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Kuliński W, Figura-Bock M. SELECTED PROBLEMS IN THE REHABILITATION OF PATIENTS IN A NURSING AND CARE INSTITUTION. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1613-1621. [PMID: 35962669 DOI: 10.36740/wlek202207101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of the study was to assess selected problems in the rehabilitation of patients staying at a nursing and care institution. PATIENTS AND METHODS Materials and methods: The study included 33 patients aged 55 to 96 years who were staying at the nursing and care institution in Lipsko. Study patients were examined over a period of 3 months using the standardised Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (I-ADL) scores, the Abbreviated Mental Test Score (AMTS) and the Timed Up and Go Test (TUG). RESULTS Results: Standardised ADL testing showed that a considerable proportion of study patients (60%) aged 66-75 years had moderate disability. Standardised Lawton scale testing showed that the most difficult complex activities were home maintenance (96.97%), shopping (90.91%), cooking (87.88%), cleaning (87.88%) and doing laundry (78.79%). The standardised Timed Up and Go Test showed that a large proportion of study patients (71.43%) aged 66-75 years had considerable functional mobility limitations. The AMTS, which assessed the cognitive function, revealed normal results in 36.36% of study patients. CONCLUSION Conclusions: 1. Study patients had significant functional disability. 2. The patients' sex did not influence the ability to perform complex activities of daily living. 3. Sociodemographic determinants did not influence cognitive functioning. 4. Physical therapy and rehabilitation in the elderly should be performed on a regular basis and in the entire society.
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Affiliation(s)
- Włodzisław Kuliński
- DEPARTMENT OF REHABILITATION, MILITARY INSTITUTE OF MEDICINE, WARSAW, POLAND
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Sobolewski P, Brola W, Wilczyński J, Szczuchniak W, Wójcik T, Wach-Klink A, Kos M, Kozera G. Cerebral Thrombolysis in Rural Residents Aged ≥ 80. Clin Interv Aging 2020; 15:1737-1751. [PMID: 33061326 PMCID: PMC7522422 DOI: 10.2147/cia.s256070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose The proportion of older people in Poland is higher in rural areas than in urban areas. Thus, we aimed to evaluate treatment rate and factors associated with outcome and safety of intravenous thrombolysis (IVT) in rural residents aged ≥80 years admitted to primary stroke centers. Patients and Methods This study was a retrospective, observational cohort study of 873 patients treated with recombinant tissue plasminogen activator (rt-PA) in primary stroke centers between February 1, 2009 and December 31, 2017. Among them were 527 rural residents and 231 (26.5%) were ≥80 years of age. The analyses between rural and urban patients aged ≥80 and between rural patients aged <80 and aged ≥80 were performed. Results The proportion of patients aged ≥80 treated with rt-PA was comparable in rural and urban residents (27.9% vs 24.3% p = 0.24). Rural patients aged ≥80 were also characterized by lower incidence of cardiovascular risk factors and better patients’ conditions on admission to hospital. Symptomatic intracerebral hemorrhage rate among ≥80-year-old stroke patients was lower in those living in rural areas than in those living in urban areas (5.4% vs 14.3%, p = 0.02); there were no differences regarding mortality and 3-month functional outcome between both populations. The older group of rural patients was characterized by a higher 3-month mortality (28.5% vs 12.6%, p < 0.001) and lower functional independence rate (34.0% vs 50.5%, p < 0.001) than rural younger patients. Antiplatelet (OR 2.43, 95% CI 1.04–5.66, p = 0.04) and anticoagulant therapy before stroke (OR 3.64, 95% CI 1.21–10.99, p = 0.022), early ischemic changes in baseline computerized tomograprpahy (OR 2.65, 95% CI 1.03–6.82, p = 0.043) were associated with unfavorable outcome; and higher National Institute of Health Stroke Scale score on admission (OR 1.01, 95% CI 1.01–1.20, p = 0.039), higher baseline count of white blood cells (OR 1.33, 95% CI 1.10–0.62, p = 0.003) were associated with mortality in rural patients over 80. Conclusion We suggest that rural patients aged ≥80 may be safely treated with IVT in routine practice. However, lower efficacy and a higher mortality must be considered in former use of Vitamin K antagonist and antiplatelet or high white blood cells count.
