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Nindrea RD, Hasanuddin A. Non-modifiable and modifiable factors contributing to recurrent stroke: A systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Oe M, Fujihara K, Harada-Yamada M, Osawa T, Kitazawa M, Matsubayashi Y, Sato T, Yaguchi Y, Iwanaga M, Seida H, Yamada T, Sone H. Impact of prior cerebrovascular disease and glucose status on incident cerebrovascular disease in Japanese. Cardiovasc Diabetol 2021; 20:174. [PMID: 34479567 PMCID: PMC8417951 DOI: 10.1186/s12933-021-01367-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although both a history of cerebrovascular disease (CVD) and glucose abnormality are risk factors for CVD, few large studies have examined their association with subsequent CVD in the same cohort. Thus, we compared the impact of prior CVD, glucose status, and their combinations on subsequent CVD using real-world data. METHODS This is a retrospective cohort study including 363,627 men aged 18-72 years followed for ≥ 3 years between 2008 and 2016. Participants were classified as normoglycemia, borderline glycemia, or diabetes defined by fasting plasma glucose, HbA1c, and antidiabetic drug prescription. Prior and subsequent CVD (i.e. ischemic stroke, transient ischemic attack, and non-traumatic intracerebral hemorrhage) were identified according to claims using ICD-10 codes, medical procedures, and questionnaires. RESULTS Participants' mean age was 46.1 ± 9.3, and median follow up was 5.2 (4.2, 6.7) years. Cox regression analysis showed that prior CVD + conferred excess risk for CVD regardless of glucose status (normoglycemia: hazard ratio (HR), 8.77; 95% CI 6.96-11.05; borderline glycemia: HR, 7.40, 95% CI 5.97-9.17; diabetes: HR, 5.73, 95% CI 4.52-7.25). Compared with normoglycemia, borderline glycemia did not influence risk of CVD, whereas diabetes affected subsequent CVD in those with CVD- (HR, 1.50, 95% CI 1.34-1.68). In CVD-/diabetes, age, current smoking, systolic blood pressure, high-density lipoprotein cholesterol, and HbA1c were associated with risk of CVD, but only systolic blood pressure was related to CVD risk in CVD + /diabetes. CONCLUSIONS Prior CVD had a greater impact on the risk of CVD than glucose tolerance and glycemic control. In participants with diabetes and prior CVD, systolic blood pressure was a stronger risk factor than HbA1c. Individualized treatment strategies should consider glucose tolerance status and prior CVD.
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Affiliation(s)
- Momoko Oe
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
- Kowa Company. Ltd, 10-4 Nihonbashi-honcho 3-chome, Chuo-ku, Tokyo, 103-0023, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan.
| | - Mayuko Harada-Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Taeko Osawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Masaru Kitazawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Yasuhiro Matsubayashi
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Takaaki Sato
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Yuta Yaguchi
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Midori Iwanaga
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Hiroyasu Seida
- JMDC Inc, 2-5-5 Shiba Daimon, Minato-ku, Tokyo, 105-0012, Japan
| | - Takaho Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
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Li L, Pan Y, Wang M, Jing J, Meng X, Jiang Y, Guo C, Jin Z, Wang Y. Trends and predictors of myocardial infarction or vascular death after ischaemic stroke or TIA in China, 2007-2018: insights from China National Stroke Registries. Stroke Vasc Neurol 2020; 6:214-221. [PMID: 33127855 PMCID: PMC8258052 DOI: 10.1136/svn-2020-000503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 11/04/2022] Open
Abstract
Background Although stroke management, primary and secondary preventions have been improved in China last decades, the trends and predictors of major vascular events after ischaemic stroke or transient ischaemic attack (TIA) at national scale are less known. Methods Data were obtained from the three phases of China National Stroke Registry (CNSR), including CNSR-Ⅰ (years 2007–2008), CNSR-Ⅱ (years 2012–2013) and CNSR-III (years 2015–2018). For comparison, patients who were diagnosed as ischaemic stroke or TIA were included. Kaplan-Meier estimates of myocardial infarction (MI) or vascular death were calculated at 1 year. Independent predictors were further assessed with a Cox proportional hazards regression. Results From 2007 to 2018, a total of 50 284 patients with ischaemic stroke or TIA were enrolled in this study. A declining trend was found in 1-year MI or vascular death (p for trend <0.001), while recurrent stroke depicted a U-shape curve with a nadir in 2012–2013 cohort. A similar trend was also observed in patients who were admitted to 26 hospitals in all three CNSRs. In 2015–2018 cohort, only 251 (1.7%; 95% CI 1.5% to 1.9%) MI or vascular death had occurred at 1 year. Older age, previous stroke or TIA, history of coronary artery disease and the National Institutes of Health Stroke Scale >6 were associated with both an increased risk of MI or vascular death and recurrent stroke. While early antiplatelet therapy and lipid-lowering agents at discharge predicted a reduced risk. Conclusion A declining trend and current low incidence of MI or vascular death, rather than recurrent stroke, after ischaemic stroke or TIA were observed in China. Traditional factors were found as independent predictors. These findings suggested there is still much room to improve for stroke management.
