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Li H, Fagerberg B, Sallsten G, Borné Y, Hedblad B, Engström G, Barregard L, Andersson EM. Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco: Malmö Diet and Cancer Cohort Study. Environ Health 2019; 18:56. [PMID: 31200698 PMCID: PMC6570857 DOI: 10.1186/s12940-019-0495-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/31/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Smoking is a strong risk factor for cardiovascular disease (CVD) and causes exposure to cadmium, which is a pro-atherosclerotic metal. Cadmium exposure has also been shown to increase the risk of CVD, even after adjustment for smoking. Our hypothesis was that part of the risk of CVD in smokers may be mediated by cadmium exposure from tobacco smoke. We examined this hypothesis in a mediation analysis, trying to assess how much of the smoking-induced CVD risk could be explained via cadmium. METHODS We used prospective data on CVD (incidence and mortality) in a Swedish population-based cohort of 4304 middle-aged men and women (the Malmö Diet and Cancer Study). Blood cadmium was analyzed in base-line samples from 1991, and clinical events were followed up for 16-19 years based on registry data. Mediation analysis was conducted to evaluate the indirect effect (via cadmium) of smoking on CVD. Survival was analyzed by the accelerated failure time (AFT) model and the Aalen additive hazard model. RESULTS The mean blood cadmium level in the study population was 0.43 μg/L (median 0.24 μg/L) and increased with recent and current smoking. As expected, shorter survival time (AFT model) and higher incidence rate (Aalen model) were found in current smokers for all CVD outcomes and this effect seemed to be partly mediated by cadmium. For the sum of acute myocardial infarction, bypass grafts and percutaneous coronary intervention, and death in ischemic heart disease, about half of the increased risk of such events in current smokers was mediated via cadmium, with similar results for the AFT and Aalen models. CONCLUSIONS Cadmium plays an important role in smoking-induced CVDs. This provides evidence for mechanisms and is of importance for both individuals and policy makers.
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Affiliation(s)
- Huiqi Li
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, P.O. Box 414, 405 30 Gothenburg, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, P.O. Box 414, 405 30 Gothenburg, Sweden
| | - Yan Borné
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Bo Hedblad
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, P.O. Box 414, 405 30 Gothenburg, Sweden
| | - Eva M. Andersson
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, P.O. Box 414, 405 30 Gothenburg, Sweden
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152
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Tian Y, Wang S, Jiao F, Kong Q, Liu C, Wu Y. Telomere Length: A Potential Biomarker for the Risk and Prognosis of Stroke. Front Neurol 2019; 10:624. [PMID: 31263449 PMCID: PMC6585102 DOI: 10.3389/fneur.2019.00624] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/28/2019] [Indexed: 12/22/2022] Open
Abstract
Stroke is one of the leading causes of death and disability worldwide. Age is associated with increased risk of stroke, while telomere length shortening plays a pivotal role in the process of aging. Moreover, telomere length shortening is associated with many risk factors of stroke in addition to age. Accumulated evidence shows that short leukocyte telomere length is not only associated with stroke occurrence but also associated with post-stroke recovery in the elderly population. In this review, we aimed to summarize the association between leukocyte telomere length and stroke, and discuss that telomere length might serve as a potential biomarker to predict the risk and prognosis of stroke.
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Affiliation(s)
- Yanjun Tian
- Collaborative Innovation Center for Birth Defect Research and Transformation of Shandong Province, Jining Medical University, Jining, China
| | - Shuai Wang
- Shandong Collaborative Innovation Center for Diagnosis, Treatment and Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jining, China.,Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China
| | - Fengjuan Jiao
- Shandong Collaborative Innovation Center for Diagnosis, Treatment and Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jining, China.,Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China
| | - Qingsheng Kong
- Collaborative Innovation Center for Birth Defect Research and Transformation of Shandong Province, Jining Medical University, Jining, China
| | - Chuanxin Liu
- Collaborative Innovation Center for Birth Defect Research and Transformation of Shandong Province, Jining Medical University, Jining, China
| | - Yili Wu
- Collaborative Innovation Center for Birth Defect Research and Transformation of Shandong Province, Jining Medical University, Jining, China.,Shandong Collaborative Innovation Center for Diagnosis, Treatment and Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jining, China.,Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China
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153
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Abstract
Background The pattern of stroke in rural population differs from that in urban ones. Although there are many studies on this condition in sub-Saharan Africa, few studies about stroke pattern in a Kenyan rural area exist.. This study therefore aims at describing the characteristics of stroke in a rural Kenyan hospital. Patients and Methods The study was conducted on 227 consecutive patients admitted with a World Health Organization (WHO) diagnosis of stroke in Kangundo Hospital, a level IV facility in Machakos, Eastern Kenya, between April 2015 and September 2016. The sub-type and anatomical distribution of stroke as well as the age, gender of the patients were recorded prospectively. Diagnosis was made through physical neurological examination and confirmed by Computerized Tomography (CT) scan imaging. Only those with complete bio-data, past medical and social history, clinical and physical findings of the patients and imaging results were included. The data were entered into a pre-formatted questionnaire, analysed for means, standard deviations and frequencies, and are presented in tables and bar charts. Results Out of 3200 medical admissions, 227 (7.09%) had a confirmed diagnosis of stroke. Ischaemic stroke was more common (67.4%) than haemorrhagic stroke (32.6%). It affected mainly the anterior circulation, especially the middle cerebral artery (39%). The mean age of patients was 68.8 years, (Range 32–96). It was more common in females (62%) than in males (38%). Hypertension was the most common (74%) risk factor followed by alcohol abuse (63%), tobacco smoking (48%) and diabetes mellitus (42%). Conclusion Ischaemic stroke was the more common major cause of morbidity in the rural hospital studied in Kenya. It occurred most commonly among elderly females, with the most frequent comorbidities being hypertension. In addition, modifiable lifestyle factors like alcohol abuse and cigarette smoking contributed to the prevalence; hence we recommend the control of blood pressure and glucose as well as lifestyle modification to reduce the scourge in our studied population.
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154
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Schlieder I, Richard M, Nacar A, Rieger R, Bethge A, Vijayakumar S, Dietzek AM. Active Tobacco Use in Patients with Claudication Does Not Affect Outcomes after Endovascular Interventions. Ann Vasc Surg 2019; 60:279-285. [PMID: 31103674 DOI: 10.1016/j.avsg.2019.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND With the advent of endovascular procedures, the indications for intervention in claudicants have become less strict. Many interventionalists, however, will not intervene in patients with lifestyle-limiting claudication unless they have discontinued tobacco use. Many patients are unable to comply with this goal, and there is little published evidence to suggest that continued tobacco use results in poorer outcomes. We sought to determine if it is justified to deny this group of patients endovascular, potentially lifestyle-improving, procedures based on their outcomes. METHODS A retrospective chart review was performed between 2007 and 2011 at a midsize community teaching hospital. Patients included had documented lifestyle-limiting claudication, underwent endovascular therapy, and had no previous vascular intervention. Patients were divided into 2 groups: active smokers (AS) and nonsmokers (NS) including former and never smokers. The primary outcome was the need for reintervention and the secondary outcomes were the need for surgical revascularization, limb loss, myocardial infarction (MI), stroke, and death. RESULTS One hundred thirty-eight patients met inclusion criteria with 89 being male (64.5%). Forty-seven (34%) were active smokers versus 91 (66%) who were nonsmokers. Mean age at initial intervention for all 138 subjects was 66.34 years (standard deviation 10.7) and was not statistically different between the AS and NS groups. Mean follow-up was 3.6 years and was not significantly different between the two groups. Between the two groups (AS vs NS), there was no statistically significant difference between the rate of reintervention, surgical bypass, and limb loss. We also did not observe any significant difference in the rate of MI, stroke, or death during our follow-up period. CONCLUSIONS Although tobacco use has been shown to negatively impact bypass patency, our data show that it does not appear to increase the need for reintervention, conversion to open surgical revascularization, limb loss, or other morbidities in patients undergoing endovascular interventions for claudication. We continue to strongly recommend all our patients who smoke to discontinue tobacco use. Our results, however, do not support the notion that those patients who are unable to quit should be denied the potential benefit of an endovascular intervention. The most important limitation of our study is the small numbers of patients available for review. Larger studies will be necessary to confirm our findings.
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Affiliation(s)
- Ian Schlieder
- Department of Vascular Surgery, Danbury Hospital, Danbury, CT
| | - Michele Richard
- Department of Vascular Surgery, Danbury Hospital, Danbury, CT
| | - Alpen Nacar
- Department of Vascular Surgery, Danbury Hospital, Danbury, CT
| | - Rebecca Rieger
- Department of Vascular Surgery, Danbury Hospital, Danbury, CT
| | - Amy Bethge
- Department of Vascular Surgery, Danbury Hospital, Danbury, CT
| | | | - Alan M Dietzek
- Department of Vascular Surgery, Danbury Hospital, Danbury, CT.
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155
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Lin H, Chen C, Yeh Y, Chen Y, Guo R, Lin Y, Li Y. Dental treatment procedures for periodontal disease and the subsequent risk of ischaemic stroke: A retrospective population‐based cohort study. J Clin Periodontol 2019; 46:642-649. [DOI: 10.1111/jcpe.13113] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/07/2019] [Accepted: 04/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Hsiao‐Wei Lin
- Division of Family Dentistry Changhua Christian Hospital Changhua Taiwan
| | - Chun‐Min Chen
- Research Education and Epidemiology Centre Changhua Christian Hospital Changhua Taiwan
| | - Yi‐Chun Yeh
- Research Education and Epidemiology Centre Changhua Christian Hospital Changhua Taiwan
- Department of Public Health China Medical University Taichung Taiwan
| | - Yen‐Yu Chen
- Research Education and Epidemiology Centre Changhua Christian Hospital Changhua Taiwan
- Department of Neurology Changhua Christian Hospital Changhua Taiwan
- Institute of Clinical Medicine National Yang‐Ming University Taipei Taiwan
| | - Ru‐Yu Guo
- Dental Technology Centre Changhua Christian Hospital Changhua Taiwan
| | - Yen‐Ping Lin
- Dental Technology Centre Changhua Christian Hospital Changhua Taiwan
| | - Ya‐Ching Li
- Dental Technology Centre Changhua Christian Hospital Changhua Taiwan
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156
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Li Y, Zhang X, Sang H, Niu X, Liu T, Liu W, Li J. Urban-rural differences in risk factors for ischemic stroke in northern China. Medicine (Baltimore) 2019; 98:e15782. [PMID: 31124971 PMCID: PMC6571368 DOI: 10.1097/md.0000000000015782] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/08/2019] [Accepted: 05/01/2019] [Indexed: 12/13/2022] Open
Abstract
This study aims to investigate urban-rural differences in characteristics and risk factors of ischemic stroke in northern China.The present cross-sectional study was based on the High-risk Population Screening and Intervention Project for Stroke. The cluster sampling method was used to select urban and rural screening sites in northern China. By collecting information and screening the data, patients with ischemic stroke were obtained and a control group with similar gender, age, and regional distribution was selected among the nonischemic stroke patients. Then, the demographic and risk factors of patients with ischemic stroke were described and analyzed.The prevalence of ischemic stroke in northern China was 2.88%, with a greater prevalence in rural areas than in urban areas (3.32% vs 2.43%), and a greater prevalence in males than in females (3.06% vs 2.73%). Furthermore, rural stroke patients were younger than urban stroke patients. Hypertension, family history of stroke, and smoking were the top 3 independent risk factors for ischemic stroke. Overweight/obesity and low education were associated with increased ischemic stroke in urban areas, while low education was associated with less ischemic stroke in rural areas. In addition, the prevalence of alcoholism, dyslipidemia, diabetes, and obvious overweight/obesity was greater in urban areas, while high-salt diet and low education and income were more prevalent in rural regions. Moreover, the smoking index was higher in rural areas than in urban areas.The characteristics and risk factors of ischemic stroke differ between rural and urban areas, which could be used to design specific preventative measures.
