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Martemucci G, Fracchiolla G, Muraglia M, Tardugno R, Dibenedetto RS, D’Alessandro AG. Metabolic Syndrome: A Narrative Review from the Oxidative Stress to the Management of Related Diseases. Antioxidants (Basel) 2023; 12:2091. [PMID: 38136211 PMCID: PMC10740837 DOI: 10.3390/antiox12122091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Metabolic syndrome (MS) is a growing disorder affecting thousands of people worldwide, especially in industrialised countries, increasing mortality. Oxidative stress, hyperglycaemia, insulin resistance, inflammation, dysbiosis, abdominal obesity, atherogenic dyslipidaemia and hypertension are important factors linked to MS clusters of different pathologies, such as diabesity, cardiovascular diseases and neurological disorders. All biochemical changes observed in MS, such as dysregulation in the glucose and lipid metabolism, immune response, endothelial cell function and intestinal microbiota, promote pathological bridges between metabolic syndrome, diabesity and cardiovascular and neurodegenerative disorders. This review aims to summarise metabolic syndrome's involvement in diabesity and highlight the link between MS and cardiovascular and neurological diseases. A better understanding of MS could promote a novel strategic approach to reduce MS comorbidities.
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Affiliation(s)
- Giovanni Martemucci
- Department of Agricultural and Environmental Sciences, University of Bari Aldo Moro, 70126 Bari, Italy;
| | - Giuseppe Fracchiolla
- Department of Pharmacy–Drug Sciences, University of Bari Aldo Moro, 70126 Bari, Italy; (M.M.); (R.T.); (R.S.D.)
| | - Marilena Muraglia
- Department of Pharmacy–Drug Sciences, University of Bari Aldo Moro, 70126 Bari, Italy; (M.M.); (R.T.); (R.S.D.)
| | - Roberta Tardugno
- Department of Pharmacy–Drug Sciences, University of Bari Aldo Moro, 70126 Bari, Italy; (M.M.); (R.T.); (R.S.D.)
| | - Roberta Savina Dibenedetto
- Department of Pharmacy–Drug Sciences, University of Bari Aldo Moro, 70126 Bari, Italy; (M.M.); (R.T.); (R.S.D.)
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2
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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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3
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Younger DS. Motor sequela of adult and pediatric stroke: Imminent losses and ultimate gains. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:305-346. [PMID: 37620077 DOI: 10.1016/b978-0-323-98817-9.00025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Stroke is the leading cause of neurological disability in the United States and worldwide. Remarkable advances have been made over the past 20 years in acute vascular treatments to reduce infarct size and improve neurological outcome. Substantially less progress has been made in the understanding and clinical approaches to neurological recovery after stroke. This chapter reviews the epidemiology, bedside examination, localization approaches, and classification of stroke, with an emphasis on motor stroke presentations and management, and promising research approaches to enhancing motor aspects of stroke recovery.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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Zhang L, Li X, Wolfe CDA, O'Connell MDL, Wang Y. Diabetes As an Independent Risk Factor for Stroke Recurrence in Ischemic Stroke Patients: An Updated Meta-Analysis. Neuroepidemiology 2021; 55:427-435. [PMID: 34673640 DOI: 10.1159/000519327] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Stroke and its recurrence and diabetes will increase in incidence as the population ages globally. This study explores the relationship between diabetes and stroke recurrence to understand if diabetes is an independent predictor for stroke recurrence in ischemic stroke (IS) patients. METHODS We conducted a systematic review and meta-analysis of studies on the effect of diabetes on stroke recurrence among patients with IS. We searched population-based studies published before 15th February 2021 in PubMed and EMBASE following PRISMA guidelines. Random-effects estimates of the pooled hazard ratio (HR) and 95% confidence intervals (CIs) of each study were generated. A funnel plot and an Egger test were performed to evaluate publication bias. All statistical analyses were conducted in the R software 4.0.1 and Stata 16.0. RESULTS The search identified 3,121 citations, of which 27 studies met inclusion criteria. Diabetes was associated with a significant risk of stroke recurrence in all IS patients (pooled HR, 1.50; 95% CI: 1.36-1.65; I2 = 61.0%). Similar results were found in lacunar stroke patients with diabetes (pooled HR, 1.65; 95% CI: 1.41-1.92; I2 = 22.0%). Moreover, we found that the risk of recurrent IS among patients of IS with diabetes was higher than that in those without diabetes (pooled HR, 1.53; 95% CI: 1.30-1.81; I2 = 74.0%). CONCLUSION Diabetes is an independent risk factor for stroke recurrence among patients with IS.
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Affiliation(s)
- Li Zhang
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Xianqi Li
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Charles D A Wolfe
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom.,NIHR Applied Research Collaboration (ARC) South London, London, United Kingdom
| | - Matthew D L O'Connell
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Yanzhong Wang
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom.,NIHR Applied Research Collaboration (ARC) South London, London, United Kingdom
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Kwan A, Wei J, Dowling NM, Power MC, Nadareishvili Z. Cognitive Impairment after Lacunar Stroke and the Risk of Recurrent Stroke and Death. Cerebrovasc Dis 2021; 50:383-389. [PMID: 33752211 PMCID: PMC8266725 DOI: 10.1159/000514261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Patients with poststroke cognitive impairment appear to be at higher risk of recurrent stroke and death. However, whether cognitive impairment after lacunar stroke is associated with recurrent stroke and death remains unclear. We assessed whether global or domain-specific cognitive impairment after lacunar stroke is associated with recurrent stroke and death. METHODS We considered patients from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial with a baseline cognitive exam administered in English by certified SPS3 personnel, 14-180 days after qualifying lacunar stroke. We considered a baseline score of ≤86 on the Cognitive Assessment Screening Instrument to indicate global cognitive impairment, <10 on the Clock Drawing on Command test to indicate executive function impairment, and domain-specific summary scores in the lowest quartile to indicate memory and nonmemory impairment. We used Cox proportional hazards models to estimate the association between poststroke cognitive impairment and subsequent risk of recurrent stroke and death. RESULTS The study included 1,528 participants with a median enrollment time of 62 days after qualifying stroke. During a mean follow-up of 3.9 years, 11.4% of participants had recurrent stroke and 8.2% died. In the fully adjusted models, memory impairment was independently associated with an increased risk of recurrent stroke (hazard ratio, 1.48; 95% confidence interval [95% CI]: 1.04-2.09) and death (hazard ratio, 1.87; 95% CI: 1.25-2.79). Global impairment (hazard ratio, 1.66; 95% CI: 1.06-2.59) and nonmemory impairment (hazard ratio, 1.74; 95% CI: 1.14-2.67) were associated with an increased risk of death. DISCUSSION/CONCLUSION After lacunar stroke, memory impairment was an independent predictor of recurrent stroke and death, while global and nonmemory impairment were associated with death. Cognitive screening in lacunar stroke may help identify populations at higher risk of recurrent stroke and death.
