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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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Shiotsuki H, Saijo Y, Ogushi Y, Kobayashi S. Relationship between Alcohol Intake and Stroke Severity in Japanese Patients: a Sex- and Subtype-Stratified Analysis. J Stroke Cerebrovasc Dis 2022; 31:106513. [PMID: 35487010 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106513] [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: 01/23/2022] [Revised: 03/27/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES This study aims to clarify the association between alcohol intake and stroke severity at admission and discharge according to sex and stroke subtype in Japanese patients with acute stroke. MATERIALS AND METHODS We analyzed the data of 199,599 patients registered in the Japan Stroke Data Bank from 1999 to 2018, including sex, age, stroke subtypes (cardioembolic ischemic, noncardioembolic ischemic, hypertensive hemorrhagic, nonhypertensive hemorrhagic, and subarachnoid hemorrhagic), dates of onset and admission, National Institutes of Health Stroke Scale score at admission, modified Rankin Scale score at discharge, and alcohol intake. Multivariable logistic regression analysis adjusted for stroke-related factors was performed to estimate the odds ratios of alcohol intake for stroke severity. RESULTS In cardioembolic ischemic stroke, a significant protective effect of moderate intake on severity at admission was observed in both sexes. In noncardioembolic ischemic stroke, a significant protective effect on stroke severity at admission was found for each sex. At discharge, the results also showed a significant protective effect for each sex with moderate intake. For both subtypes of ischemic stroke, a J-shaped relationship between alcohol intake and stroke severity at admission and discharge was observed in women and men. In hypertensive hemorrhagic stroke, a significant protective effect was found in men at both admission and discharge. In women, heavy drinking had a significant harmful effect on stroke severity at admission. CONCLUSIONS Habitual alcohol intake is associated with stroke severity at admission and discharge regardless of sex.
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Affiliation(s)
- Hiroyuki Shiotsuki
- Department of Social Medicine, Asahikawa Medical University, Hokkaido, Japan.
| | - Yasuaki Saijo
- Department of Social Medicine, Asahikawa Medical University, Hokkaido, Japan
| | - Yoichi Ogushi
- Ogushi Institute of Medical Informatics, Kanagawa, Japan
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Goldstein LB, Seshadri S, Sacco RL. Risk Factors and Prevention. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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4
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Brust JC. Stroke and Substance Abuse. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Uchiyama S, Hoshino T, Sissani L, Linsay MT, Kamiyama K, Nakase T, Kitagawa K, Minematsu K, Todo K, Okada Y, Nakagawara J, Nagata K, Yamagami H, Yamaguchi T, Amarenco P. Japanese Versus Non-Japanese Patients with Transient Ischemic Attack or Minor Stroke: Subanalysis of TIA registry.org. J Stroke Cerebrovasc Dis 2019; 28:2232-2241. [PMID: 31178360 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/05/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND TIAregistry.org is an international cohort of patients with transient ischemic attack (TIA) or minor stroke within 7 days before enrollment in the registry. Main analyses of 1-year follow-up data have been reported.5 We conducted subanalysis on the baseline and 1-year follow-up data of Japanese patients. METHODS The patients were classified into 2 groups based on Japanese ethnicity, Japanese (345) and non-Japanese (3238), and their baseline data and 1-year event rates were compared. We also determined risk factors and predictors of 1-year stroke. RESULTS Current smoking, regular alcohol drinking, intracranial arterial stenosis, and small vessel occlusion; and hypertension, dyslipidemia, coronary artery disease, and extracranial arterial stenosis were more and less common among Japanese patients, respectively. Stroke risk was higher and TIA risk was lower at 1-year follow-up among Japanese patients. The baseline risk factors for recurrent stroke were diabetes, alcohol drinking, and large artery atherosclerosis. Independent predictors of 1-year stroke risk were prior congestive heart failure and alcohol consumption. CONCLUSIONS The two populations of patients featured differences in risk factors, stroke subtypes, and outcome events. Predictors of recurrent stroke among Japanese patients included congestive heart failure and regular alcohol drinking. Strategies to attenuate residual risk of stroke aside from adherence to current guidelines should take our Japanese-patient specific findings into account.
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Affiliation(s)
- Shinichiro Uchiyama
- Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo, Japan.
| | - Takao Hoshino
- Department of Neurology and Stroke Center, Bichat Hospital, Paris, France
| | - Leila Sissani
- Department of Neurology and Stroke Center, Bichat Hospital, Paris, France
| | | | - Kenji Kamiyama
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Taizen Nakase
- Department of Neurology and Stroke Science, Research Institute of Brain and Blood Vessels Akita, Akita, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Kenichi Todo
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | | | - Ken Nagata
- Yokohama General Hospital, Yokohama, Japan
| | | | | | - Pierre Amarenco
- Department of Neurology and Stroke Center, Bichat Hospital, Paris, France
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Shiotsuki H, Saijo Y, Ogushi Y, Kobayashi S. Relationships between Alcohol Intake and Ischemic Stroke Severity in Sex Stratified Analysis for Japanese Acute Stroke Patients. J Stroke Cerebrovasc Dis 2019; 28:1604-1617. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.02.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/04/2019] [Accepted: 02/23/2019] [Indexed: 11/15/2022] Open
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Teh WL, Abdin E, Vaingankar JA, Seow E, Sagayadevan V, Shafie S, Shahwan S, Zhang Y, Chong SA, Ng LL, Subramaniam M. Prevalence of stroke, risk factors, disability and care needs in older adults in Singapore: results from the WiSE study. BMJ Open 2018; 8:e020285. [PMID: 29599393 PMCID: PMC5875611 DOI: 10.1136/bmjopen-2017-020285] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The aims of the present study were to establish the prevalence of stroke, and to explore the association between stroke prevalence and sociodemographic and health factors, disability, cognitive functioning and care needs among older adult residents in Singapore. SETTING Data were drawn from the Well-being of the Singapore Elderly study-a cross-sectional epidemiological survey conducted from 2012 to 2013 on older adults living in Singapore. PARTICIPANTS Participants were Singapore residents (citizens and permanent residents) 60 years and above who were living in Singapore during the survey period . Older adult residents who were institutionalised were also included in this study. Those who were not living in Singapore or who were not contactable were excluded from the study. The response rate was 65.6 % (2565/3913). A total population sample of 2562 participants completed the survey. Participants comprised 43.6% males and 56.4% females. The sample comprised 39.4% Chinese, 29.1% Malay, 30.1% Indian and 1.4% other ethnicities . PRIMARY AND SECONDARY OUTCOME MEASURES History of stroke, along with other health and mental health conditions, disability and cognitive functioning, were determined by self-report. RESULTS Weighted stroke prevalence was 7.6% among older adults aged 60 and above. At a multivariate level, Malay ethnicity (OR 0.41, p=0.012, 95% CI 0.20 to 0.82), hypertension (OR 4.58, p=0.001, 95% CI 1.84 to 11.40), heart trouble (OR 2.45, p=0.006, 95% CI 1.30 to 4.63), diabetes (OR 2.60, p=0.001, 95% CI 1.49 to 4.53) and dementia (OR 3.57, p=0.002, 95% CI 1.57 to 8.12) were associated with stroke prevalence. CONCLUSIONS Several findings of this study were consistent with previous reports. Given that Singapore's population is ageing rapidly, our findings may indicate the need to review existing support services for stroke survivors and their caregivers. Future research could investigate the association between various sociodemographic and health conditions and stroke prevalence to confirm some of the findings of this study.
