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Xu F, Feng Y, Zhong X. Higher triglyceride‑glucose index is associated with increased risk of stroke among middle-aged and elderly Chinese: a national longitudinal study. Sci Rep 2024; 14:19054. [PMID: 39154111 PMCID: PMC11330459 DOI: 10.1038/s41598-024-70008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024] Open
Abstract
Stroke is a severe cerebrovascular disease. This study aimed to determine the association between triglyceride‑glucose (TyG) index and stroke among middle-aged and elderly Chinese. Data was extracted from China Health and Retirement Longitudinal Study survey 2015 and survey 2018. Logistic regression, trend test and subgroup analysis were conducted to assess the association. Possible nonlinear relationships were explored with restricted cubic spline (RCS). Propensity score matching (PSM) was conducted to attenuate the effect of confounding factors. ORs of stroke was positively associated with TyG index. The ORs in RCS analysis also increased with the rising TyG, though p for non-linearity was bigger than 0.05. After PSM, the ORs in the full adjusted models were 1.28 (1.01, 1.62). TyG was suggested as an independent risk factor for stroke in the middle aged and elderly Chinese.
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Affiliation(s)
- Feifei Xu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Yan Feng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Xi Zhong
- Department of Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, People's Republic of China.
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2
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Zhang W, Zhu J, Wu X, Feng T, Liao W, Li X, Chen J, Zhang L, Xiao C, Cui H, Yang C, Yan P, Wang Y, Tang M, Chen L, Liu Y, Zou Y, Wu X, Zhang L, Yang C, Yao Y, Li J, Liu Z, Jiang X, Zhang B. Phenotypic and genetic effect of carotid intima-media thickness on the risk of stroke. Hum Genet 2024:10.1007/s00439-024-02666-1. [PMID: 38578439 DOI: 10.1007/s00439-024-02666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/05/2024] [Indexed: 04/06/2024]
Abstract
While carotid intima-media thickness (cIMT) as a noninvasive surrogate measure of atherosclerosis is widely considered a risk factor for stroke, the intrinsic link underlying cIMT and stroke has not been fully understood. We aimed to evaluate the clinical value of cIMT in stroke through the investigation of phenotypic and genetic relationships between cIMT and stroke. We evaluated phenotypic associations using observational data from UK Biobank (N = 21,526). We then investigated genetic relationships leveraging genomic data conducted in predominantly European ancestry for cIMT (N = 45,185) and any stroke (AS, Ncase/Ncontrol=40,585/406,111). Observational analyses suggested an increased hazard of stroke per one standard deviation increase in cIMT (cIMTmax-AS: hazard ratio (HR) = 1.39, 95%CI = 1.09-1.79; cIMTmean-AS: HR = 1.39, 95%CI = 1.09-1.78; cIMTmin-AS: HR = 1.32, 95%CI = 1.04-1.68). A positive global genetic correlation was observed (cIMTmax-AS: [Formula: see text]=0.23, P=9.44 × 10-5; cIMTmean-AS: [Formula: see text]=0.21, P=3.00 × 10-4; cIMTmin-AS: [Formula: see text]=0.16, P=6.30 × 10-3). This was further substantiated by five shared independent loci and 15 shared expression-trait associations. Mendelian randomization analyses suggested no causal effect of cIMT on stroke (cIMTmax-AS: odds ratio (OR)=1.12, 95%CI=0.97-1.28; cIMTmean-AS: OR=1.09, 95%CI=0.93-1.26; cIMTmin-AS: OR=1.03, 95%CI = 0.90-1.17). A putative association was observed for genetically predicted stroke on cIMT (AS-cIMTmax: beta=0.07, 95%CI = 0.01-0.13; AS-cIMTmean: beta=0.08, 95%CI = 0.01-0.15; AS-cIMTmin: beta = 0.08, 95%CI = 0.01-0.16) in the reverse direction MR, which attenuated to non-significant in sensitivity analysis. Our work does not find evidence supporting causal associations between cIMT and stroke. The pronounced cIMT-stroke association is intrinsic, and mostly attributed to shared genetic components. The clinical value of cIMT as a surrogate marker for stroke risk in the general population is likely limited.
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Affiliation(s)
- Wenqiang Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Jingwei Zhu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Xuan Wu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Tianle Feng
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Wei Liao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Xuan Li
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Jianci Chen
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Li Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Chenghan Xiao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
- Department of Maternal, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Huijie Cui
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Chao Yang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Peijing Yan
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Yutong Wang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Mingshuang Tang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Lin Chen
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Yunjie Liu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Yanqiu Zou
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Xueyao Wu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Ling Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
- Department of Iatrical Polymer Material and Artificial Apparatus, School of Polymer Science and Engineering, Sichuan University, Chengdu, China
| | - Chunxia Yang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Yuqin Yao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
- Department of Occupational and Environmental Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jiayuan Li
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Zhenmi Liu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
- Department of Maternal, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xia Jiang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China.
- Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
- Department of Clinical Neuroscience, Karolinskaa Institutet, Stockholm, Sweden.
| | - Ben Zhang
- Hainan General Hospital and Hainan Affiliated Hospital, Hainan Medical University, Haikou, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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3
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Dimas GG, Zilakaki M, Giannopoulos A, Daios S, Kakaletsis N, Kaiafa G, Didangelos T, Savopoulos C, Ktenidis K, Tegos T. Assessment of Atherosclerosis in Ischemic Stroke by means of Ultrasound of Extracranial/Intracranial Circulation and Serum, Urine, and Tissue Biomarkers. Curr Med Chem 2023; 30:1107-1121. [PMID: 35980067 DOI: 10.2174/0929867329666220817123442] [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: 12/30/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022]
Abstract
It is a common practice to take into consideration age, diabetes, smoking, treated and untreated systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol for the prediction of atherosclerosis and stroke. There are, however, ultrasound markers in use for the assessment of atherosclerosis and the evaluation of stroke risk. Two areas of investigation are of interest: the carotid artery and the intracranial arterial circulation. Again, within the domain of the carotid artery, two ultrasonic markers have attracted our attention: intima media thickness of the carotid artery and the presence of carotid plaque with its various focal characteristics. In the domain of intracranial circulation, the presence of arterial stenosis and the recruitment of collaterals are considered significant ultrasonic markers for the above-mentioned purpose. On the other hand, a series of serum, urine, and tissue biomarkers are found to be related to atherosclerotic disease. Future studies might address the issue of whether the addition of proven ultrasonic carotid indices to the aforementioned serum, urine, and tissue biomarkers could provide the vascular specialist with a better assessment of the atherosclerotic load and solidify their position as surrogate markers for the evaluation of atherosclerosis and stroke risk.
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Affiliation(s)
- Grigorios G Dimas
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Maria Zilakaki
- First Neurology Department, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54636, Greece
| | - Argyrios Giannopoulos
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Stylianos Daios
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Nikolaos Kakaletsis
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki ,Greece
| | - Triantafyllos Didangelos
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Kyriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Thomas Tegos
- First Neurology Department, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54636, Greece
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4
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Kpuduwei SK, Kiridi E, Ibegu O, Amasiatu V. Normative clinical reference for intima-media thickness of carotid arteries among Nigerian adults. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:1-4. [PMID: 36203921 PMCID: PMC9531731 DOI: 10.4103/jwas.jwas_88_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/30/2022] [Indexed: 11/04/2022]
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5
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Jianu DC, Jianu SN, Dan TF, Munteanu G, Bîrdac CD, Motoc AGM, Docu Axelerad A, Petrica L, Gogu AE. Ultrasound Technologies and the Diagnosis of Giant Cell Arteritis. Biomedicines 2021; 9:biomedicines9121801. [PMID: 34944617 PMCID: PMC8698303 DOI: 10.3390/biomedicines9121801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/21/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022] Open
Abstract
Giant cell arteritis (GCA) is a primary autoimmune vasculitis that specifically affects medium-sized extracranial arteries, like superficial temporal arteries (TAs). The most important data to be considered for the ultrasound (US) diagnosis of temporal arteritis are stenosis, acute occlusions and “dark halo” sign, which represent the edema of the vascular wall. The vessel wall thickening of large vessels in GCA can be recognized by the US, which has high sensitivity and is facile to use. Ocular complications of GCA are common and consist especially of anterior arterial ischemic optic neuropathies or central retinal artery occlusion with sudden, painless, and sharp loss of vision in the affected eye. Color Doppler imaging of the orbital vessels (showing low-end diastolic velocities and a high resistance index) is essential to quickly differentiate the mechanism of ocular involvement (arteritic versus non-arteritic), since the characteristics of TAs on US do not correspond with ocular involvement on GCA. GCA should be cured immediately with systemic corticosteroids to avoid further visual loss of the eyes.
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Affiliation(s)
- Dragoș Cătălin Jianu
- Department of Neurosciences-Division of Neurology, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (D.C.J.); (A.E.G.)
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, 300041 Timișoara, Romania
| | - Silviana Nina Jianu
- Department of Internal Medicine II, Centre for Molecular Research in Nephrology and Vascular Pathology, Victor Babeş University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Traian Flavius Dan
- Department of Neurosciences-Division of Neurology, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (D.C.J.); (A.E.G.)
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, 300041 Timișoara, Romania
- Correspondence: (T.F.D.); (G.M.); Tel.: +40-745035178 (T.F.D.); +40-746151426 (G.M.)
| | - Georgiana Munteanu
- Department of Neurosciences-Division of Neurology, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (D.C.J.); (A.E.G.)
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, 300041 Timișoara, Romania
- Department of Internal Medicine II, Centre for Molecular Research in Nephrology and Vascular Pathology, Victor Babeş University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence: (T.F.D.); (G.M.); Tel.: +40-745035178 (T.F.D.); +40-746151426 (G.M.)
| | - Claudiu Dumitru Bîrdac
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, 300041 Timișoara, Romania
| | - Andrei Gheorghe Marius Motoc
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- Department of Anatomy and Embryology, Victor Babeş University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Any Docu Axelerad
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- Department of Neurology, General Medicine Faculty, Ovidius University, 900527 Constanța, Romania
| | - Ligia Petrica
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- Department of Internal Medicine II-Division of Nephrology, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Anca Elena Gogu
- Department of Neurosciences-Division of Neurology, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (D.C.J.); (A.E.G.)