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Affiliation(s)
- Yang Li
- Department of Neurology, the First Hospital of Shanxi Medical University, Taiyuan
| | - Xin Zhang
- Department of Neurology, with the Coal Group General Hospital, Datong
| | - Hui Sang
- Department of Neurology, Taiyuan Central Hospital, Taiyuan
| | - Xiaoyuan Niu
- Department of Neurology, the First Hospital of Shanxi Medical University, Taiyuan
| | - Tingting Liu
- Department of Neurology, the First Hospital of Shanxi Medical University, Taiyuan
| | - Weidong Liu
- Neurosurgical Department, Liaocheng People's Hospital, Liaocheng
| | - Jian Li
- Department of Neurology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
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157
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Verma SK, Kumar BD, Singh S, Kumari P, Agarwal A, Singh TK, Passi D, Goyal J. Effect of gutkha chewing on periodontal health and oral hygiene of peoples in Delhi NCR region of North India: A cross-sectional multicentered study. J Family Med Prim Care 2019; 8:564-567. [PMID: 30984673 PMCID: PMC6436307 DOI: 10.4103/jfmpc.jfmpc_439_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background In India, gutkha is popular among all socioeconomic groups, since it is available easily and is of less cost. Various investigations have demonstrated the relationship of gutkha biting with periodontal status and oral hygiene. Aim The aim of this study is to assess the effect of gutkha chewing on periodontal health and oral hygiene of patients attending the dental department in India. Materials and Methods A cross-sectional investigation was directed among 200 patients going to dental camps. Among them, 100 were gutkha chewers and 100 were smokers. The oral hygiene status of selected patients was determined by using the Simplified Oral Hygiene Index. Various periodontal parameters like a gingival recession, clinical attachment loss, mobility, and furcation were used to evaluate the periodontal status. Data were collected and analyzed with the help of SPSS software version 20. Result Among the 200 subjects, 102 were males and 78 were females. In 100 gutkha chewers, 67% were male and 33% were females. About 68% gutkha chewers showed poor oral hygiene as compared to nonchewers (41%). The values of all the periodontal parameters were significantly higher in gutkha smokers compared to nonchewers. Conclusion Gutkha chewing has a strong effect on oral hygiene. The findings can contribute to the evidence of smokeless tobacco (gutkha) as a risk factor for periodontal disease.
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Affiliation(s)
- Santosh Kumar Verma
- Department of Periodontics, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Barun Dev Kumar
- Department of Orthodontics, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Swati Singh
- Department of Periodontics, Hazaribag College of Dental Sciences and Hospital, Hazaribag, Jharkhand, India
| | - Puja Kumari
- Department of Periodontics, Hazaribag College of Dental Sciences and Hospital, Hazaribag, Jharkhand, India
| | - Anurag Agarwal
- Department of Periodontics, Maharana Pratap Dental College and Hospital, Kanpur, Uttar Pradesh, India
| | - Tarun Kumar Singh
- Department of Conservative Dentistry and Endodontics, Inderprastha Dental College and Hospital, Muradnagar, Ghaziabad, Uttar Pradesh, India
| | - Deepak Passi
- Department of Dentistry, Subdivisional Hospital, Ranchi, Jharkhand, India
| | - Jyoti Goyal
- Department of Public Health Dentistry, ITS Centre for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India
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158
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Pistilli M, Howard VJ, Safford MM, Lee BK, Lovasi GS, Cushman M, Malek AM, McClure LA. Association of secondhand tobacco smoke exposure during childhood on adult cardiovascular disease risk among never-smokers. Ann Epidemiol 2019; 32:28-34.e1. [PMID: 30799203 PMCID: PMC6441374 DOI: 10.1016/j.annepidem.2019.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/11/2018] [Accepted: 01/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Adult secondhand tobacco smoke (SHS) exposure is related to stroke and coronary heart disease (CHD) risk, but long-term effects are less clear. We evaluated whether childhood SHS exposure affects subsequent stroke or CHD risk among adult black and white never-smokers followed for stroke and CHD. METHODS In this prospective cohort study, inverse probability weights were calculated to correct for bias due to attrition and survey nonresponse. Cox proportional hazards models were used to assess hazard ratios and 95% confidence intervals for stroke or CHD, separately, by number of childhood household smokers. RESULTS Of 13,142 eligible participants, 6136 had childhood SHS exposure assessed. Baseline mean (SD) age was 63.5 (9.0), 65% were female, 30% black, 46% reported 0 childhood household smokers, 36% reported 1, and 18% reported 2+. In 60,649 person-years, 174 strokes were observed (2.9% of participants), and in 45,195 person-years, 114 CHD events were observed (2.1% of participants). The weighted and adjusted hazard ratios (95% confidence intervals) of stroke for 2+ versus 0 childhood household smokers was 1.66 (1.29-2.13) and was 1.15 (0.82-1.59) for CHD. CONCLUSIONS We observed a significant association between childhood SHS exposure and stroke, but not CHD, after age 45 years and adjusting for missing information.
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Affiliation(s)
- Maxwell Pistilli
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama, Birmingham
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Brian K Lee
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Mary Cushman
- Department of Medicine, College of Medicine, University of Vermont, Burlington
| | - Angela M Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
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159
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Autophagy in Crotonaldehyde-Induced Endothelial Toxicity. Molecules 2019; 24:molecules24061137. [PMID: 30901980 PMCID: PMC6471975 DOI: 10.3390/molecules24061137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 11/16/2022] Open
Abstract
Crotonaldehyde is an extremely toxic α,β-unsaturated aldehyde found in cigarette smoke, and it causes inflammation and vascular dysfunction. Autophagy has been reported to play a key role in the pathogenesis of vascular diseases. However, the precise mechanism underlying the role of acute exposure crotonaldehyde in vascular disease development remains unclear. In the present study, we aimed to investigate the effect of crotonaldehyde-induced autophagy in endothelial cells. Acute exposure to crotonaldehyde decreased cell viability and induced autophagy followed by cell death. In addition, inhibiting the autophagic flux markedly promoted the viability of endothelial cells exposed to high concentrations of crotonaldehyde. Crotonaldehyde activated the AMP-activated protein kinase (AMPK) and p38 mitogen-activated protein kinase (MAPK) pathways, and pretreatment with inhibitors specific to these kinases showed autophagy inhibition and partial improvement in cell viability. These data show that acute exposure to high concentrations of crotonaldehyde induces autophagy-mediated cell death. These results might be helpful to elucidate the mechanisms underlying crotonaldehyde toxicity in the vascular system and contribute to environmental risk assessment.
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160
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Sanuade OA, Dodoo FNA, Koram K, de-Graft Aikins A. Prevalence and correlates of stroke among older adults in Ghana: Evidence from the Study on Global AGEing and adult health (SAGE). PLoS One 2019; 14:e0212623. [PMID: 30865654 PMCID: PMC6415815 DOI: 10.1371/journal.pone.0212623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/06/2019] [Indexed: 01/19/2023] Open
Abstract
This study examines the prevalence and correlates of stroke among older adults in Ghana. This cross-sectional study retrieved data from Wave 1 of the World Health Organization (WHO) Survey on Global Ageing and Adult Health (SAGE) conducted between 2007 and 2008. The sample, comprising 4,279 respondents aged 50 years and above, was analysed using descriptive statistics, cross tabulations and Chi-Square tests, and a multivariable binary logistic regression. Respondents ranged in age from 50 to 114 years, with a median age of 62 years. Stroke prevalence was 2.6%, with the correlates being marital status, level of education, employment status, and living with hypertension or diabetes. The results showed that being separated/divorced, having primary and secondary education, being unemployed and living with hypertension and diabetes, significantly increased the odds of stroke prevalence in this population. The results suggest that interventions to reduce stroke prevalence and impact must be developed alongside interventions for hypertension, diabetes and sociodemographic/economic factors such as marital status, level of education, and employment status.
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Affiliation(s)
| | | | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana., Accra, Ghana
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
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161
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El-Hajj M, Salameh P, Rachidi S, Al-Hajje A, Hosseini H. Cigarette and Waterpipe Smoking are Associated with the Risk of Stroke in Lebanon. J Epidemiol Glob Health 2019; 9:62-70. [PMID: 30932392 PMCID: PMC7310762 DOI: 10.2991/jegh.k.181231.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/05/2018] [Indexed: 10/31/2022] Open
Abstract
Cigarette and waterpipe (shisha and hookah) smoking are main public health concerns in Lebanon. We aim to assess the relationship between smoking and stroke, mainly waterpipe smoking, to better apply preventive and therapeutic interventions. A case-control study was conducted at five tertiary private and governmental hospitals in Lebanon between January 1st, 2015 and December 31st, 2016, using a standardized questionnaire. A stepwise ascending logistic regression was conducted. Odds ratio through 95% confidence interval (CI) expressed the degree of association among variables. In total, 650 patients were involved in the study with 205 stroke cases and 445 stroke-free normal individuals considered as controls. The risk of stroke was found to increase significantly among current cigarette smokers; total stroke Odds ratio (OR) = 2.79 (95% CI, 1.72-4.54), ischemic stroke OR = 2.59 (95% CI, 1.46-4.59), and hemorrhagic stroke OR = 4.25 (95% CI, 1.33-13.59). The risk of total and ischemic stroke was also found to increase significantly among current waterpipe smokers; OR 4.99 (95% CI, 2.07-11.99) and 6.25 (95% CI, 2.26-17.39), respectively. Moreover, waterpipe smoking was observed to have a stronger association with stroke in current cigarette smokers than non-smokers. Waterpipe smoking was found to be associated with stroke in this study. Moreover, this association is stronger among cigarette smokers, demonstrating a quantitative interaction between waterpipe and cigarette smoking.
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Affiliation(s)
- Maya El-Hajj
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
- Department of Neurology, UMR 955, IMRM, Institut Mondor de Recherche Biomédicale, Université Paris-Est, Créteil, France
| | - Pascale Salameh
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Samar Rachidi
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Hassan Hosseini
- Department of Neurology, UMR 955, IMRM, Institut Mondor de Recherche Biomédicale, Université Paris-Est, Créteil, France
- Department of Neurology, Hôpital Henri-Mondor, UPEC, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
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162
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Polivka J, Polivka J, Pesta M, Rohan V, Celedova L, Mahajani S, Topolcan O, Golubnitschaja O. Risks associated with the stroke predisposition at young age: facts and hypotheses in light of individualized predictive and preventive approach. EPMA J 2019; 10:81-99. [PMID: 30984317 DOI: 10.1007/s13167-019-00162-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/06/2019] [Indexed: 12/25/2022]
Abstract
Stroke is one of the most devastating pathologies of the early twenty-first century demonstrating 1-month case-fatality rates ranging from 13 to 35% worldwide. Though the majority of cases do occur in individuals at an advanced age, a persistently increasing portion of the patient cohorts is affected early in life. Current studies provide alarming statistics for the incidence of "young" strokes including adolescents. Young stroke is a multifactorial disease involving genetic predisposition but also a number of modifiable factors, the synergic combination of which potentiates the risks. The article analyzes the prevalence and impacts of "traditional" risk factors such as sedentary lifestyle, smoking, abnormal alcohol consumption, drug abuse, overweight, hypertension, abnormal sleep patterns, and usage of hormonal contraceptives, among others. Further, less explored risks such as primary vascular dysregulation and associated symptoms characteristic for Flammer syndrome (FS) are considered, and the relevance of the FS phenotype for the stroke predisposition at young age is hypothesized. Considering the high prevalence of known genetic and modifiable risk factors in the overall predisposition to the young stroke, the risk mitigating measures are recommended including innovative screening programs by application of specialized questionnaires and biomarker panels as well as educational programs adapted to the target audiences such as children, adolescents, and young adults.