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Affiliation(s)
- Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Esmond Seow
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Li Ling Ng
- Psychogeriatrics, Changi General Hospital, Singapore, Singapore
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Seki S, Oki Y, Tsunoda S, Takemoto T, Koyama T, Yoshimura M. Impact of alcohol intake on the relationships of uric acid with blood pressure and cardiac hypertrophy in essential hypertension. J Cardiol 2016; 68:447-454. [DOI: 10.1016/j.jjcc.2015.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/29/2015] [Accepted: 11/05/2015] [Indexed: 12/26/2022]
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Fazio M, Bardelli M, Fabris B, Macaluso L, Fiammengo F, Vran F, Bossi M, Candido R, Gerloni R, Carretta R. Large-Artery Hemodynamics After Acute Alcohol Administration in Young, Healthy Volunteers. Angiology 2016; 55:139-45. [PMID: 15026868 DOI: 10.1177/000331970405500205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of the present study was to investigate the acute effects of alcohol on blood flow volume and velocity, on wall motion of superficial large arteries, and on systemic hemodynamics in humans. In 10 healthy volunteers small doses of alcohol were administered either orally (0.3 g/kg in 250 mL water) or intravenously (7.5 mg/kg/minute in 250 mL saline in 40 minutes). The effects of alcohol were compared with those of saline 250 mL infused for 40 minutes (6.25 mL/min). Blood velocity and systodiastolic changes of wall diameter were measured in the common carotid, femoral, and brachial arteries simultaneously with cardiac output and finger blood pressure. Skin temperature was measured at the cheek, hand, and toe. Ethanol administration caused a transitory blood pressure increase accompanied by a rise in peripheral resistances at 20 minutes. Arterial blood flow was not changed by either mode of alcohol administration at any of the measurement sites. However, this result was achieved through different compensatory mechanisms in each artery. In fact, mean carotid diameter increased after both oral and intravenous ethanol administration but remained unchanged at the brachial and femoral level. Mean blood velocity was reduced after alcohol administration at the carotid but was unchanged at the brachial and femoral level after oral or intravenous alcohol administration. Skin temperature increased 20 minutes after alcohol administration at all sites. This study shows that although acute alcohol administration does not change blood flow in superficial large arteries, it causes different autoregulatory local responses of vessel walls.
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Affiliation(s)
- Massimiliano Fazio
- Department of Clinical Medicine and Neurology, University of Trieste, Italy
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Paraskevas KI, Daskalopoulou SS, Daskalopoulos ME, Liapis CD. Secondary Prevention of Ischemic Cerebrovascular Disease. What Is the Evidence? Angiology 2016; 56:539-52. [PMID: 16193192 DOI: 10.1177/000331970505600504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients who had a transient ischemic attack or stroke are at increased risk of experiencing recurrent cerebrovascular events. For this reason, secondary prevention of ischemic cerebrovascular disease is essential. Several modifiable, lifestyle-associated risk factors have been implicated, such as physical activity, smoking, and alcohol consumption. Established and emerging vascular risk factors are associated with an increased risk of stroke. Pharmacologic treatment, including the use of antiplatelet, antihypertensive, and lipid-lowering agents, has also been shown to reduce the risk of secondary cerebrovascular events. Surgical intervention, either open or endovascular, may be the preferred therapeutic option in well-defined subsets of patients. It is important to establish specific measures for the early detection and prevention of recurrent cerebrovascular disease. Therefore, further research and greater awareness in this field are needed.
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Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular Surgery, Athens University Medical School, Athens, Greece.
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Dufour MC. Are there net health benefits from moderate alcohol consumption? morbidity and other parameters of health. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009145099402100115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mary C. Dufour
- (National Institute on Alcohol Abuse and Alcoholism, 6000 Executive Blvd., Rockville, MD 20892–7003), Division of Biometry and Epidemiology at the U.S. National Institute on Alcohol Abuse and Alcoholism
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Affiliation(s)
- Sam Zakhari
- Chief of the biomedical research branch at the National Institute on Alcohol Abuse and Alcoholism (National Institutes of Health, Willco Building, Suite 402, 6000 Executive Blvd., MSC 7003, Rockville, MD 20982–7003)
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Battaini F, Pascale A, Ancona DM, Cagiano R, Cuomo V, Govoni S. Moderate Alcohol Intake: Behavioral and Neurochemical Correlates in Rats. Nutr Neurosci 2016; 1:151-9. [DOI: 10.1080/1028415x.1998.11747224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Owolabi MO, Akpa OM, Agunloye AM. Carotid IMT is more associated with stroke than risk calculators. Acta Neurol Scand 2016; 133:442-50. [PMID: 27045896 PMCID: PMC4824548 DOI: 10.1111/ane.12482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND It is unclear whether a natural marker of atherosclerosis (carotid intima-media thickness: CIMT) or calculated risk score is more associated with stroke. We therefore comparatively examined the relationship between CIMT as well as two cardiovascular risk calculators (Omnibus Risk Score -ORS and Framingham Risk Score- FRS) and the occurrence of stroke among hypertensive African patients. METHODS CIMT was measured in 555 consecutive consenting hypertensive adults (377 stroke patients and 178 stroke-free subjects). The 10-year cardiovascular risk was calculated for each participant with the FRS and ORS. The strengths of association between FRS, ORS, CIMT, and stroke occurrence were examined using logistic regression. The discriminative capacity of FRS, ORS, and CIMT for stroke occurrence was assessed with c-statistics. RESULTS Higher average CIMT (OR 11.71; 95% CI 1.65-83.07; P = 0.01) was strongly associated with stroke after adjusting for age, sex, blood pressure, serum cholesterol, and blood sugar. Neither the FRS (OR: 1.03; CI: 0.89-1.19, P = 0.68) nor the ORS (OR: 1.08; CI: 0.90-1.30; P = 0.41) was significantly associated with stroke. CIMT had a higher c-statistic for differentiating stroke patients from hypertensive controls (right: c = 0.63, P < 0.001; left: c = 0.67, P < 0.001; average: c = 0.66, P < 0.001) than some conventional risk factors. Neither FRS (P = 0.39) nor ORS (P = 0.55) was able to independently differentiate between stroke and hypertensive patients. CONCLUSION CIMT, but neither FRS nor ORS, is independently associated with stroke among Nigerian African hypertensive patients. CIMT may be a better tool for estimating the overall risk of stroke than FRS or ORS in this population.