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Affiliation(s)
- Long Li
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Caixia Guo
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zening Jin
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Xie YM, Gao Y, Cai YF, Shen XM, Zhao DX, Xie YZ, Zhang Y, Wang GQ, Wei X, Wei RL. Risk factors associated with recurrence within 90 days of ischemic stroke onset in chinese medicine hospital: A national cross-sectional study in China. WORLD JOURNAL OF TRADITIONAL CHINESE MEDICINE 2020. [DOI: 10.4103/wjtcm.wjtcm_32_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Naito R, Miyauchi K, Nojiri S, Suzuki N, Daida H. Differences in Clinical Features in Patients with Acute Coronary Syndrome and Stroke: Japanese Multicenter Registry Results. Intern Med 2018; 57:3233-3240. [PMID: 29877288 PMCID: PMC6287985 DOI: 10.2169/internalmedicine.1020-18] [Citation(s) in RCA: 2] [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: 11/06/2022] Open
Abstract
Objective Coronary artery and cerebrovascular disease are the main causes of non-communicable diseases. In particular, acute coronary syndrome (ACS) and ischemic stroke are the most serious conditions of coronary artery disease and cerebrovascular disease, respectively. Therefore, it is important to prevent these conditions by identifying populations at high risk of these diseases. We sought to investigate the differences in the clinical features of patients with these atherothrombotic diseases in nationwide Japanese multicenter registries. Gender differences were also examined. Methods The dataset of the two nationwide multicenter registries for ACS [Prevention of AtherothrombotiC Incidents Following Ischemic Coronary (PACIFIC)] and ischemic stroke [Effective Vascular Event REduction after STroke (EVEREST)] was analyzed. Clinical features were examined and compared using datasets from the two registries. Results A total of 6,878 patients (PACIFIC: n=3,426, EVEREST: n=3,452) were evaluated. The patients' background characteristics were significantly different between the two populations. Patients with ACS tended to be younger, had a higher body mass index, had a greater prevalence of diabetes mellitus and dyslipidemia, were current smokers, and more often had a prior history of ischemia heart disease than patients with a stroke. Hypertension was more prevalent in patients with stroke than in those with ACS. The differences in patients' background characteristics between ACS and stroke in men were similar to those in the whole sample. However, the prevalence of hypertension in women was similar between the ACS and stroke groups, in contrast to the results from the whole sample. Conclusion Patients' background characteristics were significantly different between those with ACS and stroke. Gender differences were also observed.
