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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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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 2022:S2173-5808(22)00142-0. [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] [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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Kumar P, Swarnkar P, Misra S, Nath M. Lipoprotein (a) level as a risk factor for stroke and its subtype: A systematic review and meta-analysis. Sci Rep 2021; 11:15660. [PMID: 34341405 PMCID: PMC8329213 DOI: 10.1038/s41598-021-95141-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/13/2021] [Indexed: 01/11/2023] Open
Abstract
The role of lipoprotein-A [Lp (a)] as a risk factor for stroke is less well documented than for coronary heart disease. Hence, we conducted a systematic review and meta-analysis for the published observational studies in order to investigate the association of Lp (a) levels with the risk of stroke and its subtypes. In our meta-analysis, 41 studies involving 7874 ischemic stroke (IS) patients and 32,138 controls; 13 studies for the IS subtypes based on TOAST classification and 7 studies with 871 Intracerebral hemorrhage (ICH) cases and 2865 control subjects were included. A significant association between increased levels of Lp (a) and risk of IS as compared to control subjects was observed (standardized mean difference (SMD) 0.76; 95% confidence interval (CIs) 0.53-0.99). Lp (a) levels were also found to be significantly associated with the risk of large artery atherosclerosis (LAA) subtype of IS (SMD 0.68; 95% CI 0.01-1.34) as well as significantly associated with the risk of ICH (SMD 0.65; 95% CI 0.13-1.17) as compared to controls. Increased Lp (a) levels could be considered as a predictive marker for identifying individuals who are at risk of developing IS, LAA and ICH.
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Affiliation(s)
- Pradeep Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Priyanka Swarnkar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Shubham Misra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manabesh Nath
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
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Levels of Lipid Parameters in Children with Arterial Ischemic Stroke and Headache: Case-Control Study and Meta-Analysis. Brain Sci 2021; 11:brainsci11040417. [PMID: 33810303 PMCID: PMC8065863 DOI: 10.3390/brainsci11040417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Abnormalities in levels of lipid parameters are one of the main causes of cardiovascular and cerebrovascular disease in adults. There are limited data on the role of disturbances of lipid metabolism in the etiopathogenesis of arterial ischemic stroke (AIS) in children and the results provided are ambiguous. The aim of the study was to compare the levels of lipid parameters (total cholesterol [TC], triglycerides [TG], high-density lipoprotein [HDL] and low-density lipoprotein [LDL]) between children with AIS, children with headache and healthy children. In addition, we performed meta-analysis of available data on lipid parameters in young patients with AIS. Methods: We retrospectively analyzed 218 children hospitalized between 2002 and 2018 in the Upper-Silesian Child’s Health Center (n = 82 children with AIS, n = 45 children with headache, n = 91 healthy children) with available data on lipid levels, i.e., TC, TG, and HDL. The levels of LDL, non-HDL cholesterol, and a very-low density lipoprotein (VLDL) were calculated. The ratios of TC/HDL, TG/HDL and LDL/HDL were also assessed. Data between cases and controls were analyzed using STATISTICA 13.0 whereas meta-analysis was performed with RevMan version 5.4 software. Results: Children with headache were significantly older than children with AIS (p = 0.001). Ten percent of children with AIS had posterior stroke. The mean TC level was significantly higher in the AIS children than in controls or in children with headache. Mean TG and VLDL levels were significantly different between all groups (p < 0.001 each). The hypertriglyceridemia was more prevalent in AIS children than in children with headache (39% vs. 13%, OR = 4.16 95% CI 1.58–10.94, p = 0.004). Similarly, the frequency of dyslipidemia was higher in children with AIS compared to children with headache (38% vs. 22%, OR = 2.13 95% CI 0.93–4.89, p = 0.078). The meta-analysis was conducted based on data from 4 studies (3 studies published previously plus the results we obtained in the present case-control analysis) with total number of 236 young patients with AIS and 272 healthy controls. Significant Standard Mean Difference (SMD) was found in triglycerides level between young patients with AIS and controls (0.78 95%CI 0.30–1.26 p = 0.002). Conclusions: Lipid abnormalities, especially levels of triglycerides, seem to be of particular importance in children with AIS, as confirmed in meta-analysis. The results of the present study may be a significant contribution to the further research on the role of lipid metabolism disorders in the development of childhood stroke.
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Zhang N, Zhang L, Wang Q, Zhao J, Liu J, Wang G. Cerebrovascular risk factors associated with ischemic stroke in a young non-diabetic and non-hypertensive population: a retrospective case-control study. BMC Neurol 2020; 20:424. [PMID: 33225904 PMCID: PMC7681954 DOI: 10.1186/s12883-020-02005-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background Globally, rates of ischemic stroke (IS) have been rising among young adults. This study was designed to identify risk factors associated with IS incidence in young adults unaffected by hypertension or diabetes. Methods This was a retrospective case-control study of early-onset IS patients without diabetes and hypertension. Control patients were matched with healthy individuals based upon sex, age (±2 years), and BMI (±3 kg/m2) at a 1:3 ratio. Sociodemographic, clinical, and risk factor-related data pertaining to these patients was collected. The association between these risk factors and IS incidence was then assessed using conditional logistic regression models. Results We recruited 60 IS patients and 180 controls with mean ages of 44.37 ± 4.68 and 44.31 ± 4.71 years, respectively, for this study. Relative to controls, IS patients had significantly higher total cholesterol (TG), homocysteine (HCY), white blood cell (WBC), absolute neutrophil count (ANC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels, and significantly lower high-density lipoprotein cholesterol (HDL-C) and triglyceride cholesterol (TC), free triiodothyronine (FT3), and free thyroxine (FT4) levels (all P < 0.05). After controlling for potential confounding factors, HCY and ANC were found to be significantly positively associated with IS incidence (OR 1.518, 95%CI 1.165–1.977, P = 0.002 and OR 2.418, 95%CI 1.061–5.511, P = 0.036, respectively), whereas HDL-C and FT3 levels were negatively correlated with IS incidence (OR 0.001, 95%CI 0.000–0.083, P = 0.003 and OR 0.053, 95%CI 0.008–0.326, P = 0.002, respectively). Conclusions In young non-diabetic and non-hypertensive patients, lower HDL-C and FT3 levels and higher HCY and ANC levels may be associated with an elevated risk of IS. Additional prospective studies of large patient cohorts will be essential to validate these findings.
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Affiliation(s)
- Nan Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lin Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Qiu Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jingwei Zhao
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
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Ayoade O, Umoh I, Amadi C. Dyslipidemia and Associated Risk Factors among Nigerians with Hypertension. DUBAI MEDICAL JOURNAL 2020. [DOI: 10.1159/000509570] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
<b><i>Background:</i></b> Abnormalities in serum lipids and lipoprotein levels with essential hypertension are vital independent causal factors for atherosclerotic cardiovascular disease (ASCVD). The coexistence of these factors has a synergistic effect in heightening the risk of cardiovascular events. The aim of the study was to evaluate the pattern of dyslipidemia among hypertensives and to determine some of its correlations in patients attending a tertiary hospital in South South Nigeria. <b><i>Methods:</i></b> This was a cross-sectional study conducted on 544 eligible hypertensive patients attending the Cardiology Clinic, University of Uyo Teaching Hospital (UUTH), Uyo, Nigeria, over a period of 6 months. Fasting lipids, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were evaluated. <b><i>Results:</i></b> Overall, 60.0% of the hypertensive patients had dyslipidemia, with 43.4.0% having high TC, 30.3% high LDL-C, 20.8% elevated TG, and 12.9% low HDL-C, respectively. There was a significant relationship between gender and lipoproteins, with women having significantly higher lipoproteins (TC, HDL-C, LDL-C, and non-HDL-C) than men. Women also had more measures of obesity with a higher body mass index and waist circumference. TC and non-HDL had a significant association with both systolic and diastolic blood pressure (BP). Altogether, 43.4% of the hypertensives had poorly controlled BP and significantly higher atherogenic lipoproteins (TC, LDL-C, and non-HDL-C). <b><i>Conclusion:</i></b> This study has demonstrated the relatively high prevalence of dyslipidemia among hypertensive patient in this population. High plasma TC is the most dominant pattern of dyslipidemia. Hypertensive patients with poorly controlled BP have worse atherogenic lipoprotein values and are more likely predisposed to ASCVD.