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Affiliation(s)
- Piotr Sobolewski
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.,Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
| | - Waldemar Brola
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.,Department of Neurology and Stroke Unit, Saint Lukas Hospital in Końskie, Końskie, Poland
| | | | - Wiktor Szczuchniak
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
| | - Tomasz Wójcik
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Aleksandra Wach-Klink
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
| | - Marek Kos
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland.,Department of Public Health, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Kozera
- Medical Simulation Center, Medical University of Gdańsk, Gdańsk, Poland
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Jokanovic N, Kautiainen H, Bell JS, Tan ECK, Pitkälä KH. Change in Prescribing for Secondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities. Drugs Aging 2019; 36:571-579. [PMID: 30949985 DOI: 10.1007/s40266-019-00656-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND One quarter of residents in long-term care facilities (LTCFs) have a diagnosis of CHD or stroke and over half use at least one preventative cardiovascular medication. There have been no studies that have investigated the longitudinal change in secondary preventative cardiovascular medication use in residents in LTCFs over time. OBJECTIVE The aim of this study was to investigate the change in cardiovascular medication use among residents with coronary heart disease (CHD) and prior stroke in nursing homes (NHs) and assisted living facilities (ALFs) in Finland over time, and whether this change differs according to dementia status. METHODS Three comparable cross-sectional audits of cardiovascular medication use among residents aged 65 years and over with CHD or prior stroke in NHs in 2003 and 2011 and ALFs in 2007 and 2011 were compared. Logistic regression analyses adjusted for gender, age, mobility, cancer and length of stay were performed to examine the effect of study year, dementia and their interaction on medication use. RESULTS Cardiovascular medication use among residents with CHD (NHs: 89% vs 70%; ALFs: 89% vs 84%) and antithrombotic medication use among residents with stroke (NHs: 72% vs 63%; ALFs: 78% vs 69%) declined between 2003 and 2011 in NHs and 2007 and 2011 in ALFs. Decline in the use of diuretics, nitrates and digoxin were found in both groups and settings. Cardiovascular medication use among residents with CHD and dementia declined in NHs (88% [95% CI 85-91] in 2003 vs 70% [95% CI 64-75] in 2011) whereas there was no change among people without dementia. There was no change in cardiovascular medication use among residents with CHD in ALFs with or without dementia over time. Antithrombotic use was lower in residents with dementia compared with residents without dementia in NHs (p < 0.001) and ALFs (p = 0.026); however, the interaction between dementia diagnosis and time was non-significant. CONCLUSIONS The decline in cardiovascular medication use in residents with CHD and dementia suggests Finnish physicians are adopting a more conservative approach to the management of cardiovascular disease in the NH population.
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Affiliation(s)
- Natali Jokanovic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia. .,Pharmacy Department, Alfred Hospital, Melbourne, Australia.
| | - Hannu Kautiainen
- Department of General Practice and Unit of Primary Health Care, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Edwin C K Tan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.,School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden
| | - Kaisu H Pitkälä
- Department of General Practice and Unit of Primary Health Care, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Zayed MA, Hsu FF, Patterson BW, Yan Y, Naim U, Darwesh M, De Silva G, Yang C, Semenkovich CF. Diabetes adversely affects phospholipid profiles in human carotid artery endarterectomy plaques. J Lipid Res 2018; 59:730-738. [PMID: 29478028 PMCID: PMC5880490 DOI: 10.1194/jlr.m081026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 02/21/2018] [Indexed: 12/22/2022] Open
Abstract
Patients with diabetes are at higher risk of developing carotid artery stenosis and resultant stroke. Arachidonoyl phospholipids affect plaque inflammation and vulnerability, but whether diabetic patients have unique carotid artery phospholipidomic profiles is unknown. We performed a comprehensive paired analysis of phospholipids in extracranial carotid endarterectomy (CEA) plaques of matched diabetic and nondiabetic patients and analyzed mass spectrometry-derived profiles of three phospholipids, plasmenyl-phosphatidylethanolamine (pPE), phosphatidylserine (PS), and phosphatidylinositol (PI), in maximally (MAX) and minimally (MIN) diseased CEA segments. We also measured levels of arachidonic acid (AA), produced by pPE hydrolysis, and choline-ethanolamine phosphotransferase 1 (CEPT1), responsible for most pPE de novo biosynthesis. In paired analysis, MIN CEA segments had higher levels than MAX segments of pPE (P < 0.001), PS (P < 0.001), and PI (P < 0.03). MIN diabetic plaques contained higher levels than MAX diabetic plaques of arachidonoyl pPE38:4 and pPE38:5 and CEPT1 was upregulated in diabetic versus nondiabetic plaques. AA levels were relatively greater in MIN versus MAX segments of all CEA segments, and were higher in diabetic than nondiabetic plaques. Our findings suggest that arachidonoyl phospholipids are more likely to be abundant in the extracranial carotid artery plaque of diabetic rather than nondiabetic patients.
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Affiliation(s)
- Mohamed A Zayed
- Section of Vascular Surgery, Department of Surgery, Center for Human Nutrition Washington University School of Medicine, St. Louis, MO; Department of Surgery, Veterans Affairs St. Louis Health Care System, St. Louis, MO.
| | - Fong-Fu Hsu
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University, St. Louis, MO
| | - Bruce W Patterson
- Department of Medicine, and Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Uzma Naim
- Section of Vascular Surgery, Department of Surgery, Center for Human Nutrition Washington University School of Medicine, St. Louis, MO
| | - Malik Darwesh
- Section of Vascular Surgery, Department of Surgery, Center for Human Nutrition Washington University School of Medicine, St. Louis, MO
| | - Gayan De Silva
- Section of Vascular Surgery, Department of Surgery, Center for Human Nutrition Washington University School of Medicine, St. Louis, MO
| | - Chao Yang
- Section of Vascular Surgery, Department of Surgery, Center for Human Nutrition Washington University School of Medicine, St. Louis, MO
| | - Clay F Semenkovich
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University, St. Louis, MO
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Grace EL, Allen RS, Ivey K, Knapp SM, Burgio LD. Racial and ethnic differences in psychotropic medication use among community-dwelling persons with dementia in the United States. Aging Ment Health 2018; 22:458-467. [PMID: 28282730 DOI: 10.1080/13607863.2017.1286451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Little is known about the patterns of psychotropic medication use in community-dwelling minority persons with dementia (PWD). The purpose of this study was to investigate racial/ethnic differences in psychotropic medication use across a diverse population of community-dwelling PWD and to examine the extent to which caregiver characteristics influence this use. METHOD Data were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Generalized linear models were used to identify racial/ethnic differences in psychotropic medication use. Akaike Information Criterion (AIC) model selection was used to evaluate possible explanations for observed differences across racial/ethnic group. RESULTS Differences in anxiolytic and antipsychotic medication use were observed across racial/ethnic groups; however, race/ethnicity alone was not sufficient to explain those differences. Perceptions of caregiving and caregiver socioeconomic status were important predictors of anxiolytic use while PWD characteristics, including cognitive impairment, functional impairment, problem behavior frequency, pain, relationship to the caregiver, sex, and age were important for antipsychotic use. CONCLUSION Racial/ethnic differences in psychotropic medication use among community-dwelling PWD cannot be explained by race/ethnicity alone. The importance of caregiver characteristics in predicting anxiolytic medication use suggest that interventions aimed at caregivers may hold promise as an effective alternative to pharmacotherapy.