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Affiliation(s)
- Jiri Polivka
- 1Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
- 2Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
- 3Department of Neurology, University Hospital Pilsen, and Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | - Jiri Polivka
- 3Department of Neurology, University Hospital Pilsen, and Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | - Martin Pesta
- 2Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
- 4Department of Biology, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | - Vladimir Rohan
- 3Department of Neurology, University Hospital Pilsen, and Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | - Libuse Celedova
- 5Department of Social and Assessment Medicine, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | | | - Ondrej Topolcan
- 7Department of Immunochemistry, University Hospital Pilsen, Pilsen, Czech Republic
| | - Olga Golubnitschaja
- 8Radiological Clinic, UKB, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- 9Breast Cancer Research Centre, UKB, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
- 10Centre for Integrated Oncology, Cologne-Bonn, UKB, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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163
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Jacob L, Kostev K. Cancer risk in stroke survivors followed for up to 10 years in general practices in Germany. J Cancer Res Clin Oncol 2019; 145:1013-1020. [PMID: 30739168 DOI: 10.1007/s00432-019-02855-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/01/2019] [Indexed: 01/01/2023]
Abstract
AIMS The goal of this study was to analyze cancer risk in stroke survivors followed for up to 10 years in general practices in Germany. METHODS The current study sample included patients who received an initial stroke diagnosis in one of 1262 general practices in Germany between 2006 and 2015 (index date). Patients without stroke were matched (1:1) to patients with stroke by age, gender, index year, and 16 comorbidities diagnosed in the 12 months prior to the index date using a propensity score method. The main outcome of the study was the risk of cancer as a function of stroke within 10 years of the index date. RESULTS The stroke and non-stroke groups included 9579 men and 9089 women. After 10 years of follow-up, 29.3% of men with stroke and 23.8% of those without stroke developed any of the included types of cancer (log-rank p value < 0.001). During the same time, the prevalence of cancer was 25.0% in women with stroke and 20.5% in women without stroke (log-rank p value < 0.001). There was a positive association between stroke and any cancer in men (hazard ratio [HR] = 1.18, 95% confidence interval [CI] 1.09-1.28) and in women (HR = 1.22, 95% CI 1.12-1.34). This association was significant for cancers of respiratory and intrathoracic organs in men and women and for cancers of digestive organs in men. CONCLUSIONS This study, including more than 37,000 patients from Germany, found that stroke was associated with an increased cancer risk.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Karel Kostev
- Epidemiology, IQVIA, Unterschweinstiege 2-14, 60549, Frankfurt am Main, Germany.
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164
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Age-related cardiovascular risk in adult patients with congenital heart disease. Int J Cardiol 2019; 277:90-96. [DOI: 10.1016/j.ijcard.2018.09.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/31/2018] [Accepted: 09/10/2018] [Indexed: 01/09/2023]
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165
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Miao Q, Xu Y, Zhang H, Xu P, Ye J. Cigarette smoke induces ROS mediated autophagy impairment in human corneal epithelial cells. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2019; 245:389-397. [PMID: 30453137 DOI: 10.1016/j.envpol.2018.11.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/19/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
Cigarette smoke is an important indoor air pollutant which has deleterious effects on human health. Continued daily exposure to cigarette smoke has been attributed to the risk factor of ocular surface diseases. However, the mechanisms underlying the ocular surface damage are not fully elucidated. In this study, exposure to cigarette smoke extract (CSE) induced a dose- and time-dependent cytotoxicity in human corneal epithelial (HCE) cells, supported by the observation of reduced cell viability, increased apoptotic cells, elevated intracellular oxidative stress and loss of mitochondrial transmembrane potential. In addition, CSE exposure led to the impairment of proteostasis and autophagy, which resulted in the accumulation of ubiquitinated proteins as aggregates in peri-nuclear spaces. Furthermore, the autophagy inducer, cysteamine was shown to attenuate the CSE induced cell damage, oxidative stress and mitochondrial dysfunction in HCE cells. Moreover, cysteamine inhibited the formation of ubiquitin-positive aggregates around the peri-nuclear region, through regulating the autophagic activity of HCE cells. Similar to in vitro experiments, cigarette smoke induced proteostasis and autophagy impairment in corneal epithelial cells could be rescued by cysteamine in a cigarette smoke-exposed murine model. Therefore, this study may provide first evidence that dysfunction of autophagy contributes to the pathogenesis of ocular surface diseases associated with cigarette smoke exposure. Besides, it also suggests the potential therapeutic value of cysteamine in the prevention and treatment of cigarette smoke induced ocular surface injury. CSE induces cytotoxicity and accumulation of ubiquitinated proteins in HCE cells due to impairment of proteostasis and autophagy, which can be rescued by cysteamine.
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Affiliation(s)
- Qi Miao
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yufeng Xu
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Huina Zhang
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Peifang Xu
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Juan Ye
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
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166
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Hoyer C, Schmidt HL, Kranaster L, Alonso A. Impact of psychiatric comorbidity on the severity, short-term functional outcome, and psychiatric complications after acute stroke. Neuropsychiatr Dis Treat 2019; 15:1823-1831. [PMID: 31308675 PMCID: PMC6614829 DOI: 10.2147/ndt.s206771] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/03/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE The comorbidity of psychiatric disorders and cerebrovascular disease appears to be complex with underlying bidirectional influences. Hitherto, research has focused mainly on the evaluation of stroke risk in particular psychiatric disorders; only a few studies have assessed their role in the acute natural history of stroke. The aim of this study was to provide a perspective on psychiatric premorbidity and its impact on stroke severity, psychiatric complications during the initial treatment phase, and the short-term functional outcome of stroke. PATIENTS AND METHODS We retrospectively studied the impact of a predocumented psychiatric diagnosis (PDPD) on stroke severity, short-term functional outcome, and psychiatric complications in a sample of 798 patients consecutively admitted for acute ischemic or hemorrhagic stroke by performing a chart review. Group comparisons (PDPD vs non-PDPD) with adjustment for covariates were carried out either using multivariate analysis of variance or logistic regression analysis. RESULTS More severe strokes (ie, mean National Institute of Health Stroke Scale score on admission 10.1±7.9 vs 7.5±7.4; F(10,796)=18.5, p<0.0001) and higher prevalence of poor outcome (73.7 vs 54.9%; OR: 2.6, standard error: 0.5, z=4.82, p<0.0001) was found in patients with a documented psychiatric diagnosis at the time of stroke, as well as a higher rate of psychiatric complications during the initial treatment phase (46.7 vs 28.9%; OR: -0.78, z=4.59, p<0.0001). CONCLUSION Our data have clinical implications in that they call for identification of psychiatric premorbidity or comorbidity through careful history-taking and particularly close monitoring for psychiatric complications with respect to their potentially negative impact on outcome after stroke.
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Affiliation(s)
- Carolin Hoyer
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hanna Luise Schmidt
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Laura Kranaster
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Angelika Alonso
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
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167
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Dinh PC, Schrader LA, Svensson CJ, Margolis KL, Silver B, Luo J. Smoking cessation, weight gain, and risk of stroke among postmenopausal women. Prev Med 2019; 118:184-190. [PMID: 30359645 DOI: 10.1016/j.ypmed.2018.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/13/2018] [Accepted: 10/19/2018] [Indexed: 01/09/2023]
Abstract
The relationship between smoking cessation, concurrent weight gain, and stroke events is not yet understood. Thus, we examined the association between smoking cessation and subsequent stroke risk and whether the association was modified by concurrent weight gain. In 2017, we analyzed data from 109,498 postmenopausal US women enrolled in the Women's Health Initiative from 1993 to 1998. Women with a history of cancer or cardiovascular disease events were excluded. The median length of follow-up time was 14.01 years. Variables of primary focus were smoking cessation, weight change, and clinically confirmed incident cases of hemorrhagic and ischemic stroke. Hazard ratios were estimated for stroke incidences (all, ischemic, and hemorrhagic) associated with smoking cessation using Cox regression. The exposure-outcome relationship of smoking cessation and risk of stroke was evaluated for effect modification by weight change. Recent quitters between baseline and year 3 had a significantly lower risk for all stroke and ischemic stroke, but not hemorrhagic stroke, when compared to the reference group of continuing smokers. In the multivariable-adjusted model for ischemic stroke, the hazard ratio for recent quitters was 0.66 (95% CI: 0.46, 0.95). In the model for hemorrhagic stroke, the hazard ratio for recent quitters was 0.76 (95% CI: 0.36, 1.61). The association between recent quitting and stroke risk was not significantly modified by weight change. Smoking cessation was associated with a significant reduction in stroke risk. The benefit of smoking cessation on the risk of stroke was not attenuated by concurrent weight gain.
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Affiliation(s)
- Paul C Dinh
- Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN 47405, United States of America.
| | - Lauren A Schrader
- Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN 47405, United States of America.
| | - Catherine J Svensson
- Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN 47405, United States of America.
| | - Karen L Margolis
- HealthPartners Institute, Box 1524, Mailstop 21111R, Minneapolis, MN, United States of America.
| | - Brian Silver
- Department of Neurology, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655, United States of America.
| | - Juhua Luo
- Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN 47405, United States of America.
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168
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Smoking and Postoperative Complications in Plastic and General Surgical Procedures. Plast Reconstr Surg 2018; 142:1633-1643. [DOI: 10.1097/prs.0000000000005008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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169
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Thayabaranathan T, Immink MA, Stevens P, Hillier S, Thrift AG, Brodtmann A, Carey L, Kilkenny MF, Cadilhac DA. Understanding the potential for yoga and tai chi interventions to moderate risk factors for stroke – a scoping review. FUTURE NEUROLOGY 2018. [DOI: 10.2217/fnl-2018-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Following an initial stroke, approximately two in five people will experience another stroke within 10 years. Recurrent strokes are often more severe and fatal. Mindfulness-based interventions (MBIs) that use movement to focus attention, such as yoga and tai chi, may offer a lifestyle strategy in addition to standard rehabilitation options, for moderating risk factors for stroke. We conducted a scoping review to explore the potential for yoga or tai chi to moderate modifiable risk factors for stroke. 26 papers between 1985 and 2017 were identified using online and gray literature databases. Overall, yoga or tai chi may reduce hypertension (up to 16/9 mmHg), and to a lesser extent some lipid and blood sugar levels. Study designs were heterogeneous. Further research on mediating pathways of MBIs, such as yoga or tai chi, on modifiable risk factors for stroke is warranted.
