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Ramírez-Moreno JM, Rebollo B, Macías-Sedas P, Valverde N, Parejo A, Felix-Redondo FJ, Roa Montero AM, Constantino AB, Gómez Baquero MJ, Ceberino-Muñoz D, Fernández-Bergés D. Strength of association of classical vascular risk factors in young patients with ischaemic stroke: a case-control study. Neurologia 2024; 39:604-613. [PMID: 36309160 DOI: 10.1016/j.nrleng.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/24/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Recent studies have reported an increasing incidence of ischaemic stroke among young adults. However, the strength of the association between traditional vascular risk factors has not been fully established. METHODS We compared 120 patients with a first ischaemic stroke before the age of 55 years admitted to the stroke unit of our centre with 600 healthy non-stroke controls from a population-based cohort study (HERMEX), matched for sex. Risk factors assessed included: hypertension, obesity, auricular fibrillation, current smoking, estimated glomerular filtration rate (eGFR), total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, high-density lipoprotein cholesterol (HDL-C) and diabetes mellitus. We used logistic regression analysis and calculated population attributable risk. We performed an overall analysis, by sex and aetiological subgroup. RESULTS Using logistic regression analysis, we found that overall, the significant risk factors were: hypertension (OR: 1.58; 95%CI: 1.01-2.50), atrial fibrillation (OR: 4.77; 95%CI: 1.20-19.00), low eGFR (OR: 4.74; 95%CI: 1.3-21.94) and low HDL-C (OR: 5.20; 95%CI: 3.29-8.21), as well as smoking for males (OR: 1.86; 95%CI: 1.14-3.03). LDL-C showed an inverse association with stroke. The population attributable risk for HDL-C was 37.8% and for hypertension 21.1%. In terms of aetiological subgroups, only low HDL-C was associated with stroke of undetermined aetiology. CONCLUSIONS Hypertension, auricular fibrillation, low eGFR, and low HDL-C, plus tobacco use in men, are the main risk factors among patients under 55 years of age with a first ischaemic stroke. We believe that it would be of particular interest to further explore the management of low HDL-C levels as part of preventive strategies in young stroke patients.
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Affiliation(s)
- J M Ramírez-Moreno
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain; Departamento de Ciencias Biomédicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, Badajoz, Spain; Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE).
| | - B Rebollo
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - P Macías-Sedas
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - N Valverde
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - A Parejo
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - F J Felix-Redondo
- Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE); Servicio Extremeño de Salud, Spain
| | - A M Roa Montero
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - A B Constantino
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - M J Gómez Baquero
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - D Ceberino-Muñoz
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - D Fernández-Bergés
- Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE); Servicio Extremeño de Salud, Spain
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Ramírez-Moreno J, Rebollo B, Macías-Sedas P, Valverde N, Parejo A, Felix Redondo F, Roa Montero A, Constantino A, Gómez Baquero M, Ceberino-Muñoz D, Fernández-Bergés D. Fuerza de asociación de factores de riesgo vascular clásicos en pacientes jóvenes con ictus isquémico: un estudio de casos y controles. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Cayuela A, Cayuela L, Ortega Belmonte MJ, Rodríguez-Domínguez S, Escudero-Martínez I, González A. Has stroke mortality stopped declining in Spain? Neurologia 2022; 37:550-556. [PMID: 31780318 DOI: 10.1016/j.nrl.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/06/2019] [Accepted: 06/20/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. METHODS Mortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. RESULTS Joinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from -3.4% in Catalonia and Extremadura, to -6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands. In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from -3.1% in Catalonia to -6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. CONCLUSIONS Current data show that stroke mortality rates have decreased (in women in Andalusia), stabilised (in both sexes in Murcia, in men in Castile-La Mancha, and in women in Extremadura), and have even reversed (in both sexes in the Canary Islands). Further study is needed to identify the causes of these trends.
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Affiliation(s)
- A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España.
| | - L Cayuela
- Departamento de Medicina Interna, Hospital Severo Ochoa, Leganés, Madrid, España
| | - M J Ortega Belmonte
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España
| | | | - I Escudero-Martínez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A González
- Servicio de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, España
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Maldonado-Cárceles AB, Hernando-Arizaleta L, Palomar-Rodríguez JA, Morales-Ortiz A. Trends in hospitalisation for ischaemic stroke in young adults in the region of Murcia (Spain) between 2006 and 2014. Neurologia 2022; 37:524-531. [PMID: 32001039 DOI: 10.1016/j.nrl.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/13/2019] [Accepted: 10/13/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Recent studies conducted in Europe and the United States suggest upward trends in both incidence and hospitalisation rates for ischaemic stroke in young adults; however, data for Spain are scarce. This study analyses the trend in hospitalisation due to ischaemic stroke in adults aged under 50 years in the region of Murcia between 2006 and 2014. METHOD We performed a retrospective study of patients discharged after hospitalisation due to cerebrovascular disease (CVD); data were obtained from the regional registry of the Minimum Basic Data Set. Standardised rates were calculated, disaggregated by age and CVD subtype. Time trends were analysed using joinpoint regression to obtain the annual calculated standardised rate and the annual percentage of change (APC). RESULTS A total of 27 064 patients with CVD were discharged during the 9-year study period. Ischaemic stroke was the most frequent subtype (61.0%). In patients aged 18 to 49 years, the annual number of admissions due to ischaemic stroke increased by 26%, and rates by 29.2%; however, the joinpoint regression analysis showed no significant changes in the trend (APC=2.74%, P≥.05). By contrast, a downward trend was identified in individuals older than 49 (APC=-1.24%, P<.05). CONCLUSIONS No significant changes were observed in the rate of hospitalisation due to ischaemic stroke among young adults, despite the decline observed in older adults. Identifying the causes of these disparate trends may be beneficial to the development of specific measures targeting younger adults.