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Chen KN, He L, Zhong LM, Ran YQ, Liu Y. Meta-Analysis of Dyslipidemia Management for the Prevention of Ischemic Stroke Recurrence in China. Front Neurol 2020; 11:483570. [PMID: 33329292 PMCID: PMC7717969 DOI: 10.3389/fneur.2020.483570] [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: 07/29/2019] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The benefit of blood cholesterol reduction for secondary prevention of ischemic stroke remains undetermined in Chinese patients. The purpose of this meta-analysis was to determine whether lipid-lowering agents including statins, fibrates, nicotinic acid, and ezetimibe reduced the risk of recurrent stroke in ischemic stroke patients in China and whether such findings could inform treatment decisions for blood lipid-lowering treatment in China. Methods: The English electronic databases PubMed, EMBASE, Cochrane Library and Chinese databases CNKI, Sino-Med, Wan Fang, and VIP were searched for studies published between January 1990 and April 2020. This meta-analysis included published data from trials that randomly assigned patients to groups treated with either blood lipid-lowering regimens or placebo. Effect comparisons were made using fixed effects model in meta-analysis and linear and spline regression were performed to identify the relative risk of stroke recurrence. The primary outcome was the reduction of total ischemic stroke events, and relative risk values were obtained using a risk prediction equation developed from the control groups of the included trials. Results: Five studies including 4,999 individuals with available data met the inclusion criteria. Relative to the control groups, the pooled estimated odds ratio (OR) for recurrent stroke among those who received lipid-lowering therapy was 0.79 (95% confidence interval [CI]: 0.63-1.00). A 50% or greater reduction in low-density lipoprotein cholesterol (LDL-C) significantly reduced the risk of ischemic stroke recurrence (OR: 0.15 [95% CI: 0.11-0.20]). The overall beneficial effect of statin therapy was confirmed to prevent ischemic stroke with an OR of 0.51 (95% CI: 0.36-0.72). Conclusions: Effective lipid-lowering therapy could decrease the blood LDL-C level, which had a protective effect against stroke recurrence. These results support the use of predicted baseline cerebrovascular disease risk equations to inform decisions regarding blood lipid-lowering treatment in ischemic stroke patients in China.
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Affiliation(s)
- Kang-Ning Chen
- Department of Neurology, The First Hospital Affiliated to Army Medical University (Southwest Hospital), Chongqing, China
- *Correspondence: Kang-Ning Chen
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lian-Mei Zhong
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yu-Qin Ran
- Medical Affairs, MSD (China) Holding Co., Ltd., Shanghai, China
| | - Yan Liu
- Medical Affairs, MSD (China) Holding Co., Ltd., Shanghai, China
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Kivioja R, Pietilä A, Martinez-Majander N, Gordin D, Havulinna AS, Salomaa V, Aarnio K, Curtze S, Leiviskä J, Rodríguez-Pardo J, Surakka I, Kaste M, Tatlisumak T, Putaala J. Risk Factors for Early-Onset Ischemic Stroke: A Case-Control Study. J Am Heart Assoc 2019; 7:e009774. [PMID: 30608196 PMCID: PMC6404210 DOI: 10.1161/jaha.118.009774] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Recent studies have shown an increasing prevalence of vascular risk factors in young adults with ischemic stroke (IS). However, the strength of the association between all vascular risk factors and early‐onset IS has not been fully established. Methods and Results We compared 961 patients with a first‐ever IS at 25 to 49 years to 1403 frequency‐matched stroke‐free controls from a population‐based cohort study (FINRISK). Assessed risk factors included an active malignancy, atrial fibrillation, cardiovascular disease, current smoking status, a family history of stroke, high low‐density lipoprotein cholesterol, high triglycerides, low high‐density lipoprotein cholesterol, hypertension, and type 1 and type 2 diabetes mellitus. We performed subgroup analyses based on age, sex, and IS etiology. In a fully adjusted multivariable logistic regression analysis, significant risk factors for IS consisted of atrial fibrillation (odds ratio [OR], 10.43; 95% confidence interval [CI], 2.33–46.77], cardiovascular disease (OR, 8.01; 95% CI, 3.09–20.78), type 1 diabetes mellitus (OR, 6.72; 95% CI, 3.15–14.33), type 2 diabetes mellitus (OR, 2.31; 95% CI, 1.35–3.95), low high‐density lipoprotein cholesterol (OR, 1.81; 95% CI, 1.37–2.40), current smoking status (OR, 1.81; 95% CI, 1.50–2.17), hypertension (OR, 1.43; 95% CI, 1.17–1.75), and a family history of stroke (OR, 1.37; 95% CI, 1.04–1.82). High low‐density lipoprotein cholesterol exhibited an inverse association with IS. In the subgroup analyses, the most consistent associations appeared for current smoking status and type 1 diabetes mellitus. Conclusions Our study establishes the associations between 11 vascular risk factors and early‐onset IS, among which atrial fibrillation, cardiovascular disease, and both type 1 and 2 diabetes mellitus in particular showed strong associations.
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Affiliation(s)
- Reetta Kivioja
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland
| | - Arto Pietilä
- 2 National Institute for Health and Welfare Helsinki Finland
| | - Nicolas Martinez-Majander
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland
| | - Daniel Gordin
- 3 Abdominal Center Nephrology University of Helsinki and Helsinki University Central Hospital Helsinki Finland.,4 Folkhälsan Institute of Genetics Folkhälsan Research Center Helsinki Finland.,5 Joslin Diabetes Center Harvard Medical School Boston MA
| | - Aki S Havulinna
- 2 National Institute for Health and Welfare Helsinki Finland.,8 Institute for Molecular Medicine Finland (FIMM) University of Helsinki Helsinki Finland
| | - Veikko Salomaa
- 2 National Institute for Health and Welfare Helsinki Finland
| | - Karoliina Aarnio
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland
| | - Sami Curtze
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland
| | - Jaana Leiviskä
- 6 Department of Clinical Chemistry University of Helsinki and Helsinki University Hospital HUSLAB Helsinki Finland
| | | | - Ida Surakka
- 2 National Institute for Health and Welfare Helsinki Finland.,8 Institute for Molecular Medicine Finland (FIMM) University of Helsinki Helsinki Finland
| | - Markku Kaste
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland
| | - Turgut Tatlisumak
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland.,9 Department of Clinical Neurosciences Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Sweden.,10 Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
| | - Jukka Putaala
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland
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Cui Q, Naikoo NA. Modifiable and non-modifiable risk factors in ischemic stroke: a meta-analysis. Afr Health Sci 2019; 19:2121-2129. [PMID: 31656496 PMCID: PMC6794552 DOI: 10.4314/ahs.v19i2.36] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Stroke is a heterogeneous, multifactorial disease regulated by modifiable and non-modifiable risk factors like total cholesterol, triglycerides, high density lipid-cholesterol (HDL-C), low density lipid-cholesterol (LDL-C) and glucose and non-modifiable factors like age. Evaluation of these risk factors for ischemic stroke may contribute to more effective prevention. Methods This meta-analysis investigated the data up to 2018 with respect to age, total cholesterol, triglycerides, high density lipid-cholesterol (HDL-C), low density lipid-cholesterol (LDL-C) and glucose levels in the Ischemic stroke patients and controls. Data from each eligible study was extracted such as year of publication, first author name, ethnicity/country, number of ischemic stroke patients and healthy controls and studies were subjected to heterogeneity analysis. Results Meta-analysis of the modifiable and non-modifiable risk factors like total cholesterol, HDL-C and LDL-C glucose, triglycerides levels and age were not having significantly associated with ischemic stroke (p>0.05). However meta-analysis of triglyceride yielded significant association ischemic stroke with overall 95% CI (−0.62- (−0.09) and P= 0.007 and glucose also showed significant association with ischemic stroke with 95% CI (-1.08- (−0.14), P=0.01. Studies were subjected to heterogeneity which revealed significant heterogeneity with (P<0.00) and I2>96%. Conclusion Meta-analysis revealed that levels of triglyceride and glucose are the predisposing factors for ischemic stroke in the Asian population.