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Affiliation(s)
- Abraham Kwan
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Jingkai Wei
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - N Maritza Dowling
- Department of Acute and Chronic Care, School of Nursing, George Washington University, Washington, District of Columbia, USA
| | - Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Zurab Nadareishvili
- Department of Neurology, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA,
- Stroke Center, Virginia Hospital Center, Arlington, Virginia, USA,
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6
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Krinock MJ, Singhal NS. Diabetes, stroke, and neuroresilience: looking beyond hyperglycemia. Ann N Y Acad Sci 2021; 1495:78-98. [PMID: 33638222 DOI: 10.1111/nyas.14583] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022]
Abstract
Ischemic stroke is a leading cause of morbidity and mortality among type 2 diabetic patients. Preclinical and translational studies have identified critical pathophysiological mediators of stroke risk, recurrence, and poor outcome in diabetic patients, including endothelial dysfunction and inflammation. Most clinical trials of diabetes and stroke have focused on treating hyperglycemia alone. Pioglitazone has shown promise in secondary stroke prevention for insulin-resistant patients; however, its use is not yet widespread. Additional research into clinical therapies directed at diabetic pathophysiological processes to prevent stroke and improve outcome for diabetic stroke survivors is necessary. Resilience is the process of active adaptation to a stressor. In patients with diabetes, stroke recovery is impaired by insulin resistance, endothelial dysfunction, and inflammation, which impair key neuroresilience pathways maintaining cerebrovascular integrity, resolving poststroke inflammation, stimulating neural plasticity, and preventing neurodegeneration. Our review summarizes the underpinnings of stroke risk in diabetes, the clinical consequences of stroke in diabetic patients, and proposes hypotheses and new avenues of research for therapeutics to stimulate neuroresilience pathways and improve stroke outcome in diabetic patients.
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Affiliation(s)
- Matthew J Krinock
- Department of Neurology, University of California - San Francisco, San Francisco, California
| | - Neel S Singhal
- Department of Neurology, University of California - San Francisco, San Francisco, California
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7
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Zhou LW, Panenka WJ, Al-Momen G, Gicas KM, Thornton AE, Jones AA, Woodward M, Heran MKS, Vertinsky AT, Su W, Barr AM, MacEwan GW, Lang DJ, Rauscher A, Honer WG, Field TS. Cerebral Small Vessel Disease, Risk Factors, and Cognition in Tenants of Precarious Housing. Stroke 2020; 51:3271-3278. [PMID: 33019899 DOI: 10.1161/strokeaha.120.030446] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE We aim to describe the burden, characteristics, and cognitive associations of cerebral small vessel disease in a Canadian sample living with multimorbidity in precarious housing. METHODS Participants received T1, T2-fluid-attenuated inversion recovery, and susceptibility-weighted imaging 3T magnetic resonance imaging sequences and comprehensive clinical, laboratory, and cognitive assessments. Cerebral small vessel disease burden was characterized using a modified Small Vessel Disease (mSVD) score. One point each was given for moderate-severe white matter hyperintensities, ≥1 cerebral microbleeds, and ≥1 lacune. Multivariable regression explored associations between mSVD score, risk factors, and cognitive performance. RESULTS Median age of the 228 participants (77% male) was 44.7 years (range, 23.3-63.2). In n=188 participants with consistent good quality magnetic resonance imaging sequences, mSVD scores were 0 (n=127, 68%), 1 (n=50, 27%), and 2 (n=11, 6%). Overall, one-third had an mSVD ≥1 n=61 (32%); this proportion was unchanged when adding participants with missing sequences n=72/228 (32%). The most prevalent feature was white matter hyperintensities 53/218 (24%) then cerebral microbleed 16/191 (8%) and lacunes 16/228 (7%). Older age (odds ratio, 1.10 [95% CI, 1.05-1.15], P<0.001), higher diastolic blood pressure (odds ratio, 1.05 [95% CI, 1.01-1.09], P=0.008), and a history of injection drug use (odds ratio, 3.13 [95% CI, 1.07-9.16], P=0.037) had significant independent associations with a mSVD score of ≥1 in multivariable analysis. mSVD ≥1 was associated with lower performance on tests of verbal memory, sustained attention, and decision-making, contributing 4% to 5% of the variance in each cognitive domain. CONCLUSIONS The 32% prevalence of cerebral small vessel disease in this young, socially marginalized cohort was higher than expected for age and was associated with poorer cognitive performance.