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Affiliation(s)
| | - Maarten A Immink
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Philip Stevens
- School of Primary Health Care, Monash University, Clayton, Victoria, Australia
| | - Susan Hillier
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Amanda G Thrift
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Amy Brodtmann
- Dementia Division, The Florey Institute of Neuroscience & Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Leeanne Carey
- Stroke Division, The Florey Institute of Neuroscience & Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Monique F Kilkenny
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience & Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Dominique A Cadilhac
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience & Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
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170
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Gan Y, Wu J, Li L, Zhang S, Yang T, Tan S, Mkandawire N, Zhong Y, Jiang J, Wang Z, Lu Z. Association of smoking with risk of stroke in middle-aged and older Chinese: Evidence from the China National Stroke Prevention Project. Medicine (Baltimore) 2018; 97:e13260. [PMID: 30461631 PMCID: PMC6392934 DOI: 10.1097/md.0000000000013260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Although the impacts of smoking on health are well established, it is unclear on how they affect the Chinese population aged ≥40 years. This study aimed to investigate the association between smoking and risk of stroke in middle-aged and older Chinese adults, based on the data from the China National Stroke Prevention Project.A community-based cross-sectional study with 12,704 (5681 men, 7023 women) Chinese adults aged ≥40 years was conducted to examine the association of smoking with stroke. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).Among the study population, a total of 524 stroke survivors were identified. The age-adjusted prevalence of stroke was 4.06% for both sexes, 2.95% for women, and 5.38% for men. The multivariate-adjusted ORs (95% CI) of stroke associated with current cigarette smoking and former cigarette smoking were 1.67 (1.24-2.25) and 1.93 (1.29-2.87), respectively. Compared with those who were never-smokers, the multivariate-adjusted OR of stroke (95% CI) were 1.48 (0.96 to -2.29), 1.75 (1.20-2.56), and 2.37 (1.20 to -4.68) for those who smoked 1 to 10, 11 to 20, and ≥21 cigarettes per day; and 0.51 (0.19 to -1.42), 1.90 (1.36 to -2.67), and 2.01 (1.17 to -3.46) for those who smoked 1 to 19, 20 to 39, and ≥40 years, respectively (both P < .001 for linear trends). Among former smokers, the multivariable-adjusted ORs of stroke by duration of smoking cessation (compared with never smokers) for <5, 5 to 19, and ≥20 years were 3.47 (1.42-8.49), 3.37 (1.95-5.80), and 0.95 (0.49-1.84), respectively (P = .009 for linear trend). The increased odds of stroke with smoking were more evident among participants who were men, >60 years old, or without family history of stroke than their counterparts.This study suggests the increased odds of stroke in current cigarette smokers with a graded increase in prevalent risk that depended on how many cigarettes and how many years were smoked. Moreover, quitting smoking appears to decrease this excess risk substantially.
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Affiliation(s)
- Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiang Wu
- Bao’an Central Hospital of Shenzhen, Guangdong
| | - Liqing Li
- Department of Management Science and Engineering, School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi
| | | | - Tingting Yang
- Department of Nutrition, Henan Provincial People's Hospital, Zhengzhou, Henan
| | - Shuran Tan
- The First Clinical School, Tongji Medical College, Huazhong University of Science and Technology
| | - Naomie Mkandawire
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanyan Zhong
- Huazhong University of Science and Technology Hospital
| | - Jie Jiang
- Department of Respiratory Medicine, Wuhan Central Hospital, Wuhan, Hubei
| | - Zhihong Wang
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen University, Shenzhen, Guangdong, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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171
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Study of transesophageal echocardiography in young patients (<40 years) with acute arterial ischemic stroke: A pilot study. Med J Armed Forces India 2018; 76:47-50. [PMID: 32020968 DOI: 10.1016/j.mjafi.2018.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 07/12/2018] [Indexed: 11/22/2022] Open
Abstract
Background The aim is to study cardiac abnormalities as detected by transesophageal echocardiography (TEE) in young patients (<40 years) presenting with acute ischemic arterial stroke. Methods A cross-sectional observational study was conducted in young patients aged <40 years presenting with acute arterial ischemic stroke without any valvular heart disease, prosthetic valve, or previously diagnosed atrial fibrillation (AF). TEE was performed in all eligible patients preferably within the first week of the onset of ischemic arterial stroke. All patients with normal TEE underwent holter to rule out paroxysmal AF. Results Totally, 40 young patients were included in the study. Mean age was 35.17 (SD [standard deviation] ± 2.99) years. TEE abnormalities were noted in total 13 (32.5%) patients, of which patent foramen ovale was the most common cardiac abnormality in eight (20%) patients followed by left atrial appendage clot in three (7.5%) and atrial septal aneurysm in two (5%) patients. One patient (2.5%) was observed with atrial septal aneurysm along with a sieved septum. All the patients with normal TEE underwent holter, and four of 27 (14.8%) of these patients were noted to have paroxysmal AF. Conclusion Cardiac abnormalities on TEE and holter were detected in 42.5% of the young patients with idiopathic arterial stroke. TEE abnormality was noted in 33% (13/40), whereas AF on holter was seen in 14.8% (4/27) with normal TEE. Thus, probable cardioembolic stroke was responsible for acute ischemic stroke in 42.5% (17/40) of young patients in the absence of valvular heart disease, prosthetic valves, and persistent/permanent AF.
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172
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Sifat AE, Vaidya B, Villalba H, Albekairi TH, Abbruscato TJ. Neurovascular unit transport responses to ischemia and common coexisting conditions: smoking and diabetes. Am J Physiol Cell Physiol 2018; 316:C2-C15. [PMID: 30207783 DOI: 10.1152/ajpcell.00187.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Transporters at the neurovascular unit (NVU) are vital for the regulation of normal brain physiology via ion, water, and nutrients movement. In ischemic stroke, the reduction of cerebral blood flow causes several complex pathophysiological changes in the brain, one of which includes alterations of the NVU transporters, which can exacerbate stroke outcome by increased brain edema (by altering ion, water, and glutamate transporters), altered energy metabolism (by altering glucose transporters), and enhanced drug toxicity (by altering efflux transporters). Smoking and diabetes are common risk factors as well as coexisting conditions in ischemic stroke that are also reported to change the expression and function of NVU transporters. Coexistence of these conditions could cause an additive effect in terms of the alterations of brain transporters that might lead to worsened ischemic stroke prognosis and recovery. In this review, we have discussed the effects of ischemic stroke, smoking, and diabetes on some essential NVU transporters and how the simultaneous presence of these conditions can affect the clinical outcome after an ischemic episode. Further scientific investigations are required to elucidate changes in NVU transport in cerebral ischemia, which can lead to better, personalized therapeutic interventions tailor-made for these comorbid conditions.
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Affiliation(s)
- Ali E Sifat
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
| | - Bhuvaneshwar Vaidya
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
| | - Heidi Villalba
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
| | - Thamer H Albekairi
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
| | - Thomas J Abbruscato
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
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173
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Malenica M, Prnjavorac B, Bego T, Dujic T, Semiz S, Skrbo S, Gusic A, Hadzic A, Causevic A. Effect of Cigarette Smoking on Haematological Parameters in Healthy Population. Med Arch 2018; 71:132-136. [PMID: 28790546 PMCID: PMC5511531 DOI: 10.5455/medarh.2017.71.132-136] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: Tobacco cigarette smoking is one of the major leading causes of death throughout the world. Smoking has both acute and chronic effect on haematological parameters. The aim of the present study was to assess the extent of adverse effects of cigarette smoking on biochemical characteristics in healthy smokers. Subjects and Method: One hundred and fifty six subjects participated in this study, 56 smokers and 100 non-smokers. The smokers were regularly consuming 10-20 cigarettes per day for at least 3 years. Complete blood cell count was analyzed by CELL-DYN 3700 fully automatic haematological analyzer. Results: The smokers had significantly higher levels of white blood cell (p<0,001), hemoglobin (p=0,042), mean corpuscular volume (p=0,001) and mean corpuscular hemoglobin concentration (p<0,001). All other measured parameters did not differ significantly. Cigarette smoking caused a significant increase (p<0,001) in red blood cells, white blood cells (p=0,040), hemoglobin (p<0,001), hematocrit (p=0,047) and mean corpuscular hemoglobin (p<0,001) in males in comparison to female smokers. Conclusion: In conclusion, our study showed that continuous cigarette smoking has severe adverse effects on haematological parameters (e.g., hemoglobin, white blood cells count, mean corpuscular volume, mean corpuscular hemoglobin concentration, red blood cells count, hematocrit) and these alterations might be associated with a greater risk for developing atherosclerosis, polycythemia vera, chronic obstructive pulmonary disease and/or cardiovascular diseases.
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Affiliation(s)
- Maja Malenica
- Department for Biochemistry and Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Bosnia and Herzegovina (BH)
| | | | - Tamer Bego
- Department for Biochemistry and Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Bosnia and Herzegovina (BH)
| | - Tanja Dujic
- Department for Biochemistry and Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Bosnia and Herzegovina (BH)
| | - Sabina Semiz
- Department for Biochemistry and Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Bosnia and Herzegovina (BH).,Faculty of Engineering and Natural Sciences, International University of Sarajevo, Sarajevo, Bosnia and Herzegovina (BH)
| | - Selma Skrbo
- Department for Clinical Pharmacy, Faculty of Pharmacy, University of Sarajevo, Bosnia and Herzegovina (BH)
| | - Amar Gusic
- Faculty of Pharmacy, University of Sarajevo, Bosnia and Herzegovina (BH)
| | - Ajla Hadzic
- Faculty of Pharmacy, University of Sarajevo, Bosnia and Herzegovina (BH)
| | - Adlija Causevic
- Department for Biochemistry and Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Bosnia and Herzegovina (BH)
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174
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Miao Z, Guo M, Zhou S, Sun X, Wang F, Lu H, Cui Z. Smoking and drinking influence the advancing of ischemic stroke disease by targeting PTGS2 and TNFAIP3. Exp Ther Med 2018; 16:61-66. [PMID: 29977356 PMCID: PMC6030864 DOI: 10.3892/etm.2018.6138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/08/2018] [Indexed: 01/26/2023] Open
Abstract
In the present study, we explored the influence of cigarette smoking and alcohol drinking on gene expression level and related functions and pathways on the development of ischemic stroke (IS) disease. The gene expression profile of E-GEOD-22255 was obtained from 20 IS samples (7 patients without smoking or drinking history and 13 patients with smoking or drinking history) and 20 controls (9 normal controls without smoking or drinking history and 11 controls with smoking or drinking history). The correlation degree between gene expression and grouping were measured by significance analysis of microarray (SAM). Smoking or drinking-related DEGs were screened. GO functional and KEGG pathway enrichment analyses were processed. Based on the KEGG database, a pathway relationship network was constructed. DEGs in significant functions and pathways were inserted and regarded as key DEGs. Gene co-expression network was constructed based on the expression value of key genes. In total, 319 IS-related DEGs, which were induced by smoking and drinking, were screened and enriched in various functions and pathways, including inflammatory response, nuclear factor-κB (NF-κB) signaling pathway and influenza A. Pathway relationship network was constructed with 44 nodes and the hub node was the MAPK signaling pathway. After merging, 87 key DEGs were obtained. The gene co-expression network with 43 node edges was constructed and the hub node was prostaglandin-endoperoxide synthase 2. In IS patients, smoking and drinking may induce different expression of many genes, including PTGS2, TNFAIP3, ZFP36 and NFKBIZ. In addition, these genes participated in various pathways, such as inflammatory response.
