Artificial cold wave-induced cerebral infarction in rats with carotid atherosclerosis

Low ambient temperature exposure increases the risk of ischemic stroke by promoting platelet activation

BACKGROUND

Accumulating epidemiological evidence suggests the association between low ambient temperature exposure and the risk of ischemic stroke, but the underlying mechanisms remain unclear.

OBJECTIVE

Given the crucial role of platelet activation and thrombosis in ischemic stroke, this study aims to investigate the effect of ambient temperature on platelet activation through multi-center clinical data in Tianjin as well as animal experiments.

METHODS

From 2018 to 2020, nearly 3000 ischemic stroke patients from three stroke centers in Tianjin were included in the analysis, among them the ADP induced platelet aggregation rate was available. Meteorological data from the same period had also been collected. After controlling for confounding factors, the generalized additive mixed model (GAMM) was used to evaluate the correlation between environmental temperature and platelet aggregation rate. In further animal experiments, platelet function assessments were conducted on mice from the cold exposure group and the normal temperature group, including platelet aggregation, spreading, and clot retraction. Additionally, tail bleeding and mesentery thrombosis were also tested to monitor hemostasis and thrombosis in vivo.

RESULT

A nonlinear "S" shaped relationship between outdoor temperature and platelet aggregation was found. Each 1 °C decrease of mean temperature was associated with an increase of 7.77 % (95 % CI: 2.06 % - 13.48 %) in platelet aggregation. The ambient temperature is not related to other platelet parameters. Subgroup analysis found that males, people aged ≥65 years, and hypertensive individuals are more susceptible to temperature changes. Furthermore, animal experiments demonstrated that the increased CIRBP levels and subsequent activation of p-AKT/p-ERK may be one of the reasons for cold exposure induced platelets activation.

CONCLUSION

Both clinical data and basic research support that low ambient temperature exposure has the potential to increase platelet activation. These results provide a basis for understanding the potential mechanism of temperature variations on the pathogenesis of cerebrovascular diseases.

The underlying mechanisms of cold exposure-induced ischemic stroke

Growing evidence suggests that cold exposure is to some extent a potential risk factor for ischemic stroke. At present, although the mechanism by which cold exposure induces ischemic stroke is not fully understood, some potential mechanisms have been mentioned. First, the seasonal and temperature variability of cerebrovascular risk factors (hypertension, hyperglycemia, hyperlipidemia, atrial fibrillation) may be involved. Moreover, the activation of sympathetic nervous system and renin-angiotensin system and their downstream signaling pathways (pro-inflammatory AngII, activated platelets, and dysfunctional immune cells) are also major contributors. Finally, the influenza epidemics induced by cold weather are also influencing factors that cannot be ignored. This article is the first to systematically and comprehensively describe the underlying mechanism of cold-induced ischemic stroke, aiming to provide more preventive measures and medication guidance for stroke-susceptible individuals in cold season, and also provide support for the formulation of public health policies.

Artificial cold air increases the cardiovascular risks in spontaneously hypertensive rats

The purpose was to investigate the effects of artificial cold air on cardiovascular risk in hypertensive subjects. An artificial cold air was simulated with hourly ambient temperature data of a real moderate cold air in China. Twenty-four male SHR rats were randomly divided into the minimum temperature (Tmin) group, the rewarming temperature (Tr) group and two concurrent control groups with six rats in each (Tmin and Tr represent two cold air time points, respectively). Tmin and Tr groups were exposed to the cold air that was stopped at Tmin and Tr, respectively. After cold air exposure, blood pressure, heart rate and body weight were monitored, blood was collected for the detection of some indexes like fibrinogen, total cholesterol and uric acid. Results demonstrated that blood pressure, whole blood viscosity, blood fibrinogen, total cholesterol and uric acid increased significantly both in the Tmin and Tr groups; low density lipoprotein/high density lipoprotein increased significantly only in Tr group; there was higher level of blood fibrinogen in the Tr group than the Tmin group; higher levels of creatine kinase-MB was found in both the Tmin and Tr groups. These results suggest that cold air may increase the cardiovascular risks in hypertensive subjects indirectly through its effects on the sympathetic nervous system and renin angiotensin system, blood pressure and atherosclerosis risk factors like blood viscosity and fibrinogen, lipids and uric acid in the blood.