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Affiliation(s)
- Lily W Zhou
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - William J Panenka
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Ghadeer Al-Momen
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Kristina M Gicas
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Allen E Thornton
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Andrea A Jones
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Melissa Woodward
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Manraj K S Heran
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - A Talia Vertinsky
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Wayne Su
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Alasdair M Barr
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - G William MacEwan
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Donna J Lang
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Alexander Rauscher
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - William G Honer
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Thalia S Field
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
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8
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Naqvi IA, Kamal AK, Rehman H. Multiple versus fewer antiplatelet agents for preventing early recurrence after ischaemic stroke or transient ischaemic attack. Cochrane Database Syst Rev 2020; 8:CD009716. [PMID: 32813275 PMCID: PMC7437397 DOI: 10.1002/14651858.cd009716.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality worldwide. Antiplatelet agents are considered to be the cornerstone for secondary prevention of stroke, but the role of using multiple antiplatelet agents early after stroke or transient ischaemic attack (TIA) to improve outcomes has not been established. OBJECTIVES To determine the effectiveness and safety of initiating, within 72 hours after an ischaemic stroke or TIA, multiple antiplatelet agents versus fewer antiplatelet agents to prevent stroke recurrence. The analysis explores the evidence for different drug combinations. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched 6 July 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 7 of 12, 2020) (last searched 6 July 2020), MEDLINE Ovid (from 1946 to 6 July 2020), Embase (1980 to 6 July 2020), ClinicalTrials.gov, and the WHO ICTRP. We also searched the reference lists of identified studies and reviews and used the Science Citation Index Cited Reference search for forward tracking of included studies. SELECTION CRITERIA We selected all randomised controlled trials (RCTs) that compared the use of multiple versus fewer antiplatelet agents initiated within 72 hours after stroke or TIA. DATA COLLECTION AND ANALYSIS We extracted data from eligible studies for the primary outcomes of stroke recurrence and vascular death, and secondary outcomes of myocardial infarction; composite outcome of stroke, myocardial infarction, and vascular death; intracranial haemorrhage; extracranial haemorrhage; ischaemic stroke; death from all causes; and haemorrhagic stroke. We computed an estimate of treatment effect and performed a test for heterogeneity between trials. We analysed data on an intention-to-treat basis and assessed bias for all studies. We rated the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 15 RCTs with a total of 17,091 participants. Compared with fewer antiplatelet agents, multiple antiplatelet agents were associated with a significantly lower risk of stroke recurrence (5.78% versus 7.84%, risk ratio (RR) 0.73, 95% confidence interval (CI) 0.66 to 0.82; P < 0.001; moderate-certainty evidence) with no significant difference in vascular death (0.60% versus 0.66%, RR 0.98, 95% CI 0.66 to 1.45; P = 0.94; moderate-certainty evidence). There was a higher risk of intracranial haemorrhage (0.42% versus 0.21%, RR 1.92, 95% CI 1.05 to 3.50; P = 0.03; low-certainty evidence) and extracranial haemorrhage (6.38% versus 2.81%, RR 2.25, 95% CI 1.88 to 2.70; P < 0.001; high-certainty evidence) with multiple antiplatelet agents. On secondary analysis of dual versus single antiplatelet agent therapy, benefit for stroke recurrence (5.73% versus 8.06%, RR 0.71, 95% CI 0.62 to 0.80; P < 0.001; moderate-certainty evidence) was maintained as well as risk of extracranial haemorrhage (1.24% versus 0.40%, RR 3.08, 95% CI 1.74 to 5.46; P < 0.001; high-certainty evidence). The composite outcome of stroke, myocardial infarction, and vascular death (6.37% versus 8.77%, RR 0.72, 95% CI 0.64 to 0.82; P < 0.001; moderate-certainty evidence) and ischaemic stroke (6.30% versus 8.94%, RR 0.70, 95% CI 0.61 to 0.81; P < 0.001; high-certainty evidence) were significantly in favour of dual antiplatelet therapy, whilst the risk of intracranial haemorrhage became less significant (0.34% versus 0.21%, RR 1.53, 95% CI 0.76 to 3.06; P = 0.23; low-certainty evidence). AUTHORS' CONCLUSIONS Multiple antiplatelet agents are more effective in reducing stroke recurrence but increase the risk of haemorrhage compared to one antiplatelet agent. The benefit in reduction of stroke recurrence seems to outweigh the harm for dual antiplatelet agents initiated in the acute setting and continued for one month. There is lack of evidence regarding multiple versus multiple antiplatelet agents. Further studies are required in different populations to establish comprehensive safety profiles and long-term outcomes to establish duration of therapy.
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Affiliation(s)
- Imama A Naqvi
- Stroke Service, International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University, New York, USA
| | - Ayeesha K Kamal
- Stroke Service, International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Hasan Rehman
- Stroke Service, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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9
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Mengozzi M, Kirkham FA, Girdwood EER, Bunting E, Drazich E, Timeyin J, Ghezzi P, Rajkumar C. C-Reactive Protein Predicts Further Ischemic Events in Patients With Transient Ischemic Attack or Lacunar Stroke. Front Immunol 2020; 11:1403. [PMID: 32733466 PMCID: PMC7358589 DOI: 10.3389/fimmu.2020.01403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/01/2020] [Indexed: 11/13/2022] Open
Abstract
Patients who have experienced a first cerebral ischemic event are at increased risk of recurrent stroke. There is strong evidence that low-level inflammation as measured by high sensitivity C-reactive protein (hs-CRP) is a predictor of further ischemic events. Other mechanisms implicated in the pathogenesis of stroke may play a role in determining the risk of secondary events, including oxidative stress and the adaptive response to it and activation of neuroprotective pathways by hypoxia, for instance through induction of erythropoietin (EPO). This study investigated the association of the levels of CRP, peroxiredoxin 1 (PRDX1, an indicator of the physiological response to oxidative stress) and EPO (a neuroprotective factor produced in response to hypoxia) with the risk of a second ischemic event. Eighty patients with a diagnosis of lacunar stroke or transient ischemic attack (TIA) were included in the study and a blood sample was collected within 14 days from the initial event. Hs-CRP, PRDX1, and EPO were measured by ELISA. Further ischemic events were recorded with a mean follow-up of 42 months (min 24, max 64). Multivariate analysis showed that only CRP was an independent predictor of further events with an observed risk (OR) of 1.14 (P = 0.034, 95% CI 1.01–1.29). No association was observed with the levels of PRDX1 or EPO. A receiver operating curve (ROC) determined a cut-off CRP level of 3.25 μg/ml, with a 46% sensitivity and 81% specificity. Low-level inflammation as detected by hs-CRP is an independent predictor of recurrent cerebrovascular ischemic events.
