760] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/05/2023] [Accepted: 05/20/2023] [Indexed: 07/28/2023]
Abstract
Microvascular cerebral blood flow exhibits pulsatility at the cardiac frequency that carries valuable information about cerebrovascular health. This study used diffuse correlation spectroscopy to quantify normative features of these waveforms in a cohort of thirty healthy adults. We demonstrate they are sensitive to changes in vascular tone, as indicated by pronounced morphological changes with hypercapnia. Further, we observe significant sex-based differences in waveform morphology, with females exhibiting higher flow, greater area-under-the-curve, and lower pulsatility. Finally, we quantify normative values for cerebral critical closing pressure, i.e., the minimum pressure required to maintain flow in a given vascular region.
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Affiliation(s)
- Tara M Urner
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Kyle R Cowdrick
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Rowan O Brothers
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Tisha Boodooram
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Hongting Zhao
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Vidisha Goyal
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Eashani Sathialingam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Ayesha Quadri
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Katherine Turrentine
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Mariam M Akbar
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Sydney E Triplett
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Shasha Bai
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA 30322, USA
| | - Erin M Buckley
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA 30322, USA
- Children's Research Scholar, Children's Healthcare of Atlanta, 2015 Uppergate Dr., Atlanta, GA 30322, USA
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Wallen M, Banerjee P, Webb-McAdams A, Mirajkar A, Stead T, Ganti L. Systolic blood pressure in acute ischemic stroke and impact on clinical outcomes. J Osteopath Med 2023:jom-2022-0191. [PMID: 37043363 DOI: 10.1515/jom-2022-0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/13/2023] [Indexed: 04/13/2023]
Abstract
CONTEXT Stroke is one of the largest healthcare burdens in the United States and globally. It continues to be one of the leading causes of morbidity and mortality. Patients with acute ischemic stroke (AIS) often present with elevated blood pressure (BP). OBJECTIVES The objective of our study was to evaluate the association of systolic blood pressure (SBP) in the emergency department (ED) with stroke severity in patients with AIS. METHODS This observational study was conducted at an ED with an annual census of 80,000 visits, approximately half (400) of which are for AIS. The cohort consisted of adult patients who presented to the ED within 24 h of stroke symptom onset. BP was measured at triage by a nurse blinded to the study. Stroke severity was measured utilizing the National Institutes of Health Stroke Scale (NIHSS). Statistical analyses were performed utilizing JMP 14.0. This study was approved by our medical school's institutional review board. RESULTS Patients with higher SBP had significantly lower NIHSS scores (p=0.0038). This association was significant even after adjusting for age and gender. By contrast, diastolic blood pressure (DBP) did not appear to impact stroke severity. There was no difference in the DBP values between men and women. Higher SBP was also significantly associated with being discharged home as well as being less likely to die in the hospital or discharged to hospice. The DBP did not demonstrate this association. Neither the SDP nor the DBP were significantly associated with the hospital length of stay (LOS). In multivariate models that included age, gender, basal metabolic index (BMI), comorbidities, and ED presentation, elevated SBP was associated with better prognosis. CONCLUSIONS In this cohort of patients presenting with stroke-like symptoms to the ED, higher SBP was associated with lower stroke severity and higher rates of being discharged to home rather than hospice or death.