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Affiliation(s)
- M O Owolabi
- Department of Medicine, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - O M Akpa
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A M Agunloye
- Department of Radiology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
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Seshadri S, Wolf PA. Modifiable Risk Factors and Determinants of Stroke. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shravani K, Parmar MY, Macharla R, Mateti UV, Martha S. Risk factor assessment of stroke and its awareness among stroke survivors: A prospective study. Adv Biomed Res 2015; 4:187. [PMID: 26605226 PMCID: PMC4617151 DOI: 10.4103/2277-9175.164011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/05/2015] [Indexed: 11/07/2022] Open
Abstract
Background: Stroke is the second most common cause of death and major cause of disability worldwide. The objective of this study is to identify the major risk factors and assess the awareness among the stroke survivors. Materials and Methods: A prospective study was conducted at super specialty hospital, from December 2010 to July 2011. All the stroke patients of the age >25 years with either sex admitted in the hospital were included in the study. In order to assess the awareness among the stroke survivors, questionnaire established on the risk factors for stroke from the previously published studies. Results: A total of 100 patients with stroke or cerebrovascular accident were included in the study. Of 100 patients, 73% patients had ischemic stroke and 26% patients had hemorrhagic stroke. The mean age of the patients was 50 years and the incidence of stroke was predominant in males 73%, followed by females 27. It was observed that 70% of patients were hypertensives, 28% were diabetics, 27% were alcoholics, and 24% of patients had a habit of smoking, followed by others. The knowledge of the risk factors for stroke in stroke survivors was also very low, and the knowledge was varied among the subjects according to their level of educational status. Conclusion: This study reveals that hypertension is the most common risk factor for stroke followed by diabetes, smoking, and dyslipidemia. The awareness of risk factor among stroke survivors was poor.
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Affiliation(s)
- K Shravani
- Department of Pharmacy Practice, St. Peter's Institute of Pharmaceutical Sciences, Hanamkonda, India
| | - Mihir Y Parmar
- Department of Pharmacy Practice, St. Peter's Institute of Pharmaceutical Sciences, Hanamkonda, India
| | - Ramyasri Macharla
- Department of Pharmacy Practice, St. Peter's Institute of Pharmaceutical Sciences, Hanamkonda, India
| | - Uday Venkat Mateti
- Department of Pharmacy Practice, St. Peter's Institute of Pharmaceutical Sciences, Hanamkonda, India ; Department of Pharmacy Management, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India
| | - Srinivas Martha
- Department of Pharmacy Practice, St. Peter's Institute of Pharmaceutical Sciences, Hanamkonda, India ; Department of Pharmacology and Clinical Pharmacy, Balaji Institute of Pharmacy, Laknepally, Narsampet, Warangal, Telangana, India
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Idewaki Y, Iwase M, Fujii H, Ohkuma T, Ide H, Kaizu S, Jodai T, Kikuchi Y, Hirano A, Nakamura U, Kubo M, Kitazono T. Association of Genetically Determined Aldehyde Dehydrogenase 2 Activity with Diabetic Complications in Relation to Alcohol Consumption in Japanese Patients with Type 2 Diabetes Mellitus: The Fukuoka Diabetes Registry. PLoS One 2015; 10:e0143288. [PMID: 26599441 PMCID: PMC4658066 DOI: 10.1371/journal.pone.0143288] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 11/02/2015] [Indexed: 12/31/2022] Open
Abstract
Aldehyde dehydrogenase 2 (ALDH2) detoxifies aldehyde produced during ethanol metabolism and oxidative stress. A genetic defect in this enzyme is common in East Asians and determines alcohol consumption behaviors. We investigated the impact of genetically determined ALDH2 activity on diabetic microvascular and macrovascular complications in relation to drinking habits in Japanese patients with type 2 diabetes mellitus. An ALDH2 single-nucleotide polymorphism (rs671) was genotyped in 4,400 patients. Additionally, the relationship of clinical characteristics with ALDH2 activity (ALDH2 *1/*1 active enzyme activity vs. *1/*2 or *2/*2 inactive enzyme activity) and drinking habits (lifetime abstainers vs. former or current drinkers) was investigated cross-sectionally (n = 691 in *1/*1 abstainers, n = 1,315 in abstainers with *2, n = 1,711 in *1/*1 drinkers, n = 683 in drinkers with *2). The multiple logistic regression analysis for diabetic complications was adjusted for age, sex, current smoking habits, leisure-time physical activity, depressive symptoms, diabetes duration, body mass index, hemoglobin A1c, insulin use, high-density lipoprotein cholesterol, systolic blood pressure and renin-angiotensin system inhibitors use. Albuminuria prevalence was significantly lower in the drinkers with *2 than that of other groups (odds ratio [95% confidence interval (CI)]: *1/*1 abstainers as the referent, 0.94 [0.76-1.16] in abstainers with *2, 1.00 [0.80-1.26] in *1/*1 drinkers, 0.71 [0.54-0.93] in drinkers with *2). Retinal photocoagulation prevalence was also lower in drinkers with ALDH2 *2 than that of other groups. In contrast, myocardial infarction was significantly increased in ALDH2 *2 carriers compared with that in ALDH2 *1/*1 abstainers (odds ratio [95% CI]: *1/*1 abstainers as the referent, 2.63 [1.28-6.13] in abstainers with *2, 1.89 [0.89-4.51] in *1/*1 drinkers, 2.35 [1.06-5.79] in drinkers with *2). In summary, patients with type 2 diabetes and ALDH2 *2 displayed a lower microvascular complication prevalence associated with alcohol consumption but a higher macrovascular complication prevalence irrespective of alcohol consumption.