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Affiliation(s)
- Manuela Mengozzi
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Frances A Kirkham
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Esme E R Girdwood
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Eva Bunting
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Erin Drazich
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Jean Timeyin
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Pietro Ghezzi
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Chakravarthi Rajkumar
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom.,Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
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10
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Yaghi S, Liberman AL, Henninger N, Grory BM, Nouh A, Scher E, Giles J, Liu A, Nagy M, Kaushal A, Azher I, Fakhri H, Espaillat KB, Asad SD, Pasupuleti H, Martin H, Tan J, Veerasamy M, Esenwa C, Cheng N, Moncrieffe K, Moeini-Naghani I, Siddu M, Trivedi T, Ishida K, Frontera J, Lord A, Furie K, Keyrouz S, de Havenon A, Mistry E, Leon Guerrero CR, Khan M. Factors associated with therapeutic anticoagulation status in patients with ischemic stroke and atrial fibrillation. J Stroke Cerebrovasc Dis 2020; 29:104888. [PMID: 32414583 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/09/2020] [Accepted: 04/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Understanding factors associated with ischemic stroke despite therapeutic anticoagulation is an important goal to improve stroke prevention strategies in patients with atrial fibrillation (AF). We aim to determine factors associated with therapeutic or supratherapeutic anticoagulation status at the time of ischemic stroke in patients with AF. METHODS The Initiation of Anticoagulation after Cardioembolic stroke (IAC) study is a multicenter study pooling data from stroke registries of eight comprehensive stroke centers across the United States. Consecutive patients hospitalized with acute ischemic stroke in the setting of AF were included in the IAC cohort. For this study, we only included patients who reported taking warfarin at the time of the ischemic stroke. Patients not on anticoagulation and patients who reported use of a direct oral anticoagulant were excluded. Analyses were stratified based on therapeutic (INR ≥2) versus subtherapeutic (INR <2) anticoagulation status. We used binary logistic regression models to determine factors independently associated with anticoagulation status after adjustment for pertinent confounders. In particular, we sought to determine whether atherosclerosis with 50% or more luminal narrowing in an artery supplying the infarct (a marker for a competing atherosclerotic mechanism) and small stroke size (≤ 10 mL; implying a competing small vessel disease mechanism) related to anticoagulant status. RESULTS Of the 2084 patients enrolled in the IAC study, 382 patients met the inclusion criteria. The mean age was 77.4 ± 10.9 years and 52.4% (200/382) were women. A total of 222 (58.1%) subjects presented with subtherapeutic INR. In adjusted models, small stroke size (OR 1.74 95% CI 1.10-2.76, p = 0.019) and atherosclerosis with 50% or more narrowing in an artery supplying the infarct (OR 1.96 95% CI 1.06-3.63, p = 0.031) were independently associated with INR ≥2 at the time of their index stroke. CONCLUSION Small stroke size (≤ 10 ml) and ipsilateral atherosclerosis with 50% or more narrowing may indicate a competing stroke mechanism. There may be important opportunities to improve stroke prevention strategies for patients with AF by targeting additional ischemic stroke mechanisms to improve patient outcomes.
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Affiliation(s)
- Shadi Yaghi
- Department of Neurology, New York Langone Health, 150 55th St Suite 3667, Brooklyn, NY, 11220, USA.
| | - Ava L Liberman
- Department of Neurology, Montefiore Medical Center, New York, NY, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts, Worcester, MA, USA; Department of Psychiatry, University of Massachusetts, Worcester, MA, USA
| | - Brian Mac Grory
- Department of Neurology, Brown University, Providence, RI, USA
| | - Amre Nouh
- Department of Neurology, Hartford Hospital, Hartford, CT, USA
| | - Erica Scher
- Department of Neurology, New York Langone Health, 150 55th St Suite 3667, Brooklyn, NY, 11220, USA
| | - James Giles
- Department of Neurology, Washington University, Saint Louis, MO, USA
| | - Angela Liu
- Department of Neurology, Washington University, Saint Louis, MO, USA
| | - Muhammad Nagy
- Department of Neurology, University of Massachusetts, Worcester, MA, USA
| | | | - Idrees Azher
- Department of Neurology, Brown University, Providence, RI, USA
| | - Hiba Fakhri
- Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | | | | | | | - Heather Martin
- Department of Neurology, Spectrum Health, Grand Rapids, MI, USA
| | - Jose Tan
- Department of Neurology, Spectrum Health, Grand Rapids, MI, USA
| | | | - Charles Esenwa
- Department of Neurology, Montefiore Medical Center, New York, NY, USA
| | - Natalie Cheng
- Department of Neurology, Montefiore Medical Center, New York, NY, USA
| | | | | | - Mithilesh Siddu
- Department of Neurology, George Washington University, Washington, DC, USA
| | - Tushar Trivedi
- Department of Neurology, New York Langone Health, 150 55th St Suite 3667, Brooklyn, NY, 11220, USA
| | - Koto Ishida
- Department of Neurology, New York Langone Health, 150 55th St Suite 3667, Brooklyn, NY, 11220, USA
| | - Jennifer Frontera
- Department of Neurology, New York Langone Health, 150 55th St Suite 3667, Brooklyn, NY, 11220, USA
| | - Aaron Lord
- Department of Neurology, New York Langone Health, 150 55th St Suite 3667, Brooklyn, NY, 11220, USA
| | - Karen Furie
- Department of Neurology, Brown University, Providence, RI, USA
| | - Salah Keyrouz
- Department of Neurology, Washington University, Saint Louis, MO, USA
| | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Eva Mistry
- Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | | | - Muhib Khan
- Department of Neurology, Spectrum Health, Grand Rapids, MI, USA
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11
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Lee JD, Hu YH, Lee M, Huang YC, Kuo YW, Lee TH. High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke. Curr Neurovasc Res 2019; 16:250-257. [DOI: 10.2174/1567202616666190618164528] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 11/22/2022]
Abstract
Background and Purpose:
Recurrent ischemic strokes increase the risk of disability
and mortality. The role of conventional risk factors in recurrent strokes may change due to increased
awareness of prevention strategies. The aim of this study was to explore the potential risk
factors besides conventional ones which may help to affect the advances in future preventive concepts
associated with one-year stroke recurrence (OSR).
Methods:
We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics
between patients with and without OSR were analyzed using multivariate logistic regression
and classification and regression tree (CART) analyses.
Results:
Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression
analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI
1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major
factors associated with OSR. CART analysis further identified age and a prior history of ischemic
stroke were important factors for OSR when classified the patients into three subgroups
(with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no
prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively).
Conclusions:
Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR
by multivariate logistic regression analysis, and CART analysis further demonstrated that patients
with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of
OSR.