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, 300041 Timișoara, Romania
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Tjan A, Widiana IGR, Martadiani ED, Ayusta IMD, Asih MW, Sitanggang FP. Carotid artery stiffness measured by strain elastography ultrasound is a stroke risk factor. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100850] [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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7
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Tung H, Lin HJ, Chen PL, Lu TJ, Jhan PP, Chen JP, Chen YM, Wu CC, Lin YY, Hsiao TH. Characterization of familial hypercholesterolemia in Taiwanese ischemic stroke patients. Aging (Albany NY) 2021; 13:19339-19351. [PMID: 34314377 PMCID: PMC8386562 DOI: 10.18632/aging.203320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
Familial hypercholesterolemia (FH) is a common genetic disorder characterized by a lifelong elevated low-density lipoprotein cholesterol (LDL-C) level. The relationship between FH and ischemic stroke is still controversial. We enrolled ischemic stroke patients prospectively in our neurological ward, and divided them into two groups according to LDL-C levels with a threshold of 130 mg/dl. Targeted sequencing was performed in all stroke patients for LDLR, APOB, and PCSK9 genes. The fifty-eight high-LDL subjects were older, prevalence of previous myocardial infarction/stroke history was lower, and the first stroke age was older compared with values in the sixty-three low-LDL cases. The prevalence of FH in Han-Chinese stroke patients was 5.0%, and was 10.3% in those with a higher LDL-C level. We identified six carriers, who had higher percentages of large vessel stroke subtype (66.7% vs. 15.4%) and transient ischemic attack (33.3% vs. 3.8%), previous myocardial infarction/stroke history (50.0% vs. 11.5%), statin use (50.0% vs. 11.5%), and increased carotid intima-media thickness (IMT) (0.9-1.2mm vs.0.7-9.0mm) compared with the other hypercholesterolemic patients without pathogenic variants. Ischemic stroke patients carrying FH pathogenic variants seemed to have a higher risk for large artery stroke and transient ischemic attack. The IMT exam could be useful to screen for FH in hypercholesterolemic stroke patients.
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Affiliation(s)
- Hsin Tung
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Center of Faculty Development, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Epilepsy, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsueh-Ju Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Lin Chen
- Division of General Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Tsai-Jung Lu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pei-Pei Jhan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun-Peng Chen
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ming Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chen-Chin Wu
- Division of Epilepsy, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of General Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yung-Yang Lin
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzu-Hung Hsiao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Public Health, Fu Jen Catholic University, New Taipei City, Taiwan.,Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan
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8
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Immune-inflammatory, coagulation, adhesion, and imaging biomarkers combined in machine learning models improve the prediction of death 1 year after ischemic stroke. Clin Exp Med 2021; 22:111-123. [PMID: 34120242 DOI: 10.1007/s10238-021-00732-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/04/2021] [Indexed: 01/02/2023]
Abstract
Some clinical, imaging, and laboratory biomarkers have been identified as predictors of prognosis of acute ischemic stroke (IS). The aim of this study was to evaluate the prognostic validity of a combination of clinical, imaging, and laboratory biomarkers in predicting 1-year mortality of IS. We evaluated 103 patients with IS within 24 h of their hospital admission and assessed demographic data, IS severity using the National Institutes of Health Stroke Scale (NIHSS), carotid intima-media thickness (cIMT), and degree of stenosis, as well as laboratory variables including immune-inflammatory, coagulation, and endothelial dysfunction biomarkers. The IS patients were categorized as survivors and non-survivors 1 year after admission. Non-survivors showed higher NIHSS and cIMT values, lower antithrombin, Protein C, platelet counts, and albumin, and higher Factor VIII, von Willebrand Factor (vWF), white blood cells, tumor necrosis factor (TNF)-α, interleukin (IL)-10, high-sensitivity C-reactive protein (hsCRP), and vascular cellular adhesion molecule 1 (VCAM-1) than survivors. Neural network models separated non-survivors from survivors using NIHSS, cIMT, age, IL-6, TNF-α, hsCRP, Protein C, Protein S, vWF, and platelet endothelial cell adhesion molecule 1 (PECAM-1) with an area under the receiving operating characteristics curve (AUC/ROC) of 0.975, cross-validated accuracy of 93.3%, sensitivity of 100% and specificity of 85.7%. In conclusion, imaging, immune-inflammatory, and coagulation biomarkers add predictive information to the NIHSS clinical score and these biomarkers in combination may act as predictors of 1-year mortality after IS. An early prediction of IS outcome is important for personalized therapeutic strategies that may improve the outcome of IS.