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Affiliation(s)
- Elsie L Grace
- a Center for Social Epidemiology and Population Health , School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - Rebecca S Allen
- b Alabama Research Institute on Aging and Department of Psychology , University of Alabama , Tuscaloosa , AL , USA
| | - Keisha Ivey
- b Alabama Research Institute on Aging and Department of Psychology , University of Alabama , Tuscaloosa , AL , USA
| | - Shannon M Knapp
- c Statistics Consulting Lab , Bio5 Institute, University of Arizona , Tucson , AZ , USA
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Association between traditional cardiovascular risk factors and mortality in the oldest old: untangling the role of frailty. BMC Geriatr 2017; 17:234. [PMID: 29025410 PMCID: PMC5639737 DOI: 10.1186/s12877-017-0626-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 10/08/2017] [Indexed: 12/25/2022] Open
Abstract
Background To date, there is no consensus regarding cardiovascular risk management in the very old. Studies have shown that the relationship between traditional cardiovascular risk factors and mortality is null or even inverted within this age group. This relationship could be modified by the presence of frailty. This study was performed to examine the effect of frailty on the association between cardiovascular risk factors and mortality in the oldest old. Methods The BELFRAIL study is a prospective, observational, population-based cohort study of 567 subjects aged 80 years and older. Data on cardiovascular risk factors were recorded. Frailty was assessed using three different models: the Groningen Frailty Indicator, Fried and Puts models. Participants were considered robust if they were ‘not frail’ according to all three models, and frail if they met the frailty criteria for one of the three models. The follow-up data on mortality and cause of death were registered. Results No cardiovascular risk factor was associated with mortality in subjects with and without cardiovascular disease. The presence of frailty was a strong risk factor for mortality [HR: 2.5, 95%CI: (1.9–3.2) for all-cause mortality; HR: 2.2, 95%CI: (1.4–3.4) for cardiovascular mortality]. In robust patients, a history of cardiovascular disease increased the risk for mortality [HR: 1.7, 95%CI: (1.1–2.5) for all-cause mortality; HR: 2.2, 95%CI: (1.2–3.9) for cardiovascular mortality]. In frail patients, there was no association between any of the traditional risk factors and mortality. Conclusions Traditional cardiovascular risk factors were not associated with mortality in very old subjects. Frailty was shown to be a strong risk factor for mortality in this age group. However, frailty could not be used to identify additional subjects who might benefit more from cardiovascular risk management. Electronic supplementary material The online version of this article (10.1186/s12877-017-0626-x) contains supplementary material, which is available to authorized users.
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Grace EL, Burgio LD, Allen RS, DeCoster J, Aiello AE, Algase DL. Caregiver and care recipient characteristics as predictors of psychotropic medication use in community-dwelling dementia patients. Aging Ment Health 2016; 20:1297-1304. [PMID: 26304301 PMCID: PMC6684031 DOI: 10.1080/13607863.2015.1075960] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The current practice of prescribing psychotropic medication for the management of dementia-related behavioral disturbances is under substantial debate. Using Pearlin's stress process model as theoretical underpinning, the aim of this investigation is to identify caregiver and care recipient characteristics as predictors of anxiolytic, antipsychotic, and antidepressant use among community-dwelling dementia patients. We hypothesized that caregiving burden and patient characteristics, particularly behavior disturbances and pain, would be positively associated with psychotropic medication use. METHODS Data for this exploratory, cross-sectional study were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Only participants with full baseline information were examined (N = 598). Caregiver characteristics, such as confidence managing problematic behaviors, and care recipient characteristics including pain, problem behaviors, cognitive impairment, and functional impairment, were examined in relation to care recipient psychotropic medication use. RESULTS Contrary to our hypothesis, behavioral disturbances and burden associated with these disturbances were not significantly associated with psychotropic use. Rather, caregiver characteristics such as race and overall vigilance, and care recipient characteristics such as cognitive status, functional status, and pain were significantly associated with the use of psychotropic medication. Findings differed by class of medication. CONCLUSION These exploratory findings suggest the utility of a holistic approach to understanding the factors associated with pharmacotherapy among community-dwelling elders with dementia. Significant associations between caregiver characteristics and care recipient psychotropic medication use suggest that educating caregivers in non-pharmacologic strategies hold promise for a more balanced biopsychosocial approach to maintaining dementia patients in the community.