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Affiliation(s)
| | - Paul Banerjee
- Envision Physician Services, Plantation, FL, USA
- Polk County Fire Rescue, Bartow, FL, USA
| | - Amanda Webb-McAdams
- Envision Physician Services, Plantation, FL, USA
- University of Central Florida College of Medicine/HCA GME Consortium, Orlando, FL, USA
| | - Amber Mirajkar
- Envision Physician Services, Plantation, FL, USA
- University of Central Florida College of Medicine/HCA GME Consortium, Orlando, FL, USA
| | - Tej Stead
- Brown University, Providence, RI, USA
| | - Latha Ganti
- Envision Physician Services, Plantation, FL, USA
- University of Central Florida College of Medicine/HCA GME Consortium, Orlando, FL, USA
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Park HK, Lee KJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Han MK, Kang J, Kim BJ, Park TH, Park MS, Lee KB, Lee J, Hong KS, Cho YJ, Lee BC, Yu KH, Oh MS, Kim JT, Choi KH, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Sohn SI, Hong JH, Lee J, Lee K, Song J, Bae JS, Cheong HS, Debette S, Bae HJ. Prevalence of Mutations in Mendelian Stroke Genes in Early Onset Stroke Patients. Ann Neurol 2023; 93:768-782. [PMID: 36541592 DOI: 10.1002/ana.26575] [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: 03/15/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Heritability of stroke is assumed not to be low, especially in the young stroke population. However, most genetic studies have been performed in highly selected patients with typical clinical or neuroimaging characteristics. We investigated the prevalence of 15 Mendelian stroke genes and explored the relationships between variants and the clinical and neuroimaging characteristics in a large, unselected, young stroke population. METHODS We enrolled patients aged ≤55 years with stroke or transient ischemic attack from a prospective, nationwide, multicenter stroke registry. We identified clinically relevant genetic variants (CRGVs) in 15 Mendelian stroke genes (GLA, NOTCH3, HTRA1, RNF213, ACVRL1, ENG, CBS, TREX1, ABCC6, COL4A1, FBN1, NF1, COL3A1, MT-TL1, and APP) using a customized, targeted next generation sequencing panel. RESULTS Among 1,033 patients, 131 (12.7%) had 28 CRGVs, most frequently in RNF213 (n = 59), followed by ABCC6 (n = 53) and NOTCH3 (n = 15). The frequency of CRGVs differed by ischemic stroke subtypes (p < 0.01): the highest in other determined etiology (20.1%), followed by large artery atherosclerosis (13.6%). It also differed between patients aged ≤35 years and those aged 51 to 55 years (17.1% vs 9.3%, p = 0.02). Only 27.1% and 26.7% of patients with RNF213 and NOTCH3 variants had typical neuroimaging features of the corresponding disorders, respectively. Variants of uncertain significance (VUSs) were found in 15.4% patients. INTERPRETATION CRGVs in 15 Mendelian stroke genes may not be uncommon in the young stroke population. The majority of patients with CRGVs did not have typical features of the corresponding monogenic disorders. Clinical implications of having CRGVs or VUSs should be explored. ANN NEUROL 2023;93:768-782.
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Affiliation(s)
- Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Keon-Joo Lee
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, South Korea
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, South Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Moon-Ku Han
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jihoon Kang
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, South Korea
| | - Moo-Seok Park
- Department of Neurology, Seoul Hospital, Ewha Woman's University College of Medicine, Seoul, South Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, South Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea
- Research Center for Artificial Intelligence, JLK Corporation, Seoul, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University College of Medicine, Ulsan, South Korea
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University College of Medicine, Ulsan, South Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk University Hospital, Cheongju, South Korea
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Kyunghoon Lee
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Junghan Song
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Joon Seol Bae
- Research Institute of Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Hyun Sub Cheong
- Research Institute for Life Science, GW Vitek, Seoul, South Korea
| | - Stéphanie Debette
- University of Bordeaux, Bordeaux Population Health Research Center, Bordeaux, France
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Volz M, Ladwig S, Werheid K. Return to work and depressive symptoms in young stroke survivors after six and twelve months: cross-sectional and longitudinal analyses. Top Stroke Rehabil 2023; 30:263-271. [PMID: 35068384 DOI: 10.1080/10749357.2022.2026562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND While depression after stroke is common and stroke prevalence globally increases in working age populations, the role of return-to-work (RTW) in the pathogenesis of post-stroke depression (PSD) remains unclear. This study examined if RTW is linked to PSD within the first year after ischemic stroke, independently from established risk factors. METHOD Stroke survivors (n = 176) in their working age (<65 years) recruited from two rehabilitation clinics were assessed for established risk factors: pre-stroke depression, activities of daily living, stroke severity, cognitive impairment, and social support. RTW and depressive symptoms (Geriatric Depression Scale: GDS-15) were assessed six- and twelve-months post-stroke. Multivariate regression analyses were used to assess the cross-sectional and longitudinal relationship between RTW and GDS-15, while controlling for established PSD risk factors. RESULTS Successful RTW was independently associated with lower GDS-15 at both measurement occasions (p < .05), next to the absence of pre-stroke depression and higher social support. Stroke severity predicted GDS-15 at twelve months. The predictive value of six-months RTW for subsequent depressive symptoms beyond the influence of established risk factors was ß = -1.73 (p = .09). DISCUSSION RTW was independently associated with PSD in young stroke survivors within the first-year post-stroke, and exerted a (marginally significant) effect on subsequent depression. Our study highlights the relevance of RTW for young stroke survivors' PSD, beyond the influence of established risk factors. Further assessments examining to what extent fostering RTW contributes to mental well-being after stroke might be promising for PSD prevention, next to evident beneficial economic effects.