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9
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Effects of inverted photoperiods on the blood pressure and carotid artery of spontaneously hypertensive rats and Wistar-Kyoto rats. J Hypertens 2021; 39:871-879. [PMID: 33824259 DOI: 10.1097/hjh.0000000000002732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the effects of inverted photoperiods on the blood pressure and carotid arteries in spontaneously hypertensive rats (SHRs) and Wistar-Kyoto (WKY) rats (homologous control group). METHODS AND RESULTS This study used two inverted photoperiods [inverted light:dark (ILD)16 : 8 and ILD12 : 12] to create the model. A total of 27 male SHR and 27 male WKY rats were randomly divided into six groups (nine rats per group): SHR (LD12 : 12), SHR (ILD16 : 8), SHR (ILD12 : 12), WKY (LD12 : 12), WKY (ILD16 : 8) and WKY (ILD12 : 12). We recorded the trajectory of the activity rhythm of the rats and performed carotid vascular ultrasound examination, MRI (arterial spin labelling) analysis and carotid biopsy. The results showed that inverted photoperiods increased the blood pressure, carotid intima-media thickness, resistance index and blood flow velocity. In addition, inverted photoperiods led to the development of carotid arterial thrombosis, significantly reduced cerebral blood flow and increased the number of collagen fibres. Moreover, it increased the expression of angiotensin receptor and low-density lipoprotein receptor in the carotid arteries, leading to decreased expression of 3-hydroxy-3-methylglutaryl-Coenzyme A reductase and nitric oxide synthase. Inverted photoperiods induced the formation of atherosclerotic plaque. Multiple results of SHR were worse than those of WKY rats. CONCLUSION Taken together, inverted photoperiods can produce a series of adverse consequences on blood pressure and carotid arteries. Hypertension can aggravate the adverse effects of inverted photoperiods.
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10
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Carotid Intima-Media Thickness, Genetic Risk, and Ischemic Stroke: A Family-Based Study in Rural China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010119. [PMID: 33375320 PMCID: PMC7795493 DOI: 10.3390/ijerph18010119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Carotid intima-media thickness (cIMT) has been associated with an elevated risk of ischemic stroke (IS) in several studies, but the results are inconsistent. We investigated whether the association between cIMT and IS varied across different IS subtypes, and further assessed gene-cIMT interactions' association with IS risk. METHODS A total of 1048 IS cases (795 large-artery atherosclerosis (LAA) cases, 103 small-vessel occlusion (SVO) cases, and 150 other subtypes) and 2696 IS-free controls across 2179 families were included in the analysis. Self-reported IS cases were confirmed through medical records' review and head imaging by computed tomography and/or magnetic resonance imaging. The mean values of the common cIMT obtained in bilateral distal and proximal carotid artery segments were used. The genotype information of rs2910164 polymorphism in microRNA-146a (miR-146a) was also collected. RESULTS We found that cIMT was significantly associated with a higher risk of IS and LAA subtype but not SVO subtype in the multivariate-adjusted models. The odds ratio (OR) and 95% confidence interval (CI) in the highest quartile versus the lowest quartile of cIMT was 2.48 (1.92-3.20) for IS and 2.75 (2.08-3.64) for LAA (both p trend <0.001). The results also showed that there was a significant interaction between cIMT and rs2910164 genotype with the risk of IS (p interaction = 0.03) and LAA (p interaction = 0.02). The associations of cIMT with IS and LAA were strengthened among participants carried rs2910164_GG genotype compared with those with rs2910164_CC genotype. CONCLUSIONS Our results indicate that higher cIMT levels were significantly associated with IS and LAA subtype but not SVO subtype, and the relations were modified by rs2910164 polymorphism in miR-146a.
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11
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Shimoda S, Kitamura A, Imano H, Cui R, Muraki I, Yamagishi K, Umesawa M, Sankai T, Hayama-Terada M, Kubota Y, Shimizu Y, Okada T, Kiyama M, Iso H. Associations of Carotid Intima-Media Thickness and Plaque Heterogeneity With the Risks of Stroke Subtypes and Coronary Artery Disease in the Japanese General Population: The Circulatory Risk in Communities Study. J Am Heart Assoc 2020; 9:e017020. [PMID: 32990124 PMCID: PMC7792402 DOI: 10.1161/jaha.120.017020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Evidence on the associations of carotid intima-media thickness and carotid plaque characteristics with stroke subtypes and coronary artery disease risks in Asians is limited. This study investigated these associations in the Japanese general population. Methods and Results Maximum intima-media thicknesses of both the common carotid artery and internal carotid artery and carotid plaque characteristics were evaluated in 2943 Japanese subjects aged 40 to 75 years without history of cardiovascular disease. Subjects were followed up for a median of 15.1 years. Using a multivariate Cox proportional hazard model, we found that hazard ratios (HRs) and 95% CIs for the highest (≥1.07 mm) versus lowest (≤0.77 mm) quartiles of maximum intima-media thicknesses of the common carotid artery were 1.97 (1.26-3.06) for total stroke, 1.52 (0.67-3.41) for hemorrhagic stroke, 2.45 (1.41-4.27) for ischemic stroke, 3.60 (1.64-7.91) for lacunar infarction, 1.53 (0.69-3.41) for nonlacunar cerebral infarction, 2.68 (1.24-5.76) for coronary artery disease, and 2.11 (1.44-3.12) for cardiovascular disease (similar results were found for maximum intima-media thicknesses of the internal carotid artery). HRs(95% CIs) for heterogeneous plaque versus no plaque were 1.58 (1.09-2.30) for total stroke, 1.25 (0.58-2.70) for hemorrhagic stroke, 1.74 (1.13-2.67) for ischemic stroke, 1.84 (1.03-3.19) for lacunar infarction, 1.58 (0.80-3.11) for nonlacunar cerebral infarction, 2.11 (1.20-3.70) for coronary artery disease, and 1.71 (1.25-2.35) for cardiovascular disease. Conclusions Maximum intima-media thicknesses of the common carotid artery, maximum intima-media thicknesses of the internal carotid artery, and heterogeneous plaque were associated with the risks of stroke, lacunar infarction, coronary artery disease, and cardiovascular disease in Asians.