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Affiliation(s)
- Elsie L. Grace
- The University of Michigan, School of Public Health, Center for Social Epidemiology and Population Health, Ann Arbor, MI
| | - Louis D. Burgio
- University of Michigan, School of Social Work, Ann Arbor, MI
| | - Rebecca S. Allen
- The University of Alabama, Alabama Research Institute on Aging, Tuscaloosa, AL.,The University of Alabama, Department of Psychology, Tuscaloosa, AL
| | - Jamie DeCoster
- The University of Virginia, Curry School of Education, Charlottesville, VA
| | - Allison E. Aiello
- The University of Michigan, School of Public Health, Center for Social Epidemiology and Population Health, Ann Arbor, MI
| | - Donna L. Algase
- The University of Michigan, School Nursing, Ann Arbor, MI., Address correspondence to: Louis D. Burgio, Burgio Geriatric Consulting, 4199 126th Ave, Allegan, MI 49010. Phone: (205) 394-1647.
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Correia M, Magalhães R, Felgueiras R, Quintas C, Guimarães L, Silva MC. Changes in stroke incidence, outcome, and associated factors in Porto between 1998 and 2011. Int J Stroke 2016; 12:169-179. [DOI: 10.1177/1747493016669846] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Year 2000 marked a turning point in stroke prevention and treatment in Portugal. In face of high incidence rates stroke awareness campaigns, close surveillance of vascular risk factors and implementation of hospital stroke units were advanced by the National Health Authorities. To understand the effect of such measures, we assessed changes in stroke incidence and short-term outcome using data from two community-based registers undertaken in Porto in 1998–2000 and 2009–2011. Methods We used standard diagnostic criteria and multiple overlapping sources of case-ascertainment for first-ever strokes. Short-term outcome was measured by the modified Rankin Scale; disabling stroke was defined whenever post-stroke mRS score>pre-stroke mRS and >1. Results Globally, 462 and 405 first-ever stroke cases were registered in 1998–2000 and 2009–2011, respectively. Stroke incidence decreased by 23%, from 261 to 203/100,000 after adjustment for the Portuguese population. Significant reduction was found in those aged <75 years (31%) and in women (32%). Incidence of disabling strokes was reduced by 29%. Fatal strokes decreased by 46%, while intracerebral hemorrhage decreased by 51%. Risk of disability from stroke decreased by 11% (RR = 0.89; 95%CI, 0.81–0.98) in 2009–2011, as found after adjusting for patient/stroke characteristics in a Poisson model. Moreover, when patients arrived hospital within 3 h from stroke onset, the risk of disabling stroke was 0.76 (95%CI, 0.67–0.87) in 2009–2011 vs. 1998–2000, compared to 1.03 (95%CI, 0.89–1.12) for late arrival. Conclusion Risk of stroke, mainly of hemorrhagic stroke, was substantially reduced over time. Timely action in acute phase was responsible for the decline in disability across periods.
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Affiliation(s)
- Manuel Correia
- Serviço de Neurologia, Hospital Santo António–Centro Hospitalar do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Rui Magalhães
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Rui Felgueiras
- Serviço de Neurologia, Hospital Santo António–Centro Hospitalar do Porto, Porto, Portugal
| | - Cláudia Quintas
- Serviço de Neurologia, Hospital Santo António–Centro Hospitalar do Porto, Porto, Portugal
| | - Laura Guimarães
- CIIMAR – Interdisciplinary Centre of Marine and Environmental Research, Porto, Portugal
| | - Maria C Silva
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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De Rango P, Simonte G, Farchioni L, Cieri E, Manzone A, Parlani G, Lenti M, Verzini F. Safety of Carotid Revascularization in Symptomatic Patients with less than 70 Years. Ann Vasc Surg 2016; 32:73-82. [PMID: 26802293 DOI: 10.1016/j.avsg.2015.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 10/07/2015] [Accepted: 10/10/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Age is a main risk factor for stroke and perioperative risk. This study aims to analyze the effect of age by symptomatic status in young patients receiving carotid revascularization. METHODS Consecutive carotid revascularization procedures performed during the period 2001-2009 were reviewed. Patients were analyzed by age using the 70-year threshold as suggested by trials. Primary end point was perioperative stroke or death rate. Secondary end points included survival and late stroke incidence at 6 years. RESULTS A total of 2,196 procedures (1,080 by carotid artery stenting [CAS] and 1,116 by carotid endarterectomy [CEA]) were analyzed. Symptomatic patients (n = 684) showed higher perioperative stroke or death risks (24 of 684 [3.5%] versus 29 of 1,512 [1.9%], odds ratio [OR] 1.8; 95% confidence interval [CI] 1.07-3.22; P = 0.034) and lower 6-year survival (74% vs. 82%, P < 0.0001) or freedom from late stroke (93% vs. 97%, P = 0.001) when compared with asymptomatic patients with similar differences detected within CEA or CAS procedure. Overall 949 procedures were in patients with 70 years or less at the time of intervention (500 CEA and 449 CAS); 282 were in patients symptomatic for minor stroke or transient ischemic attack within 6 months before revascularization. For young symptomatic patients, primary end point rates were <2.5% after both CEA and CAS procedure. Perioperative stroke or death rates were 2.4% in symptomatic versus 1.5% in asymptomatic (4 of 170 vs. 5 of 330; OR 1.57; 95% CI 0.42-5.91; P = 0.50) within the CEA group and 1.8% in symptomatic versus 1.2% in asymptomatic (2 of 112 vs. 4 of 337; OR 1.51; 95% CI 0.27-8.38; P = 0.64) within the CAS group. At 6 years, symptomatic young patients showed survival (89.5% vs. 89%, P = 0.76) and freedom from late stroke (97% vs. 98%, P = 0.56) rates comparable to those found in asymptomatic patients, with similar incidences after CAS or CEA procedure. CONCLUSIONS Outcomes after carotid revascularization are related to patients' age. At younger ages (<70 years), after carotid revascularization, symptomatic patients show low perioperative risks of stroke or death, comparable with those in asymptomatic patients. The same, 2.5% or lower, threshold for perioperative stroke or death risk related to asymptomatic carotid procedures must be applied today to symptomatic patients when younger than age of 70 years.