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Affiliation(s)
- Jiann-Der Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ya-Han Hu
- Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi County, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ya-Wen Kuo
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
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12
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Zheng S, Yao B. Impact of risk factors for recurrence after the first ischemic stroke in adults: A systematic review and meta-analysis. J Clin Neurosci 2019; 60:24-30. [DOI: 10.1016/j.jocn.2018.10.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/05/2018] [Indexed: 11/26/2022]
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13
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Aziz S, Sheikh Ghadzi SM, Abidin NE, Tangiisuran B, Zainal H, Looi I, Ibrahim KA, Sidek NN, Wei LK, Keng Yee L, Abdul Aziz Z, Harun SN. Gender Differences and Risk Factors of Recurrent Stroke in Type 2 Diabetic Malaysian Population with History of Stroke: The Observation from Malaysian National Neurology Registry. J Diabetes Res 2019; 2019:1794267. [PMID: 31886276 PMCID: PMC6927021 DOI: 10.1155/2019/1794267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/25/2019] [Accepted: 11/08/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Diabetes mellitus has been reported as a strong independent risk factor for stroke recurrence. Data on the modifiable factors contributing to the recurrence of stroke in type 2 diabetic Malaysian population with a history of stroke stratified by genders are lacking, and this supports the importance of this study. METHOD The data of 4622 patients with T2DM who had a history of stroke was obtained from the Malaysian National Stroke Registry. Univariate analysis was performed to differentiate between genders with and without stroke recurrence in terms of demographics, first stroke attack presentations, and other clinical characteristics. The significant factors determined from the univariate analysis were further investigated using logistic regression. RESULTS Ischemic heart diseases were found significantly associated with the stroke recurrence in males (OR = 1.738; 95% CI: 1.071-2.818) as well as female (OR = 5.859; 95% CI: 2.469-13.752) diabetic patients. The duration of hypertension, as well as the duration of diabetes, has been associated with the recurrence in both male and female subjects (p value < 0.05). Smoking status has an impact on the stroke recurrence in male subjects, while no significant association was observed among their peers. CONCLUSIONS Most of the predictive factors contributing to the recurrence of stroke in type 2 diabetic Malaysian population with a history of stroke are modifiable, in which IHD was the most prominent risk factor in both genders. The impact of optimizing the management of IHD as well as blood glucose control on stroke recurrence may need to be elucidated. No major differences in recurrent stroke predictors were seen between genders among the Malaysian population with type 2 diabetes mellitus who had a previous history of stroke.
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Affiliation(s)
- Sohail Aziz
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | | | - Nur Ezzati Abidin
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Balamurugan Tangiisuran
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
- Pusat Racun Negara, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Hadzliana Zainal
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Irene Looi
- Clinical Research Centre, Seberang Jaya Hospital, Ministry of Health, Penang, Malaysia
| | - Khairul Azmi Ibrahim
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Ministry of Health, Terengganu, Malaysia
| | - Norsima Nazifah Sidek
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Ministry of Health, Terengganu, Malaysia
| | - Loo Keat Wei
- Department of Biological Science, Faculty of Science, Universiti Tunku Abdul Rahman, Bandar Barat, 31900 Kampar, Perak, Malaysia
| | - Lee Keng Yee
- National Institutes of Health (NIH), Ministry of Health, Malaysia, Kuala Lumpur, Malaysia
| | - Zariah Abdul Aziz
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Ministry of Health, Terengganu, Malaysia
| | - Sabariah Noor Harun
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
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14
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Zhu H, Li Z, Lv J, Zhao R. Effects of cerebral small vessel disease on the outcome of patients with ischemic stroke caused by large artery atherosclerosis. Neurol Res 2018. [PMID: 29543130 DOI: 10.1080/01616412.2018.1446283] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Hui Zhu
- Medical College, Qingdao University, Qingdao, China
| | - Zhixing Li
- Medical College, Qingdao University, Qingdao, China
| | - Jinglei Lv
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Renliang Zhao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
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15
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Barrett EJ, Liu Z, Khamaisi M, King GL, Klein R, Klein BEK, Hughes TM, Craft S, Freedman BI, Bowden DW, Vinik AI, Casellini CM. Diabetic Microvascular Disease: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2017; 102:4343-4410. [PMID: 29126250 PMCID: PMC5718697 DOI: 10.1210/jc.2017-01922] [Citation(s) in RCA: 290] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 01/18/2023]
Abstract
Both type 1 and type 2 diabetes adversely affect the microvasculature in multiple organs. Our understanding of the genesis of this injury and of potential interventions to prevent, limit, or reverse injury/dysfunction is continuously evolving. This statement reviews biochemical/cellular pathways involved in facilitating and abrogating microvascular injury. The statement summarizes the types of injury/dysfunction that occur in the three classical diabetes microvascular target tissues, the eye, the kidney, and the peripheral nervous system; the statement also reviews information on the effects of diabetes and insulin resistance on the microvasculature of skin, brain, adipose tissue, and cardiac and skeletal muscle. Despite extensive and intensive research, it is disappointing that microvascular complications of diabetes continue to compromise the quantity and quality of life for patients with diabetes. Hopefully, by understanding and building on current research findings, we will discover new approaches for prevention and treatment that will be effective for future generations.