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Affiliation(s)
- Zhimin Miao
- Department of Neurology Two, The People's Hospital of Shouguang, Weifang, Shandong 262700, P.R. China
| | - Meifang Guo
- Department of Oncology Two, The People's Hospital of Shouguang, Weifang, Shandong 262700, P.R. China
| | - Suqin Zhou
- Department of Blood Rheumatic Immunology, The People's Hospital of Shouguang, Weifang, Shandong 262700, P.R. China
| | - Xuemei Sun
- Department of Respiratory Medicine One, The People's Hospital of Shouguang, Weifang, Shandong 262700, P.R. China
| | - Fang Wang
- Department of General Surgery Three, The People's Hospital of Shouguang, Weifang, Shandong 262700, P.R. China
| | - Haiying Lu
- Department of Yang Kou Medical Ward, The People's Hospital of Shouguang, Weifang, Shandong 262700, P.R. China
| | - Zhenhong Cui
- Department of Gastroenterology, The Fourth People's Hospital of Jinan, Jinan, Shandong 250031, P.R. China
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175
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Rheumatoid arthritis significantly increased recurrence risk after ischemic stroke/transient ischemic attack. J Neurol 2018; 265:1810-1818. [PMID: 29860668 DOI: 10.1007/s00415-018-8885-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 12/22/2022]
Abstract
The effect of RA on recurrent stroke is unknown. Therefore, we examined effects of rheumatoid arthritis (RA) on risk of stroke recurrence and investigated the interaction between RA and traditional cardiovascular risk factors on recurrence risk after ischemic stroke (IS) or transient ischemic attack (TIA). Of 3190 patients with IS or TIA recruited in this cohort study, 638 were comorbid with RA and 2552 without RA. Stroke recurrence, RA, lifestyle, lipid variables and other comorbidities were identified through linkage between a nationwide stroke database in Taiwan and the National Health Insurance claims database. Cox proportional hazard models with competing risk adjustment were used to evaluate the relationship between RA and recurrent stroke. Patients with RA showed a significantly increased risk of recurrent stroke, particular in recurrent IS/TIA. The increased risk of recurrent IS/TIA in RA patients may through the changes of triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C) ratio. A positive additive interaction was observed between RA and current smoking on the risk of recurrent IS/TIA. Significantly increased risks for recurrent IS/TIA were observed among RA patients who smoked > 40 years or those who smoked > 20 cigarettes/day. This study provides the first evidence that RA significantly increased recurrence IS/TIA risk. The changes of TG/HDL-C ratio may play some roles in the recurrence IS/TIA risk in RA patients. In addition, our results suggest that smoking increases the risk of recurrent IS/TIA in RA patients and reinforces the need for aggressive smoking cessation efforts in RA patients.
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176
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Royal W, Can A, Gould TD, Guo M, Huse J, Jackson M, Davis H, Bryant J. Cigarette smoke and nicotine effects on brain proinflammatory responses and behavioral and motor function in HIV-1 transgenic rats. J Neurovirol 2018; 24:246-253. [PMID: 29644536 DOI: 10.1007/s13365-018-0623-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 01/21/2018] [Accepted: 02/15/2018] [Indexed: 01/08/2023]
Abstract
Cognitive impairment in HIV-1 infection is associated with the induction of chronic proinflammatory responses in the brains of infected individuals. The risk of HIV-related cognitive impairment is increased by cigarette smoking, which induces brain inflammation in rodent models. To better understand the role of smoking and the associated immune response on behavioral and motor function in HIV infection, wild-type F344 and HIV-1 transgenic (HIV1Tg) rats were exposed to either smoke from nicotine-containing (regular) cigarettes, smoke from nicotine-free cigarettes, or to nicotine alone. The animals were then tested using the rotarod test (RRT), the novel object recognition test (NORT), and the open field test (OFT). Subsequently, brain frontal cortex from the rats was analyzed for levels of TNF-α, IL-1, and IL-6. On the RRT, impairment was noted for F344 rats exposed to either nicotine-free cigarette smoke or nicotine alone and for F344 and HIV1Tg rats exposed to regular cigarette smoke. Effects from the exposures on the OFT were seen only for HIV1Tg rats, for which function was worse following exposure to regular cigarette smoke as compared to exposure to nicotine alone. Expression levels for all three cytokines were overall higher for HIV1Tg than for F344 rats. For HIV1Tg rats, TNF-α, IL-1, and IL-6 gene expression levels for all exposure groups were higher than for control rats. All F344 rat exposure groups also showed significantly increased TNF-α expression levels. However, for F344 rats, IL-1 expression levels were higher only for rats exposed to nicotine-free and nicotine-containing CS, and no increase in IL-6 gene expression was noted with any of the exposures as compared to controls. These studies, therefore, demonstrate that F344 and HIV1Tg rats show differential behavioral and immune effects from these exposures. These effects may potentially reflect differences in the responsiveness of the various brain regions in the two animal species as well as the result of direct toxicity mediated by the proinflammatory cytokines that are produced by HIV proteins and by other factors that are present in regular cigarette smoke.
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Affiliation(s)
- Walter Royal
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. .,Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA. .,Baltimore Veterans Administration Medical Center, Baltimore, MD, USA.
| | - Adem Can
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Todd D Gould
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ming Guo
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jared Huse
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Myles Jackson
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Harry Davis
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph Bryant
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
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177
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Lou H, Dong Z, Zhang P, Shao X, Li T, Zhao C, Zhang X, Lou P. Interaction of diabetes and smoking on stroke: a population-based cross-sectional survey in China. BMJ Open 2018; 8:e017706. [PMID: 29622573 PMCID: PMC5892748 DOI: 10.1136/bmjopen-2017-017706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Diabetes and smoking are known independent risk factors for stroke; however, their interaction concerning stroke is less clear. We aimed to explore such interaction and its influence on stroke in Chinese adults. DESIGN Cross-sectional study. SETTING Community-based investigation in Xuzhou, China. PARTICIPANTS A total of 39 887 Chinese adults who fulfilled the inclusion criteria were included. METHODS Participants were selected using a multistage stratified cluster method, and completed self-reported questionnaires on stroke and smoking. Type 2 diabetes mellitus (DM2) was assessed by fasting blood glucose or use of antidiabetic medication. Interaction, relative excess risk owing to interaction (RERI), attributable proportion (AP) and synergy index (S) were evaluated using a logistic regression model. RESULTS After adjustment for age, sex, marital status, educational level, occupation, physical activity, body mass index, hypertension, family history of stroke, alcohol use and blood lipids, the relationships between DM2 and stroke, and between smoking and stroke, were still significant: ORs were 2.75 (95% CI 2.03 to 3.73) and 1.70 (95% CI 1.38 to 2.10), respectively. In subjects with DM2 who smoked, the RERI, AP and S values (and 95% CIs) were 1.80 (1.24 to 3.83), 0.52 (0.37 to 0.73) and 1.50 (1.18 to 1.84), respectively. CONCLUSIONS The results suggest there are additive interactions between DM2 and smoking and that these affect stroke in Chinese adults.
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Affiliation(s)
- Heqing Lou
- The School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Zongmei Dong
- The School of Public Health, Xuzhou Medical University, Xuzhou, China
- Department of Non-communicable Disease Control, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Pan Zhang
- Department of Non-communicable Disease Control, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Xiaoping Shao
- The School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Ting Li
- Department of Non-communicable Disease Control, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Chunyan Zhao
- The School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Xunbao Zhang
- The School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Peian Lou
- The School of Public Health, Xuzhou Medical University, Xuzhou, China
- Department of Non-communicable Disease Control, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
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178
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4550] [Impact Index Per Article: 758.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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179
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Li C, Sun H, Xu G, McCarter KD, Li J, Mayhan WG. Mito-Tempo prevents nicotine-induced exacerbation of ischemic brain damage. J Appl Physiol (1985) 2018; 125:49-57. [PMID: 29420160 DOI: 10.1152/japplphysiol.01084.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Nicotine may contribute to the pathogenesis of cerebrovascular disease via the generation of reactive oxygen species (ROS). Overproduction of ROS leads to brain damage by intensifying postischemic inflammation. Our goal was to determine the effect of Mito-Tempo, a mitochondria-targeted antioxidant, on ischemic brain damage and postischemic inflammation during chronic exposure to nicotine. Male Sprague-Dawley rats were divided into four groups: control, nicotine, Mito-Tempo-treated control, and Mito-Tempo-treated nicotine. Nicotine (2 mg·kg-1·day-1) was administered via an osmotic minipump for 4 wk. Mito-Tempo (0.7 mg·kg-1·day-1 ip) was given for 7 days before cerebral ischemia. Transient focal cerebral ischemia was induced by occlusion of the middle cerebral artery for 2 h. Brain damage and inflammation were evaluated after 24 h of reperfusion by measuring infarct volume, expression of adhesion molecules, activity of matrix metalloproteinase, brain edema, microglial activation, and neutrophil infiltration. Nicotine exacerbated infarct volume and worsened neurological deficits. Nicotine did not alter baseline ICAM-1 expression, matrix metallopeptidase-2 activity, microglia activation, or neutrophil infiltration but increased these parameters after cerebral ischemia. Mito-Tempo did not have an effect in control rats but prevented the chronic nicotine-induced augmentation of ischemic brain damage and postischemic inflammation. We suggest that nicotine increases brain damage following cerebral ischemia via an increase in mitochondrial oxidative stress, which, in turn, contributes to postischemic inflammation. NEW & NOTEWORTHY Our findings have important implications for the understanding of mechanisms contributing to increased susceptibility of the brain to damage in smokers and users of nicotine-containing tobacco products.
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Affiliation(s)
- Chun Li
- Department of Cellular Biology and Anatomy, Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center-Shreveport , Shreveport, Louisiana
| | - Hong Sun
- Department of Cellular Biology and Anatomy, Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center-Shreveport , Shreveport, Louisiana
| | - Guodong Xu
- Department of Cellular Biology and Anatomy, Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center-Shreveport , Shreveport, Louisiana.,Department of Neurology, Hebei General Hospital , Shijiazhuang, Hebei , China
| | - Kimberly D McCarter
- Department of Cellular Biology and Anatomy, Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center-Shreveport , Shreveport, Louisiana
| | - Jiyu Li
- Department of Cellular Biology and Anatomy, Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center-Shreveport , Shreveport, Louisiana
| | - William G Mayhan
- Division of Basic Biomedical Sciences, Sanford School of Medicine, The University of South Dakota, Vermillion, South Dakota
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180
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Raag M, Pärna K. Cigarette smoking and smoking-attributable diseases among Estonian physicians: a cross-sectional study. BMC Public Health 2018; 18:194. [PMID: 29378544 PMCID: PMC5789589 DOI: 10.1186/s12889-018-5105-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 01/19/2018] [Indexed: 12/24/2022] Open
Abstract
Background Smoking is a risk factor for several diseases. Physicians are role models for their patients. Physicians who smoke underestimate the health risks of smoking and may be less likely to offer advice to help their patients to quit. The aim of this study was to: provide an overview of smoking behaviour among Estonian physicians; assess the relationship between smoking and ischaemic heart disease (IHD), chronic bronchitis (CB), and lung emphysema (LE); and estimate fractions of prevalences of the three diseases attributable to smoking. Methods Self-administered questionnaires were sent to practising physicians (n = 5666) in Estonia in 2014. Prevalence of smoking and relative risks for IHD, CB and LE as well as the risks of IHD, CB and LE attributable to smoking were calculated by age and sex. Post-stratification was used to compensate non-response. Results There were 535 male and 2404 female physicians participating. The prevalence of daily smoking was 12.4% (95% CI 10.4–14.4%) among men and 5.0% (95% CI 4.4–5.6%) among women. Mean duration of smoking among male and female daily smokers was 28.6 (95% CI 26.1–31.1) and 28.6 (95% CI 27.1–30.2) years. Compared to lifelong non-smokers, the age-adjusted risk for IHD was 1.29 times (95% CI 0.88–1.89) higher for men, but 1.69 times (95% CI 1.17–2.40) lower for all women who have ever smoked. The risk for CB was 2.29 (95% CI 1.30–4.03) times higher for smokers among men and, 1.32 (95% CI 0.95–1.82) among women; the risk ratio for LE was 4.92 (95% CI 1.14–21.1) among men and 2.45 (95% CI 0.63–9.52) among women. The smoking-attributable risk for IHD was 3.2% (95% CI 2.3–4.1%) among men and − 0.1% (95% CI -0.7–0.4%) among women; for CB 6.9% (95% CI 6.0–7.8%) and 4.2% (95% CI 3.5–4.8%); and for LE 18.8% (95% CI 17.0–22.5%) and 22.6% (95% CI 18.5–26.9%), respectively. Conclusion Prevalence of daily smoking was relatively low among Estonian physicians (and twice lower among female physicians). The risk attributable to smoking was higher for LE and CB than for IHD. Electronic supplementary material The online version of this article (10.1186/s12889-018-5105-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mait Raag
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
| | - Kersti Pärna
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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181
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Vijayan M, Reddy PH. Stroke, Vascular Dementia, and Alzheimer's Disease: Molecular Links. J Alzheimers Dis 2018; 54:427-43. [PMID: 27567871 DOI: 10.3233/jad-160527] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Stroke is a brain disease that occurs when blood flow stops, resulting in reduced oxygen supply to neurons. Stroke occurs at any time and at any age, but increases after the age of 55. It is the second leading cause of death and the third leading cause of disability-adjusted, life-years. The pathophysiology of ischemic stroke is complex and recent molecular, cellular, and animal models and postmortem brain studies have revealed that multiple cellular changes have been implicated, including oxidative stress/mitochondrial dysfunction, inflammatory responses, micro RNA alterations, and marked changes in brain proteins. These cellular changes provide new information for developing therapeutic strategies for ischemic stroke treatment. Research also revealed that stroke increases with a number of modifiable factors and most strokes can be prevented and/or controlled through pharmacological or surgical interventions and lifestyle changes. Ischemic stroke is the major risk factor for vascular dementia and Alzheimer's disease. This review summarizes the latest research findings on stroke, including causal factors and molecular links between stroke and vascular disease/Alzheimer's disease.