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Affiliation(s)
- Paola De Rango
- Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy.
| | - Gioele Simonte
- Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Luca Farchioni
- Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Enrico Cieri
- Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Alessandra Manzone
- Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Giovanbattista Parlani
- Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Massimo Lenti
- Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Fabio Verzini
- Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
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Paredes SD, Rancan L, Kireev R, González A, Louzao P, González P, Rodríguez-Bobada C, García C, Vara E, Tresguerres JAF. Melatonin Counteracts at a Transcriptional Level the Inflammatory and Apoptotic Response Secondary to Ischemic Brain Injury Induced by Middle Cerebral Artery Blockade in Aging Rats. Biores Open Access 2015; 4:407-16. [PMID: 26594596 PMCID: PMC4642830 DOI: 10.1089/biores.2015.0032] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aging increases oxidative stress and inflammation. Melatonin counteracts inflammation and apoptosis. This study investigated the possible protective effect of melatonin on the inflammatory and apoptotic response secondary to ischemia induced by blockade of the right middle cerebral artery (MCA) in aging male Wistar rats. Animals were subjected to MCA obstruction. After 24 h or 7 days of procedure, 14-month-old nontreated and treated rats with a daily dose of 10 mg/kg melatonin were sacrificed and right and left hippocampus and cortex were collected. Rats aged 2 and 6 months, respectively, were subjected to the same brain injury protocol, but they were not treated with melatonin. mRNA expression of interleukin-1 beta (IL-1β), tumor necrosis factor alpha (TNF-α), Bcl-2-associated death promoter (BAD), Bcl-2-associated X protein (BAX), glial fibrillary acidic protein (GFAP), B-cell lymphoma 2 (Bcl-2), and sirtuin 1 was measured by reverse transcription–polymerase chain reaction. In nontreated animals, a significant time-dependent increase in IL-1β, TNF-α, BAD, and BAX was observed in the ischemic area of both hippocampus and cortex, and to a lesser extent in the contralateral hemisphere. Hippocampal GFAP was also significantly elevated, while Bcl-2 and sirtuin 1 decreased significantly in response to ischemia. Aging aggravated these changes. Melatonin administration was able to reverse significantly these alterations. In conclusion, melatonin may ameliorate the age-dependent inflammatory and apoptotic response secondary to ischemic cerebral injury.
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Affiliation(s)
- Sergio D Paredes
- Department of Physiology, School of Medicine, Complutense University of Madrid , Madrid, Spain
| | - Lisa Rancan
- Department of Biochemistry and Molecular Biology III, School of Medicine, Complutense University of Madrid , Madrid, Spain
| | - Roman Kireev
- Instituto de Investigación Biomédica de Vigo (IBIV), Xerencia de Xestión Integrada de Vigo, SERGAS, Biomedical Research Unit, Hospital Rebullón (CHUVI) , Vigo, Spain
| | - Alberto González
- Department of Biochemistry and Molecular Biology III, School of Medicine, Complutense University of Madrid , Madrid, Spain
| | - Pedro Louzao
- Department of Biochemistry and Molecular Biology III, School of Medicine, Complutense University of Madrid , Madrid, Spain
| | - Pablo González
- Experimental Medicine and Surgery Unit, Hospital Clínico San Carlos , Madrid, Spain
| | | | - Cruz García
- Department of Biochemistry and Molecular Biology III, School of Medicine, Complutense University of Madrid , Madrid, Spain
| | - Elena Vara
- Department of Biochemistry and Molecular Biology III, School of Medicine, Complutense University of Madrid , Madrid, Spain
| | - Jesús A F Tresguerres
- Department of Physiology, School of Medicine, Complutense University of Madrid , Madrid, Spain
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Abstract
General thinking has previously centered on managing carotid artery stenosis (CAS) by carotid endarterectomy and subsequently, stenting for higher risk patients. However for CAS and other forms of vascular disease, especially when asymptomatic, there is new emphasis on defining underlying mechanisms. Knowledge of these mechanisms can lead to medical treatments that result in possible atherosclerotic plaque stabilization, and even plaque regression, including in the patient with CAS. For now, the key medication class for a medical approach are the statins. Their use is supported by good cardiovascular clinical trial evidence including some directed carotid artery studies, especially with a demonstrated decrease in carotid intima-media thickness. Procedural controversy still exists but the current era in medicine offers significant support for medical management of asymptomatic CAS while techniques to recognize the vulnerable plaque evolve. If CAS converts to a symptomatic status, early referral for endarterectomy or stenting is indicated.