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Affiliation(s)
- Saeko Shimoda
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Akihiko Kitamura
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan.,Research Team for Social Participation and Community Health Tokyo Metropolitan Institute of Gerontology Tokyo Japan.,Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Hironori Imano
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan.,Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Renzhe Cui
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Isao Muraki
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Kazumasa Yamagishi
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan.,Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center University of Tsukuba Ibaraki Japan.,Ibaraki Western Medical Center Ibaraki Japan
| | - Mitsumasa Umesawa
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center University of Tsukuba Ibaraki Japan.,Department of Public Health Dokkyo Medical University Tochigi Japan
| | - Tomoko Sankai
- Department of Public Health and Nursing, Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Mina Hayama-Terada
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan.,Yao Public Health Center, Yao City Office Osaka Japan
| | - Yasuhiko Kubota
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Yuji Shimizu
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Takeo Okada
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
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12
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Endothelial Dysfunction, a Marker of Atherosclerosis, Is Independent of Metabolic Syndrome in NAFLD Patients. Int J Hepatol 2020; 2020:1825142. [PMID: 32724678 PMCID: PMC7382713 DOI: 10.1155/2020/1825142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The study was designed to assess cardiovascular risk factors flow-mediated dilatation % (FMD%) and carotid intima-media thickness (CIMT) in NAFLD. METHODS 126 NAFLD subjects and 31 chronic hepatitis B (CHB) controls were studied. Measuring carotid intima-media thickness (CIMT) and the flow-mediated dilatation % (FMD%) by brachial artery Doppler ultrasound were used to assess atherosclerosis. The risk of cardiac events at 10 years (ROCE 10) was estimated by the Prospective Cardiovascular Munster Study (PROCAM) score. RESULTS 58 of 126 NAFLD have coexistent metabolic syndrome. Mean CIMT was 0.73 ± 0.041 mm among NAFLD with MS, 0.66 ± 0.016 mm among NAFLD without MS, and 0.66 ± 0.037 in controls CHB patients. FMD% in NAFLD with MS was 10.43 ± 3.134%, but was 8.56 ± 3.581% in NAFLD without MS and 17.78 ± 6.051% in controls. PROCAM score of NAFLD with MS was 46.95 ± 6.509 while in NAFLD without MS was 38.2 ± 3.738. Controls had a PROCAM score of 38.13 ± 5.755. ROCE 10 in NAFLD with MS was 13.64 ± 8.568 while NAFLD without MS was 5.55 ± 1.949. Controls have a ROCE 10 of 5.95 ± 3.973. Post hoc analysis showed CIMT was dependent upon MS while FMD% was different between all subgroups hence independent of metabolic syndrome. CONCLUSION The markers of endothelial dysfunction are significantly higher in patients with NAFLD than controls.
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13
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Soneye MA, Adekanmi AJ, Obajimi MO, Aje A. Intima-media thickness of femoral arteries and carotids among an adult hypertensive Nigerian population: A case-control study to assess their use as surrogate markers of atherosclerosis. Ann Afr Med 2020; 18:158-166. [PMID: 31417017 PMCID: PMC6704813 DOI: 10.4103/aam.aam_57_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Increased intima-media thickness (IMT) is an established and important surrogate marker for atherosclerosis. Intima-media thickening in the femoral arteries occur earlier and reflect the true extent of generalized atherosclerosis better than in the carotids. Aims: To study the ultrasound-detected morphological changes in the common femoral versus carotid artery wall. Patients and Methods: A case-control study design was used, with 61 adult hypertensive as cases and 61 age-, sex- and BMI-matched normotensive as controls. Variables were participants' characteristics, cardiovascular risk factors, and ultrasonographically evaluated IMT of the carotid and femoral arteries. Results: A total of 122 participants were studied. The mean femoral IMT in hypertensives and controls on the right and left was 0.63 ± 0.07mm vs. 0.52 ± 0.06mm [P < 0.0001] and 0.69 ± 0.0 mm vs. 0.55 ± 0.05mm [P < 0.0001]. Also, the mean carotid IMT among hypertensives and controls on the right =0.80 ±0.15mm vs. 0.64 ± 0.06mm [P < 0.0001], and 0.91 ± 0.22mm vs. 0.65 ± 0.06mm [P < 0.0001] on the left. Significant correlation was observed between IMT and age (B = 0.006, P < 0.001 and B = 0.003, P < 0.001), hypertension (B = 0.205, P < 0.001 and B = 0.122, p< 0.001), and duration of hypertension (B = 0.02, P < 0.001 and B = 0.006, P = 0.02) the femoral and carotid arteries respectively. Conclusion: The femoral and the carotid artery show similar significantly increased IMT in hypertensive adults. The femoral IMT appears to be a good surrogate marker of atherosclerosis among hypertensive Nigerians.