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Affiliation(s)
- Eugene J. Barrett
- Division of Endocrinology, Department of Medicine, University of Virginia, Charlottesville, Virginia 22908
| | - Zhenqi Liu
- Division of Endocrinology, Department of Medicine, University of Virginia, Charlottesville, Virginia 22908
| | - Mogher Khamaisi
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215
| | - George L. King
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705
| | - Barbara E. K. Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705
| | - Timothy M. Hughes
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Suzanne Craft
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Barry I. Freedman
- Divisions of Nephrology and Endocrinology, Department of Internal Medicine, Centers for Diabetes Research, and Center for Human Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Donald W. Bowden
- Divisions of Nephrology and Endocrinology, Department of Internal Medicine, Centers for Diabetes Research, and Center for Human Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Aaron I. Vinik
- EVMS Strelitz Diabetes Center, Eastern Virginia Medical Center, Norfolk, Virginia 23510
| | - Carolina M. Casellini
- EVMS Strelitz Diabetes Center, Eastern Virginia Medical Center, Norfolk, Virginia 23510
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16
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Early life characteristics and late life burden of cerebral small vessel disease in the Lothian Birth Cohort 1936. Aging (Albany NY) 2017; 8:2039-2061. [PMID: 27652981 PMCID: PMC5076451 DOI: 10.18632/aging.101043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/04/2016] [Indexed: 11/25/2022]
Abstract
It is unknown whether relations between early-life factors and overall health in later life apply to burden of cerebral small vessel disease (cSVD), a major cause of stroke and dementia. We explored relations between early-life factors and cSVD in the Lothian Birth Cohort, a healthy aging cohort. Participants were recruited at age 70 (N = 1091); most had completed a test of cognitive ability at age 11 as part of the Scottish Mental Survey of 1947. Of those, 700 participants had brain MRI that could be rated for cSVD conducted at age 73. Presence of lacunes, white matter hyperintensities, microbleeds, and perivascular spaces were summed in a score of 0-4 representing all MRI cSVD features. We tested associations with early-life factors using multivariate logistic regression. Greater SVD score was significantly associated with lower age-11 IQ (OR higher SVD score per SD age-11 IQ = .78, 95%CI 0.65-.95, p=.01). The associations between SVD score and own job class (OR higher job class, .64 95%CI .43-.95, p=.03), age-11 deprivation index (OR per point deprivation score, 1.08, 95%CI 1.00-1.17, p=.04), and education (OR some qualifying education, .60 95%CI .37-.98, p=.04) trended towards significance (p<.05 for all) but did not meet thresholds for multiple testing. No early-life factor was significantly associated with any one individual score component. Early-life factors may contribute to age-73 burden of cSVD. These relations, and the potential for early social interventions to improve brain health, deserve further study.
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Shoamanesh A, Pearce LA, Bazan C, Catanese L, McClure LA, Sharma M, Marti-Fabregas J, Anderson DC, Kase CS, Hart RG, Benavente OR. Microbleeds in the Secondary Prevention of Small Subcortical Strokes Trial: Stroke, mortality, and treatment interactions. Ann Neurol 2017; 82:196-207. [PMID: 28681535 DOI: 10.1002/ana.24988] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To characterize cerebral microbleeds (CMBs) in lacunar stroke patients in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial and to assess their relationship with recurrent stroke and death, and response to assigned treatment. METHODS SPS3 is a randomized, clinical trial conducted between 2003 and 2011. Patients with recent magnetic resonance imaging (MRI)-documented lacunar infarcts were randomly assigned in a factorial design to target levels of systolic blood pressure (130-149mmHg vs <130mmHg; open label) and to antiplatelet treatment (aspirin/clopidogrel vs aspirin/placebo; double-blinded). The current analysis involves 1,278 trial participants who had a baseline axial T2*-weighted gradient echo MRI sequence allowing for CMB detection. RESULTS CMBs were present in 30% of 1,278 patients (mean age = 63 years). Male gender (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.3-2.3), history of hypertension (OR = 1.6, 95% CI = 1.2-2.3), increased systolic blood pressure (1.2 per 20mmHg, 95% CI = 1.1-1.4), nondiabetic status (OR = 1.4, 95% CI = 1.1-1.9), multiple old lacunar infarcts (OR = 1.9, 95% CI = 1.5-2.5), and moderate (OR = 1.7, 95% CI = 1.2-2.3) or severe (OR = 4.2, 95% CI = 3.0-5.9) white matter hyperintensities on MRI were independently associated with CMBs. During a mean follow-up of 3.3 years, overall stroke recurrence was 2.5% per patient-year. Patients with CMBs had an adjusted 2-fold increased risk of recurrent stroke (hazard ratio = 2.1, 95% CI = 1.4-3.1). CMBs were not a risk factor for death. There were no statistically significant interactions between CMBs and treatment assignments. INTERPRETATION Patients with lacunar stroke and CMBs likely harbor a more advanced form of cerebral small vessel disease in need of efficacious therapeutic strategies. Ann Neurol 2017;82:196-207.
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Affiliation(s)
- Ashkan Shoamanesh
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada
| | | | - Carlos Bazan
- University of Texas Health Sciences Center, San Antonio, TX
| | | | | | - Mukul Sharma
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada
| | - Joan Marti-Fabregas
- Hospital of the Holy Cross and Saint Paul (Biomedical Research Institute, IIB Saint Paul), Barcelona, Spain
| | - David C Anderson
- Department of Neurology, University of Minnesota, Minneapolis, MN
| | | | - Robert G Hart
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada
| | - Oscar R Benavente
- Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada
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Wilson LK, Pearce LA, Arauz A, Anderson DC, Tapia J, Bazan C, Benavente OR, Field TS. Morphological classification of penetrating artery pontine infarcts and association with risk factors and prognosis: The SPS3 trial. Int J Stroke 2016; 11:412-9. [PMID: 26956031 DOI: 10.1177/1747493016637366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/24/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pontine infarcts are common and often attributed to small vessel disease ("small deep infarcts") or basilar branch atherosclerosis ("wedge shaped"). A well-described morphological differentiation using magnetic resonance images has not been reported. Furthermore, whether risk factors and outcomes differ by morphology, or whether infarct morphology should guide secondary prevention strategy, is not well characterized. METHODS All participants in the Secondary Prevention of Small Subcortical Strokes Study with magnetic resonance imaging -proven pontine infarcts were included. Infarcts were classified as well-circumscribed small deep (small deep infarct, i.e. lacunar), paramedian, atypical paramedian, or other based on diffusion-weighted imaging, T2/fluid-attenuated inversion recovery, and T1-magnetic resonance images. Inter-rater reliability was high (90% agreement, Cohen's kappa = 0.84). Clinical and radiologic features independently associated with small deep infarct versus paramedian infarcts were identified (multivariable logistic regression). Differences in stroke risk and death were assessed using Cox proportional hazards. RESULTS Of the 3020 patients enrolled, 644 had pontine infarcts; 619 images were available: 302(49%) small deep infarct, 245 (40%) paramedian wedge, 35 (6%) atypical paramedian, and 37 (6%) other. Among vascular risk factors, only smoking (OR 2.1, 95% CI 1.3-3.3) was independently associated with small deep infarct versus paramedian infarcts; on neuroimaging, old lacunes on T1/fluid-attenuated inversion recovery (OR 1.8, 1.3-2.6) and intracranial stenosis (any location) ≥50% (OR 0.62, 0.41-0.96). Small deep infarct versus paramedian was not predictive of either recurrent stroke or death, and there was no interaction with assigned treatment. CONCLUSIONS Pontine infarcts can be reliably classified based on morphology using clinical magnetic resonance images. Few risk factors differed between small deep infarct and paramedian infarcts with no differences in recurrent stroke or mortality. There was no difference in response to different antiplatelet or blood pressure treatment strategies between these two groups. REGISTRATION http://www.clinicaltrials.gov/NCT00059306.