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Affiliation(s)
| | - Niyaz Ahmad Naikoo
- Xingping people's hospital, No.15 jincheng road, xingping city, shaanxi province. China, 713100
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Lasek-Bal A, Kopyta I, Warsz-Wianecka A, Puz P, Łabuz-Roszak B, Zaręba K. Risk factor profile in patients with stroke at a young age. Neurol Res 2018; 40:593-599. [PMID: 29577820 DOI: 10.1080/01616412.2018.1455367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background The distribution of risk factors for stroke is related to gender and age. The main objective of study was to determine the type and frequency of stroke risk factors in patients with first-in-life stroke before the age of 50. Methods Our study included patients under the age of 50 with first-in-life stroke. The following data obtained from all participants were analyzed: a neuroimaging of the head, wide panel of blood tests, electrocardiogram, transesophageal echocardiography, ultrasound of the carotid/cerebral arteries. 24-hour ECG monitoring and angio-MRI of head were performed in most patients. Results One hundred and eighty-four patients were qualified into the study; mean age - 39 years (female 45%). The female gender was significantly more often associated with diabetes, carotid/cerebral artery stenosis, myocardial infarction, cardiomyopathy and risk factors associated with lifestyle. More than half of the patients presented at least two risk stroke factors. The most frequent categories of risk factors were related to arteries and metabolic diseases. Vascular risk factors were among the most frequent in individual age categories. Hereditary stroke-burden was significant in the patient before the age of 20.15% of the patients haven't got known stroke risk factor. Conclusions Angiopathy is the most common risk factor for stroke at a young age. More than half of the patients with stroke at a young age have at least two independent risk factors for stroke. In the first two decades of life, the most frequent risk factors for stroke are heart diseases; arterial diseases play a dominant role in the consecutive three decades.
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Affiliation(s)
- Anetta Lasek-Bal
- a Department of Neurology, School of Health Sciences , Medical University of Silesia , Katowice , Poland
| | - Ilona Kopyta
- b Department of Child Neurology , Upper-Silesian Child's Health Center, Medical University of Silesia , Katowice , Poland
| | - Aldona Warsz-Wianecka
- a Department of Neurology, School of Health Sciences , Medical University of Silesia , Katowice , Poland
| | - Przemysław Puz
- a Department of Neurology, School of Health Sciences , Medical University of Silesia , Katowice , Poland
| | - Beata Łabuz-Roszak
- c Faculty of Public Health, Department of Basic Medical Sciences , Medical University of Silesia , Katowice , Poland
| | - Katarzyna Zaręba
- a Department of Neurology, School of Health Sciences , Medical University of Silesia , Katowice , Poland
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Gebrie A, Gnanasekaran N, Menon M, Sisay M, Zegeye A. Evaluation of lipid profiles and hematological parameters in hypertensive patients: Laboratory-based cross-sectional study. SAGE Open Med 2018; 6:2050312118756663. [PMID: 29468066 PMCID: PMC5813853 DOI: 10.1177/2050312118756663] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/09/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Hypertension and dyslipidemia are the two coexisting and synergizing major risk factors for cardiovascular diseases. The cellular constituents of blood affect the volume and viscosity of blood, thus playing a key role in regulating blood pressure. Overweight and obesity are key determinants of adverse metabolic changes including an increase in blood pressure. The aim of this study was to evaluate lipid profiles and hematological parameters in hypertensive patients at Debre Markos Referral Hospital, Northwest Ethiopia. METHODS Laboratory-based cross-sectional study was conducted in 100 eligible hypertensive patients at the hospital. The required amount of blood was withdrawn from the patients by healthcare professionals for immediate automated laboratory analyses. Data were collected on socio-demographic factors, anthropometric measurements, blood pressure, lipid profiles, and hematological parameters. RESULT The mean serum levels of triglyceride, total cholesterol, and low-density lipoprotein were significantly higher than their respective cut-off values in the hypertensive patients. Besides, 54%, 52%, 35%, and 11% of the hypertensive patients had abnormal low-density lipoprotein, total cholesterol, triglyceride, and high-density lipoprotein levels, respectively. Higher levels of low-density lipoprotein, hemoglobin, and red blood cell count were observed in the hypertensive patients whose blood pressure had been poorly controlled than the controlled ones (p < 0.05). Waist circumference had a significant positive association with the serum levels of total cholesterol and white blood cell count (p < 0.05). CONCLUSION Hypertensive patients had a high prevalence of lipid profile abnormalities and poorly controlled blood pressure which synergize in accelerating other cardiovascular diseases. Some hematological parameters such as red blood cell count are also increased as do the severity of hypertension.
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Affiliation(s)
- Alemu Gebrie
- Medical Biochemistry, Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Natesan Gnanasekaran
- Medical Biochemistry, Department of Biochemistry, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Menakath Menon
- Medical Biochemistry, Department of Biochemistry, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abriham Zegeye
- Medical Physiology, Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
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Nayak P, Panda S, Thatoi PK, Rattan R, Mohapatra S, Mishra PK. Evaluation of Lipid Profile and Apolipoproteins in Essential Hypertensive Patients. J Clin Diagn Res 2016; 10:BC01-BC04. [PMID: 27891330 PMCID: PMC5121668 DOI: 10.7860/jcdr/2016/20985.8626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/28/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Essential hypertension is one of the most common diseases of the Indian population contributing greatly to the morbidity, mortality and economic burden. It has a strong association with cardiovascular disease and abnormal lipid metabolism. Not only the traditional lipid parameters, but also the novel lipid components like Apo A1 and Apo B100 also have been identified to play a role. AIM The present study was done to evaluate serum lipid profile and Apo A1, Apo B 100 in essential hypertensive patients and correlate their values with the degree of hypertension. MATERIALS AND METHODS Fasting samples from 55 age and sex matched controls and 55 essential hypertensives were tested for plasma glucose, serum urea, creatinine, lipid profile, apo A1 and apo B100. The cases were subclassified based on the severity of hypertension according to JNC criteria. RESULTS The study showed a significantly raised value for serum cholesterol, triacylglycerol, Low Density Lipoprotein (LDL), Very Low-Density Lipoprotein (VLDL) in the hypertensive patients than the control group whereas serum High-Density Lipoprotein (HDL) registered a fall in the cases. Apo A1 revealed a non-significant fall in the hypertensive patients. In contrast, there was a rise in the serum apo B100 in the cases. Apo B100/apo A1 ratio was significantly raised in both stage I and stage II hypertensive patients in comparision to the controls. When correlated, serum apo A1 revealed a negative association where as serum apo B 100 showed a positive association with systolic and diastolic bloood pressure. Both LDL/HDL and apoB100/apo A1 and apo B100 revealed a significant positive association with both SBP and DBP. However, apoB100/apo A1 revealed a more positive association in comparision to LDL/HDL ratio (r=0.749, p<0.001, r=0.756, p<0.001 vs r=0.336, p<0.000, r=0.312, p<0.001). CONCLUSION Apo B100/apoA1 has emerged as an important complementary parameter in addition to traditional lipid ratio for evaluation of risk for future cardiovascular disease.