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Affiliation(s)
| | | | | | - Akinyemi Aje
- Department of Medicine, Cardiology Unit, University College Hospital, Ibadan, Nigeria
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14
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Sun P, Liu L, Liu C, Zhang Y, Yang Y, Qin X, Li J, Cao J, Zhang Y, Zhou Z, Xu X, Huo Y. Carotid Intima-Media Thickness and the Risk of First Stroke in Patients With Hypertension. Stroke 2020; 51:379-386. [PMID: 31948356 DOI: 10.1161/strokeaha.119.026587] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background and Purpose—
This study aimed to investigate the association between mean carotid intima-media thickness (cIMT) and the risk of first stroke and examine any possible effect modifiers in patients with hypertension.
Methods—
A total of 11 547 hypertensive participants without history of stroke from the CSPPT (China Stroke Primary Prevention Trial) were included in this analysis. The primary outcome was first stroke.
Results—
Over a median follow-up of 4.4 years, 726 first strokes were identified, of which 631 were ischemic, and 90 were hemorrhagic. A per SD increase in mean cIMT was positively associated with the risk of first stroke (hazard ratio [HR], 1.11 [95% CI, 1.03–1.20]), and first ischemic stroke (HR, 1.10 [95% CI, 1.01–1.20]). Moreover, when cIMT was categorized in quartiles, the higher risks of first stroke (HR, 1.31 [95% CI, 1.06–1.61]) and first hemorrhagic stroke (HR, 2.25 [95% CI, 1.11–4.58]) were found in participants in quartile 2 to 4 (≥0.66 mm), compared with those in quartile 1 (<0.66 mm). More importantly, the cIMT-first stroke association was significantly stronger in participants with higher mean arterial pressure (≥109.3 [quintile 5] versus <109.3 mm Hg,
P
-interaction=0.024) or diastolic blood pressure levels (≥90.7 [quintile 5] versus <90.7 mm Hg,
P
-interaction=0.009).
Conclusions—
There was a significant positive association between baseline cIMT and the risk of first stroke in patients with hypertension. This association was even stronger among those with higher mean arterial pressure or diastolic blood pressure levels.
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Affiliation(s)
- Pengfei Sun
- From the Department of Cardiology, Peking University First Hospital, Beijing, China (P.S., Y. Zhang, Y.Y., J.L., Y.H.)
| | - Lishun Liu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, China (L.L., Z.Z., X.X.)
| | | | - Yan Zhang
- From the Department of Cardiology, Peking University First Hospital, Beijing, China (P.S., Y. Zhang, Y.Y., J.L., Y.H.)
| | - Ying Yang
- From the Department of Cardiology, Peking University First Hospital, Beijing, China (P.S., Y. Zhang, Y.Y., J.L., Y.H.)
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.Q., Y. Zhang)
| | - Jianping Li
- From the Department of Cardiology, Peking University First Hospital, Beijing, China (P.S., Y. Zhang, Y.Y., J.L., Y.H.)
| | - Jingjing Cao
- Institute of Biomedicine, Anhui Medical University, Hefei, China (J.C.)
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.Q., Y. Zhang)
| | - Ziyi Zhou
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, China (L.L., Z.Z., X.X.)
| | - Xiping Xu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, China (L.L., Z.Z., X.X.)
| | - Yong Huo
- From the Department of Cardiology, Peking University First Hospital, Beijing, China (P.S., Y. Zhang, Y.Y., J.L., Y.H.)
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15
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Hicks CW, Daya NR, Black JH, Matsushita K, Selvin E. Race and sex-based disparities associated with carotid endarterectomy in the Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2020; 292:10-16. [PMID: 31731080 PMCID: PMC6928429 DOI: 10.1016/j.atherosclerosis.2019.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/12/2019] [Accepted: 10/30/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS The indications for carotid endarterectomy (CEA) are well established. The aim of the current study was to investigate sex and race-based disparities in the incidence of CEA after adjusting for carotid artery stenosis risk factors. METHODS We conducted a prospective cohort analysis of 14,492 black and white participants in the Atherosclerosis Risk in Communities (ARIC) study without prevalent stroke at baseline (1987-1989). We used Kaplan-Meier curves and Cox proportional hazards models adjusting for sociodemographic, cardiovascular, and disease severity risk factors to quantify the associations of sex and race with incident CEA. RESULTS CEA was performed in 330 of 14,492 ARIC participants during a median of 27 years of follow-up [incidence rate 1.00 (95% CI 0.90-1.12) per 1000 persons-years]. The crude incidence of CEA varied significantly by sex [female vs. male: HR 0.60 (95% CI 0.48-0.74)] and race [black vs. white: HR 0.65 (95% CI 0.49-0.86)]. Adjustment for sociodemographic and cardiovascular risk factors, carotid intima-media thickness, and symptomatic status attenuated the association of sex with CEA [females vs. males HR 0.96 (0.76-1.22)], but black participants had a lower risk of incident CEA after adjustment [HR 0.68 (95% CI 0.49-0.95)]. CONCLUSIONS We found significant variation in the incidence of CEA procedures based on race that was independent of traditional risk factors and carotid IMT. Whether this disparity is a reflection of differences in disease presentation or access to care deserves investigation.