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Affiliation(s)
- Yasuhiro Idewaki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Diabetes Center, Hakujyuji Hospital, Fukuoka, Japan
| | - Masanori Iwase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Diabetes Center, Hakujyuji Hospital, Fukuoka, Japan
- * E-mail:
| | - Hiroki Fujii
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of General Internal Medicine, School of Oral Health Science, Kyushu Dental University, Kitakyushu, Japan
| | - Toshiaki Ohkuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Research Management, Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hitoshi Ide
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinako Kaizu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tamaki Jodai
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yohei Kikuchi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Hirano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - Udai Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michiaki Kubo
- Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Lee SJ, Cho YJ, Kim JG, Ko Y, Hong KS, Park JM, Kang K, Park TH, Park SS, Lee KB, Cha JK, Kim DH, Lee J, Kim JT, Lee J, Lee JS, Jang MS, Han MK, Gorelick PB, Bae HJ. Moderate alcohol intake reduces risk of ischemic stroke in Korea. Neurology 2015; 85:1950-6. [PMID: 26519539 DOI: 10.1212/wnl.0000000000002165] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/03/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We undertook a population-based, case-control study to examine a dose-response relationship between alcohol intake and risk of ischemic stroke in Koreans who had different alcoholic beverage type preferences than Western populations and to examine the effect modifications by sex and ischemic stroke subtypes. METHODS Cases (n = 1,848) were recruited from patients aged 20 years or older with first-ever ischemic stroke. Stroke-free controls (n = 3,589) were from the fourth and fifth Korean National Health and Nutrition Examination Survey and were matched to the cases by age (±3 years), sex, and education level. All participants completed an interview using a structured questionnaire about alcohol intake. RESULTS Light to moderate alcohol intake, 3 or 4 drinks (1 drink = 10 g ethanol) per day, was significantly associated with a lower odds of ischemic stroke after adjusting for potential confounders (no drinks: reference; <1 drink: odds ratio 0.38, 95% confidence interval 0.32-0.45; 1-2 drinks: 0.45, 0.36-0.57; and 3-4 drinks: 0.54, 0.39-0.74). The threshold of alcohol effect in women was slightly lower than that in men (up to 1-2 drinks in women vs up to 3-4 drinks in men), but this difference was not statistically significant. There was no statistical interaction between alcohol intake and the subtypes of ischemic stroke (p = 0.50). The most frequently used alcoholic beverage was one native to Korea, soju (78% of the cases), a distilled beverage with 20% ethanol by volume. CONCLUSIONS Our findings suggest that light to moderate distilled alcohol consumption may reduce the risk of ischemic stroke in Koreans.
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Affiliation(s)
- Soo Joo Lee
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Yong-Jin Cho
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Jae Guk Kim
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Youngchai Ko
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Keun-Sik Hong
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Jong-Moo Park
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Kyusik Kang
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Tai Hwan Park
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Sang-Soon Park
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Kyung Bok Lee
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Jae Kwan Cha
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Dae-Hyun Kim
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Jun Lee
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Joon-Tae Kim
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Juneyoung Lee
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Ji Sung Lee
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Myung Suk Jang
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Moon-Ku Han
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
| | - Philip B Gorelick
- From the Department of Neurology (S.J.L., J.G.K., Y.K.), Eulji University Hospital, Daejeon; Department of Neurology (Y.-J.C., K.-S.H.), Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital Seoul; Department of Neurology (J.K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (Jun Lee), Yeungnam University Medical Center, Daegu; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology and Cerebrovascular Center (M.S.J., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; and Department of Translational Science & Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine and Medical Director, Mercy Health Hauenstein Neurosciences, Grand Rapids, MI
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Arboix A, Alio J. Acute cardioembolic cerebral infarction: answers to clinical questions. Curr Cardiol Rev 2013; 8:54-67. [PMID: 22845816 PMCID: PMC3394108 DOI: 10.2174/157340312801215791] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 01/15/2023] Open
Abstract
Cardioembolic cerebral infarction (CI) is the most severe subtype of ischaemic stroke but some clinical aspects of this condition are still unclear. This article provides the reader with an overview and up-date of relevant aspects related to clinical features, specific cardiac disorders and prognosis of CI. CI accounts for 14-30% of ischemic strokes; patients with CI are prone to early and long-term stroke recurrence, although recurrences may be preventable by appropriate treatment during the acute phase and strict control at follow-up. Certain clinical features are suggestive of CI, including sudden onset to maximal deficit, decreased level of consciousness at onset, Wernicke's aphasia or global aphasia without hemiparesis, a Valsalva manoeuvre at the time of stroke onset, and co-occurrence of cerebral and systemic emboli. Lacunar clinical presentations, a lacunar infarct and especially multiple lacunar infarcts, make cardioembolic origin unlikely. The most common disorders associated with a high risk of cardioembolism include atrial fibrillation, recent myocardial infarction, mechanical prosthetic valve, dilated myocardiopathy and mitral rheumatic stenosis. Patent foramen ovale and complex atheromatosis of the aortic arch are potentially emerging sources of cardioembolic infarction. Mitral annular calcification can be a marker of complex aortic atheroma in stroke patients of unkown etiology. Transthoracic and transesophageal echocardiogram can disclose structural heart diseases. Paroxysmal atrial dysrhythmia can be detected by Holter monitoring. Magnetic resonance imaging, transcranial Doppler, and electrophysiological studies are useful to document the source of cardioembolism. In-hospital mortality in cardioembolic stroke (27.3%, in our series) is the highest as compared with other subtypes of cerebral infarction. Secondary prevention with anticoagulants should be started immediately if possible in patients at high risk for recurrent cardioembolic stroke in which contraindications, such as falls, poor compliance, uncontrolled epilepsy or gastrointestinal bleeding are absent. Dabigatran has been shown to be non-inferior to warfarin in the prevention of stroke or systemic embolism. All significant structural defects, such as atrial septal defects, vegetations on valve or severe aortic disease should be treated. Aspirin is recommended in stroke patients with a patent foramen ovale and indications of closure should be individualized. CI is an important topic in the frontier between cardiology and vascular neurology, occurs frequently in daily practice, has a high impact for patients, and health care systems and merits an update review of current clinical issues, advances and controversies.
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Affiliation(s)
- Adria Arboix
- Cerebrovascular Division, Department of Neurology, Capio-Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Spain.
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Lenchus JD. Recent advances in antithrombotic therapy for stroke prevention in patients with atrial fibrillation. Hosp Pract (1995) 2013; 41:49-60. [PMID: 23466967 DOI: 10.3810/hp.2013.02.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia and patients with AF have a higher risk for stroke than the general population. The prevalence of AF is increasing, which underscores the importance of understanding the therapeutic options available for stroke prevention in the primary care setting. This article examines evidence for the use of novel oral anticoagulant (OAC) therapy, including the direct thrombin inhibitor dabigatran and the activated factor X inhibitors rivaroxaban and apixaban for stroke prevention in patients with AF. Although warfarin therapy is the gold standard for prevention of stroke, its use is associated with significant challenges related to drug-drug and food-drug interactions. Warfarin use also requires frequent blood monitoring to maintain anticoagulation within a narrow therapeutic window. Overall, the novel OACs are as good as, or better than, warfarin therapy for stroke prevention in patients with AF, and they have a comparable or reduced risk of associated major bleeding. In addition, the novel OACs have fewer drug-drug and food-drug interactions and do not require continuous blood monitoring. Integration of the novel OACs into clinical practice offers patients with AF new treatment options, and as therapeutic use of the novel OACs increases, real-world experience will add to our understanding of the value of these agents.
