Importance rating of risk factors of ischemic stroke in patients over 85 years old in the polish population

Analysis of ischemic stroke burden in Asia from 1990 to 2019: based on the global burden of disease 2019 data

Background

Ischemic stroke has the characteristics of high morbidity, mortality, and recurrence rate. This study aimed to describe and assess the burden of ischemic stroke in Asia based on the global burden of disease (GBD) 2019 data and provide a crucial scientific foundation for the prevention and control of this life-threatening disease.

Method

This study used the GBD 2019 data to assess the burden of ischemic stroke. The indicators used in this study were derived from the following methods: (i) the incidence of ischemic stroke was estimated using the disability model for the global burden of disease study-mixed effects regression (DisMod-MR), a Bayesian meta-regression disease modeling tool; (ii) the non-specific codes of all available data on mortality were corrected and used to estimate mortality rates for ischemic stroke and the cause of death ensemble model was used to estimate mortality rates; and (iii) the disability-adjusted life years (DALYs) is the sum of years lived with disability (YLD) and the years of life lost (YLL), which quantifies the health loss due to specific diseases and injuries. In addition, the joinpoint regression model was adopted to analyze the temporal trend of ischemic stroke from 1990 to 2019 in Asia.

Result

This study found an increase in the burden of ischemic stroke in 2019 compared to 1990. Moreover, the age-standardized incidence rate (ASIR) of ischemic stroke showed a gradual upward trend over the specific period. The age-standardized mortality rate (ASMR) showed a downward trend in Asia from 1990 to 2019. The burden of ischemic stroke was more concentrated on older age groups, particularly those older than 65 years. East Asia had the highest burden of ischemic stroke compared to other regions in Asia. Particularly, China, India, Indonesia, and Japan had the highest burdens of ischemic stroke among the Asian countries and regions. However, the population with the highest burden of ischemic stroke was still the elderly group.

Conclusion

Based on our study, it is evident that the burden of ischemic stroke exists substantially and exhibits variations in the aspects of age, gender, and geographical region in Asia. Without targeted implementation of population-wide primary strategies for prevention and control, the burden of ischemic stroke is likely to worsen significantly in the future.

Monitoring risk and preventing ischemic stroke in the very old

INTRODUCTION

Stroke is a significant cause of death, and the leading cause of severe long-term disability for individuals over 80 (the very old), yet few studies of such risk factors for ischemic stroke, or the known mitigation techniques, in this population, and the evidence base regarding risk modification strategies in this susceptible population can be inconsistent and incomplete. This article examines current guidelines and evidence regarding medical management, lifestyle changes, and psychosocial interactions that can contribute to the primary and secondary prevention of ischemic stroke in the very old.

AREAS COVERED

The authors conducted a literature search for ischemic stroke prevention and risk assessment in the elderly via PubMed. Furthermore, they describe current strategies for monitoring risk and preventing ischemic stroke in the elderly population.

EXPERT OPINION

Ischemic stroke poses a significant health risk to the elderly, with prevention relying on managing modifiable risk factors such as hypertension, atrial fibrillation, diabetes, and high cholesterol, as well as promoting healthy lifestyle choices like quitting smoking, regular physical activity and a heart-healthy diet. Healthcare providers must adopt a multifaceted approach, addressing individual and population-level factors while remaining vigilant in monitoring and managing risk factors to reduce the incidence and impact of stroke in older adults.

Association of premature ventricular complexes and risk of ischemic stroke: A systematic review and meta-analysis

Recent studies have suggested that patients with premature ventricular complexes (PVCs) may have a higher risk of ischemic stroke. However, the data are limited and inconclusive. We conducted a systematic review and meta‐analysis to investigate the association between PVCs and the risk of ischemic stroke. A comprehensive literature review was conducted by searching for published articles indexed in MEDLINE and EMBASE databases from inception through September 25, 2020, to identify studies that compared the risk of ischemic stroke between patients with PVCs and individuals without PVCs. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random‐effect, generic inverse variance method of Dersimonian and Laird. A total of four observational studies (2 prospective and 2 retrospective cohort studies) with 42 677 participants met the eligibility criteria and were included in the meta‐analysis. We found that patients with PVCs have a significantly higher risk of ischemic stroke than individuals without PVCs with the pooled RR of 1.31 (95% CI, 1.07–1.60, I² = 43%). From our systematic review and meta‐analysis, we found that PVCs are associated with a higher risk of ischemic stroke. Whether this association is causal and how it should be addressed in clinical practice require further investigations.

Susceptibility of PON1/PON2 Genetic Variations to Ischemic Stroke Risk in a Chinese Han Population

Background

Paraoxonases (PONs) are a family of orphan enzymes with multiple functions, including anti-inflammatory, antioxidative, antiatherogenic activities. Studies have suggested that genetic variations in PON1 and PON2 are associated with ischemic stroke (IS) risk; however, the conclusion remains unclear in the Chinese population.

Methods

To investigate the susceptibility of genetic variations in PON1 and PON2 to risk of IS and its subtypes, this case–control study was carried out on a Chinese population comprising 300 IS patients and 300 healthy controls. Genotypes of six genetic variations in PON1 and PON2 were identified with an improved multiplex ligase detection–reaction technique.