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Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Natalie R Daya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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16
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Cerebral Small Vessel Disease Associated with Subclinical Vascular Damage Indicators in Asymptomatic Hypertensive Patients. Behav Sci (Basel) 2019; 9:bs9090091. [PMID: 31443428 PMCID: PMC6769830 DOI: 10.3390/bs9090091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/30/2019] [Accepted: 08/17/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Cerebral small vessel disease (CSVD) is frequent in patients with cardiovascular risk factors including arterial hypertension, and it is associated with vascular damage in other organs and the risk of stroke, cognitive impairment, and dementia. Early diagnosis of CSVD could prevent deleterious consequences. Objective: To characterize CSVD associated with indicators of subclinical vascular damage in asymptomatic hypertensive patients. Materials and Methods: Participants were hypertensive (HT) and non-hypertensive (non-HT) individuals; without signs of cerebrovascular disease, dementia, and chronic renal failure. For CSVD, white matter hyperintensities (WMH), enlarged Virchow-Robin perivascular spaces (EVRPS), lacunar infarcts, and microbleeds were investigated. Subclinical vascular damage was evaluated (hypertensive retinopathy, microalbuminuria, and extracranial carotid morphology: intima media thickness (IMT) and atheroma plaque). Results: CSVD MRI findings were more frequent in HT; as well as greater intimal thickening. The IMT + plaque was significantly associated with all MRI variables; but retinopathy was correlated with EVRPS and lacunar infarcts. Only microalbuminuria was related to the greater severity of WMH in HT. Multivariate analysis evidenced that CSVD was independently associated with the combination of indicators of vascular damage and systolic blood pressure. Conclusions: Combining indicators of subclinical vascular damage, such as carotid morphological variables, microalbuminuria, and hypertensive retinopathy for early detection of CSVD in asymptomatic hypertensive patients could prove to be useful to take actions for the prevention of irreversible brain damage, which could lead to cognitive impairment, dementia and stroke.
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17
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Kolkenbeck-Ruh A, Woodiwiss AJ, Monareng T, Sadiq E, Mabena P, Robinson C, Motau TH, Stevens B, Manyatsi N, Tiedt S, Dembskey R, Abdool-Carrim T, Veller M, Cassimjee I, Modi G, Hale M, Norton GR. Complementary Impact of Carotid Intima-Media Thickness With Plaque in Associations With Noncardiac Arterial Vascular Events. Angiology 2019; 71:122-130. [PMID: 31303025 DOI: 10.1177/0003319719862681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The ability of carotid intima-media thickness (IMT) to predict risk beyond plaque is controversial. In 952 participants (critical limb ischemia [CLI] or stroke, n = 473; community, n = 479), we assessed whether relationships with events for IMT complement the impact of plaque in young patients depending on the extent of thrombotic versus atherosclerotic disease. The extent of atherosclerotic versus thrombotic occlusion was determined in 54 patients with CLI requiring amputations. Thrombotic occlusion in CLI was associated with younger age (P < .0001) and less plaque (P = .02). Independent relations between plaque and CLI were noted in older (>50 years; P < .005 to <.0001) but not younger (P > .38) participants, while independent relations between plaque and stroke (P < .005 to <.0001) and between IMT and CLI (P < .0001) were noted in younger participants. Although in performance (area under the receiver operating curve) for event detection, IMT thresholds failed to add to plaque alone in older patients (0.680 ± 0.020 vs 0.664 ± 0.017, P = .27), IMT improved performance for combined stroke and CLI detection when added to plaque in younger patients (0.719 ± 0.023 vs 0.631 ± 0.026, P < .0001). Because in younger participants the high prevalence of thrombotic occlusion in CLI is associated with less plaque, IMT adds information in associations with arterial vascular events.