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Affiliation(s)
- Parsuram Nayak
- Senior Resident, Department of Biochemistry, SCB Medical College, Cuttack, Odisha, India
| | - Suchismita Panda
- Assistant Professor, Department of Biochemistry, SCB Medical College, Cuttack, Odisha, India
| | - Pravat Kumar Thatoi
- Assistant Professor, Department of Medicine, SCB Medical College, Cuttack, Odisha, India
| | - Roma Rattan
- Assistant Professor, Department of Biochemistry, SCB Medical College, Cuttack, Odisha, India
| | - Srikrushna Mohapatra
- Professor and Head, Department of Biochemistry, SCB Medical College, Cuttack, Odisha, India
| | - Pramila Kumari Mishra
- Professor and Head, Department of Biochemistry, MKCG Medical College, Berhampur, Odisha, India
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Pandey A, Shrivastava A, Solanki A. Study of atherogenic lipid profile, high sensitive C-reactive protein neurological deficit and short-term outcome in stroke subtypes. IRANIAN JOURNAL OF NEUROLOGY 2016; 15:146-52. [PMID: 27648176 PMCID: PMC5027150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stroke is one of the most frequent causes of death and disability worldwide and has significant clinical and socioeconomic impact. Hyperlipidemia and inflammation play major roles in atherothrombosis and in stroke. This study is conducted to compare the high sensitive C-reactive protein (hs-CRP) levels and the lipid profile parameters between stroke patients and control group and demonstrate correlation between markers, neurological deficit, and short-term outcome. METHODS We have studied a total 162 patients according to inclusion criteria. Serum level of hs-CRP and lipid profile estimated and correlated with neurological deficit and short-term outcome. RESULTS We found stroke patients had significantly higher levels of hs-CRP, total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and low level of high-density lipoprotein (HDL) than control. When we compared ischemic and hemorrhagic stroke (HS), data show increased level of triglyceride, LDL and HDL, and decreased the level of hs-CRP in ischemic stroke group than HS group. However, the National Institutes of Health Stroke Scale (NIHSS) score significantly higher in HS as compared to ischemic stroke at the time of admission and on the 7(th) day. CONCLUSION Thus, continuous clinical observation is necessary for clear differentiation of those changes. Furthermore, the determination of some reliable soluble markers of neuronal damage in blood and cerebrospinal fluid in the early infarction period would be much easier and more useful for tracking the course and prognosis of the disease and for any appropriate therapeutic approach.
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Affiliation(s)
- Aparna Pandey
- Department of Biochemistry, Narsinhbhai Patel Dental College and Hospital, Visnagar, India
| | - Amit Shrivastava
- Department of Biochemistry, Medanta-The Medicity, Gurgaon, India
| | - Ashok Solanki
- Department of Physiology, AMC MET Medical College, L.G. Hospital, Maninagar, Ahmedabad, India
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Lasek-Bal A, Gąsior Z. Cardiovascular diseases in patients 65 years and younger with non-cardiogenic stroke. Arch Med Sci 2016; 12:556-62. [PMID: 27279848 PMCID: PMC4889690 DOI: 10.5114/aoms.2016.59929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/13/2014] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Approximately 10-15% of patients with stroke are under 65 years of age. The aim of the study was to determine types of stroke In people below 65. We analysed the incidence and types of associated cardiovascular diseases in patients with non-cardiogenic stroke. MATERIAL AND METHODS In this prospective study patients (aged ≤ 65) with stroke underwent physical examination, computed tomography of the head, blood tests, electrocardiogram, echocardiography, and transcranial and carotid artery ultrasound. Classification of stroke was performed according to the ASCOD scale. Analysis considered the incidence of heart diseases in patients with non-cardiogenic stroke and the incidence of heart diseases recognised as a cause of cerebral embolism in patients with cardiogenic stroke. RESULTS The study included 611 patients with stroke at the age of 27-65 (mean: 57.2 ±6.7; M/F 380/231). Stroke of heterogeneous aetiology was observed in 321 patients, cardiogenic stroke in 78, and stroke caused by small vessel and carotid artery disease in 73 and 72 patients, respectively. The most common heart diseases in non-cardiogenic stroke patients included persistent foramen ovale, coronary heart disease and past myocardial infarction. The most common causes of cardiogenic embolism were cardiomyopathy, atrial fibrillation and interatrial septal defect. CONCLUSIONS Aetiologically heterogeneous stroke and cardiogenic stroke are the most commonly observed among young stroke patients. Cardiomyopathy and atrial fibrillation are the most common sources of cerebral embolism in young patients with cardiogenic stroke. Nearly 1/5 of patients with a non-cardiogenic stroke have congenital or acquired structural changes in the heart.
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Affiliation(s)
- Anetta Lasek-Bal
- Department of Neurology, Medical University of Silesia, Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
- High School of Science, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, High School of Science, Medical University of Silesia, Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
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Putaala J. Ischemic stroke in the young: Current perspectives on incidence, risk factors, and cardiovascular prognosis. Eur Stroke J 2016; 1:28-40. [PMID: 31008265 DOI: 10.1177/2396987316629860] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/06/2016] [Indexed: 12/25/2022] Open
Abstract
About one-fourth of ischemic strokes occur in working-aged individuals in the high-income countries, with worldwide increasing incidence in this age group from 1980s to present. Recent evidence suggests that traditional vascular risk factors are more prevalent than previously suggested in young adult stroke patients and they accumulate with age particularly in men. Accordingly, relatively high rates of atherosclerotic changes have been detected in these patients. The strength of association of vascular risk factors has gone poorly studied, however. Many young patients with ischemic stroke have, in turn, no traditional risk factors, while they may harbor other conditions with weak or uncertain association with the stroke alone. These individual conditions often represent a risk factor that may be strictly young-age specific, more prevalent in younger than older stroke patients (e.g. patent foramen ovale), or more prevalent among the young in the population. Despite high rates of vascular risk factors and atherosclerotic changes, these findings do not translate to higher frequencies of identified classical stroke mechanisms. In fact, cryptogenic causes are markedly common and even more frequent among the very young patients. Limited randomized trial evidence exists to support secondary prevention decision-making in patients, yet they face an increased risk of death and future vascular events for years to come-dependent on risk factor profile and cause of the stroke. This review provides an overview of recent data on epidemiology, risk factors, and their strength of association in ischemic stroke in the young. Furthermore, the relationship between with the risk factors and cardiovascular outcomes and key features on the evidence related to secondary prevention will be discussed.
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Affiliation(s)
- Jukka Putaala
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
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Jaffre A, Ruidavets JB, Nasr N, Guidolin B, Ferrieres J, Larrue V. Tobacco Use and Cryptogenic Stroke in Young Adults. J Stroke Cerebrovasc Dis 2015; 24:2694-700. [PMID: 26481958 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/14/2015] [Accepted: 07/20/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Cryptogenic stroke is the leading subtype of ischemic stroke in the young. We sought to evaluate the association between traditional cardiovascular risk factors and cryptogenic stroke by using a case-control study. METHODS Patients aged 18-54 years, consecutively treated for first-ever cryptogenic ischemic stroke in an academic stroke unit, were compared with subjects from the general population living in the same geographic area. Control subjects were matched for age and sex with patients. We further evaluated the association between significant risk factors and nonobstructive (<50% stenosis) carotid plaque and thrombus among patients with cryptogenic stroke. Odds ratios [OR] were calculated using logistic regression analysis. RESULTS A total of 155 patients with cryptogenic stroke (66.4% men, mean age 43.5 years [SD 8.4]) were included in the study. Cryptogenic stroke was associated with current tobacco use (42.6% in patients versus 23.9% in control subjects; OR = 2.38, 95% confidence interval [CI] 1.40-4.05, P = .002). Current tobacco use was associated with nonobstructive carotid plaque (OR = 6.22; 95% CI, 2.43-15.9; P = .001) and nonobstructive carotid thrombus (OR = 13.7; 95% CI, 1.42-132.7; P = .03) among the patients. CONCLUSION Our case-control study showed a strong link between current tobacco use and cryptogenic stroke in young adults.