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Affiliation(s)
- Laura K Wilson
- Center for Brain Health, and Division of Neurology, University of British Columbia, Vancouver BC Canada
| | | | - Antonio Arauz
- Neurology and Neurosurgery National Institute, Mexico City, Mexico
| | | | - Jorge Tapia
- Department of Neurology, Catholic University, Santiago, Chile
| | - Carlos Bazan
- Department of Radiology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Oscar R Benavente
- Center for Brain Health, and Division of Neurology, University of British Columbia, Vancouver BC Canada
| | - Thalia S Field
- Center for Brain Health, and Division of Neurology, University of British Columbia, Vancouver BC Canada
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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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Policardo L, Seghieri G, Francesconi P, Anichini R, Franconi F, Seghieri C, Del Prato S. Gender difference in diabetes-associated risk of first-ever and recurrent ischemic stroke. J Diabetes Complications 2015; 29:713-7. [PMID: 25660138 DOI: 10.1016/j.jdiacomp.2014.12.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 11/25/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the effect of diabetes by gender on the peak-risk of first-ever-ischemic stroke and its recurrence. METHODS Administrative datasets including all hospital discharges for ischemic stroke (N = 43,332) in the diabetic (N = 207,568) and non-diabetic (N = 2,808,554) population of the Tuscany region, Italy were used to calculate Hazard ratios (HR) after Cox-regression, of first-ever and recurrent ischemic strokes, between 2005 and 2011. RESULTS Overall, diabetes increased the HR of first-ever ischemic stroke by about 50% in both genders. However, this risk significantly declined with age and was higher in women aged 55-74 yr than in men of the same age (HR; 95% CI: 1.392; 1.228-1.579 in age-class 55-64 yr and 1.203; 1.110-1.304 in age class 65-74 yr; p < 0.001). Diabetes also increased the adjusted risk of three-year-stroke recurrence (N = 5,998) in women, independently of age, whereas this was the case in men < 70 yr. CONCLUSIONS Diabetes is associated with increased risk of ischemic stroke although it declines with age though at lower rate among women than men. Moreover, diabetic women have greater risk of recurrence than in men > 70 yrs old, supporting a high-risk "time-window" in postmenopausal-elderly diabetic women.
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Affiliation(s)
| | - Giuseppe Seghieri
- Agenzia Regionale Sanità Toscana, Florence, Italy; Centre of Study for Gender Health Azienda USL 3, Pistoia, Italy.
| | | | | | - Flavia Franconi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy and Laboratory of Gender Medicine, National Institute of Biostructures and Biosystems, Osilo, Sassari, Italy
| | - Chiara Seghieri
- Laboratorio Management e Sanità, Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy
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Field TS, Pearce LA, Asinger RW, Smyth NGC, De SK, Hart RG, Benavente OR. Left Ventricular Geometry on Transthoracic Echocardiogram and Prognosis after Lacunar Stroke: The SPS3 Trial. J Stroke Cerebrovasc Dis 2015; 24:1423-9. [PMID: 25840952 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 03/03/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The spectrum, prevalence, and prognostic implications of abnormal left ventricular geometry (LVG) in patients with lacunar stroke are unknown. We examined the spectrum of LVG and its relationship with vascular risk factors and outcomes after lacunar stroke. METHODS LVG was determined with transthoracic echocardiography for 1961 patients with magnetic resonance imaging-verified recent lacunar stroke participating in the Secondary Prevention of Small Subcortical Strokes trial. Multivariable logistic regression and Cox proportional hazards models were used to identify characteristics independently associated with LVG and to estimate risk from abnormal LVG for recurrent stroke and death. RESULTS Abnormal LVG was present in 77%. Hispanic (odds ratio [OR], 1.4; 95% confidence interval, 1.1-1.8) or black (OR, 2.0; 1.3-2.9) race-ethnicity, diabetes (OR, 1.3; 1.0-1.7), hypertension, impaired renal function (OR, 1.8; 1.2-2.5), intracranial stenosis (OR, 1.5; 1.1-2.1), and abnormal left ventricular function (OR, 2.0; 1.4-3.0) were independently associated with abnormal LVG. Subjects with abnormal LVG also more frequently had advanced manifestations of small-vessel disease specifically previous subcortical infarcts and white matter hyperintensities. After adjusting for assigned treatments, clinical risk factors, and advanced manifestations of small-vessel disease, subjects with abnormal LVG remained at increased risk of stroke recurrence (hazard ratio, 1.5; confidence interval, 1.0-2.4). There was no interaction between LVG and assigned antiplatelet or blood pressure target. Abnormal LVG was not associated with mortality. CONCLUSIONS LVG consistent with chronic hypertensive changes was highly prevalent and correlated with neuroradiologic manifestations of small-vessel disease in lacunar stroke patients. These results support the constructs that both cerebral small-vessel disease and LVG represent end-organ consequences of chronic hypertension.