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Affiliation(s)
- Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Japan
| | - Shuko Nojiri
- Clinical Research Support Center, Juntendo University School of Medicine, Japan
| | - Norihiro Suzuki
- Department of Neurology, Keio University School of Medicine, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Japan
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Yamazaki M, Ohnishi T, Hosokawa K, Yamaguchi K, Yoneyama T, Kawashima A, Okada Y, Kitagawa K, Uchiyama S. Measurement of residual platelet thrombogenicity under arterial shear conditions in cerebrovascular disease patients receiving antiplatelet therapy. J Thromb Haemost 2016; 14:1788-97. [PMID: 27328457 DOI: 10.1111/jth.13391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 05/22/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED Essentials A consensus methodology for assessing the effects of antiplatelet agents has not been established. Measuring platelet thrombus formation (PTF) for evaluating antiplatelet effects was assessed. PTF differentially reflected antiplatelet effects compared to other tests. PTF may be associated with the severity of carotid or intracranial arterial stenosis. Click to hear a presentation on platelet function testing in the clinic by Gresele and colleagues SUMMARY Background A consensus methodology for assessing the effects of antiplatelet agents has not been established. Objective We investigated the usefulness of directly measuring platelet thrombus formation (PTF) using a microchip-based flow chamber system for evaluating antiplatelet therapy. Patients/Methods Platelet thrombus formation in the whole blood of 94 patients with ischemic cerebrovascular disease treated with clopidogrel and/or aspirin was measured in a flow chamber system at a shear rate of 1500 s(-1) and was compared with the results of assays for agonist-induced platelet aggregability, phosphorylation of vasodilator-stimulated phosphoprotein, platelet p-selectin expression (PS), and platelet-monocyte complexes. Results In all patients tested, area under the flow pressure curve (AUC10), which represents platelet thrombogenicity, showed weak correlation with platelet aggregation induced by either adenosine diphosphate or collagen. In addition, AUC10 was lower in patients treated with dual antiplatelet therapy (median 79.4) compared with patients treated with aspirin or clopidogrel alone (217.7 and 301.0, respectively), whereas the parameters evaluated by the other assays did not reflect the combined treatment efficacy. In clopidogrel monotherapy patients, AUC10 was associated with the severity of arterial stenosis (R(2) = 0.127, β = 1.25), and AUC10 and PS were higher in patients with severe carotid or intracranial arterial stenosis than in those with mild stenosis. Conclusions Platelet thrombus formation measurement using a flow-chamber system was useful for evaluating the efficacy of treatment with aspirin and clopidogrel, both alone and in combination. The present findings indicate that high residual platelet thrombogenicity in patients treated with clopidogrel may be associated with the severity of carotid or intracranial arterial stenosis.
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Affiliation(s)
- M Yamazaki
- Department of Neurology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
| | - T Ohnishi
- Research Institute, Fujimori Kogyo Co., Ltd, Yokohama, Kanagawa, Japan
| | - K Hosokawa
- Research Institute, Fujimori Kogyo Co., Ltd, Yokohama, Kanagawa, Japan
| | - K Yamaguchi
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - T Yoneyama
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - A Kawashima
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Y Okada
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - K Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - S Uchiyama
- Department of Neurology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
- Clinical Research Center for Medicine, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo, Minato-ku, Japan
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Kang K, Park TH, Kim N, Jang MU, Park SS, Park JM, Ko Y, Lee S, Lee KB, Lee J, Kim DE, Cho YJ, Kim JT, Kim DH, Cha JK, Han MK, Lee JS, Lee J, Oh MS, Choi JC, Lee BC, Hong KS, Bae HJ. Recurrent Stroke, Myocardial Infarction, and Major Vascular Events during the First Year after Acute Ischemic Stroke: The Multicenter Prospective Observational Study about Recurrence and Its Determinants after Acute Ischemic Stroke I. J Stroke Cerebrovasc Dis 2016; 25:656-64. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/19/2015] [Accepted: 11/23/2015] [Indexed: 11/27/2022] Open
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Continuation and adherence rates on initially-prescribed intensive secondary prevention therapy after Rapid Access Stroke Prevention (RASP) service assessment. J Neurol Sci 2016; 361:13-8. [DOI: 10.1016/j.jns.2015.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 11/15/2015] [Accepted: 12/07/2015] [Indexed: 11/15/2022]
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Lee M, Wu YL, Ovbiagele B. Trends in Incident and Recurrent Rates of First-Ever Ischemic Stroke in Taiwan between 2000 and 2011. J Stroke 2015; 18:60-5. [PMID: 26687123 PMCID: PMC4747065 DOI: 10.5853/jos.2015.01326] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/23/2015] [Accepted: 10/25/2015] [Indexed: 12/03/2022] Open
Abstract
Background and Purpose The burden of stroke is comparatively greater in Asian countries than in the Western world. While there has been a documented recent decline in the incidence of stroke in several Western nations due to better risk factor management, much less is known about the nature and trajectory of stroke in Asia over the last decade. The objective of this study was to explore risk factors, medication use, incidence, and one-year recurrence of stroke in Taiwan. Methods We conducted a nationwide cohort study by reviewing all hospitalized patients (≥ 18 years) with a primary diagnosis of ischemic stroke between 2001 and 2011 from Taiwan National Health Insurance Research Database. Results A total of 291,381 first-ever ischemic stroke patients were enrolled between 2000 and 2011. The average age was about 70 years and approximately 58.6% of them were men. While prevalence of diabetes mellitus and hyperlipidemia, as well as use of statins, antiplatelet agents, and oral anticoagulant agents for atrial fibrillation significantly increased; incidence (142.3 vs. 129.5 per 100,000 in 2000 and 2011, respectively) and one-year recurrence (9.6% vs. 7.8% in 2000 and 2011, respectively) of stroke declined during this period of time. Conclusions Over the last decade in Taiwan, rates of primary ischemic stroke and one-year recurrent stroke decreased by 9% and 18% respectively.