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Affiliation(s)
- Matthias Volz
- Department of Psychology, Universität Kassel, Kassel, Germany
| | - Simon Ladwig
- Department of Psychology, Humboldt Universität zu Berlin, Berlin, Germany.,Clinic of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Katja Werheid
- Department of Psychology, Universität Bielefeld, Bielefeld, Germany
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Busby N, Hillis AE, Bunker L, Rorden C, Newman-Norlund R, Bonilha L, Meier E, Goldberg E, Hickok G, Yourganov G, Fridriksson J. Comparing the brain-behaviour relationship in acute and chronic stroke aphasia. Brain Commun 2023; 5:fcad014. [PMID: 37056476 PMCID: PMC10088484 DOI: 10.1093/braincomms/fcad014] [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: 03/04/2022] [Revised: 07/23/2022] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
In stroke aphasia, lesion volume is typically associated with aphasia severity. Although this relationship is likely present throughout recovery, different factors may affect lesion volume and behaviour early into recovery (acute) and in the later stages of recovery (chronic). Therefore, studies typically separate patients into two groups (acute/chronic), and this is often accompanied with arguments for and against using data from acute stroke patients over chronic. However, no comprehensive studies have provided strong evidence of whether the lesion-behaviour relationship early in recovery is comparable to later in the recovery trajectory. To that end, we investigated two aims: (i) whether lesion data from acute and chronic patients yield similar results in region-based lesion-symptom mapping analyses and (ii) if models based on one timepoint accurately predict the other. Lesions and aphasia severity scores from acute (N = 63) and chronic (N = 109) stroke survivors with aphasia were entered into separate univariate region-based lesion-symptom mapping analyses. A support vector regression model was trained on lesion data from either the acute or chronic data set to give an estimate of aphasia severity. Four model-based analyses were conducted: trained on acute/chronic using leave-one-out, tested on left-out behaviour or trained on acute/chronic to predict the other timepoint. Region-based lesion-symptom mapping analyses identified similar but not identical regions in both timepoints. All four models revealed positive correlations between actual and predicted Western Aphasia Battery-Revised aphasia-quotient scores. Lesion-to-behaviour predictions were almost equivalent when comparing within versus across stroke stage, despite differing lesion size/locations and distributions of aphasia severity between stroke timepoints. This suggests that research investigating the brain-behaviour relationship including subsets of patients from only one timepoint may also be applicable at other timepoints, although it is important to note that these comparable findings may only be seen using broad measures such as aphasia severity, rather than those aimed at identifying more specific deficits. Subtle differences found between timepoints may also be useful in understanding the nature of lesion volume and aphasia severity over time. Stronger correlations found when predicting acute behaviour (e.g. predicting acute: r = 0.6888, P < 0.001, predicting chronic r = 0.5014, P < 0.001) suggest that the acute lesion/perfusion patterns more accurately capture the critical changes in underlying vascular territories. Differences in critical brain regions between timepoints may shed light on recovery patterns. Future studies could focus on a longitudinal design to compare acute and chronic patients in a more controlled manner.
