1
|
Kakaletsis N, Protogerou AD, Kotsis V, Vemmos K, Korompoki E, Kollias A, Milionis H, Ntaios G, Savopoulos C. Advanced vascular aging and outcomes after acute ischemic stroke: a systematic review and meta-analysis. J Hum Hypertens 2024:10.1038/s41371-024-00961-y. [PMID: 39317753 DOI: 10.1038/s41371-024-00961-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 09/26/2024]
Abstract
Pulse wave velocity (PWV) is as a reliable marker of arterial stiffness and vascular aging, surpassing traditional risk factors in predicting detrimental cardiovascular events. The present meta-analysis aims to investigate PWV thresholds and assess its prognostic value in outcomes of acute ischemic stroke (AIS). A search was conducted in PubMed, Cochrane, Web of Science, and Scopus for studies published up to January 2024, focusing on patients admitted with AIS, wherein arterial stiffness was assessed through PWV measurements during hospitalization. Identified studies reported PWV values in individuals with both favorable and unfavorable outcomes at the end of follow-up. Initially, 35 eligible studies provided data for weighted mean baPWV (11,953 AIS patients) and cfPWV (2,197 AIS patients) calculations. The average age was 67 years, with approximately 60% male, 67% hypertensive, 30% diabetic and 30% smoker participants. The weighted mean systolic blood pressure was approximately 150 mmHg. In AIS patients, the mean PWV was 10 m/s for standard cfPWV and 20 m/s for baPWV. Nine cohort studies (6,006 AIS patients) were included in the quantitative analysis of clinical outcomes. Higher PWV levels were associated with poorer functional outcomes (2.3 m/s higher, 95%CI:1.2-3.4, p < 0.001; I2 = 87.4%). AIS patients with arterial stiffness/vascular aging (higher PWV) had approximately 46.2% increased risk of poor functional outcome, 12.7% higher risk of mortality, 13.9% greater risk of major adverse cardiovascular events, and 13.9% greater risk of stroke recurrence over the long term compared to those without arterial stiffness. Advanced vascular aging, as indicated by PWV, significantly predicts adverse outcomes in AIS patients. Integrating the assessment of vascular aging into clinical practice can improve risk perception in these patients.
Collapse
Affiliation(s)
- Nikolaos Kakaletsis
- Second Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
| | - Athanase D Protogerou
- Cardiovascular Prevention & Research Unit, Clinic & Laboratory of Pathophysiology, Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Kotsis
- Third Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Konstantinos Vemmos
- Department of Clinical Therapeutics of Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics of Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Kollias
- Third Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Medical School, University of Ioannina, University Hospital of Ioannina, Ioannina, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| |
Collapse
|
2
|
Stillfried MRV, Sperber PS, Broersen LHA, Huo S, Piper SK, Heuschmann PU, Endres M, Siegerink B, Liman TG. Low ankle-brachial index and cognitive function after stroke—the PROSpective with Incident Stroke Berlin (PROSCIS-B). Front Neurol 2022; 13:963262. [PMID: 36247749 PMCID: PMC9554657 DOI: 10.3389/fneur.2022.963262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Low ankle-brachial index (ABI) ≤0. 9 is a marker for generalized atherosclerosis and a risk factor for cognitive decline in the general population. Objective To evaluate the impact of ABI ≤0.9 on cognitive function up to 3 years after first-ever ischemic stroke. Methods Data was used from the “PROspective Cohort with Incident Stroke-Berlin” (PROSCIS-B; NCT01363856). ABI was measured at baseline and categorized into normal (1.4–0.9) vs. low (≤0.9). Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA) and the Mini-Mental-State-Examination (MMSE) at baseline and with the Telephone Interview for Cognitive Status-modified (TICS-m) at 1–3 years of follow-up. We performed confounder adjusted generalized linear models (GLM) to calculate relative risks (RR) for cognitive impairment at baseline (MMSE≤26; MoCA≤25) and linear mixed models (LMM) to estimate the impact of low ABI on TICS-m over time. Results We included 325 patients [mean age: 66 (SD = 13); 38% female, median NIHSS = 2 (IQR = 1–4), ABI≤0.9: 59 (18%)]. Patients with low ABI were at increased risk of cognitive impairment at baseline (adjusted RR for MoCA≤25 = 1.98; 95%-CI:1.24 to 3.16). TICS-m scores were consistently lower over time in patients with low ABI (adjusted ß = −1.96; 95%-CI:−3.55 to −0.37). Independent of ABI, cognitive function did not decline over time (adjusted ß:0.29; 95%-CI:−0.06 to 0.64). Conclusion In patients with mild to moderate first-ever ischemic stroke, low ABI is associated with reduced cognitive function over a 3-year follow-up. Study Registration https://clinicaltrials.gov; Unique identifier: NCT01363856.
Collapse
Affiliation(s)
- Maria R. V. Stillfried
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Pia S. Sperber
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research DZHK, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Leonie H. A. Broersen
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Shufan Huo
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Sophie K. Piper
- German Center for Neurodegenerative Disease DZNE, Berlin Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter U. Heuschmann
- Institute of Biometry and Clinical Epidemiology, University of Würzburg, Würzburg, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research DZHK, Charité –Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité- Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Disease DZNE, partner site Berlin Charité-Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bob Siegerink
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Thomas G. Liman
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research DZHK, Charité –Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Disease DZNE, partner site Berlin Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
- *Correspondence: Thomas G. Liman
| |
Collapse
|
3
|
Yan X, Ren Z, Wen Q, Jin X, Wang Y, Zhang W. Uric Acid and Cognitive Impairment in Patients with Acute Ischemic Stroke: A Meta-Analysis. Horm Metab Res 2022; 54:316-324. [PMID: 35533675 DOI: 10.1055/a-1798-0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Serum uric acid (UA) has been suggested to be correlated with outcomes after stroke. We performed a meta-analysis to evaluate the association between serum UA and post-stroke cognitive impairment (PSCI) in patients with acute ischemic stroke (AIS). Relevant observational studies were identified by search of electronic databases including PubMed, Embase, and Web of Science. A randomized-effect model incorporating the possible between-study heterogeneity was used to pool the results. Overall, eleven studies with 4246 patients of AIS were included, 2073 (48.8%) of them had PSCI. Pooled results showed that patients with PSCI had significantly higher level of serum UA as compared to those without PSCI (mean difference: 35.70 μmol/l, 95% confidence interval (CI): 8.36 to 63.01, p=0.01; I2=95%). Subgroup analysis showed significant higher level of serum UA in patients with PSCI evaluated during follow-up of 3 months to 3 years, but not for those evaluated during hospitalization (p for subgroup difference=0.01). In addition, results of meta-analysis also showed that compared to patients with lower serum UA, AIS patients with higher serum UA had increased risk of PSCI (odds ratio: 1.33, 95% CI: 1.02 to 1.73, p=0.04; I2=72%). Higher level of serum UA after disease onset may be a marker of increased risk of PSCI in patients with AIS. Although these findings need to be validated in large-scale prospective studies, the possible mechanisms underlying the association between UA and PSCI should be also investigated.
Collapse
Affiliation(s)
- Xue Yan
- Center of Cerebral Diseases, the Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Zhong Ren
- Center of Cerebral Diseases, the Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Quan Wen
- Center of Cerebral Diseases, the Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Xi Jin
- Center of Cerebral Diseases, the Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Ying Wang
- Center of Cerebral Diseases, the Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Weimin Zhang
- Center of Cerebral Diseases, the Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| |
Collapse
|