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Affiliation(s)
- Thomas F Whayne
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky
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Birkenhäger-Gillesse EG, den Elzen WPJ, Achterberg WP, Mooijaart SP, Gussekloo J, de Craen AJM. Association Between Glycosylated Hemoglobin and Cardiovascular Events and Mortality in Older Adults without Diabetes Mellitus in the General Population: The Leiden 85-Plus Study. J Am Geriatr Soc 2015; 63:1059-66. [PMID: 26032644 DOI: 10.1111/jgs.13457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the association between glycosylated hemoglobin (HbA1c) and incident cardiovascular disease and mortality in 85-year-old individuals without diabetes mellitus from the general population. DESIGN Population-based prospective follow-up study. SETTING General population. PARTICIPANTS Individuals without known diabetes mellitus (N = 445, n = 291 female). MEASUREMENTS HbA1c levels were categorized into three groups (<5.0% (31 mmol/mol), 5.0-5.7% (31-39 mmol/mol; reference), 5.7-6.5% (39-48 mmol/mol)). RESULTS At baseline, a history of myocardial infarction (MI) was more prevalent in subjects in the highest HbA1c group (18%) than in the reference group (7%) (P = .001). Prospectively, those with the highest level of HbA1c at baseline had a risk of incident MI during the 5-year follow-up that was 3.6 (95% confidence interval = 1.5-8.3) times as great as that of the reference group. No association was found between HbA1c level and incident stroke, cardiovascular mortality, or all-cause mortality. CONCLUSION In individuals aged 85 and older without diabetes mellitus, higher HbA1c is associated with greater risk of MI but not with stroke and mortality.
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Affiliation(s)
- Elizabeth G Birkenhäger-Gillesse
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Laurens Care Centers, Rotterdam, The Netherlands
| | - Wendy P J den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.,Institute for Evidence-Based Medicine in Old Age, Leiden, the Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
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van Peet PG, Gussekloo J, den Elzen WP, Blom JW, de Waal MW, de Ruijter W. Drug prescription rates in secondary cardiovascular prevention in old age: Do vulnerability and severity of the history of cardiovascular disease matter? Scand J Prim Health Care 2015; 33:260-8. [PMID: 26683286 PMCID: PMC4750735 DOI: 10.3109/02813432.2015.1117281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To assess the influence vulnerability and severity of cardiovascular disease (CVD), on prescription rates of secondary cardiovascular preventive drugs in old age. DESIGN Population-based observational study within the ISCOPE study. SETTING General practices in the Netherlands. SUBJECTS A total of 1350 patients with a history of CVD (median age 81 years, 50% female). MAIN OUTCOME MEASURES One-year prescription rates of lipid-lowering drugs and antithrombotics were obtained from the electronic medical records of 46 general practitioners (GPs). Prescription of both drugs for ≥ 270 days per year was considered optimal. GPs made a judgement of vulnerability. Severity of CVD was expressed as major (myocardial infarction, stroke, or arterial surgery) versus minor (angina, transient ischaemic attack, or claudication). RESULTS GPs considered 411 (30%) participants to be vulnerable and 619 (55%) participants had major CVD. Optimal treatment was prescribed to 680 (50%) participants, whereas 370 (27%) received an antithrombotic drug only, 53 (4%) a lipid-lowering drug only, and 247 (18%) received neither. Optimal treatment was lower in participants aged ≥ 85 years (OR 0.37 [95% CI 0.29-0.48]), in females (OR 0.63 [0.50-0.78]), in vulnerable persons (OR 0.79 [0.62-0.99]) and in participants with minor CVD (OR 0.65 [0.53-0.81]). Multivariate ORs remained similar whereas vulnerability lost its significance (OR 0.88 [0.69-1.1]). CONCLUSION In old age, GPs' judgement of vulnerability is not independently associated with lower treatment rates of both lipid-lowering drugs and antithrombotics, whereas a history of minor CVD is. Individual proactive re-evaluation of preventive treatment in older (female) patients, especially those with a history of minor CVD, is recommended. Key points Prescriptions of lipid-lowering drugs and antithrombotics in secondary cardiovascular prevention tend to decline with age. In this study with median age 81 years, 50% of participants received optimal treatment with both lipid-lowering drugs and antithrombotics. GPs' judgement of vulnerability was not independently associated with optimal treatment. A history of less severe cardiovascular disease was independently associated with lower prescription rates of lipid-lowering drugs and antithrombotics. Proactive individual re-evaluation of cardiovascular preventive treatment in older (female) patients, especially patients with less severe cardiovascular disease, is recommended.
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Affiliation(s)
- Petra G. van Peet
- CONTACT Petra G van Peet Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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14
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Sun MC, Lai TB, Jeng JS, Sung SF, Sung PS, Tang SC, Chen WL, Chen CH. Safety of intravenous thrombolysis for ischaemic stroke in Asian octogenarians and nonagenarians. Age Ageing 2015; 44:158-61. [PMID: 25355619 DOI: 10.1093/ageing/afu172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND symptomatic intracerebral haemorrhage (ICH) is a major concern of intravenous thrombolysis (IVT) for ischaemic stroke. Asians are considered more vulnerable to ICH than non-Asians. Reports on safety of IVT for Asian octogenarians and nonagenarians are limited. AIMS the aims of our study were to compare the safety of IVT between octogenarians and nonagenarians and between Asian and Western patients. METHODS patients receiving IVT for ischaemic stroke were prospectively registered from four hospitals in Taiwan. Octogenarians and nonagenarians were recruited for analysis. The primary safety outcome measure was symptomatic ICH. The secondary outcome measure was 3-month mortality. We searched the literature on IVT for ischaemic stroke for comparison. RESULTS from January 2007 to December 2012, a total of 186 (18.3%) ischaemic stroke patients aged 80 and older, including 166 octogenarians and 20 nonagenarians, were recruited from 1,018 patients receiving IVT. Nine (4.8%) of recruited patients had symptomatic ICH, all in the octogenarian group (5.4%). Three-month mortality was 14.1% in recruited patients and without difference between the two age groups (P = 0.558). The results were comparable with reports on Western octogenarians and nonagenarians in the literature. CONCLUSION octogenarians and nonagenarians receiving IVT have a similar safety outcome. Asian octogenarians and nonagenarians receiving IVT for ischaemic stroke are not at higher risk of symptomatic ICH and mortality than Western patients.