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Affiliation(s)
- Joshua D Lenchus
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
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Massaro M, Scoditti E, Carluccio MA, De Caterina R. Alcohol and atherosclerosis: A double edged sword. Vascul Pharmacol 2012; 57:65-8. [DOI: 10.1016/j.vph.2012.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 05/26/2012] [Indexed: 10/28/2022]
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Suzuki K, Izumi M. Alcohol is a risk factor not for thalamic but for putaminal hemorrhage: the Akita Stroke Registry. J Stroke Cerebrovasc Dis 2012; 22:1064-9. [PMID: 22939201 DOI: 10.1016/j.jstrokecerebrovasdis.2012.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 07/08/2012] [Accepted: 07/09/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although the risk factors of cerebral hemorrhage were established long ago, there is little agreement as to the risk factors for the site of cerebral hemorrhage. METHODS We obtained mass health screening data collected between 1990 and 2000 regarding 151,796 subjects from the Akita Prefectural Federation of Agricultural Cooperative for Health and Welfare. A first-ever cerebral hemorrhage occurring <3 years after the screening examination was defined as an event. Stroke events were determined from the Akita stroke registry between 1990 and 2003. Clinical risk factors for stroke, such as age, blood pressure, severe obesity (body mass index >30 kg/m(2)), low serum total cholesterol, hepatic disorder, renal disorder, and drinking habits were then assessed. RESULTS Cerebral hemorrhage developed in 344 cases in the study population. The distribution of subtypes (putaminal hemorrhage [PH], thalamic hemorrhage [TH], and subcortical hemorrhage [SH]) were 122 cases (35.5%), 110 cases (32.0%), and 44 cases (12.8%), respectively. We evaluated the risk factors by multiple logistic regression analysis among these 3 groups. Age was a significant risk factor among these 3 groups, but blood pressure was not a risk factor in SH. Low serum cholesterol and drinking habits were significant risk factors only in PH. Hepatic disorder was a strong risk factor in PH and a weak risk factor in TH. Interestingly, a drinking habit was a significant risk factor only in PH. CONCLUSIONS Drinking habits had been a risk factor for cerebral hemorrhage, but it was a risk factor not for PH and not for TH or SH.
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Affiliation(s)
- Kazuo Suzuki
- Department of Epidemiology, Research Institute for Brain and Blood Vessels, Akita, Japan
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Arboix A, Alió J. Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis. Curr Cardiol Rev 2011; 6:150-61. [PMID: 21804774 PMCID: PMC2994107 DOI: 10.2174/157340310791658730] [Citation(s) in RCA: 254] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 04/10/2010] [Accepted: 05/25/2010] [Indexed: 12/13/2022] Open
Abstract
This article provides the reader with an overview and up-date of clinical features, specific cardiac disorders and prognosis of cardioembolic stroke. Cardioembolic stroke accounts for 14-30% of ischemic strokes and, in general, is a severe condition; patients with cardioembolic infarction are prone to early and long-term stroke recurrence, although recurrences may be preventable by appropriate treatment during the acute phase and strict control at follow-up. Certain clinical features are suggestive of cardioembolic infarction, including sudden onset to maximal deficit, decreased level of consciousness at onset, Wernicke’s aphasia or global aphasia without hemiparesis, a Valsalva manoeuvre at the time of stroke onset, and co-occurrence of cerebral and systemic emboli. Lacunar clinical presentations, a lacunar infarct and especially multiple lacunar infarcts, make cardioembolic origin unlikely. The more common high risk cardioembolic conditions are atrial fibrillation, recent myocardial infarction, mechanical prosthetic valve, dilated myocardiopathy, and mitral rheumatic stenosis. Transthoracic and transesophageal echocardiogram can disclose structural heart diseases. Paroxysmal atrial dysrhyhtmia can be detected by Holter monitoring. In-hospital mortality in cardioembolic stroke (27.3%, in our series) is the highest as compared with other subtypes of cerebral infarction. In our experience, in-hospital mortality in patients with early embolic recurrence (within the first 7 days) was 77%. Patients with alcohol abuse, hypertension, valvular heart disease, nausea and vomiting, and previous cerebral infarction are at increased risk of early recurrent systemic embolization. Secondary prevention with anticoagulants should be started immediately if possible in patients at high risk for recurrent cardioembolic stroke in which contraindications, such as falls, poor compliance, uncontrolled epilepsy or gastrointestinal bleeding are absent.
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Affiliation(s)
- Adrià Arboix
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain
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Li Y, Jensen GA. Effects of drinking on hospital stays and emergency room visits among older adults. J Aging Health 2011; 24:67-91. [PMID: 21383225 DOI: 10.1177/0898264311398394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate whether alcohol drinking influences emergency room (ER) visits or hospital admissions among adults aged 65 and older. METHOD Data from two independent national surveys are used to estimate multivariate logit models that quantify the relationship between drinking and ER visits and hospital admissions. The authors distinguish between ER visits linked to a hospital admission for that individual and ER visits not linked to an admission. RESULTS The authors find no significant effects of alcohol consumption on either ER visits or hospital admissions among older adults. These findings occur in both data sets, and for both men and women. Distinguishing between different types of ER visits makes no difference. DISCUSSION Analysis of two large and nationally representative data sets suggests that among older adults drinking alcohol, or even heavily drinking alcohol, does not raise or lower the risk of a hospital admission or the risk of an ER visit.
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Affiliation(s)
- Yong Li
- Competitive Health Analytics, Inc., Louisville, KY 40202, USA.
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Stroke and Substance Abuse. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Patra J, Taylor B, Irving H, Roerecke M, Baliunas D, Mohapatra S, Rehm J. Alcohol consumption and the risk of morbidity and mortality for different stroke types--a systematic review and meta-analysis. BMC Public Health 2010; 10:258. [PMID: 20482788 PMCID: PMC2888740 DOI: 10.1186/1471-2458-10-258] [Citation(s) in RCA: 251] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 05/18/2010] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Observational studies have suggested a complex relationship between alcohol consumption and stroke, dependent on sex, type of stroke and outcome (morbidity vs. mortality). We undertook a systematic review and a meta-analysis of studies assessing the association between levels of average alcohol consumption and relative risks of ischemic and hemorrhagic strokes separately by sex and outcome. This meta-analysis is the first to explicitly separate morbidity and mortality of alcohol-attributable stroke and thus has implications for public health and prevention. METHODS Using Medical Subject Headings (alcohol drinking, ethanol, cerebrovascular accident, cerebrovascular disorders, and intracranial embolism and thrombosis and the key word stroke), a literature search of MEDLINE, EMBASE, CINAHL, CABS, WHOlist, SIGLE, ETOH, and Web of Science databases between 1980 to June 2009 was performed followed by manual searches of bibliographies of key retrieved articles. From twenty-six observational studies (cohort or case-control) with ischemic or hemorrhagic strokes the relative risk or odds ratios or hazard ratios of stroke associated with alcohol consumption were reported; alcohol consumption was quantified; and life time abstention (manually estimated where data for current abstainers were given) was used as the reference group. Two reviewers independently extracted the information on study design, participant characteristics, level of alcohol consumption, stroke outcome, control for potential confounding factors, risk estimates and key criteria of study quality using a standardized protocol. RESULTS The dose-response relationship for hemorrhagic stroke had monotonically increasing risk for increasing consumption, whereas ischemic stroke showed a curvilinear relationship, with a protective effect of alcohol for low to moderate consumption, and increased risk for higher exposure. For more than 3 drinks on average/day, in general women had higher risks than men, and the risks for mortality were higher compared to the risks for morbidity. CONCLUSIONS These results indicate that heavy alcohol consumption increases the relative risk of any stroke while light or moderate alcohol consumption may be protective against ischemic stroke. Preventive measures that should be initiated are discussed.