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Affiliation(s)
- Aude Jaffre
- Department of Neurology, Toulouse University Hospital, 31059 Toulouse Cedex 9, France.
| | - Jean Bernard Ruidavets
- Department of Epidemiology and INSERM U1027, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| | - Nathalie Nasr
- Department of Neurology, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| | - Brigitte Guidolin
- Department of Neurology, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| | - Jean Ferrieres
- Department of Epidemiology and INSERM U1027, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| | - Vincent Larrue
- Department of Neurology, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
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Mustanoja S, Haapaniemi E, Putaala J, Strbian D, Kaste M, Tatlisumak T. Haemorrhagic Transformation of Ischaemic Stroke in Young Adults. Int J Stroke 2014; 9 Suppl A100:85-92. [DOI: 10.1111/j.1747-4949.2012.00904.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/30/2012] [Indexed: 12/01/2022]
Abstract
Background Frequency, factors associated with, and impact on outcome of haemorrhagic transformation in young adults with ischaemic stroke are unknown. Methods Consecutive young patients (age 15–49) with first-ever ischaemic stroke were included, having their first brain computed tomography/magnetic resonance imaging within seven-days of stroke onset, and second within seven-days from the first imaging. Haemorrhagic transformation in any imaging was classified as haemorrhagic infarct or parenchymal haemorrhage within or remote from the infarct. Symptomatic haemorrhagic transformation was defined according to the European Cooperative Acute Stroke Study II (ECASS II) criteria as any haemorrhage leading to a National Institutes of Health Stroke Scale score increase of ≥4 points or death. Unfavourable three-month outcome was defined as a modified Rankin Scale 2–6. Results In 636 eligible patients, any haemorrhagic transformation occurred in 79 patients (12·4%; 10·0–15·2%): 66 (10·4%; 8·24–12·9%) had haemorrhagic infarct, and 13 (2·04%; 1·19–3·46%) had parenchymal haemorrhage. Symptomatic haemorrhagic transformation occurred in 16 patients (2·5%; 4·04–1·55%). In logistic regression analysis, independent factors associated with haemorrhagic transformation were large anterior (18·70; 6·72–52·04), large posterior (9·41; 3·13–28·25), medium-sized (odds ratio 3·30; 95% confidence interval 1·14–9·57) lesions, higher low-density lipoprotein level (1·44 per unit increment; 1·10–1·90), and lower platelet count (1·005 per unit decrement; 1·009–1·001). Haemorrhagic infarct (1·76; 0·76–4·11) or parenchymal haemorrhage (2·39; 0·23–24·76) were not associated with unfavourable functional outcome or death at three-months. Conclusions In young adults, haemorrhagic transformation of ischaemic stroke occurred in comparable rates to haemorrhagic transformation in elderly patients. Although haemorrhagic transformation was more common in severe strokes, it was the lesion size and baseline stroke severity that were associated with three-month clinical outcome, not haemorrhagic transformation per se.
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Affiliation(s)
- Satu Mustanoja
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Elena Haapaniemi
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Markku Kaste
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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Risk factor profile by etiological subtype of ischemic stroke in the young. Clin Neurol Neurosurg 2014; 120:78-83. [DOI: 10.1016/j.clineuro.2014.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/11/2014] [Accepted: 02/19/2014] [Indexed: 12/29/2022]
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Shi Z, Zhang X, Chen Z, Liebeskind DS, Lou M. Elevated thyroid autoantibodies and intracranial stenosis in stroke at an early age. Int J Stroke 2013; 9:735-40. [PMID: 24024979 DOI: 10.1111/ijs.12177] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous studies have shown that hyperthyroidism was related to Moyamoya disease and intracranial artery stenosis. However, it is not clear whether thyroid hormone or thyroid autoantibodies was associated with them. AIMS AND/OR HYPOTHESIS Thyroid autoimmunity was previously shown to be associated with Moyamoya disease. Our study aimed to investigate the association between thyroid autoantibodies and intracranial large artery stenosis in young ischemic stroke patients with apparent euthyroid states. METHODS We retrospectively reviewed first-onset ischemic stroke patients (age ≤55 years old) consecutively admitted to a single academic center. Intracranial large artery stenosis was defined as ≥50% luminal diameter narrowing. We compared demographic profiles, risk factors (age, hypertension, diabetes, current smoker, atrial fibrillation, hyperlipidemia), thyroid function test, and thyroid autoantibodies including antithyroperoxidase antibody and antithyroglobulin antibody between patients with and without intracranial large artery stenosis. We also performed multivariate logistic regression analysis to evaluate the association between thyroid autoantibodies and intracranial large artery stenosis. RESULTS A total of 351 patients were analyzed. The mean age of the patients was 47·0 ± 7·7 (range, 10-55 years), and 252 (71·8%) patients were male. We identified intracranial large artery stenosis in 121 (34·5%) patients. Patients with intracranial large artery stenosis showed a higher frequency of elevated antithyroperpxidase antibody levels in comparison with nonintracranial large artery stenosis group (16·5% vs. 3·9%, P < 0·001). After adjusting for covariates, the presence of elevated antithyroperpxidase antibody levels (odds ratio: 5·318; 95% confidence interval: 2·157-13·110, P < 0·001), age (odds ratio: 1·037; 95% confidence interval: 1·002-1·073, P = 0·039), and atrial fibrillation (odds ratio: 0·091; 95% confidence interval: 0·011-0·756, P = 0·027) was independently associated with intracranial large artery stenosis. CONCLUSIONS Thyroid autoantibodies may be associated with the presence of intracranial large artery stenosis in young stroke patients, potentially providing insight on immune pathogenesis of intracranial large artery stenosis.
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Affiliation(s)
- Zhenghao Shi
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Serum lipid profile of newly diagnosed hypertensive patients in nnewi, South-East Nigeria. Int J Hypertens 2012; 2012:710486. [PMID: 23304451 PMCID: PMC3523141 DOI: 10.1155/2012/710486] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/08/2012] [Accepted: 11/09/2012] [Indexed: 02/02/2023] Open
Abstract
Abnormalities in serum lipid and lipoprotein levels are recognized major modifiable cardiovascular disease and essential hypertension risk factors. The objective of this study was to examine the serum lipid patterns of newly diagnosed hypertensive patients attending a tertiary healthcare centre in South East Nigeria. Methods. Two hundred and fifty newly diagnosed adult hypertensive patients and an equal number of age- and sex-matched controls without hypertension were consecutively recruited from the Medical and General Outpatient Clinics of Nnamdi Azikiwe University Teaching Hospital, Nnewi. Result. 126 males and 124 females were in each of the two groups. Mean age was comparable in both groups. Hypertensives had significantly higher mean systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, waist-hip ratio, and fasting blood sugar than the controls. The mean TC, TG, and LDL-C were significantly higher among the hypertensives. The mean HDL-C was comparable; P = 0.8. Among the hypertensive subjects, there was statistically significant positive correlation between BMI and TC; LDL-C and TG; WC and TG; FBS and TC; LDL-C and TG. HDL-C showed a statistically significant inverse correlation with WHR in hypertensives. Conclusion. This study showed that lipid abnormalities are highly prevalent among newly diagnosed hypertensives in South-East Nigeria.