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Affiliation(s)
- Mu-Chien Sun
- Stroke Center, Changhua Christian Hospital, Changhua, Taiwan Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Tien-Bao Lai
- Stroke Center, Changhua Christian Hospital, Changhua, Taiwan Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Liang Chen
- Stroke Center, Changhua Christian Hospital, Changhua, Taiwan Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Hung Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Lucke-Wold BP, Logsdon AF, Turner RC, Rosen CL, Huber JD. Aging, the metabolic syndrome, and ischemic stroke: redefining the approach for studying the blood-brain barrier in a complex neurological disease. ADVANCES IN PHARMACOLOGY 2014; 71:411-49. [PMID: 25307225 DOI: 10.1016/bs.apha.2014.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The blood-brain barrier (BBB) has many important functions in maintaining the brain's immune-privileged status. Endothelial cells, astrocytes, and pericytes have important roles in preserving vasculature integrity. As we age, cell senescence can contribute to BBB compromise. The compromised BBB allows an influx of inflammatory cytokines to enter the brain. These cytokines lead to neuronal and glial damage. Ultimately, the functional changes within the brain can cause age-related disease. One of the most prominent age-related diseases is ischemic stroke. Stroke is the largest cause of disability and is third largest cause of mortality in the United States. The biggest risk factors for stroke, besides age, are results of the metabolic syndrome. The metabolic syndrome, if unchecked, quickly advances to outcomes that include diabetes, hypertension, cardiovascular disease, and obesity. The contribution from these comorbidities to BBB compromise is great. Some of the common molecular pathways activated include: endoplasmic reticulum stress, reactive oxygen species formation, and glutamate excitotoxicity. In this chapter, we examine how age-related changes to cells within the central nervous system interact with comorbidities. We then look at how comorbidities lead to increased risk for stroke through BBB disruption. Finally, we discuss key molecular pathways of interest with a focus on therapeutic targets that warrant further investigation.
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Affiliation(s)
- Brandon P Lucke-Wold
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, West Virginia, USA; The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia, USA
| | - Aric F Logsdon
- The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia, USA; Department of Basic Pharmaceutical Sciences, West Virginia University, School of Pharmacy, Morgantown, West Virginia, USA
| | - Ryan C Turner
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, West Virginia, USA; The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia, USA
| | - Charles L Rosen
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, West Virginia, USA; The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia, USA
| | - Jason D Huber
- The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia, USA; Department of Basic Pharmaceutical Sciences, West Virginia University, School of Pharmacy, Morgantown, West Virginia, USA.
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Gupta HV, Farrell AM, Mittal MK. Transient ischemic attacks: predictability of future ischemic stroke or transient ischemic attack events. Ther Clin Risk Manag 2014; 10:27-35. [PMID: 24476667 PMCID: PMC3891764 DOI: 10.2147/tcrm.s54810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The short-term risk of an ischemic stroke after a transient ischemic attack (TIA) is estimated to be approximately 3%–10% at 2 days, 5% at 7 days, and 9%–17% at 90 days, depending on active or passive ascertainment of ischemic stroke. Various risk prediction scores are available to identify high-risk patients. We present here a pragmatic review of the literature discussing the main scoring systems. We also provide the sensitivity, specificity, positive predictive value, and negative predictive value for each scoring system. Our review shows that scoring systems including brain imaging and vascular imaging are better at risk prediction than scores that do not include this information.
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Affiliation(s)
- Harsh V Gupta
- Department of Neurology, The University of Arkansas Medical Sciences, Little Rock, AR
| | - Ann M Farrell
- Department of Knowledge and Evaluation Research, Mayo Clinic, Rochester, MN
| | - Manoj K Mittal
- Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, USA
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NT-proBNP best predictor of cardiovascular events and cardiovascular mortality in secondary prevention in very old age: the Leiden 85-plus Study. PLoS One 2013; 8:e81400. [PMID: 24278434 PMCID: PMC3836793 DOI: 10.1371/journal.pone.0081400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/22/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In the aging population cardiovascular disease (CVD) is highly prevalent. Identification of very old persons at high risk of recurrent CVD is difficult, since traditional risk markers loose predictive value with age. METHODS In a population-based sample of 282 85-year old participants with established CVD from the Leiden 85-plus Study, we studied predictive values of traditional cardiovascular risk markers, a history of major CVD (myocardial infarction, stroke or arterial surgery), and new cardiovascular biomarkers (estimated glomerular filtration rate (MDRD), C-reactive protein (CRP), homocysteine and N-terminal pro B-type natriuretic peptide (NT-proBNP)) regarding 5-year risk of recurrent cardiovascular events and mortality (composite endpoint). RESULTS During complete 5-year follow-up 157 (56%) participants died. 109 (39%) had a cardiovascular event or died from cardiovascular causes. Individually related to the composite endpoint were: a history of major CVD (HR 1.5 (95%CI 1.03-2.3)), CRP (HR 1.3 (95%CI 1.03-1.5)), homocysteine (HR 1.4 (95%CI 1.2-2.6)) and NT-proBNP (HR 1.7 (95%CI 1.4-2.1)). A prediction model including all traditional risk markers yielded a C-statistic of 0.59 (95%CI 0.52-0.66). Of all five new markers only addition of NT-proBNP improved the C-statistic (0.67 (95%CI 0.61-0.74, p=0.023)). The categoryless net reclassification improvement for NT-proBNP was 39% (p=0.001), for a history of major CVD 27.2% (p=0.03) and for homocysteine 24.7% (p=0.04). CONCLUSIONS Among very old subjects with established CVD, NT-proBNP was the strongest risk marker for cardiovascular events and cardiovascular mortality. When estimating risk in secondary prevention in very old age, use of NT-proBNP should be considered.