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Affiliation(s)
- Meng Lee
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi branch, Taiwan
| | - Yi-Ling Wu
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi branch, Taiwan
| | - Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Kostenko EV, Petrova LV, Eneeva MA, Kamchatnov PR. [Sleep disorders and circadian rhythms in diseases of the cardiovascular system]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:30-36. [PMID: 26120978 DOI: 10.17116/jnevro20151153130-36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study disturbances of sleep and circadian rhythms in patients with cardiovascular diseases taking into account the level of melatonin secretion and to optimize a complex approach to their treatment. MATERIALS AND METHODS The study included patients with cardiovascular diseases with- (n=121) and without (n=105) cerebrovascular diseases (CVD). All patients received melaxen in dose 3 mg daily 30-40 min before sleep. Examination of patients included assessment of neurological status, psychometric scales, the definition of circadian rhythm of the heart and blood pressure, determination of 6-SOMT in daily urine. RESULTS Pathological changes in circadian rhythms affected sleep disturbances, emotional and cognitive disorders and were associated with a reduction in the level of 6-SOMT in the urine. These changes were most pronounced in patients with CVD and stroke. The inclusion of melaxen in the comprehensive regimen of treatment improved sleep, reduced mood disorders and normalized the circadian heart rate profile and blood pressure. CONCLUSION The data obtained allowed to consider melaxen as an effective tool in the complex therapy of patients with CVD.
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Affiliation(s)
- E V Kostenko
- Pirogov Russian National Research Medical University, Moscow; Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow
| | - L V Petrova
- Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow
| | - M A Eneeva
- Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow
| | - P R Kamchatnov
- Pirogov Russian National Research Medical University, Moscow
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Shou J, Zhou L, Zhu S, Zhang X. Diabetes is an Independent Risk Factor for Stroke Recurrence in Stroke Patients: A Meta-analysis. J Stroke Cerebrovasc Dis 2015; 24:1961-8. [PMID: 26166420 DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/08/2014] [Accepted: 04/03/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study aimed to assess the association between diabetes and risk of stroke recurrence (especially ischemic stroke recurrence) and to evaluate whether diabetes was an independent predictor for stroke recurrence in stroke patients with diabetes. METHODS The relevant studies were identified through searching databases of PubMed, EMBASE, and Cochrane library. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled to evaluate the association between diabetes and risk of stroke recurrence. Funnel plot and Egger's regression tests were used to assess publication bias. All statistical analyses were conducted in Stata 12.0. RESULTS Eighteen studies containing totally 43,899 participants were included in the meta-analysis. The results showed that stroke recurrence risk of all stroke patients with diabetes was significantly higher than those without diabetes (HR, 1.45; 95% CI, 1.32-1.59), similar results were achieved in ischemic stroke patients (HR, 1.44; 95% CI, 1.28-1.61), and there were no regional differences (Europe: HR, 1.28; 95% CI, 1.13-1.44; USA: HR, 1.89; 95% CI, 1.53-2.33; Asia: HR, 1.57, 95% CI, 1.28-1.92, respectively) and age differences (mean age <70 years: HR, 1.58; 95% CI, 1.34-1.86; mean age ≥70 years: HR, 1.27; 95% CI, 1.11-1.45, respectively). The heterogeneity of all included studies was not statistically significant, and no publication bias was observed. CONCLUSIONS This meta-analysis shows that diabetes is an independent risk factor for stroke recurrence in stroke patients.