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Affiliation(s)
- Murali Vijayan
- Garrison Institute on Aging, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - P Hemachandra Reddy
- Garrison Institute on Aging, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Neuroscience and Pharmacology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Department of Speech, Language and Hearing Sciences Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Garrison Institute on Aging, South West Campus, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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182
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Hypothetical interventions to prevent stroke: an application of the parametric g-formula to a healthy middle-aged population. Eur J Epidemiol 2018; 33:557-566. [PMID: 29294206 DOI: 10.1007/s10654-017-0344-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/09/2017] [Indexed: 12/17/2022]
Abstract
The effects of interventions on multiple lifestyle and metabolic risk factors, initiated in midlife or later in a healthy population, on the long-term risk of first-ever stroke is not known. A particular methodological challenge in observational studies is to estimate the unbiased effect of a time-varying exposure in presence of time-varying confounders, if those confounders are affected by prior exposure. In such cases, the parametric g-formula can be applied to estimate an unbiased effect. We applied the parametric g-formula to estimate the 18-years (1994-2012) cumulative stroke risk under different scenarios of hypothetical interventions on levels of blood pressure, cholesterol, weight, physical activity, smoking and alcohol intake; and compared these to the observed scenario, to calculate the population risk ratios and risk differences. Among 14,796 eligible participants in the prospective, population-based Tromsø study (baseline mean age 46.1 years, 51% women), the observed 18-years stroke risk was 5.9%. A feasible joint hypothetical intervention on six lifestyle and metabolic risk factors would reduce the 18-year stroke risk by 32% (95% confidence interval 16, 44). A combination of more intensive interventions reduced the estimated 18-years stroke risk by 64% (95% confidence interval 40, 80). Blood pressure reduction and quitting smoking significantly reduced the risk when applied separately.
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183
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Haque S, Sinha N, Ranjit S, Midde NM, Kashanchi F, Kumar S. Monocyte-derived exosomes upon exposure to cigarette smoke condensate alter their characteristics and show protective effect against cytotoxicity and HIV-1 replication. Sci Rep 2017; 7:16120. [PMID: 29170447 PMCID: PMC5701054 DOI: 10.1038/s41598-017-16301-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/10/2017] [Indexed: 01/10/2023] Open
Abstract
Smoking is known to exacerbate HIV-1 pathogenesis, especially in monocytes, through the oxidative stress pathway. Exosomes are known to alter HIV-1 pathogenesis through inter-cellular communication. However, the role of exosomes in smoking-mediated HIV-1 pathogenesis is unknown. In this study, we investigated the effect of cigarette smoke condensate (CSC) on the characteristics of monocyte-derived exosomes and their influence on HIV-1 replication. Initially, we demonstrated that CSC reduced total protein and antioxidant capacity in exosomes derived from HIV-1-infected and uninfected macrophages. The exosomes from CSC-treated uninfected cells showed a protective effect against cytotoxicity and viral replication in HIV-1-infected macrophages. However, exosomes derived from HIV-1-infected cells lost their protective capacity. The results suggest that the exosomal defense is likely to be more effective during the early phase of HIV-1 infection and diminishes at the latter phase. Furthermore, we showed CSC-mediated upregulation of catalase in exosomes from uninfected cells, with a decrease in the levels of catalase and PRDX6 in exosomes derived from HIV-1-infected cells. These results suggest a potential role of antioxidant enzymes, which are differentially packaged into CSC-exposed HIV-1-infected and uninfected cell-derived exosomes, on HIV-1 replication of recipient cells. Overall, our study suggests a novel role of exosomes in tobacco-mediated HIV-1 pathogenesis.
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Affiliation(s)
- Sanjana Haque
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Namita Sinha
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Sabina Ranjit
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Narasimha M Midde
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Fatah Kashanchi
- Laboratory of Molecular Virology, George Mason University, Manassas, VA, 20110, USA
| | - Santosh Kumar
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
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184
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Acute Exposure to Cigarette Smoking Followed by Myocardial Infarction Aggravates Renal Damage in an In Vivo Mouse Model. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:5135241. [PMID: 29177025 PMCID: PMC5671747 DOI: 10.1155/2017/5135241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/06/2017] [Accepted: 09/19/2017] [Indexed: 12/24/2022]
Abstract
Cigarette smoking (S) is a risk factor for progressive chronic kidney disease, renal dysfunction, and renal failure. In this study, the effect of smoking on kidney function was investigated in a mouse model of myocardial infarction (MI) using 4 groups: control (C), smoking (S), MI, and S+MI. Histological analysis of S+MI group showed alterations in kidney structure including swelling of the proximal convoluted tubules (PCTs), thinning of the epithelial lining, focal loss of the brush border of PCTs, and patchy glomerular retraction. Molecular analysis revealed that nephrin expression was significantly reduced in the S+MI group, whereas sodium-hydrogen exchanger-1 (NHE-1) was significantly increased, suggesting altered glomerular filtration and kidney functions. Moreover, S+MI group, but not S alone, showed a significant increase in the expression of connective tissue growth factor (CTGF) and fibrotic proteins fibronectin (FN) and α-smooth muscle actin (SMA), in comparison to controls, in addition to a significant increase in mRNA levels of IL-6 and TNF-α inflammatory markers. Finally, reactive oxygen species (ROS) production was significantly accentuated in S+MI group concomitant with a significant increase in NOX-4 protein levels. In conclusion, smoking aggravates murine acute renal damage caused by MI at the structural and molecular levels by exacerbating renal dysfunction.
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185
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Prediction of hemorrhagic transformation after acute thrombolysis following major artery occlusion using relative ADC ratio: A retrospective study. J Neuroradiol 2017; 44:361-366. [DOI: 10.1016/j.neurad.2017.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 07/03/2017] [Accepted: 07/19/2017] [Indexed: 11/22/2022]
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186
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Story LM, Duke JM, Smeds MR, Ali AT, Moursi MM, Lyons LC, Escobar GA. Contemporary Characteristics and Outcomes of Young Patients (Under 50 Years) Undergoing Open Carotid Artery Surgery. Ann Vasc Surg 2017; 44:375-380. [DOI: 10.1016/j.avsg.2017.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/10/2017] [Accepted: 01/24/2017] [Indexed: 11/17/2022]
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187
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Chung WS, Lin CL. Incidence and risk of acute coronary syndrome in patients with acute pancreatitis: A nationwide cohort study. Pancreatology 2017; 17:675-680. [PMID: 28760495 DOI: 10.1016/j.pan.2017.07.189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies on the relationship between acute pancreatitis (AP) and acute coronary syndrome (ACS) are scant. We conducted a nationwide cohort study to investigate the incidence and risk of ACS in patients with AP. METHODS We enrolled patients newly diagnosed with AP between 2000 and 2010 from the Taiwan National Health Insurance Research Database and randomly selected a control cohort without a history of AP after frequency-matching for age, sex, and index year at a ratio of 4:1 for each patient with AP. The follow-up period was from the index date of new AP diagnosis to the diagnosis of ACS, censoring, or the end of 2011. RESULTS We assessed 87 068 patients in the AP cohort and 348 272 participants in the control cohort for 508 991 and 2 301 317 person-years, respectively. The AP cohort exhibited a higher overall incidence of ACS than the control cohort (5.44 vs 3.03 per 1000 person-y). After adjustment for sex, age, and comorbidities, the AP cohort exhibited a 1.24-fold higher adjusted hazard ratio (aHR) of ACS (95% confidence interval = 1.19-1.30) than did the control cohort. When stratified by age, the patients with AP aged ≤39 years presented a 2.37-fold higher aHR of ACS than did their corresponding controls (95% CI = 1.88-2.99). Approximate one third of ACS developed within 1 month of AP occurrence. CONCLUSIONS This nationwide cohort study indicated that patients with AP are at an increased risk of ACS compared with those without AP.
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Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan.
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
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188
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Wabnitz AM, Turan TN. Symptomatic Carotid Artery Stenosis: Surgery, Stenting, or Medical Therapy? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:62. [PMID: 28677035 PMCID: PMC5496976 DOI: 10.1007/s11936-017-0564-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Symptomatic carotid artery disease is a significant cause of ischemic stroke, and these patients are at high risk for recurrent vascular events. Patients with symptoms of stroke or transient ischemic attack attributable to a significantly stenotic vessel (70–99% luminal narrowing) should be treated with intensive medical therapy. Intensive medical therapy is a combination of pharmacologic and lifestyle interventions consistent with best-known practices as follows: initiation of antiplatelet agent or anticoagulation if medically indicated, high potency statin medication, blood pressure control with goal blood pressure of greater than 140/90, Mediterranean-style diet, exercise, and smoking cessation. Further, patients who have extracranial culprit lesions should be considered for revascularization with either carotid endarterectomy or carotid angioplasty and stenting depending on several factors including the patient’s anatomy, age, gender, and procedural risk. Based on current evidence, patients with symptomatic intracranial stenosis should be managed with intensive medical therapy, including the use of dual antiplatelet therapy with aspirin and clopidogrel for the first 90 days following the ischemic event. While the literature has shown a stronger benefit of revascularization of extracranial symptomatic disease among certain subgroups of patients with greater than 70% stenosis, there is less benefit from revascularization with endarterectomy in patients with moderate stenosis of 50–69% if the surgeon’s risk of perioperative stroke or death rate is greater than 6%.