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Affiliation(s)
- Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29209, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MA 21287, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MA 21218, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MA 21287, USA
| | - Lisa Bunker
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MA 21287, USA
| | - Chis Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | - Roger Newman-Norlund
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29209, USA
| | - Leo Bonilha
- Department of Neurology, Emory University, Atlanta, GA 30322, USA
| | - Erin Meier
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MA 21287, USA
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA 02115, USA
| | - Emily Goldberg
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MA 21287, USA
- Department of Communication Disorders, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Gregory Hickok
- Department of Cognitive Sciences, University of California, Irvine, CA 92697, USA
- Department of Language Science, University of California, Irvine, CA 92697, USA
| | - Grigori Yourganov
- Advanced Computing and Data Science, Cyberinfrastructure and Technology Integration, Clemson University, Clemson, SC 29634, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29209, USA
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Mo J, Hu J, Cheng X. The role of high mobility group box 1 in neuroinflammatory related diseases. Biomed Pharmacother 2023; 161:114541. [PMID: 36963363 DOI: 10.1016/j.biopha.2023.114541] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
High mobility group box 1 (HMGB1) is a ubiquitous and highly conserved non-histone DNA-binding protein with different biological functions according to its subcellular localization. It is widely believed that HMGB1, which is released into the extracellular space, plays a key role in the inflammatory response. In recent years, numerous studies have shown that the development of various neurological diseases such as epilepsy, Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), cerebrovascular disease and traumatic brain injury (TBI) are inextricably linked to inflammation. We will review the mechanisms of HMGB1 and its receptors in nervous system inflammation to provide a basis for further development of new HMGB1-based therapies.
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Affiliation(s)
- Jialu Mo
- The First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei, China
| | - Jiao Hu
- The First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei, China
| | - Xianglin Cheng
- The First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei, China.
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Ahmed R, Mhina C, Philip K, Patel SD, Aneni E, Osondu C, Lamikanra O, Akano EO, Anikpezie N, Albright KC, Latorre JG, Chaturvedi S, Otite FO. Age- and Sex-Specific Trends in Medical Complications After Acute Ischemic Stroke in the United States. Neurology 2023; 100:e1282-e1295. [PMID: 36599695 PMCID: PMC10033158 DOI: 10.1212/wnl.0000000000206749] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/15/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To test the hypothesis that the age and sex-specific prevalence of infectious (pneumonia, sepsis, and urinary tract infection [UTI]) and noninfectious (deep venous thrombosis [DVT], pulmonary embolism [PE], acute renal failure [ARF], acute myocardial infarction [AMI], and gastrointestinal bleeding [GIB]) complications increased after acute ischemic stroke (AIS) hospitalization in the United States from 2007 to 2019. METHODS We conducted a serial cross-sectional study using the 2007-2019 National Inpatient Sample. Primary AIS admissions in adults (aged 18 years or older) with and without complications were identified using International Classification of Diseases codes. We quantified the age/sex-specific prevalence of complications and used negative binomial regression models to evaluate trends over time. RESULTS Of 5,751,601 weighted admissions, 51.4% were women. 25.1% had at least 1 complication. UTI (11.8%), ARF (10.1%), pneumonia (3.2%), and AMI (2.5%) were the most common complications, while sepsis (1.7%), GIB (1.1%), DVT (1.2%), and PE (0.5%) were the least prevalent. Marked disparity in complication risk existed by age/sex (UTI: men 18-39 years 2.1%; women 80 years or older 22.5%). Prevalence of UTI (12.9%-9.7%) and pneumonia (3.8%-2.7%) declined, but that of ARF increased by ≈3-fold (4.8%-14%) over the period 2007-2019 (all p < 0.001). AMI (1.9%-3.1%), DVT (1.0%-1.4%), and PE (0.3%-0.8%) prevalence also increased (p < 0.001), but that of sepsis and GIB remained unchanged over time. After multivariable adjustment, risk of all complications increased with increasing NIH Stroke Scale (pneumonia: prevalence rate ratio [PRR] 1.03, 95% CI 1.03-1.04, for each unit increase), but IV thrombolysis was associated with a reduced risk of all complications (pneumonia: PRR 0.80, 85% CI 0.73-0.88; AMI: PRR 0.85, 95% CI 0.78-0.92; and DVT PRR 0.87, 95% CI 0.78-0.98). Mechanical thrombectomy was associated with a reduced risk of UTI, sepsis, and ARF, but DVT and PE were more prevalent in MT hospitalizations compared with those without. All complications except UTI were associated with an increased risk of in-hospital mortality (sepsis: PRR 1.97, 95% CI 1.78-2.19). DISCUSSION Infectious complications declined, but noninfectious complications increased after AIS admissions in the United States in the last decade. Utilization of IV thrombolysis is associated with a reduced risk of all complications.
