Cardiovascular risk factors and quality of life among stroke survivors in Korea from 2013 to 2018: a cross-sectional cohort study

Background

Although the cardiovascular health and quality of life (QoL) of stroke survivors have been previously studied, no study has investigated the correlation between cardiovascular health and QoL. This study aimed to investigate whether there would be a difference in the quality of life (QoL) in this population depending on the degree of cardiovascular health.

Methods

Overall, 577 people aged > 40 years who participated in the Korea National Health and Nutrition Examination Survey from 2013 to 2018 were included and were divided into three groups according to the survey period (2013–2014, n = 145; 2015–2016, n = 198; and 2017–2018, n = 234). Participants were further divided into the following groups based on their cardiovascular health score, as defined by the American Heart Association: poor, intermediate, and ideal groups. We examined how the health-related QoL score was expressed through the five-dimensional European Quality of Life Questionnaire (EQ-5D-3L).

Results

The ideal (cardiovascular health scores 11–14) and intermediate (cardiovascular health scores 8–10) groups had the lowest (7.72–8.14%) and highest (46.39–57.70%) number of participants, respectively. The total EQ-5D index score was highest in the ideal group, followed by the intermediate and poor groups across all three periods (2013–2014, p = 0.0015; 2015–2016, p = 0.0040; 2017–2018, p < 0.0001). The dimension-specific analysis revealed that, Findings showed that stroke survivors' mobility significantly varied by cardiovascular health scores (p = 0.0371 in 2015–2016, p =0.0486 in 2017–2018), whereas usual activities (p = 0.0322) and pain/discomfort (p = 0.0420) were significantly different among the three groups in 2015–2016.

Conclusion

QoL in post-stroke survivors, when related to cardiovascular health degree, could be correlated with stroke sequelae.

Fasting and Non-Fasting Triglycerides in Patients With Acute Ischemic Stroke

BACKGROUND

Clinical implications of elevated fasting triglycerides (FTGs) and non-fasting triglycerides (NFTGs) in acute ischemic stroke (AIS) remain unknown. We aimed to elucidate the correlation and clinical significance of FTG and NFTG levels in AIS patients.

METHODS

Using a multicenter prospective stroke registry, we identified AIS patients hospitalized within 24 hours of onset with available NFTG results. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all-cause mortality up to one year.

RESULTS

This study analyzed 2,176 patients. The prevalence of fasting and non-fasting hypertriglyceridemia was 11.5% and 24.6%, respectively. Multivariate analysis revealed that younger age, diabetes, higher body mass index and initial systolic blood pressure were independently associated with both fasting and non-fasting hypertriglyceridemia (all P < 0.05). Patients with higher quartiles of NFTG were more likely to be male, younger, ever-smokers, diabetic, and have family histories of premature coronary heart disease and stroke (all P < 0.05). Similar tendencies were observed for FTG. The composite outcome was not associated with FTG or NFTG quartiles.

CONCLUSION

The fasting and non-fasting hypertriglyceridemia were prevalent in AIS patients and showed similar clinical characteristics and outcomes. High FTG and NFTG levels were not associated with occurrence of subsequent clinical events up to one year.

Local and systemic metabolic alterations in brain, plasma, and liver of rats in response to aging and ischemic stroke, as detected by nuclear magnetic resonance (NMR) spectroscopy

Metabolic dysfunction impacts stroke incidence and outcome. However, the intricate association between altered metabolic program due to aging, and focal ischemia in brain, circulation, and peripheral organs is not completely elucidated. Here we identified locally and systemically altered metabolites in brain, liver, and plasma as a result of normal aging, ischemic-stroke, and extended time of reperfusion injury. Comprehensive quantitative metabolic profiling was carried out using nuclear magnetic resonance spectroscopy. Aging, but healthy rats showed significant metabolic alterations in the brain, but only a few metabolic changes in the liver and plasma as compared to younger rats. But, ischemic stroke altered metabolites significantly in liver and plasma of older rats during early acute phase. Major metabolic changes were also seen in the brains of younger rats following ischemic stroke during early acute phase of injury. We further report that metabolic changes occur sequentially in a tissue specific manner during extended reperfusion time of late repair phase. First metabolic alterations occurred in brain due to local injury. Next, changes in circulating metabolites in plasma occurred during acute-repair phase transition time. Lastly, the delayed systemic effect was seen in the peripheral organ, liver that exhibited significant and persistent changes in selected metabolites during later reperfusion time. The metabolic pathways involved in energy/glucose, and amino acid metabolism, inflammation, and oxidative stress were mainly altered as a result of aging and ischemia/reperfusion. Biomarker analysis revealed citrate, lysine, and tyrosine as potential age-independent blood metabolic biomarkers of ischemia/reperfusion. Overall, our study elucidates the complex network of metabolic events as a function of normal aging and acute stroke. We further provide evidence for a clear transition from local to systemic metabolic dysfunction due to ischemic injury in a time dependent manner, which may altogether greatly impact the post-stroke outcome.

Effect of Statins on Survival Following Stroke in Patients With Cancer

The objective of this study was to investigate the potential benefits of statin therapy initiation in acute stroke in patients with active cancer. This study was conducted in two parts. First, data from patients who are presented with stroke and active cancer were obtained from prospectively collected multicenter hospital-based stroke registries. Patients were classified into statin user and non-user groups; the statin group was further divided into low-potency and high-potency statin subgroups. The primary outcome was time to mortality. Second, we obtained data from the Korean National Health Information Service-National Sample Cohort (NHIS-NSC) database for external validation and analyzed the effect of statins on mortality, taking compliance into consideration. For the stroke registry cohort, statin use was independently associated with reduced mortality in a multivariable model [hazard ratio (HR) = 0.675, 95% confidence interval (CI) = 0.457–0.996]. There was no interaction between statin use and cancer characteristics, vascular risk factors, or laboratory findings. A dose-dependent relationship between statin use and survival was also demonstrated. Analysis of the NHIS-NSC database found a similar association between statin therapy and reduced mortality (adjusted HR = 0.64, 95% CI = 0.45–0.90) and this effect persisted even after controlling for the adherence of statin use (HR = 0.60, 95% CI = 0.41–0.89). Statin therapy could be associated with reduced mortality in patients with acute stroke and active cancer.