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Affiliation(s)
- Ashley M Wabnitz
- Division of Neurology, Medical University of South Carolina, 19 Hagood Ave, Harborview Office Tower Suite 501, Charleston, SC, 29425-8050, USA.
| | - Tanya N Turan
- Division of Neurology, Medical University of South Carolina, 19 Hagood Ave, Harborview Office Tower Suite 501, Charleston, SC, 29425-8050, USA
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Ji R, Pan Y, Yan H, Zhang R, Liu G, Wang P, Wang Y, Li H, Zhao X, Wang Y. Current smoking is associated with extracranial carotid atherosclerotic stenosis but not with intracranial large artery disease. BMC Neurol 2017. [PMID: 28651523 PMCID: PMC5485653 DOI: 10.1186/s12883-017-0873-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Accumulating evidence has shown that cigarette smoking is an important risk factor for ischemic stroke. However, it is not clear about the potential mechanisms through which cigarette smoking affects stroke risk. In the study, we aimed to investigate the relationship between cigarette smoking and the occurrence of extracranial (ECAS) and intracranial atherosclerotic stenosis (ICAS). Methods We analyzed patients enrolled in the Chinese intracranial atherosclerosis (CICAS), which was a prospective, multicenter, hospital-based cohort study. Smoking status was classified into never, former and current smoking. For those patients with current smoking, data on time duration (year) and extent (the number of cigarette smoked per day) was recorded and pack year of smoking was calculated. ICAS was evaluated with 3-dimentional time-of-flight MRA and ECAS was evaluated with cervical ultrasonography or contrast-enhanced MRA. Multivariable Logistic regression was performed to identify the association between smoking status and the occurrence of ECAS and ICAS. Results A total of 2656 patients (92.7%) of acute ischemic stroke and 208 (7.3%) of transient ischemic attack were analyzed. The mean age was 61.9 ± 11.2 and 67.8% were male. There were 141 (4.9%) patients had only ECAS, 1074 (37.5%) had only ICAS, and 261 (9.1%) had both ECAS and ICAS. Current smoking was significantly associated with the occurrence of ECAS (adjusted OR = 1.47, 95% CI = 1.09–1.99, P < 0.01). In addition, with 1 year of smoking increment, the risk of ECAS increased by 1.1% (adjusted OR = 1.011; 95% CI = 1.003–1.019; P = 0.005); with one cigarette smoked per day increment, the risk of ECAS increased by 1.0% (adjusted OR = 1.010; 95% CI = 1.001–1.020; P = 0.03); and with one pack year of smoking increment, the risk of ECAS increased by 0.7% (adjusted OR = 1.007; 95% CI = 1.002–1.012; P < 0.01). However, no significant association was found between smoking status and the occurrence of ICAS. Conclusion A dose–response relationship was identified between cigarette smoking and the occurrence of ECAS, but not ICAS. Further studies on molecular mechanisms were warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12883-017-0873-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruijun Ji
- Department of Neurology, Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.,Beijing Key Laboratory of Brain Function Reconstruction, Beijing, China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Hongyi Yan
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Runhua Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Gaifen Liu
- Department of Neurology, Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Penglian Wang
- Department of Neurology, Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China. .,Tiantan Comprehensive Stroke Center, Beijing Tiantan Hospital, Capital Medical University, No.6 Tiantanxili, Dongcheng District, Beijing, 100050, China.
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Abstract
BACKGROUND Smoking rates have declined; however, it remains the primary modifiable risk factor for vascular disease. While vascular surgeons often advise patients to quit, few provide assistance. We sought to understand patients' interest in quitting and determine factors that influence this willingness to quit. METHODS Anonymous surveys were given to vascular surgery clinic patients in a single institution over a 5-month period. Demographic information, smoking status, cessation attempts, and barriers to quitting were obtained. Nicotine dependence was determined using the Fagerstrom Test, and willingness to quit was assessed using a contemplation ladder. Patient's willingness to quit was evaluated in relation to symptomatic status, previous/planned operation, and nicotine dependence levels. RESULTS A total of 490 patients (92%) completed the survey with 109 (22%) current smokers, 195 (40%) former smokers, and 186 (38%) never smokers. Never smokers were more likely to be female and employed while smokers were more likely to be disabled. Although 51% of smokers displayed moderate/high nicotine dependence, 54% demonstrated willingness to consider quitting within 6 months. The primary barrier to cessation identified was previous failed attempt(s) to quit in 44%. Most (90%) had previously attempted quitting, 63% attempted 3 or more times, and the most common technique used was "quitting cold turkey". Fifty-nine percent of patients reported physicians' had offered assistance in cessation, but only 2% had been in a cessation program. There was no correlation between willingness to consider quitting and symptomatic status, previous/planned operation, or nicotine dependence. Smokers of less than 10 cigarettes/day had a lower nicotine dependence level (P = 0.0001) and higher willingness to consider quitting (P = 0.0015), as did those who had fewer failed prior attempts to quit and who did not believe it was too late to quit. CONCLUSIONS Most of our vascular patients self-report as nonsmokers. Over half of those who smoke demonstrate willingness to consider quitting within 6 months, which is not dependent on nicotine dependence, previous/planned operation, or symptomatic status. Those who smoke less than 10 cigarettes per day, have fewer past failed attempts to quit, and believe that it is not too late to quit are more likely to consider quitting. Vascular surgeons should be more aware of previous quit attempts and patterns of smoking and be proactive in assisting patients in cessation attempts.
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191
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Kaisar MA, Villalba H, Prasad S, Liles T, Sifat AE, Sajja RK, Abbruscato TJ, Cucullo L. Offsetting the impact of smoking and e-cigarette vaping on the cerebrovascular system and stroke injury: Is Metformin a viable countermeasure? Redox Biol 2017. [PMID: 28646795 PMCID: PMC5480985 DOI: 10.1016/j.redox.2017.06.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Recently published in vitro and in vivo findings strongly suggest that BBB impairment and increased risk for stroke by tobacco smoke (TS) closely resemble that of type-2 diabetes (2DM) and develop largely in response to common key modulators such oxidative stress (OS), inflammation and alterations of the endogenous antioxidative response system (ARE) regulated by the nuclear factor erythroid 2-related factor (Nrf2). Preclinical studies have also shown that nicotine (the principal e-liquid's ingredient used in e-cigarettes) can also cause OS, exacerbation of cerebral ischemia and secondary brain injury. Herein we provide evidence that likewise to TS, chronic e-Cigarette (e-Cig) vaping can be prodromal to the loss of blood-brain barrier (BBB) integrity and vascular inflammation as well as act as a promoting factor for the onset of stroke and worsening of post-ischemic brain injury. In addition, recent reports have shown that Metformin (MF) treatment before and after ischemic injury reduces stress and inhibits inflammatory responses. Recent published data by our group revealead that MF promotes the activation of counteractive mechanisms mediated by the activation of Nrf2 which drastically reduce TS toxicity at the brain and cerebrovascular levels and protect BBB integrity. In this study we provide additional in vivo evidence showing that MF can effectively reduce the oxidative and inflammatory risk for stroke and attenuate post-ischemic brain injury promoted by TS and e-Cig vaping. Our data also suggest that MF administration could be extended as prophylactic care during the time window required for the renormalization of the risk levels of stroke following smoking cessation thus further studies in that direction are warrated. Chronic cigarette and e-cigarette exposure downregulate throbomodulin and Nrf2. Chronic CS and e-Cig exposure worsen stroke outcome in mice undergoing tMCAO. Metformin ameliorate stroke outcomes in CS and e-Cig exposed mice undergoing tMCAO. MF protective effect correlates with renormalization of Nrf2 levels.
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Affiliation(s)
- Mohammad A Kaisar
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
| | - Heidi Villalba
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
| | - Shikha Prasad
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Taylor Liles
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
| | - Ali Ehsan Sifat
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
| | - Ravi K Sajja
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
| | - Thomas J Abbruscato
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA; Center for Blood Brain Barrier Research, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
| | - Luca Cucullo
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA; Center for Blood Brain Barrier Research, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
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Abstract
INTRODUCTION The burden of stroke is increasing globally. Reports on seasonal variations in stroke occurrence are conflicting and long-term data are absent. METHODS A retrospective cohort study using discharge registry data of all acute stroke admissions in Finland during 2004-2014 for patients ≥18 years age. A total of 97,018 admissions for ischemic stroke (IS) were included, 18,252 admissions for intracerebral hemorrhage (ICH) and 11,271 admissions for subarachnoid hemorrhage (SAH). RESULTS The rate of IS admissions increased (p = 0.025) while SAH admission rate decreased (p < 0.0001), and ICH admission rate remained stable during the study period. The lowest seasonal admission rates were detected in summer and the highest in autumn for all stroke subtypes. Seasonal variation of IS was more pronounced in men (p = 0.020), while no sex difference was detected in ICH or SAH. The seasonal patterns of in-hospital mortality and length of stay (LOS) differed markedly by stroke subtype. Diagnoses of hypertension, atrial fibrillation, or diabetes showed no seasonality. CONCLUSIONS All major stroke subtypes occurred most commonly in autumn and most infrequently in summer. Seasonality of in-hospital mortality and length of hospital stay appears to vary by stroke subtype. The seasonal pattern of ischemic stroke occurrence appears to have changed during the past decades. Key messages All major stroke subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) occurred most frequently in autumn and least frequently in summer. Seasonal patterns of in-hospital mortality and length of stay differed markedly by stroke subtype. The seasonal pattern of ischemic stroke occurrence in Finland seems to have changed compared to 1982-1992.
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Affiliation(s)
- Jussi O T Sipilä
- a North Karelia Central Hospital , Joensuu , Finland.,b Division of Clinical Neurosciences , Turku University Hospital , Turku , Finland.,c Department of Neurology , University of Turku , Turku , Finland
| | - Jori O Ruuskanen
- d Turku University Hospital , Turku , Finland.,e Department of Neurology , University of Turku , Turku , Finland
| | - Tommi Kauko
- f Department of Biostatistics , University of Turku , Turku , Finland
| | - Päivi Rautava
- g Department of Public Health , University of Turku , Turku , Finland.,h Turku Clinical Research Centre, Turku University Hospital , Turku , Finland
| | - Ville Kytö
- i Heart Center, Turku University Hospital , Turku , Finland.,j Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku , Turku , Finland
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193
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Impact of Multiple Chronic Conditions in Patients Hospitalized with Stroke and Transient Ischemic Attack. J Stroke Cerebrovasc Dis 2017; 26:1239-1248. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/05/2017] [Accepted: 01/18/2017] [Indexed: 12/30/2022] Open
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194
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Khan AA, Chung MJ, Novak E, Mori Brooks M, Brown DL. The long-term risk of smoking in diabetic patients with stable ischemic heart disease treated with intensive medical therapy and lifestyle modification. Eur J Prev Cardiol 2017; 24:1506-1514. [PMID: 28517955 DOI: 10.1177/2047487317711046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The long-term risk of smoking in diabetic patients with stable ischemic heart disease (SIHD) is unknown. We sought to analyze the impact of smoking on outcomes of diabetic patients with SIHD when other cardiovascular risk factors are being aggressively treated. Methods The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial randomized 2368 diabetics with SIHD to intensive medical therapy (IMT) with prompt revascularization or IMT alone. Smoking status was obtained at baseline, 6 months, and 1, 2, 3, 4 and 5 years. The primary endpoint of interest was all-cause mortality. Results Of 2360 patients, 33.1% of patients never smoked, 54.4% were former smokers, and 12.5% were current smokers. The rate of all-cause mortality was greater for current (2.5 deaths/100 patient-years) and former smokers (3.1 deaths/100 patient-years) than never smokers (2.1 deaths/100 patient-years) (P = 0.007). Cardiac death, cardiovascular death, fatal or nonfatal myocardial infarction, and fatal or nonfatal stroke were not increased in current or former smokers compared with never smokers. Compared with never smokers, current smokers experienced a 49% increased hazard of death (Hazard Ratio (HR) 1.49, 95% Confidence Interval (CI): 0.97-2.29, P = 0.07) whereas former smokers had a 37% increased hazard of death (HR 1.37, 95% CI: 1.04-2.79, P = 0.02) when considering smoking status as a time-dependent variable and adjusting for factors that differed by smoking status. Conclusions Current and former smoking are associated with increased all-cause mortality in diabetics with SIHD but not with increased cardiovascular morbidity or mortality.