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Affiliation(s)
- Thalia S Field
- Division of Neurology, Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | - Richard W Asinger
- Department of Medicine, Hennepin Heart Center, University of Minnesota, Minneapolis, Minnesota
| | - Nathan G Chan Smyth
- Division of Neurology, Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabe K De
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert G Hart
- Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Oscar R Benavente
- Division of Neurology, Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
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Nylander R, Lind L, Wikström J, Lindahl B, Venge P, Larsson A, Ärnlöv J, Berglund L, Ahlström H, Johansson L, Larsson EM. Relation between Cardiovascular Disease Risk Markers and Brain Infarcts Detected by Magnetic Resonance Imaging in an Elderly Population. J Stroke Cerebrovasc Dis 2015; 24:312-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/13/2014] [Accepted: 08/25/2014] [Indexed: 11/28/2022] Open
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Sandset EC, Berge E, Kjeldsen SE, Julius S, Holzhauer B, Krarup LH, Hua TA. Heart rate as a predictor of stroke in high-risk, hypertensive patients with previous stroke or transient ischemic attack. J Stroke Cerebrovasc Dis 2014; 23:2814-2818. [PMID: 25304725 DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 07/07/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Risk factors for first stroke are well established, but less is known about risk factors for recurrent stroke. In the present analysis, we aimed to assess the effect of heart rate and other possible predictors of stroke in a hypertensive population with previous stroke or transient ischemic attack (TIA). METHODS The Valsartan Antihypertensive Long-Term Use Evaluation trial was a multicentre, double-masked, randomized controlled, parallel group trial comparing the effects of an angiotensin receptor blocker (valsartan) and a calcium channel blocker (amlodipine) in patients with hypertension and high cardiovascular risk. We used Cox proportional hazard models to investigate the effect of baseline variables on the risk of stroke. Quadratic terms of the continuous variables were entered in the models to test for linearity. RESULTS Of 15,245 patients included in the trial, 3014 had a previous stroke or TIA at baseline and were included in the present analysis. Stroke recurrence occurred in 239 patients (7.9%) during a median of 4.5 years of follow-up. Resting heart rate (per 10 beats per minute; hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.18-6.58) and diabetes mellitus at baseline (HR, 1.47; 95% CI, 1.03-2.10) were significantly associated with an increased risk of stroke recurrence in the multivariable analysis. CONCLUSIONS In high-risk, hypertensive patients with previous stroke or TIA, resting heart rate was the strongest predictor of recurrent stroke.
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Affiliation(s)
| | - Eivind Berge
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Sverre E Kjeldsen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
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Asdaghi N, Pearce LA, Nakajima M, Field TS, Bazan C, Cermeno F, McClure LA, Anderson DC, Hart RG, Benavente OR. Clinical correlates of infarct shape and volume in lacunar strokes: the Secondary Prevention of Small Subcortical Strokes trial. Stroke 2014; 45:2952-8. [PMID: 25190442 DOI: 10.1161/strokeaha.114.005211] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE Infarct size and location are thought to correlate with different mechanisms of lacunar infarcts. We examined the relationship between the size and shape of lacunar infarcts and vascular risk factors and outcomes. METHODS We studied 1679 participants in the Secondary Prevention of Small Subcortical Stroke trial with a lacunar infarct visualized on diffusion-weighted imaging. Infarct volume was measured planimetrically, and shape was classified based on visual analysis after 3-dimensional reconstruction of axial MRI slices. RESULTS Infarct shape was ovoid/spheroid in 63%, slab in 12%, stick in 7%, and multicomponent in 17%. Median infarct volume was smallest in ovoid/spheroid relative to other shapes: 0.46, 0.65, 0.54, and 0.90 mL, respectively (P<0.001). Distributions of vascular risk factors were similar across the 4 groups except that patients in the ovoid/spheroid and stick groups were more often diabetic and those with multicomponent had significantly higher blood pressure at study entry. Intracranial stenosis did not differ among groups (P=0.2). Infarct volume was not associated with vascular risk factors. Increased volume was associated with worse functional status at baseline and 3 months. Overall, 162 recurrent strokes occurred during an average of 3.4 years of follow-up with no difference in recurrent ischemic stroke rate by shape or volume. CONCLUSIONS In patients with recent lacunar stroke, vascular risk factor profile was similar among the different infarct shapes and sizes. Infarct size correlated with worse short-term functional outcome. Neither shape nor volume was predictive of stroke recurrence. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00059306.
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Affiliation(s)
- Negar Asdaghi
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Lesly A Pearce
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Makoto Nakajima
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Thalia S Field
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Carlos Bazan
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Franco Cermeno
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Leslie A McClure
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - David C Anderson
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Robert G Hart
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Oscar R Benavente
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.).
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Variants of COL3A1 are associated with the risk of stroke recurrence and prognosis in the Chinese population: a prospective study. J Mol Neurosci 2014; 53:196-203. [PMID: 24664438 DOI: 10.1007/s12031-014-0283-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/04/2014] [Indexed: 01/19/2023]
Abstract
Type III collagen plays an important role in activating platelets, forming thrombus, and maintaining the mechanical properties of arteries. This study aimed to test the hypothesis that genetic variants of COL3A1 (gene encoding type III collagen) contribute to recurrence and prognosis of stroke. We investigated the associations of three variants (rs2138533, rs11887092, and rs1800255) in the COL3A1 gene with stroke recurrence and prognosis in 1,544 patients with three subtypes of stroke: lacunar infarction (n = 442), atherothrombotic infarction (n = 670), and hemorrhage (n = 432). These associations were evaluated by Kaplan-Meier analysis and Cox regression models. Patients were followed up for 4.5 years. The A allele of rs1800255 in the COL3A1 gene coding region was significantly associated with a reduced risk of stroke recurrence in patients with lacunar infarction (adjusted hazard ratio [HR] 0.58, 95 % confidence interval [CI] 0.36-0.93, P = 0.024), but there was an increased risk of all-cause mortality of atherothrombotic patients (adjusted HR 1.43, 95 % CI 1.01-2.00, P = 0.044). The TT genotype of rs2138533 showed a significantly increased risk of death caused by cardiovascular disease or stroke in lacunar infarct patients (adjusted HR 2.98, 95 % CI 1.27-6.98, P = 0.012), but there was a reduced risk of all-cause mortality for patients with intracerebral hemorrhage (adjusted HR 0.34, 95 % CI 0.12-0.93, P = 0.036). The G allele of rs11887092 increased the risk of stroke recurrence in patients with atherothrombotic stroke (adjusted HR 1.59, 95 % CI 1.04-2.44, P = 0.035). In conclusion, variants of COL3A1 might play a vital role in determining the risk of recurrence and prognosis after stroke.
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