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Ferrières J. HDL: facteur causal de l’athérosclérose ? Arguments épidémiologiques. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2011. [DOI: 10.1016/s1878-6480(11)70782-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Tarazona B, Ramos W, Arce J, Yarinsueca J, Morales S, Ronceros G, Galarza C, Pérez J. Etiología y factores de riesgo para un primer episodio de isquemia cerebral en adultos jóvenes. Neurologia 2010. [DOI: 10.1016/j.nrl.2010.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Tarazona B, Ramos W, Arce J, Yarinsueca J, Morales S, Ronceros G, Galarza C, Pérez J. Etiology and risk factors for a first episode of cerebral isquemia in young adults. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70088-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Risk factor modification remains as the principal aspect of care for stroke prevention. Understanding of risk factors has advanced and several options are now available to treat modifiable risk factors. However, effective treatment remains a challenging task in clinical practice. Prevention begins with awareness of risk factors by patients and clinicians. Risk factor assessment along with overall stroke risk estimation should be part of evaluation of patients with stroke, and used with careful clinical judgment. In this review, we discuss the impact of modifiable traditional vascular risk factors on ischemic stroke, interventions for stroke prevention, and evidence for early treatment of risk factors where available, as well as areas of research progress. Emphasis should be put on the education of patients, the community, and medical personnel. Future research in the field of genetic determinants of vascular risk factors and stroke will increase our understanding of the underlying mechanisms of cerebrovascular disease and likely result in development of new therapies and individualized programs for stroke prevention.
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Affiliation(s)
- José Rafael Romero
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA.
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Sanossian N, Saver JL, Kim D, Razinia T, Ovbiagele B. Do high-density lipoprotein cholesterol levels influence stroke severity? J Stroke Cerebrovasc Dis 2008; 15:187-9. [PMID: 17904074 DOI: 10.1016/j.jstrokecerebrovasdis.2006.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Accepted: 05/19/2006] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Low-serum high-density lipoprotein (HDL) cholesterol levels are associated with increased risk of stroke in various populations, including young patients. Severity of stroke is an important determinant of outcome and may be affected by baseline HDL cholesterol level. METHODS In all, 241 consecutive patients presenting within 24 hours of ischemic stroke onset were evaluated with the National Institutes of Health Stroke Scale (NIHSS) and had fasting serum HDL levels collected the morning after admission. We determined the impact of low HDL cholesterol (<35 mg/dL) and age on median NIHSS score, controlling for the possible confounders. RESULTS Among the 241 patients, mean age was 69.5 years, 53% were male, and the median NIHSS score was 5 (range: 0-35). There was no association between low-serum HDL and NIHSS score at presentation for the overall group (6 v 5, P = .385). In young patients (</=50 years), low HDL level was associated with more severe stroke (NIHSS score 15 v 4, P = .005). The association of HDL with stroke severity remained significant after adjusting for all factors (13 v 2, P = .01). CONCLUSION Overall, low-serum HDL was not associated with stroke severity. There may be an association of higher serum HDL with reduced stroke severity in patients aged 50 years and younger.
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Affiliation(s)
- Nerses Sanossian
- Stroke Center, University of California at Los Angeles Medical Center, Los Angeles, California, USA
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Ranga GS, Kalra OP, Tandon H, Gambhir JK, Mehrotra G. Effect of aspirin on lipoprotein(a) in patients with ischemic stroke. J Stroke Cerebrovasc Dis 2007; 16:220-4. [PMID: 17845920 DOI: 10.1016/j.jstrokecerebrovasdis.2007.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 03/26/2007] [Accepted: 05/08/2007] [Indexed: 11/18/2022] Open
Abstract
Hyperlipidemia and increased serum lipoprotein (Lp)(a) are independent risk factors for atherosclerosis and its complications. Serum Lp(a) concentration is not influenced by most lipid-lowering therapies other than niacin. Recently aspirin also has been reported to decrease its levels. In the current study, we evaluated the serum levels of Lp(a) and lipids in 25 patients with first-ever diagnosed ischemic stroke, aged 21 to 60 years, and compared their levels with an equal number of age- and sex-matched healthy control subjects. In addition, the effect of aspirin on Lp(a) levels was studied by estimating its levels after 4 weeks of daily treatment with 150 mg of aspirin. Both groups were comparable regarding their anthropometric measurements and routine laboratory parameters except that erythrocyte sedimentation rate was higher in the patients. Serum lipids were not significantly different between the two groups, although Lp(a) levels were significantly higher in the patients (27.40 +/- 22.30 mg/dL) as compared with the control subjects (14.68 +/- 11.75 mg/dL) (P = .005). Twenty of 25 patients (80%) had serum Lp(a) levels of more than 10 mg/dL, whereas only 11 of 25 control subjects (44%) had serum Lp(a) levels of more than 10 mg/dL (P = .009). After 4 weeks of treatment with aspirin, Lp(a) levels declined significantly (46.24%) from baseline 27.40 +/- 22.30 mg/dL to 14.73 +/- 10.47 mg/dL (P < .001). Patients with baseline levels greater than 25 mg/dL showed greater decline (55.63%) compared with those with levels less than 25 mg/dL (26.63%) (P = .008). Results of our study confirm that aspirin lowers the increased Lp(a) levels in patients with ischemic stroke.
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Affiliation(s)
- Gajender Singh Ranga
- Department of Medicine, University College of Medical Sciences (University of Delhi) and Guru Teg Bahadur Hospital, Delhi, India.
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Lipska K, Sylaja PN, Sarma PS, Thankappan KR, Kutty VR, Vasan RS, Radhakrishnan K. Risk factors for acute ischaemic stroke in young adults in South India. J Neurol Neurosurg Psychiatry 2007; 78:959-63. [PMID: 17220290 PMCID: PMC2117871 DOI: 10.1136/jnnp.2006.106831] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Stroke is a leading cause of death and disability in developing countries, afflicting individuals at a young age. The contribution of established vascular risk factors to ischaemic stroke in young adults has not been evaluated systematically in Indians. METHODS We conducted a case control study in 214 South Indian patients with first acute ischaemic stroke that occurred between the ages of 15 and 45 years, 99 age and sex matched hospital controls and 96 community controls. We compared the prevalence of the following risk factors: smoking, elevated blood pressure, high fasting blood glucose and abnormal lipids. RESULTS Compared with community controls, stroke patients had a higher prevalence of smoking (multivariable adjusted odds ratio (OR) 7.77, 95% CI 1.93 to 31.27), higher systolic blood pressure (OR per SD increment of 1.88, 95% CI 1.01 to 3.49) and fasting blood glucose (OR per SD increment of 4.55, 95% CI 1.63 to 12.67), but lower high density lipoprotein (HDL) cholesterol (OR per SD increment of 0.17, 95% CI 0.09 to 0.30). Compared with hospital controls, stroke patients had a higher prevalence of smoking (OR 3.95, 95% CI 1.61 to 9.71) and lower HDL cholesterol (OR per SD increment 0.27, 95% CI 0.17 to 0.44). The presence of > or = 3 metabolic syndrome components was associated strongly with stroke (OR 4.76, 95% CI 1.93 to 11.76; OR 2.09, 95% CI 1.06 to 4.13) compared with community and hospital controls. CONCLUSIONS Key components of the metabolic syndrome and smoking are associated with ischaemic stroke in young South Indian adults. Our observations underscore the importance of targeting adolescents and young adults for screening and prevention to reduce the burden of ischaemic stroke in young adults.