Results

PON1 rs662 was associated with increased risk of IS (CT vs. TT — OR_adjusted 1.79, 95% CI 1.08–2.97; p=0.025). Stratified analysis for patients by sex revealed that the significant association of PON1 rs662 with IS risk was maintained in the male cohort (CT vs. TT — OR_adjusted 2.59, 95% CI 1.29–5.21 [p=0.009]; CT/CC vs. TT — OR_adjusted 2.03, 95% CI 1.05–3.93 [p=0.036]), but not in the female cohort. Analysis according to IS subtype revealed that PON1 rs662 genetic variation was an increased risk in the subcohort of patients with large-artery atherosclerosis (CT/CC vs. TT — OR_adjusted 2.31, 95% CI 1.09–4.91; p=0.029), but not in patients with other types of IS.

Conclusion

This study suggested that PON1 rs662 presented a potential risk of IS, especially for males, and this association was more obvious for large-artery atherosclerosis.

Comparing language samples of Bangla speakers using a colour photograph and a black-and-white line drawing

BACKGROUND

A comprehensive aphasia assessment is necessary to diagnose the type and severity of aphasia differentially and guide appropriate interventions. One component of an aphasia assessment is the picture description task (PDT), designed to probe spontaneous speech fluency and information content. Most aphasia assessments use black-and-white line drawings (LD) to elicit spontaneous language samples from people with aphasia (PWA). However, recent studies reported two visuographic variables: (1) colour (over black and white) and (2) photograph (over LD), that tended to encourage easier and faster comprehension and increased overall naturalistic language production from neurologically healthy individuals as well as PWA. Additionally, a suitable stimulus for a PDT should always be culturally relevant to the target population. Therefore, we suggest that a new PDT must include a culturally appropriate colour photograph (CP).

AIMS

To investigate if a culturally appropriate CP elicits longer and more complex utterances than a culturally appropriate black-and-white LD from neurologically healthy native Bangla speakers.

METHODS & PROCEDURES

A total of 30 participants (mean age = 36.03 years) were recruited based on self-reports of no known impairments in cognition, language, vision and hearing. All were of middle socioeconomic status with at least 12 years of formal education. A culturally appropriate CP was selected showing multiple characters performing various functions. Later, an artist prepared the black-and-white LD of that CP. The elicited language samples using these two pictures were transcribed and coded following preset transcription and coding guidelines. The transcribed samples were further analysed using the Bangla adaptation of Systematic Analysis of Language Transcripts (SALT) software. To identify the differences in language production between these two picture types, investigators used four measurement variables: mean length of utterances (MLU), complexity index (CI), total number of words (TNW) and words per minute (WPM).

OUTCOMES & RESULTS

Of the four measures, only MLU showed a statistically significant difference between the CP and the black-and-white LD. CI demonstrated a strong correlation with MLU for the CP, which indicates that the participants who produced higher MLU for the CP also produced a higher CI for the CP. There were no significant differences between the two picture types for CI, TNW and WPM.

CONCLUSIONS & IMPLICATIONS

This study found that the grammatical complexity, as measured by MLU, of spontaneous language production of neurologically healthy adults was higher when a CP was used in a PDT. A CP may also be beneficial for PWA to produce complex language samples. What this paper adds What is already known on the subject There are studies on neurologically healthy individuals as well as on PWA that identified the impact of using different visuographic variables (colour and photograph) separately, which enhanced the picture comprehension and improved performances on associated language production tasks. To our knowledge, no studies have identified the combined impact of these two visuographic variables on spontaneous language production. Therefore, this initial study on neurologically healthy Bangla adults reports the impact of using a CP as a stimulus item for a PDT task to elicit spontaneous language samples. What this paper adds to existing knowledge This study reports that using a culturally appropriate CP for a PDT enhances the grammatical complexity of spontaneous language production of neurologically healthy adults. To our knowledge, this is the first study in Bangla that used the MLU as a measurement variable to analyse adults' spontaneous language production. What are the potential or actual clinical implications of this work? The development of future aphasia assessments should consider incorporating CPs as stimuli for PDTs, which may guide speech-language pathologists to provide accurate diagnoses for aphasia and related language disorders.

Ph- myeloproliferative neoplasms and the related risk factors for stroke occurrence: Results from a registry of patients treated with Anagrelide

Arterial thrombosis is a common complication in patients with Ph^- myeloproliferative neoplasms (MPN). We searched for the risk factors of stroke in MPN patients from anagrelide registry. We analyzed the potential risk factors triggering a stroke/TIA event in 249 MPN patients with previous stroke (n = 168) or Transient Ischemic Attack (TIA) (n = 140), and in 1,193 MPN control subjects (without clinical history of thrombosis). These patients were registered in a prospective manner, providing a follow-up period after Anagrelide treatment. The median age of the patients in the experimental group was of 56 years of age (ranging from 34-76) and of 53 years of age (ranging from 26-74) in the control group (p < 0.001). Using a multivariate model, we determined the following as risk factors: JAK2V617F mutation (OR 2.106, 1.458-3.043, p = 0.006), age (OR 1.017/year, 1.005-1,029, p = 0.006), male gender (OR 1.419, 1.057-1.903, p = 0.020), MPN diagnosis (OR for PMF 0.649, 0.446-0.944, p = 0.024), BMI (OR 0.687 for BMI > 25, 0.473-0.999, p = 0.05) and high TAG levels (OR 1.734, 1.162-2.586, p = 0.008), all of which were statistically significant for CMP development. Concerning the risk factors for thrombophilia, only the antiphospholipid syndrome (OR 1.994, 1.017-3.91, p = 0.048) was noteworthy in a stroke-relevant context. There was no significant difference between the blood count of the patients prior to a stroke event and the control group, both of which were under a cytoreductive treatment. We found that age, male gender, JAK2V617F mutation, previous venous thrombosis, and hypertriglyceridemia represent independent risk factors for the occurrence of a stroke in Ph^- MPN patients.