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Affiliation(s)
- Rashid Ahmed
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Carl Mhina
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Karan Philip
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Smit D Patel
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Ehimen Aneni
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Chukwuemeka Osondu
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Oluwatomi Lamikanra
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Emmanuel Oladele Akano
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Nnabuchi Anikpezie
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Karen C Albright
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Julius G Latorre
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Seemant Chaturvedi
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Fadar Oliver Otite
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore.
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Aycock DM, Clark PC, Hayat MJ, Salazar LF, Eriksen MP. Stroke Counseling Intervention for Young Adult African Americans: A Randomized Controlled Trial. Nurs Res 2023; 72:83-92. [PMID: 36729696 PMCID: PMC9991970 DOI: 10.1097/nnr.0000000000000633] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND African Americans have a higher incidence of early-onset stroke and poorer stroke-related outcomes than other race/ethnic groups. OBJECTIVES Our two-arm, randomized controlled trial was implemented to assess efficacy of the nurse-led Stroke Counseling for Risk Reduction (SCORRE) intervention in reducing stroke risk in young African American adults by improving accuracy of perceived stroke risk and lifestyle behaviors (i.e., diet, physical activity, and smoking cessation). Stroke knowledge, behavior change readiness, and perceived competence to live a healthy lifestyle were also explored as secondary outcomes. METHODS African Americans aged 20-35 years, recruited from an urban university and surrounding community, were randomized to SCORRE or an attention placebo control group receiving safe sex education. Data were collected pre-intervention, immediate post-intervention, and at 8 weeks. Multilevel models were used for primary outcome analyses. RESULTS Participants ( n = 106) were mostly in their mid-20s, female, college students, and averaged about three modifiable stroke risk factors. Compared to the control group, participants in the intervention group had, on average, a significant increase in accuracy of perceived stroke risk post-intervention, a greater change in perceived competence to live healthy, and a greater increase in dietary components at 8 weeks. Significant changes were not found in physical activity and other outcomes. DISCUSSION These findings suggest that SCORRE is a promising intervention to reduce stroke risk among young African American adults. Results will inform a more robust, randomized controlled trial of SCORRE to have an age, culture, and gender-focused intervention that effectively reduces stroke risk among African Americans early in life.
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1337] [Impact Index Per Article: 1337.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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A Systematic Review and Meta-Analysis of the Relationship between Receiving the Flu Vaccine with Acute Cerebrovascular Accident and Its Hospitalization in the Elderly. BIOMED RESEARCH INTERNATIONAL 2023; 2023:2606854. [PMID: 36814798 PMCID: PMC9940958 DOI: 10.1155/2023/2606854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 12/15/2022] [Accepted: 01/21/2023] [Indexed: 02/15/2023]
Abstract
Background and Aims In recent years, various studies have been conducted worldwide to investigate the relationship between receiving the flu vaccine with acute cerebrovascular accident or stroke and its hospitalization in the elderly; however, the results of these studies are contradictory. Therefore, this study was aimed at investigating the relationship between receiving the flu vaccine with stroke and its hospitalization in the elderly. Methods This study is a systematic review and meta-analysis of studies examining the relationship between receiving the flu vaccine with stroke and its hospitalization in the elderly during the years 1980 to 2021 which have been published in ISI Web of Science, Scopus PubMed, Cochrane, Science Direct, Google Scholar, and Embase. All analyses were performed by Stata 15, and the significance level in this study was considered <0.05. Results In the systematic search, 3088 articles were retrieved, considering the study criteria; finally, 14 studies were included in the meta-analysis. Based on the results of the meta-analysis, the odds ratio (OR) of occurrence and hospitalization of stroke compared to the nonvaccinated group in vaccine recipients is equal to 0.84 (95% confidence interval (CI): 0.78-0.90, P value ≤ 0.001). Publication bias was not observed in this study (P value = 0.101). Conclusion Getting the flu vaccine can reduce the risk of occurrence and hospitalization of stroke in the elderly by 16% (10%-22%). Therefore, receiving this vaccine as a preventive intervention for stroke in the elderly may be promising.
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