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Affiliation(s)
- K Lipska
- Department of Medicine, Brigham and Women's Hospital, Boston University School of Medicine, Boston, Massachusetts, USA
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Pasdar A, Yadegarfar G, Cumming A, Whalley L, St Clair D, MacLeod MJ. The effect of ABCA1 gene polymorphisms on ischaemic stroke risk and relationship with lipid profile. BMC MEDICAL GENETICS 2007; 8:30. [PMID: 17553166 PMCID: PMC1894956 DOI: 10.1186/1471-2350-8-30] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Accepted: 06/06/2007] [Indexed: 11/13/2022]
Abstract
Background Ischaemic stroke is a common disorder with genetic and environmental components contributing to overall risk. Atherothromboembolic abnormalities, which play a crucial role in the pathogenesis of ischaemic stroke, are often the end result of dysregulation of lipid metabolism. The ATP Binding Cassette Transporter (ABCA1) is a key gene involved in lipid metabolism. It encodes the cholesterol regulatory efflux protein which mediates the transfer of cellular phospholipids and cholesterol to acceptor apolipoproteins such as apolipoprotein A-I (ApoA-I). Common polymorphisms in this gene affect High Density Lipoprotein Cholesterol (HDL-C) and Apolipoprotein A-I levels and so influence the risk of atherosclerosis. This study has assessed the distribution of ABCA1 polymorphisms and haplotype arrangements in patients with ischaemic stroke and compared them to an appropriate control group. It also examined the relationship of these polymorphisms with serum lipid profiles in cases and controls. Methods We studied four common polymorphisms in ABCA1 gene: G/A-L158L, G/A-R219K, G/A-G316G and G/A-R1587K in 400 Caucasian ischaemic stroke patients and 487 controls. Dynamic Allele Specific Hybridisation (DASH) was used as the genotyping assay. Results Genotype and allele frequencies of all polymorphisms were similar in cases and controls, except for a modest difference in the ABCA1 R219K allele frequency (P-value = 0.05). Using the PHASE2 program, haplotype frequencies for the four loci (158, 219, 316, and 1587) were estimated in cases and controls. There was no significant difference in overall haplotypes arrangement in patients group compared to controls (p = 0.27). 2211 and 1211 haplotypes (1 = common allele, 2 = rare allele) were more frequent in cases (p = 0.05). Adjusted ORs indicated 40% and 46% excess risk of stroke for these haplotypes respectively. However, none of the adjusted ORs were statistically significant. Individuals who had R219K "22" genotype had a higher LDL level (p = 0.001). Conclusion Our study does not support a major role for the ABCA1 gene as a risk factor for ischaemic stroke. Some haplotypes may confer a minor amount of increased risk or protection. Polymorphisms in this gene may influence serum lipid profile.
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Affiliation(s)
| | - Ghasem Yadegarfar
- Public Health Sciences & Medical Statistics Group, University of Southhampton, UK
| | - Alastair Cumming
- Department of Molecular and Cell Biology, University of Aberdeen, UK
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Abstract
Background and Purpose—
The relationship between elevated lipoprotein (a) levels[Lp(a)] and stroke is controversial. We systematically reviewed the literature to determine whether Lp(a) is a risk factor for stroke.
Methods—
We searched MEDLINE (1966 to 2006), EMBASE (1974 to 2006), and Google scholar for articles on Lp(a) and cerebrovascular disease. From potentially relevant references retrieved, we excluded uncontrolled studies, studies of children with stroke, studies investigating carotid atherosclerosis, and studies lacking adequate data.
Results—
Thirty-one studies comprising 56 010 subjects with >4609 stroke events met all inclusion criteria and were included in the meta-analysis. In case-control studies (n=23 with 2600 strokes) unadjusted mean Lp(a) was higher in stroke patients (standardized mean difference, 0.39; 95% CI, 0.23 to 0.54) and was more frequently abnormally elevated (OR, 2.39; 95% CI, 1.57 to 3.63). Sensitivity analysis and meta-regression did not find any influence of study design, measurement period of Lp(a) in relationship to stroke episode, subtype, age, and sex to explain the substantial heterogeneity between studies (I
2
=83.7%;
P
<0.001). There was no evidence of publication bias. In nested case-control studies (n=3 with 364 strokes) Lp(a) was not a risk factor for incident stroke (OR, 1.04; 95% CI, 0.6 to 1.8). In prospective cohort studies (n=5 with >1645 strokes), incident stroke was more frequent in patients in the highest tertile of Lp(a) distribution compared with the lowest tertile of Lp(a) (RR, 1.22; 95% CI, 1.04 to 1.43). There was no publication bias or heterogeneity in the prospective studies (I
2
=0.00%;
P
=0.67).
Conclusion—
This meta-analysis suggests that elevated Lp(a) is a risk factor for incident stroke.
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Affiliation(s)
- Barbara Smolders
- Department of Clinical and Experimental Neurology, University Hospitals Leuven, Leuven, Belgium
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Abstract
Background and Purpose—
This review characterizes the current state of knowledge of high-density lipoprotein (HDL) in relation to stroke.
Summary of Review—
HDL has anti-atherosclerotic and anti-inflammatory properties and is an important component in atherosclerosis. Serum HDL-cholesterol levels are inversely related to heart disease and stroke risk. There are various established and experimental treatments which can raise serum HDL cholesterol and improve its function.
Conclusion—
HDL is an emerging target for atherosclerotic stroke treatment with the potential to dramatically impact the care of stroke patients.
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Affiliation(s)
- Nerses Sanossian
- Department of Neurology, University of Southern California, Los Angeles, CA 90033, USA.
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Pasdar A, Ross-Adams H, Cumming A, Cheung J, Whalley L, St Clair D, MacLeod MJ. Paraoxonase gene polymorphisms and haplotype analysis in a stroke population. BMC MEDICAL GENETICS 2006; 7:28. [PMID: 16551349 PMCID: PMC1435875 DOI: 10.1186/1471-2350-7-28] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Accepted: 03/21/2006] [Indexed: 11/10/2022]
Abstract
BACKGROUND Paraoxonase (PON) has anti-atherogenic activity due to its protective function against low density lipoprotein (LDL) oxidation. Alteration of enzyme activity due to polymorphisms in the PON genes may influence the development of atheroma and thus affect stroke risk. Three PON genes (PON1, PON2 and PON3) have been identifiedand mapped to chromosome 7. METHODS We looked at the distribution of paraoxonase polymorphisms and haplotype arrangement in 397 Caucasian ischaemic stroke patients and 405 controls. We investigated 6 different common single nucleotide polymorphisms (SNP) in PON genes; two substitutions in PON1 ["A/G": Gln (Q)/Arg (R)] at codon 192 and ["T/A": Leu (L)/Met (M)] at codon 55, two in PON2 at codon 311 ["G/A": Cys (C)/Ser (S)] and codon 148 ["C/G": Ala (A)/Gly (G)] and two SNPs, both "A" to "G" substitutions, in PON3--intronic rs2074353, which we designated PON3-1 and [Ala (A)/Ala (A)] at codon 99, designated as PON3-3. Dynamic Allele Specific Hybridisation (DASH) was used as the genotyping assay. Haplotype analysis was performed using both PHASE and EHPLUS programs. RESULTS Genotype and allele frequencies were similar in cases and controls. Lipid profiles were not influenced by PON genotype. Haplotype frequencies for the six loci (PON2-148, PON2-311, PON3-3, PON3-1, PON1-55 and PON1-192) were estimated. Comparison of the two programs showed a significant difference in haplotype arrangements with EHPLUS (p-value = 0.005) but not with PHASE Ver.2 (p-value = 0.12). The 112211 (1 = frequent allele, 2 = rare allele) haplotype arrangement was commoner in cases than controls (p = 0.015), and the 111121 haplotype was commoner in controls (p = 0.006). CONCLUSION Our study did not identify a role for individual paraoxonase gene polymorphisms in the pathogenesis of ischaemic stroke. Findings of haplotype differences should be confirmed in large scale studies. The importance of using a well-validated haplotype analysis program is also underlined.