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Affiliation(s)
- Jayadeep Patra
- Centre for Addiction and Mental Health, Toronto, Ontario Canada.
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Rehm J, Baliunas D, Borges GLG, Graham K, Irving H, Kehoe T, Parry CD, Patra J, Popova S, Poznyak V, Roerecke M, Room R, Samokhvalov AV, Taylor B. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction 2010; 105:817-43. [PMID: 20331573 PMCID: PMC3306013 DOI: 10.1111/j.1360-0443.2010.02899.x] [Citation(s) in RCA: 723] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS As part of a larger study to estimate the global burden of disease and injury attributable to alcohol: to evaluate the evidence for a causal impact of average volume of alcohol consumption and pattern of drinking on diseases and injuries; to quantify relationships identified as causal based on published meta-analyses; to separate the impact on mortality versus morbidity where possible; and to assess the impact of the quality of alcohol on burden of disease. METHODS Systematic literature reviews were used to identify alcohol-related diseases, birth complications and injuries using standard epidemiological criteria to determine causality. The extent of the risk relations was taken from meta-analyses. RESULTS Evidence of a causal impact of average volume of alcohol consumption was found for the following major diseases: tuberculosis, mouth, nasopharynx, other pharynx and oropharynx cancer, oesophageal cancer, colon and rectum cancer, liver cancer, female breast cancer, diabetes mellitus, alcohol use disorders, unipolar depressive disorders, epilepsy, hypertensive heart disease, ischaemic heart disease (IHD), ischaemic and haemorrhagic stroke, conduction disorders and other dysrhythmias, lower respiratory infections (pneumonia), cirrhosis of the liver, preterm birth complications and fetal alcohol syndrome. Dose-response relationships could be quantified for all disease categories except for depressive disorders, with the relative risk increasing with increased level of alcohol consumption for most diseases. Both average volume and drinking pattern were linked causally to IHD, fetal alcohol syndrome and unintentional and intentional injuries. For IHD, ischaemic stroke and diabetes mellitus beneficial effects were observed for patterns of light to moderate drinking without heavy drinking occasions (as defined by 60+ g pure alcohol per day). For several disease and injury categories, the effects were stronger on mortality compared to morbidity. There was insufficient evidence to establish whether quality of alcohol had a major impact on disease burden. CONCLUSIONS Overall, these findings indicate that alcohol impacts many disease outcomes causally, both chronic and acute, and injuries. In addition, a pattern of heavy episodic drinking increases risk for some disease and all injury outcomes. Future studies need to address a number of methodological issues, especially the differential role of average volume versus drinking pattern, in order to obtain more accurate risk estimates and to understand more clearly the nature of alcohol-disease relationships.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, Toronto, Canada.
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Kawano Y. Physio-pathological effects of alcohol on the cardiovascular system: its role in hypertension and cardiovascular disease. Hypertens Res 2010; 33:181-91. [DOI: 10.1038/hr.2009.226] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Vascular Diseases. Neurosurgery 2010. [DOI: 10.1007/978-3-540-79565-0_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Nervous System. ACTA ACUST UNITED AC 2009. [DOI: 10.1201/9781420036961.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Pontes-Neto OM, Oliveira-Filho J, Valiente R, Friedrich M, Pedreira B, Rodrigues BCB, Liberato B, Freitas GRD. Diretrizes para o manejo de pacientes com hemorragia intraparenquimatosa cerebral espontânea. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:940-50. [DOI: 10.1590/s0004-282x2009000500034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Accepted: 08/15/2009] [Indexed: 01/24/2023]
Abstract
A hemorragia intraparenquimatosa cerebral (HIC) é o subtipo de AVC de pior prognóstico e com tratamento ainda controverso em diversos aspectos. O comitê executivo da Sociedade Brasileira de Doenças Cerebrovasculares, através de uma revisão ampla dos artigos publicados em revistas indexadas, elaborou sugestões e recomendações que são aqui descritas com suas respectivas classificações de níveis de evidência. Estas diretrizes foram elaboradas com o objetivo de prover o leitor de um racional para o manejo apropriado dos pacientes com HIC, baseado em evidências clínicas.
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Beaglehole R, Jackson R. Alcohol, cardiovascular diseases and all causes of death: a review of the epidemiological evidence. Drug Alcohol Rev 2009; 11:275-89. [PMID: 16840082 DOI: 10.1080/09595239200185811] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This paper reviews the epidemiological evidence on the association of alcohol consumption with the major cardiovascular diseases (hypertension, stroke and coronary heart disease), and all causes of death. The focus is on light and moderate consumption and several important methodological issues are apparent with the epidemiological evidence on alcohol and mortality. The epidemiological data justify the following recommendations on alcohol consumption. The evidence does not support the unqualified claim that light and moderate drinking confers overall health benefits. However, in persons over 35 years of age, there is no consistent evidence that daily consumption of up to 2-3 drinks in men or up to 1-2 drinks in women increases the risk of dying. Non-drinkers should not be encouraged to change their drinking status. The consumption of more than 2-3 drinks per day in men and more than 1-2 drinks per day in women should be actively discouraged. Further research on the effects of light and moderate alcohol consumption on cardiovascular disease and all causes of death are required, particularly in young people, women and the elderly.
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Affiliation(s)
- R Beaglehole
- Department of Community Health, University of Auckland, Auckland, New Zealand
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Scott DM, Williams CD, Cain GE, Kwagyan J, Kalu N, Ehlers CL, Hesselbrock V, Taylor RE. Clinical course of alcohol dependence in African Americans. J Addict Dis 2009; 27:43-50. [PMID: 19042590 DOI: 10.1080/10550880802324754] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The sequence and progression of alcohol related life events were investigated in a sample of African Americans and compared with findings from a predominantly Caucasian sample. METHODS Alcohol dependent participants were recruited from treatment facilities. Participants completed the Semi-Structured Assessment for the Genetics of Alcoholism to assess the physical, psychological and social manifestations of alcoholism and related disorders. RESULTS The sequence and mean age of appearance of alcohol-related life events were similar for this sample of African-American men and women. While there were similarities in the progression of alcohol related life problems between the African American and the Caucasian samples, the frequency of symptom endorsement for most problems was significantly higher in the Caucasian sample. CONCLUSIONS Identifying ethnic differences in the clinical course of alcohol dependence may be of importance in developing treatment plans and assist in the development of culturally sensitive intervention and prevention programs.