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Affiliation(s)
- Juan Shou
- General Practice Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Zhou
- Physical Examination Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanzhu Zhu
- General Practice Department, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Xiangjie Zhang
- General Practice Department, Zhongshan Hospital, Fudan University, Shanghai, China
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Toyoda K, Uchiyama S, Hoshino H, Kimura K, Origasa H, Naritomi H, Minematsu K, Yamaguchi T. Protocol for Cilostazol Stroke Prevention Study for Antiplatelet Combination (CSPS.com): a randomized, open-label, parallel-group trial. Int J Stroke 2014; 10:253-8. [PMID: 25487817 PMCID: PMC4335602 DOI: 10.1111/ijs.12420] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 09/16/2014] [Indexed: 01/01/2023]
Abstract
Rationale and aims Monotherapy with antiplatelet agents is only modestly effective in secondary prevention of ischemic stroke (IS), particularly in patients with multiple risk factors such as cervicocephalic arterial stenosis, diabetes, and hypertension. While dual antiplatelet therapy (DAPT) with aspirin and clopidogrel reduced IS recurrence, particularly in the early stages after IS, it increased the risk of bleeding. Compared with aspirin, cilostazol prevented IS recurrence without increasing the incidence of serious bleeds. In patients with intracranial arterial stenosis, no significant increase in bleeding events was observed for DAPT with cilostazol and aspirin, compared to that for aspirin monotherapy. DAPT involving cilostazol may therefore be safer than conventional DAPT. These findings prompted us to conduct the Cilostazol Stroke Prevention Study for Antiplatelet Combination (CSPS.com; ClinicalTrials.gov identifier: NCT01995370) to evaluate the safety and efficacy of DAPT involving cilostazol for secondary IS prevention, in comparison with that of antiplatelet monotherapy. Design The CSPS.com is a multicenter, randomized, open-label, parallel-group trial. A total of 4000 high-risk patients with noncardioembolic IS will be randomized 8–180 days after onset to receive aspirin or clopidogrel monotherapy, or DAPT with cilostazol and aspirin or clopidogrel for at least one-year. Study outcomes The primary outcome is IS recurrence. Secondary outcomes are composite occurrences of any stroke, death from any cause, myocardial infarction, vascular death, and other vascular events. Discussion The CSPS.com is expected to provide evidence indicating whether secondary IS prevention in high-risk patients can be improved by using DAPT involving cilostazol.
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Affiliation(s)
- Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka, 565-8565, Japan
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Thompson DD, Murray GD, Dennis M, Sudlow CLM, Whiteley WN. Formal and informal prediction of recurrent stroke and myocardial infarction after stroke: a systematic review and evaluation of clinical prediction models in a new cohort. BMC Med 2014; 12:58. [PMID: 24708686 PMCID: PMC4022243 DOI: 10.1186/1741-7015-12-58] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/28/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The objective of this study was to: (1) systematically review the reporting and methods used in the development of clinical prediction models for recurrent stroke or myocardial infarction (MI) after ischemic stroke; (2) to meta-analyze their external performance; and (3) to compare clinical prediction models to informal clinicians' prediction in the Edinburgh Stroke Study (ESS). METHODS We searched Medline, EMBASE, reference lists and forward citations of relevant articles from 1980 to 19 April 2013. We included articles which developed multivariable clinical prediction models for the prediction of recurrent stroke and/or MI following ischemic stroke. We extracted information to assess aspects of model development as well as metrics of performance to determine predictive ability. Model quality was assessed against a pre-defined set of criteria. We used random-effects meta-analysis to pool performance metrics. RESULTS We identified twelve model development studies and eleven evaluation studies. Investigators often did not report effective sample size, regression coefficients, handling of missing data; typically categorized continuous predictors; and used data dependent methods to build models. A meta-analysis of the area under the receiver operating characteristic curve (AUROCC) was possible for the Essen Stroke Risk Score (ESRS) and for the Stroke Prognosis Instrument II (SPI-II); the pooled AUROCCs were 0.60 (95% CI 0.59 to 0.62) and 0.62 (95% CI 0.60 to 0.64), respectively. An evaluation among minor stroke patients in the ESS demonstrated that clinicians discriminated poorly between those with and those without recurrent events and that this was similar to clinical prediction models. CONCLUSIONS The available models for recurrent stroke discriminate poorly between patients with and without a recurrent stroke or MI after stroke. Models had a similar discrimination to informal clinicians' predictions. Formal prediction may be improved by addressing commonly encountered methodological problems.