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Affiliation(s)
| | | | - Alastair Cumming
- Department of Molecular and Cell Biology, University of Aberdeen, UK
| | - John Cheung
- Department of Mental Health, University of Aberdeen, UK
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32
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Affiliation(s)
- Madeline C Fields
- Department of Neurology, Stroke Center, The Mount Sinai School of Medicine, New York 10029-6574, USA
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Deschamps R, Olindo S, Cabre P, Elysée S, Fournerie P, Smadja D. Accident vasculaire cérébral chez le jeune Afro-Caribéen en Martinique : étude prospective épidémiologique et étiologique. Rev Neurol (Paris) 2004; 160:313-9. [PMID: 15037844 DOI: 10.1016/s0035-3787(04)70906-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Few data are available regarding stroke among young black patients. We have conducted, in Martinique, a prospective study among young Afro-Caribbeans aged 15 to 45 Years, from June 1994 through May 1999. We identified 60 cerebral infarcts (CI) and 20 cases of intracerebral hemorrhage (ICH). Annual incidence and case fatality rate at 30 days were 7.6/100000/Year (95p.cent confidence interval, 3.13 to 11.35) and 8.3p.cent respectively for CI, and 2.42/100000/Year (95p.cent confidence interval, 0.06 to 4.7) and 25p.cent for ICH. Hypertension was the most prevalent stroke risk factor: 35p.cent in CI and 68p.cent in ICH. According to the TOAST criteria, a probable cause of ischemic stroke was identified in 61.3p.cent. Atherosclerosis, lacunar infarcts and cardioembolism were the main causes of CI (13.3p.cent for each etiology). Spontaneous cervical arterial dissection was found in only 6.7p.cent. Hypertensive ICH (60p.cent) was the most common subtype of ICH. In Martinique, high frequencies of ICH and lacunar infarcts are characteristic of stroke in young Afro-Carribeans. These suggest the role of the high prevalence of hypertension in the black population. We confirm the heterogeneity of stroke etiologies and the low prevalence of cervical arterial dissection in black people.
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Affiliation(s)
- R Deschamps
- Service de Neurologie, CHU Fort de France, Martinique
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Slowik A, Iskra T, Turaj W, Hartwich J, Dembinska-Kiec A, Szczudlik A. LDL phenotype B and other lipid abnormalities in patients with large vessel disease and small vessel disease. J Neurol Sci 2003; 214:11-6. [PMID: 12972382 DOI: 10.1016/s0022-510x(03)00166-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Controversies concerning the significance of lipid abnormalities in stroke come mostly from the researches that studied lipid profile without considering stroke aetiologies. We investigated the prevalence of LDL phenotype B and other lipid abnormalities in stroke survivors with large vessel disease (LVD) or small vessel disease (SVD) (TOAST criteria) and in control subjects (CS). METHODS We studied 30 patients with LVD and 41 patients with SVD screened out of 585 stroke patients and 30 CS who fulfilled the following exclusion criteria: cardiac disorders, renal or hepatic failure, diabetes mellitus, or treatment with lipid-lowering agents. At least 3 months after stroke, the concentrations of total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), triglycerides (TGs), apolipoprotein E (apoE), and lipoprotein (a) [lp(a)] were measured and LDL phenotypes and apoE isoforms were identified. RESULTS Patients with LVD had significantly higher concentrations of LDL-C than CS (p<0.05). They had higher concentrations of TGs and lower concentrations of HDL-C than patients with SVD and CS (p<0.05). LDL phenotype B was more frequent in patients with LVD (63.3%) than in patients with SVD (39.0%) or in CS (16.7%) (p<0.05). The concentration of apoE was higher in patients with LVD than in patients with SVD or in CS (p<0.05). The percentage of patients with increased level of lp(a) (i.e., >30 mg/ml) was greater in patients with LVD (36.7%) than in CS (10%) (p<0.05). CONCLUSIONS Patients with stroke due to LVD, but not SVD, have high prevalence of atherogenic lipid abnormalities, including increased frequency of LDL phenotype B and higher percentage of increased lp(a) level, like patients with other atherogenic diseases.
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Affiliation(s)
- Agnieszka Slowik
- Department of Neurology, Jagiellonian University College of Medicine, Ul. Botaniczna 3, Cracow 31-503, Poland.
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Karttunen V, Alfthan G, Hiltunen L, Rasi V, Kervinen K, Kesäniemi YA, Hillbom M. Risk factors for cryptogenic ischaemic stroke. Eur J Neurol 2002; 9:625-32. [PMID: 12453078 DOI: 10.1046/j.1468-1331.2002.00464.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This case-control study was designed to identify risk factors for cryptogenic brain infarction. We assessed the frequency of prothrombotic states, homocysteine, lipoprotein (a) [Lp(a)] and other lipids and the apolipoprotein E phenotype together with conventional risk factors in 46 patients (19 women and 27 men) with cryptogenic brain infarction aged from 15 to 60 years and in 104 community-based controls. Multivariate odds ratios (ORs) for risk factors and 95% CIs were calculated by logistic regression. Hypertension (OR 4.5; 95% CI, 1.5-13.2; P = 0.006), current smoking (OR 2.9; 95% CI, 1.2-6.8; P = 0.012), low HDL cholesterol (HDL-C) (OR 5.4; 95% CI, 1.1-25.5; P = 0.035) and high clotting factor VIII activity (OR 3.6; 95% CI, 1.1-12.2; P = 0.041) were variables associated with cryptogenic brain infarction. These risk factors were not equally frequent in women and men. Low HDL-C and high factor VIII activity in the women, and hypertension, current smoking and a low level of plasma folate in the men were risk factors for cryptogenic stroke. Several of the observed risk factors for cryptogenic brain infarction were lifestyle-associated, which emphasizes the role of health education in addition to pharmacological treatment in the prevention of stroke.
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Affiliation(s)
- V Karttunen
- Department of Neurology, Oulu University Central Hospital, Helsinki, Finland.
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Misirli H, Somay G, Ozbal N, Yaşar Erenoğlu N. Relation of lipid and lipoprotein(a) to ischaemic stroke. J Clin Neurosci 2002; 9:127-32. [PMID: 11922698 DOI: 10.1054/jocn.2001.1030] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The relationship of lipids and Lp(a) to ischemic stroke hasn't been established yet. Our aim was to determine lipid profile and vascular risk factors in stroke patients and compare them with control subjects. Seventy-nine consecutive patients with ischemic stroke were analyzed by total cholesterol, HDL-C, LDL-C, triglyceride, Lp(a) and doppler ultrasonography and vascular risk factors were recorded. Thirty control subjects of same ages were compared with the patient group. Lp(a) and lipids were correlated with stroke subtype and carotid atherosclerosis. There was no statistical significance between patients and control subjects related to total cholesterol, triglyceride, HDL-C, LDL-C and Lp(a) (P>0.05). Atherotrombotic and lacunar strokes didn't show any difference correlated with lipids and Lp(a). Hypertension and diabetes mellitus were important risk factors with (OR=4.50, 95% CI=1.25-16.22) and (OR=4.43, 95% CI=1.79-10.93) respectively. These results were statistically significant (P<0.05). Total cholesterol (308.67+/-85.82) and Lp(a) (32.10+/-17.30) values showed statistical significance (P<0.05) in patients with marked stenosis when compared with patients of normal doppler ultrasonography. Hypertension and diabetes mellitus were found as independent risk factors for ischemic stroke. Lipids and Lp(a) were not independent for atherotrombotic and lacunar stroke. Lp(a) concentration and carotid atherosclerosis in ultrasonography were associated significantly.
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Affiliation(s)
- Handan Misirli
- Haydarpaşa Numune Educational and Research Hospital, Department of Neurology, Istanbul, Turkey.
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