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Affiliation(s)
- A B Maldonado-Cárceles
- Medicina Preventiva, Complejo Hospitalario Universitario de Cartagena, Murcia, España; Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Murcia, Murcia, España.
| | - L Hernando-Arizaleta
- Servicio de Planificación y Financiación Sanitaria, Consejería de Salud, Murcia, España
| | - J A Palomar-Rodríguez
- Servicio de Planificación y Financiación Sanitaria, Consejería de Salud, Murcia, España
| | - A Morales-Ortiz
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
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Maldonado-Cárceles A, Hernando-Arizaleta L, Palomar-Rodríguez J, Morales-Ortiz A. Trends in hospitalisation for ischaemic stroke in young adults in the region of Murcia (Spain) between 2006 and 2014. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:524-531. [DOI: 10.1016/j.nrleng.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 10/13/2019] [Indexed: 11/16/2022] Open
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Pérez Hernández A, Rodríguez Pérez MDC, Marcelino Rodríguez I, Cuevas Fernández FJ, Domínguez Coello S, Almeida González D, Calleja-Puerta S, Cabrera de León A. Incidence and mortality of cerebrovascular disease in Spain: 1,600,000 hospital admissions between 2001 and 2015. Int J Stroke 2022; 17:964-971. [PMID: 35212244 DOI: 10.1177/17474930221086417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: To analyze the incidence and mortality of cerebrovascular diseases (CeVD) in Spain from 2001 to 2015.Methods: Retrospective study of hospital incidence, hospital case-fatality and population mortality, with records from the Spanish Government Statistics. Days of hospital stay and risk of death during admission (RD) were estimated adjusting for age, sex, first stroke (FS), atrial fibrillation (AF), diabetes, hypertension, and smoking.Results: There were 1,662,487 stroke cases older than 15 years of age admitted to hospital (1,096,748 FS), with a national incidence = 291/105 in this period (Murcia maximum [367/105], Canary Islands minimum [238/105]). Population mortality (-50%) decreased while case-fatality remained stable (-3%), despite the increase in the age of patients (+2.29 years) and the incidence (+25%). Canary Islands had the youngest patients (-3.5 years for men and -6 years for women) and the longest hospital stay (+5.1 days). Andalusia (OR= 1.21 [1.19; 1.22]) and the Canaries (OR= 1.18 [1.15; 1.21]) had the highest RD. The factors associated to the highest increases in RD were FS (OR = 1.34 [95%CI= 1.33-1.35]) and AF (OR = 1.30 [95%CI= 1.29-1.31]).Conclusions: Population mortality due to CeVD was reduced by half in Spain between 2001 and 2015, but hospital incidence increased. Andalusia and the Canary Islands had the highest RD in the country. These Islands presented the lowest incidence, but their patients were younger, and their hospital stay longer. FS and AF were the factors associated with a higher risk of death.
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Affiliation(s)
- Azuquahe Pérez Hernández
- Servicio de Neurología, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Mª Del Cristo Rodríguez Pérez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain 375043
| | - Itahisa Marcelino Rodríguez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain 16749
| | - Francisco J Cuevas Fernández
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain 375043
| | - Santiago Domínguez Coello
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain 375043
| | - Delia Almeida González
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain 375043
| | - Sergio Calleja-Puerta
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Spain 16474
| | - Antonio Cabrera de León
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain 16749.,Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
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Cayuela A, Cayuela L, Ortega Belmonte MJ, Rodríguez-Domínguez S, Escudero-Martínez I, González A. Has stroke mortality stopped declining in Spain? NEUROLOGÍA (ENGLISH EDITION) 2021; 37:550-556. [PMID: 34521606 DOI: 10.1016/j.nrleng.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/20/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. METHODS Mortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. RESULTS Joinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from -3.4% in Catalonia and Extremadura, to -6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands. In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from -3.1% in Catalonia to -6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. CONCLUSIONS Current data show that stroke mortality rates have decreased (in women in Andalusia), stabilised (in both sexes in Murcia, in men in Castile-La Mancha, and in women in Extremadura), and have even reversed (in both sexes in the Canary Islands). Further study is needed to identify the causes of these trends.
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Affiliation(s)
- A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain.
| | - L Cayuela
- Departamento de Medicina Interna, Hospital Severo Ochoa, Leganés, Madrid, Spain
| | - M J Ortega Belmonte
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
| | | | - I Escudero-Martínez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A González
- Servicio de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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