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Affiliation(s)
- Douglas D Thompson
- Edinburgh MRC Hub for Trials Methodology Research, Centre for Population Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
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Cocchi E, Drago A, de Ronchi D, Serretti A. The genetics of vascular incidents associated with second-generation antipsychotic administration. Expert Rev Clin Pharmacol 2013; 7:75-90. [PMID: 24325740 DOI: 10.1586/17512433.2014.865515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Second-generation antipsychotics (SGA) have been associated with risk of stroke in elderly patients, but the molecular and genetic background under this association has been poorly investigated. The aim of the present study was to prioritize a list of genes with an SGA altered expression in order to characterize the genetic background of the SGA-associated stroke risk. Genes with evidence of an altered expression after SGA treatments in genome-wide investigations, both in animals and men, were identified. The Genetic Association Database (GAD) served to verify which of these genes had a proven positive association with an increased stroke risk, and along with it each evidence was tested and recorded. Seven hundred and forty five genes had evidence of a change of their expression profile after SGA administration in various studies. Nine out of them have also been significantly related to an increased strokes risk. We identified and described nine genes as potential candidates for future genetic studies aimed at identifying the genetic background of the SGA-related stroke risk. Further, we identify the molecular pathways in which these genes operate in order to provide a molecular framework to understand on which basis SGA may enhance the risk for stroke.
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Affiliation(s)
- Enrico Cocchi
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
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Sumi S, Origasa H, Houkin K, Terayama Y, Uchiyama S, Daida H, Shigematsu H, Goto S, Tanaka K, Miyamoto S, Minematsu K, Matsumoto M, Okada Y, Sato M, Suzuki N. A Modified Essen Stroke Risk Score for Predicting Recurrent Cardiovascular Events: Development and Validation. Int J Stroke 2012; 8:251-7. [DOI: 10.1111/j.1747-4949.2012.00841.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background The Essen stroke risk score is widely applied to predict the risk of recurrent ischemic stroke. We developed a modified Essen stroke risk score and validated it using a large prospective Effective Vascular Event REduction after STroke (EVEREST) registry including 3588 patients with ischemic stroke in Japan. Patients with cardioembolic stroke were excluded, and follow-up was one-year. Methods The modified Essen stroke risk score was calculated from scores for waist circumference, stroke subtype by etiology, and gender in addition to age, hypertension, diabetes mellitus, previous myocardial infarction, other cardiovascular diseases except myocardial infarction and atrial fibrillation, peripheral artery disease, smoking, and previous stroke or transient ischemic attack. A multiple logistic regression model identified the predictors (each assigned one or two points) and provided c-statistics for the modified Essen stroke risk score. We considered two outcomes, recurrent ischemic stroke and cardiovascular events (defined as the combined outcomes of fatal or nonfatal stroke, myocardial infarction, nonfatal unstable angina, and cardiac death). Results Recurrent ischemic stroke occurred in 121 patients (3·7%) and cardiovascular events occurred in 133 (4·0%) within a year. The c-statistic (used for discrimination) was 0·632 for recurrent stroke and 0·640 for cardiovascular events. Patients scoring 6 or greater were classified as high risk, otherwise were classified as low risk. Kaplan–Meier analysis revealed that the modified risk score was more predictive than the Essen stroke risk score in both men and women. Conclusions The modified Essen stroke risk score increased the ability of the Essen stroke risk score to predict recurrent cardiovascular events. Patients with a high modified Essen stroke risk score should be candidates for intensified secondary prevention strategies.
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Affiliation(s)
- Shigeki Sumi
- Department of Biostatistics, Graduate School of Medicine, Kurume University, Kurume, Japan
- Clinical Research Support Center Kyushu, The Incorporated Non-profit Organization, Fukuoka, Japan
| | - Hideki Origasa
- Division of Biostatistics and Clinical Epidemiology, University of Toyama School of Medicine, Toyama, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Yasuo Terayama
- Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Shinichiro Uchiyama
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University, School of Medicine, Tokyo, Japan
| | - Hiroshi Shigematsu
- Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan
| | - Shinya Goto
- Department of Medicine (Cardiology), Tokai University School of Medicine, Kanagawa, Japan
| | - Kortaro Tanaka
- Department of Neurology, Toyama University Hospital, Toyama, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Division of Integrated Medical Science Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Motoki Sato
- Medical Affairs, Sanofi-aventis K.K., Tokyo, Japan
| | - Norihiro Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
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