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van Peet PG, Drewes YM, de Craen AJM, Westendorp RGJ, Gussekloo J, de Ruijter W. Prognostic value of cardiovascular disease status: the Leiden 85-plus study. AGE (DORDRECHT, NETHERLANDS) 2013; 35:1433-1444. [PMID: 22760858 PMCID: PMC3705125 DOI: 10.1007/s11357-012-9443-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 06/07/2012] [Indexed: 06/01/2023]
Abstract
This study aimed to explore the prognosis of very old people depending on their cardiovascular disease (CVD) history. This observational prospective cohort study included 570 participants aged 85 years from the general population with 5-year follow-up for morbidity, functional status, and mortality. At baseline, participants were assigned to three groups: no CVD history, "minor" CVD (angina pectoris, transient ischemic attack, intermittent claudication, and/or heart failure), or "major" CVD (myocardial infarction [MI], stroke, and/or arterial surgery). Follow-up data were collected on MI, stroke, functional status, and cause-specific mortality. The composite endpoint included cardiovascular events (MI or stroke) and cardiovascular mortality. At baseline, 270 (47.4 %) participants had no CVD history, 128 (22.4 %) had minor CVD, and 172 (30.2 %) had major CVD. Compared to the no CVD history group, the risk of the composite endpoint increased from 1.6 (95 % confidence interval [CI], 1.1-2.4) for the minor CVD group to 2.7 (95 % CI, 2.0-3.9) for the major CVD group. Similar trends were observed for cardiovascular and all-cause mortality risks. In a direct comparison, the major CVD group had a nearly doubled risk of the composite endpoint (hazard ratio, 1.8; 95 % CI, 1.2-2.7), compared to the minor CVD group. Both minor and major CVD were associated with an accelerated decline in cognitive function and accelerated increase of disability score (all p < 0.05), albeit most pronounced in participants with major CVD. CVD disease status in very old age is still of important prognostic value: a history of major CVD (mainly MI or stroke) leads to a nearly doubled risk of poor outcome, including cardiovascular events, functional decline, and mortality, compared with a history of minor CVD.
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Affiliation(s)
- Petra G van Peet
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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Phipps MS, Zeevi N, Staff I, Fortunato G, Kuchel GA, McCullough LD. Stroke severity and outcomes for octogenarians receiving statins. Arch Gerontol Geriatr 2013; 57:377-82. [PMID: 23815970 DOI: 10.1016/j.archger.2013.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/26/2013] [Accepted: 05/28/2013] [Indexed: 01/29/2023]
Abstract
Pre-exposure to 3-hydroxy-3-methylgutaryl-coenzyne A reductase inhibitors (statins) appears to improve outcomes in patients with acute ischemic stroke (AIS). Whether this extends to patients over 80 is not known. Patients ≥80 years of age with AIS were retrospectively reviewed from the stroke registry of a tertiary stroke center. Pre-admission statin use, demographics, vascular risk factors, and comorbid conditions were assessed. Primary outcomes were admission National Institutes of Health Stroke Scale (NIHSS) scores and in-hospital mortality/discharge to hospice, and secondary outcomes included subsequent intracerebral hemorrhage (ICH) and modified Barthel index (mBI) at 3 months. Multivariable logistic regression was used to evaluate the association between pre-admission statin use and outcomes among elderly patients. Among 804 patients ≥80, those taking statins prior to AIS admission were overall younger, were more likely to have hypertension, coronary artery disease, diabetes, hyperlipidemia, and were more likely to be on an antiplatelet, but less likely to receive treatment with IV tissue plasminogen activator (tPA). Patients on statin had lower stroke severity (NIHSS>16: 21.9% vs. 27.6%) and in-hospital mortality/discharge to hospice (22.8% vs. 27.6%), but neither was significant. There was no difference in ICH (1.2% vs. 1.9%), and patients on statins had a non-significant trend toward less disability on mBI (27.5% vs. 35.7%). Pre-admission statin use did not show a statistical difference in either outcome, but it did show a trend toward lower stroke severity and improved short-term outcomes. In addition, our study suggests that statins may be safe in elderly stroke patients and may not increase the risk of ICH.
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Affiliation(s)
- Michael S Phipps
- Stroke Center at Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
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Current world literature. Curr Opin Anaesthesiol 2012; 25:629-38. [PMID: 22955173 DOI: 10.1097/aco.0b013e328358c68a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sicras-Mainar A, Planas-Comes A, Frias-Garrido X, Navarro-Artieda R, de Salas-Cansado M, Rejas-Gutiérrez J. Statins after recent stroke reduces recurrence and improves survival in an aging Mediterranean population without known coronary heart disease. J Clin Pharm Ther 2011; 37:441-7. [DOI: 10.1111/j.1365-2710.2011.01318.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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