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Affiliation(s)
- Denise M Scott
- Howard University Alcohol Research Center, Washington, DC, USA.
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Snow WM, Murray R, Ekuma O, Tyas SL, Barnes GE. Alcohol use and cardiovascular health outcomes: a comparison across age and gender in the Winnipeg Health and Drinking Survey Cohort. Age Ageing 2009; 38:206-12. [PMID: 19131359 DOI: 10.1093/ageing/afn284] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND research has reliably demonstrated cardioprotection from regular alcohol use. Heavy episodic drinking (HED), however, negates these beneficial effects and increases the risk of cardiovascular disease (CVD). The impact of age on the health effects of episodic drinking has not been evaluated. OBJECTIVE to examine the association between alcohol volume and pattern of consumption on the risk of cardiovascular morbidity and mortality across the lifespan. DESIGN AND SETTING prospective, community-based cohort study of adults in Winnipeg, Manitoba, Canada. SUBJECTS a total of 1,154 participants (580 men and 574 women) aged 18-64 surveyed at baseline (1990-91) on alcohol consumption levels and pattern of use. METHODS usual alcohol consumption was measured using a quantity-frequency approach. HED was estimated by asking participants how often they consumed eight or more drinks in one sitting in the past year. Questions were asked separately for wine, beer and spirits. Surveillance for cardiovascular events was conducted for 10 years (i.e. up to age 74 years). Diagnoses of CVD were obtained via health utilization records. Cox proportional hazard models were derived for both genders and for 'young adults' (baseline age 18-34), 'middle-aged adults' (baseline age 35-49) and 'older adults' (baseline 50-64). Models were adjusted for marital status, cigarette smoking status and educational level. RESULTS Reduced risk of CVD was associated with usual consumption, whereas an increased risk was associated with HED. Among male usual drinkers, cardioprotection was afforded only to middle and older age groups. The benefits of regular consumption were seen only in the youngest age group among women. The heaviest usual consumption category was associated with a decreased risk of CVD in men. Heavy episodic drinking increased the risk of coronary heart disease in middle-aged men and was marginally significant in middle-aged women. Risk of hypertension was elevated in older men with heavy episodic drinking. CONCLUSIONS The well-established relationship between regular alcohol consumption and decreased risk of CVD may not become evident until middle age or older in men. Women may benefit from usual consumption at a much younger age. In both sexes, however, these beneficial effects of alcohol use are negated when alcohol is consumed in a heavy episodic drinking pattern, particularly for middle-aged and older men.
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Affiliation(s)
- Wanda M Snow
- Research Associate, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, R3A 1R9, Canada.
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Rosenow F, Hojer C, Meyer-Lohmann C, Hilgers RD, Miihlhofer H, Kleindienst A, Owega A, Koning W, Heiss WD. Spontaneous intracerebral hemorrhage. Acta Neurol Scand 2009. [DOI: 10.1111/j.1600-0404.1997.tb00263.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fukuda K, Yuzuriha T, Kinukawa N, Murakawa R, Takashima Y, Uchino A, Ibayashi S, Iida M, Yao H, Hirano M. Alcohol intake and quantitative MRI findings among community dwelling Japanese subjects. J Neurol Sci 2008; 278:30-4. [PMID: 19059611 DOI: 10.1016/j.jns.2008.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Revised: 11/09/2008] [Accepted: 11/12/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The relationship between alcohol consumption and subclinical findings on magnetic resonance imaging (MRI) remains uncertain. We examined the relationship between light to moderate alcohol intake and silent brain infarction (SBI), white matter lesions (WMLs), and cerebral atrophy. METHODS Cranial MRI was performed on subjects>or=40 years residing in a rural community in Japan (n=385; mean age, 67.2). Alcohol intake and type was determined using a detailed questionnaire; subjects were categorized into three groups: non-drinkers, light drinkers (<7 drinks per week), and moderate drinkers (>or=7 drinks per week). Former drinkers were considered non-drinkers. Periventricular WMLs, deep WMLs and cerebral atrophy were measured quantitatively using a computer-assisted processing system (%PVWML, %DWML, and %Brain, respectively). RESULTS Compared with non-drinkers, the prevalence odds ratios for SBI were significantly higher in light and moderate drinkers, after multivariate adjustment. After adjusting for age, sex, and other related factors, the geometric mean %PVWML volumes in light and moderate drinkers were 1.27% and 1.52%, respectively, significantly larger than those for non-drinkers (0.95%). The geometric mean %DWML volume in light drinkers was 0.10%, which was larger than the value for non-drinkers (0.06%); the value for moderate drinkers (0.13%) was significantly larger than that for non-drinkers. The geometric mean %Brain values for non-, light, and moderate drinkers were 92.1, 91.9 and 90.8%, respectively; a statistically significant difference was found between non-drinkers and moderate drinkers. CONCLUSIONS The present study indicates that regular drinking, including even low levels of consumption, may be a risk factor for subclinical findings detected on MRI in community-dwelling Japanese people.
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Affiliation(s)
- Kenji Fukuda
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, and Department of Medical Information Science, Kyushu University Hospital, Fukuoka, Japan.
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Patient and aneurysm characteristics in multiple intracranial aneurysms. CHANGING ASPECTS IN STROKE SURGERY: ANEURYSMS, DISSECTIONS, MOYAMOYA ANGIOPATHY AND EC-IC BYPASS 2008; 103:19-28. [DOI: 10.1007/978-3-211-76589-0_6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hänggi D, Steiger HJ. Spontaneous intracerebral haemorrhage in adults: a literature overview. Acta Neurochir (Wien) 2008; 150:371-9; discussion 379. [PMID: 18176774 DOI: 10.1007/s00701-007-1484-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 12/04/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND A large number of reports have analysed epidemiology, pathogenesis, symptomatology, diagnostics and options for medical and surgical treatment of intracerebral haemorrhage. Nevertheless, management still remains controversial. The purpose of the present review is to summarise the clinical data and derive a current updated management concept as a result. METHODS The analysis was based on a Medline search to November 2006 for the term "intracerebral haemorrhage" (ICH). The clinical query functions were optimised for aetiology, diagnosis and therapy to limit the results. A total of 103 articles were found eligible for review. FINDINGS Race, age and sex influence the occurrence of ICH. Moreover, hypertension and alcohol consumption are the paramount risk factors. The most frequent pathophysiological mechanism of ICH seems to be a degenerative vessel wall change and, in consequence, rupture of small penetrating arteries and arterioles of 50-200 microm in diameter. The symptomatology depends on the size of ICH, possible rebleeding and the occurrence of hydrocephalus or seizures. The outcome is worse with concomitant occurrence of intraventricular haemorrhage. Treatment with recombinant factor VIIa (rFVIIa) within four hours after the onset of ICH limits the growth of haematoma, reduces mortality and improves functional outcome. Minimally invasive surgery tends to improve functional outcome. CONCLUSION A systematic knowledge of currently available data on epidemiology, pathogenesis and symptomatology, the use of diagnostics and the different conservative and surgical treatment options can lead to a balanced management strategy for patients with ICH.