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Affiliation(s)
- Asrar A Khan
- 1 Department of Internal Medicine, Washington University School of Medicine, US
| | - Matthew J Chung
- 2 Cardiovascular Division, Washington University School of Medicine, US
| | - Eric Novak
- 2 Cardiovascular Division, Washington University School of Medicine, US
| | | | - David L Brown
- 2 Cardiovascular Division, Washington University School of Medicine, US
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195
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Cox LAT. Socioeconomic and air pollution correlates of adult asthma, heart attack, and stroke risks in the United States, 2010-2013. ENVIRONMENTAL RESEARCH 2017; 155:92-107. [PMID: 28208075 DOI: 10.1016/j.envres.2017.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/04/2016] [Accepted: 01/03/2017] [Indexed: 06/06/2023]
Abstract
Asthma in the United States has become an important public health issue, with many physicians, regulators, and scientists elsewhere expressing concern that criterion air pollutants have contributed to a rising tide of asthma cases and symptoms. This paper studies recent associations (from 2008 to 2012) between self-reported asthma experiences and potential predictors, including age, sex, income, education, smoking, and county-level average annual ambient concentrations of ozone (O3) and fine particulate matter (PM2.5) levels recorded by the U.S. Environmental Protection Agency, for adults 50 years old or older for whom survey data are available from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS). We also examine associations between these variables and self-reported heart attack and stroke experience; all three health outcomes are positively associated with each other. Young divorced women with low incomes are at greatest risk of asthma, especially if they are ever-smokers. Income is an important confounder of other relations. For example, in logistic regression modeling, PM2.5 is positively associated (p<0.06) with both stroke risk and heart attack risk when these are regressed only against PM2.5, sex, age, and ever-smoking status, but not when they are regressed against these variables and income. In this data set, PM2.5 is significantly negatively associated with asthma risk in regression models, with a 10μg/m3 decrease in PM2.5 corresponding to about a 6% increase in the probability of asthma, possibly because of confounding by smoking, which is negatively associated with PM2.5 and positively associated with asthma risk. A variety of non-parametric methods are used to quantify these associations and to explore potential causal interpretations.
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Affiliation(s)
- Louis Anthony Tony Cox
- Cox Associates and University of Colorado, 503 N. Franklin Street, Denver, CO 80218, USA.
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196
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6130] [Impact Index Per Article: 875.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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197
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Karahalil B, Elkama A, Orhan G. Oxidative stress gene polymorphisms may have an impact in the development of ischemic stroke. J Gene Med 2017; 19. [PMID: 28198160 DOI: 10.1002/jgm.2947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Antioxidants are responsible for detoxification of harmful effects of reactive oxygen species. Genetic factors may influence antioxidant activity as a result of polymorphisms on antioxidant enzymes. These polymorphisms can be risk in ischemic stroke (IS) risk. IS is a disorder with genetic and environmental factors contributing to overall risk. Although a few studies have been conducted, there have been no reports on catalase (CAT C262T), manganese superoxide dismutase (MnSOD Ala16Val) and glutathione peroxidase 1 (GPX1 Pro198Leu) gene polymorphisms and IS risk. METHODS We aimed to perform a case-control study to increase the awareness of the impact of oxidative stress (OS) gene polymorphism in the development of IS. A restriction fragment length polymorphism-polymerase chain reaction was used to determine genotypes. The interactions between genes and smoking and possible risk factors were evaluated. RESULTS An approximately four-fold higher IS risk was found in patients with the Val allele compared to the Ala allele. Smoking was a risk factor in the development of IS for CAT TT and MnSOD Ala/Val genotypes; we found a 3.5- to 5.5-fold higher IS risk in CAT TT and MnSOD Ala/Val genotypes. Different logistic regression models were performed for possible risk factors (smoking, body mass index, low-density lipoprotein and diabetes mellitus). The IS risk increases statistically significant only with age by multiple logistic regression analysis. CAT gene polymorphisms in IS patients were not different from controls. CONCLUSIONS It is unlikely that CAT and GPX1 single nucleotide polymorphisms are risk factors for IS. The results of the present study show that smoking may be a risk factor for IS risk in patients with MnSOD mutant genotypes.
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Affiliation(s)
- Bensu Karahalil
- Faculty of Pharmacy, Department of Toxicology, Gazi University, Ankara, Turkey
| | - Aylin Elkama
- Faculty of Pharmacy, Department of Toxicology, Gazi University, Ankara, Turkey
| | - Gürdal Orhan
- Clinics of Neurology, Ankara Numune Hospital, Ankara, Turkey
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199
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Falkstedt D, Wolff V, Allebeck P, Hemmingsson T, Danielsson AK. Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke: A Population-Based Cohort Study of 45 000 Swedish Men. Stroke 2017; 48:265-270. [PMID: 28028147 DOI: 10.1161/strokeaha.116.015565] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/23/2016] [Accepted: 11/28/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Current knowledge on cannabis use in relation to stroke is based almost exclusively on clinical reports. By using a population-based cohort, we aimed to find out whether there was an association between cannabis use and early-onset stroke, when accounting for the use of tobacco and alcohol. METHODS The cohort comprises 49 321 Swedish men, born between 1949 and 1951, who were conscripted into compulsory military service between the ages of 18 and 20. All men answered 2 detailed questionnaires at conscription and were subject to examinations of physical aptitude, psychological functioning, and medical status. Information on stroke events up to ≈60 years of age was obtained from national databases; this includes strokes experienced before 45 years of age. RESULTS No associations between cannabis use in young adulthood and strokes experienced ≤45 years of age or beyond were found in multivariable models: cannabis use >50 times, hazard ratios=0.93 (95% confidence interval [CI], 0.34-2.57) and 0.95 (95% CI, 0.59-1.53). Although an almost doubled risk of ischemic stroke was observed in those with cannabis use >50 times, this risk was attenuated when adjusted for tobacco usage: hazards ratio=1.47 (95% CI, 0.83-2.56). Smoking ≥20 cigarettes per day was clearly associated both with strokes before 45 years of age, hazards ratio=5.04 (95% CI, 2.80-9.06), and with strokes throughout the follow-up, hazards ratio=2.15 (95% CI, 1.61-2.88). CONCLUSIONS We found no evident association between cannabis use in young adulthood and stroke, including strokes before 45 years of age. Tobacco smoking, however, showed a clear, dose-response shaped association with stroke.
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Affiliation(s)
- Daniel Falkstedt
- From the Department of Public Health Sciences (D.F., P.A., A.-K.D.) and Institute of Environmental Medicine (T.H.), Karolinska Institutet, Stockholm, Sweden; Stroke Unit, Department of Neurology, Strasbourg University Hospital, University of Strasbourg, France (V.W.); Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden (P.A.); and Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden (T.H.)
| | - Valerie Wolff
- From the Department of Public Health Sciences (D.F., P.A., A.-K.D.) and Institute of Environmental Medicine (T.H.), Karolinska Institutet, Stockholm, Sweden; Stroke Unit, Department of Neurology, Strasbourg University Hospital, University of Strasbourg, France (V.W.); Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden (P.A.); and Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden (T.H.)
| | - Peter Allebeck
- From the Department of Public Health Sciences (D.F., P.A., A.-K.D.) and Institute of Environmental Medicine (T.H.), Karolinska Institutet, Stockholm, Sweden; Stroke Unit, Department of Neurology, Strasbourg University Hospital, University of Strasbourg, France (V.W.); Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden (P.A.); and Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden (T.H.)
| | - Tomas Hemmingsson
- From the Department of Public Health Sciences (D.F., P.A., A.-K.D.) and Institute of Environmental Medicine (T.H.), Karolinska Institutet, Stockholm, Sweden; Stroke Unit, Department of Neurology, Strasbourg University Hospital, University of Strasbourg, France (V.W.); Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden (P.A.); and Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden (T.H.)
| | - Anna-Karin Danielsson
- From the Department of Public Health Sciences (D.F., P.A., A.-K.D.) and Institute of Environmental Medicine (T.H.), Karolinska Institutet, Stockholm, Sweden; Stroke Unit, Department of Neurology, Strasbourg University Hospital, University of Strasbourg, France (V.W.); Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden (P.A.); and Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden (T.H.).
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Harriott AM, Zimmerman E, Singhal AB, Jaff MR, Lindsay ME, Rordorf GA. Cerebrovascular fibromuscular dysplasia: The MGH cohort and literature review. Neurol Clin Pract 2017; 7:225-236. [PMID: 28680766 DOI: 10.1212/cpj.0000000000000339] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/28/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fibromuscular dysplasia (FMD) is a rare noninflammatory, nonatherosclerotic arteriopathy of medium-sized arteries affecting up to 7% of the population. The disease can affect any artery but commonly affects renal, extracranial carotid, and vertebral arteries. The epidemiology and natural course of cerebrovascular FMD is unknown and requires further investigation. METHODS We present demographic and outcomes data on a case series of 81 patients with cerebrovascular FMD from Massachusetts General Hospital presenting between 2011 and 2015 followed by a review of the peer-reviewed literature. RESULTS Patients were a median age of 53 years (±12 SD) and the majority were women. Approximately 50% had a history of tobacco use and more than two-thirds had hypertension. Most patients were on monoplatelet therapy with aspirin; during follow-up, 7 of 67 had progressive disease or additional symptoms. One of 67 patients had a cerebrovascular event: TIA. There were 5 of 67 who had noncerebrovascular events or disease progression and 1 death of unclear cause. CONCLUSIONS Cerebrovascular FMD may present with myriad symptoms. Our data support that patients with FMD with symptomatic disease have a low rate of recurrent symptoms or disease progression and can be managed conservatively with stroke risk modification, antiplatelet agents, surveillance imaging, and counseling.
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Affiliation(s)
- Andrea M Harriott
- Department of Neurology (AMH, EZ, ABS, GAR), The Fireman Vascular Center (MRJ), and Thoracic Aortic Center and Cardiovascular Research Center (MEL), Massachusetts General Hospital; John R. Graham Headache Center (AMH), Brigham and Women's Faulkner Hospital, Boston; and Department of Neurology (EZ), Vanderbilt University Medical Center, Nashville, TN
| | - Eli Zimmerman
- Department of Neurology (AMH, EZ, ABS, GAR), The Fireman Vascular Center (MRJ), and Thoracic Aortic Center and Cardiovascular Research Center (MEL), Massachusetts General Hospital; John R. Graham Headache Center (AMH), Brigham and Women's Faulkner Hospital, Boston; and Department of Neurology (EZ), Vanderbilt University Medical Center, Nashville, TN
| | - Aneesh B Singhal
- Department of Neurology (AMH, EZ, ABS, GAR), The Fireman Vascular Center (MRJ), and Thoracic Aortic Center and Cardiovascular Research Center (MEL), Massachusetts General Hospital; John R. Graham Headache Center (AMH), Brigham and Women's Faulkner Hospital, Boston; and Department of Neurology (EZ), Vanderbilt University Medical Center, Nashville, TN
| | - Michael R Jaff
- Department of Neurology (AMH, EZ, ABS, GAR), The Fireman Vascular Center (MRJ), and Thoracic Aortic Center and Cardiovascular Research Center (MEL), Massachusetts General Hospital; John R. Graham Headache Center (AMH), Brigham and Women's Faulkner Hospital, Boston; and Department of Neurology (EZ), Vanderbilt University Medical Center, Nashville, TN
| | - Mark E Lindsay
- Department of Neurology (AMH, EZ, ABS, GAR), The Fireman Vascular Center (MRJ), and Thoracic Aortic Center and Cardiovascular Research Center (MEL), Massachusetts General Hospital; John R. Graham Headache Center (AMH), Brigham and Women's Faulkner Hospital, Boston; and Department of Neurology (EZ), Vanderbilt University Medical Center, Nashville, TN
| | - Guy A Rordorf
- Department of Neurology (AMH, EZ, ABS, GAR), The Fireman Vascular Center (MRJ), and Thoracic Aortic Center and Cardiovascular Research Center (MEL), Massachusetts General Hospital; John R. Graham Headache Center (AMH), Brigham and Women's Faulkner Hospital, Boston; and Department of Neurology (EZ), Vanderbilt University Medical Center, Nashville, TN
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