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Abstract
Moderate drinking has complex associations with cardiovascular diseases other than coronary heart disease. Recent cohort studies examining the relationship between alcohol use and ischemic stroke have shown a modest association, with risk ratios approximating 0.8 and the lowest risk among those who drink less than daily. In contrast, alcohol use is generally associated with an approximate dose-dependent risk for hemorrhagic stroke throughout the full range of intake. Several prospective studies of alcohol intake and congestive heart failure have found lower risk with moderate drinking. This risk is also dose dependent through the moderate range, but its underlying mechanism remains uncertain. Accounting for the lower risk of myocardial infarction associated with moderate intake does not eliminate the observed association. Cohort studies have found no association of long-term alcohol intake with risk of atrial fibrillation below levels of at least 3 standard drinks per day. Finally, two prospective studies have found lower risks of claudication or clinically more severe peripheral arterial disease among moderate drinkers, an association also supported by cross-sectional studies of alcohol intake and ankle-brachial index.
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Affiliation(s)
- Kenneth Mukamal
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Maasland E, Koudstaal PJ, Habbema JDF, Dippel DWJ. Effects of an individualized multimedia computer program for health education in patients with a recent minor stroke or transient ischemic attack - a randomized controlled trial. Acta Neurol Scand 2007; 115:41-8. [PMID: 17156264 DOI: 10.1111/j.1600-0404.2006.00722.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transient ischemic attack (TIA) and stroke patients often show a striking lack of knowledge about their disease. We developed a computer program that provided health education fitting the educational level, risk profile and symptoms of patients and evaluated it in a randomized controlled trial. METHODS Transient ischemic attack or minor stroke patients were allocated to health education by a physician (n = 32) or to a combination of education by a physician and the computer program (n = 33). Knowledge was tested by means of a questionnaire at 1 and 12 weeks after inclusion. The maximum possible score was 71 points. RESULTS Overall knowledge was low - the mean score was 43.6 at 1 week and 42.0 points at 12 weeks for both the groups. The intervention group had slightly better scores at 1 week after using the computer program, 45.4 vs 41.5 (P = 0.09), with the difference increasing to 4.3 points after (post-hoc) adjustment for age and level of education (P = 0.06). After 12 weeks, the score in the intervention group dropped significantly to 42.0 points (P = 0.05), and was no longer different from the standard group. CONCLUSION This study did not show a lasting effect of health education by an individualized computer program on the knowledge of TIA and minor stroke patients.
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Affiliation(s)
- E Maasland
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Wolf PA, Kannel WB. Epidemiology of Cerebrovascular Disease. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50035-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Damiani IT, Gagliardi RJ, Scaff M. Influência do etanol das bebidas alcoólicas na aterosclerose em artérias carótidas extracranianas. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:1022-6. [PMID: 15608963 DOI: 10.1590/s0004-282x2004000600017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Existem fortes evidências de menor incidência de doença cerebrovascular oclusiva, de aterosclerose coronariana e de outros vasos em indivíduos com consumo leve ou moderado de álcool. Este estudo procura analisar o efeito do etanol, em diferentes doses no comportamento da aterosclerose carotídea extracraniana. Através do ultrassom Doppler colorido, foram investigadas 328 artérias carótidas extracranianas, de homens e mulheres brancos, com mais de 35 anos de idade, normotensos, não tabagistas e sem as principais doenças que constituam fatores de risco para doenças cardiovasculares. Foram divididos de acordo com o consumo de álcool por semana (em mililitros) em abstêmios, etilistas leves (1 a 100), moderados (101 a 300) e pesados (301 ou mais). Houve menor incidência de placas de aterosclerose e de estenose naqueles que ingeriram moderada quantidade. CONCLUSÃO: O estudo sugere uma ação protetora do álcool etílico para aterosclerose carotídea, quando ingerido em moderada quantidade.
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Zhang Y, Heeren T, Curtis Ellison R. Education modifies the effect of alcohol on memory impairment: the third national health and nutrition examination survey. Neuroepidemiology 2004; 24:63-9. [PMID: 15459511 DOI: 10.1159/000081051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We examined whether the relation of alcohol consumption to prevalence of verbal memory impairment was modified by education among 4,804 elderly subjects in the Third National Health and Nutrition Examination Survey. Verbal memory was assessed using delayed recall, with impairment defined as a combined score <4. Alcohol consumption over the previous month prior to the interview was assessed using a food frequency questionnaire. Prevalence of verbal memory impairment decreased from 11.3 to 7.2, 5.7, 5.1 and 4.4% in increasing categories of alcohol consumption (none, 1-4, 5-14, 15-30 and >30 drinks per month) in men, and from 7.2 to 3.5 and 2.8% (for none, 1-14, and >14 per month) in women, respectively. Adjusting for age, race, and other factors, prevalence ratios of verbal memory impairment decreased with each increasing alcohol category, but the effect was attenuated when further adjusted for education. There was a much stronger protection from alcohol among subjects with more education: prevalence ratios were reduced from 1.0 to 0.2 to 0.1 for non-drinkers, 1-14, and >14 drinks/month, respectively (p for trend = 0.007). Our results suggest that alcohol intake is associated with a greater decrease in the prevalence of verbal memory impairment among more educated subjects than among those with less education, possibly related to differences in drinking patterns.
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Affiliation(s)
- Yuqing Zhang
- Section of Preventive Medicine and Epidemiology, Evans Department of Medicine, School of Medicine, Boston, MA 02118, USA.
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Abstract
In the United States, more than 220,000 adults under the age of 45 have had a stroke. Secondary stroke prevention is critical in this population because of the potential impact of a second stroke on productivity and future quality of life. In addition to conventional stroke risk factors, younger patients have special risk factors inherent to genetic and environmental elements, such as the use of illicit drugs and cardiac abnormalities; in women, risk factors include pregnancy, migraine, and the use of oral contraceptives.
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Affiliation(s)
- MingMing Ning
- Massachusetts General Hospital, Boston, Massachusetts, USA
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