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Affiliation(s)
- Andrea Kolkenbeck-Ruh
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Talib Monareng
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eitzaz Sadiq
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philanathi Mabena
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chanel Robinson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshegofatso H Motau
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Belinda Stevens
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomvuyo Manyatsi
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Scott Tiedt
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Reinhard Dembskey
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Talib Abdool-Carrim
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Veller
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ismail Cassimjee
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Girish Modi
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Hale
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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18
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Parish S, Arnold M, Clarke R, Du H, Wan E, Kurmi O, Chen Y, Guo Y, Bian Z, Collins R, Li L, Chen Z. Assessment of the Role of Carotid Atherosclerosis in the Association Between Major Cardiovascular Risk Factors and Ischemic Stroke Subtypes. JAMA Netw Open 2019; 2:e194873. [PMID: 31150080 PMCID: PMC6547114 DOI: 10.1001/jamanetworkopen.2019.4873] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE A better understanding of the role of atherosclerosis in the development of ischemic stroke subtypes could help to improve strategies for prevention of stroke worldwide. OBJECTIVE To assess the role of carotid atherosclerosis in the association between major cardiovascular risk factors and ischemic stroke subtypes. DESIGN, SETTING, AND PARTICIPANTS The prospective China Kadoorie Biobank cohort study was conducted in the general population of 5 urban and 5 rural areas in China, with a baseline survey obtained between June 2004 and July 2008. A random sample of 23 973 participants with no history of cardiovascular disease at enrollment who had carotid artery ultrasonographic measurements recorded at a resurvey from September 2013 to June 2014 were included. Data analysis was performed from July 1, 2016, to April 10, 2019. EXPOSURES Major cardiovascular risk factors (ie, blood pressure [BP], blood lipid levels, smoking, and diabetes). MAIN OUTCOMES AND MEASURES Carotid ultrasonographic measures of plaque burden (derived from number and maximum size of carotid artery plaques at resurvey) and first ischemic stroke during follow-up (n = 952), with subtyping (data release, August 2018) as lacunar (n = 263), probable large artery (n = 193), probable cardioembolic (n = 66), or unconfirmed (n = 430). Associations between cardiovascular risk factors, carotid plaque burden, and ischemic stroke subtypes were adjusted for age, sex, and geographic area. RESULTS The 23 973 participants in the study had a mean (SD) age of 50.6 (10.0) years, and 14 833 (61.9%) were women. Systolic BP had a stronger association (odds ratio [OR] per SD, 1.51; 95% CI, 1.42-1.61) than plaque burden (OR per SD, 1.34; 95% CI, 1.26-1.44) with ischemic stroke, and the associations of systolic BP with each subtype of ischemic stroke were modestly attenuated by adjustment for plaque burden. After adjustment for BP, plaque burden had a stronger association with probable large artery stroke (OR, 1.43; 95% CI, 1.24-1.63) than with lacunar stroke (OR, 1.25; 95% CI, 1.10-1.43) but was not associated with probable cardioembolic stroke (OR, 1.06; 95% CI, 0.83-1.36). CONCLUSIONS AND RELEVANCE Although BP was an important risk factor for all ischemic stroke subtypes, carotid atherosclerosis was an important risk factor only for large artery and lacunar strokes, suggesting that drug treatments targeting atherosclerosis may reduce the risk of stroke subtypes to different extents.
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Affiliation(s)
- Sarah Parish
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Matthew Arnold
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Eric Wan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Om Kurmi
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Liming Li
- Chinese Academy of Medical Sciences, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Wang X, Li W, Song F, Wang L, Fu Q, Cao S, Gan Y, Zhang W, Yue W, Yan F, Shi W, Wang X, Zhang H, Zhang H, Wang Z, Lu Z. Carotid Atherosclerosis Detected by Ultrasonography: A National Cross-Sectional Study. J Am Heart Assoc 2018; 7:JAHA.118.008701. [PMID: 29622590 PMCID: PMC6015437 DOI: 10.1161/jaha.118.008701] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Carotid atherosclerosis (CA) is a reflector of generalized atherosclerosis that is associated with systemic vascular disease. Data are limited on the epidemiology of carotid lesions in a large, nationally representative population sample. We aimed to evaluate the prevalence of CA detected by carotid ultrasonography and related risk factors based on a national survey in China. Methods and Results A total of 107 095 residents aged ≥40 years from the China National Stroke Prevention Project underwent carotid ultrasound examination. Participants with carotid endarterectomy or carotid stenting and those with stroke or coronary heart disease were excluded. Data from 84 880 participants were included in the analysis. CA was defined as increased intima–media thickness (IMT) ≥1 mm or presence of plaques. Of the 84 880 participants, 46.4% were men, and the mean age was 60.7±10.3 years. The standardized prevalence of CA was 36.2% overall, increased with age, and was higher in men than in women. Prevalence of CA was higher among participants living in rural areas than in urban areas. Approximately 26.5% of participants had increased IMT, and 13.9% presented plaques. There was an age‐related increase in participants with increased IMT, plaque presence, and stenosis. In multiple logistic regression analysis, older age, male sex, residence in rural areas, smoking, alcohol consumption, physical inactivity, obesity, hypertension, diabetes mellitus, and dyslipidemia were associated with CA. Conclusions CA was highly prevalent in a middle‐aged and older Chinese population. This result shows the potential clinical importance of focusing on primary prevention of atherosclerosis progression.
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Affiliation(s)
- Xiaojun Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| | - Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| | - Fujian Song
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, United Kingdom
| | - Longde Wang
- The National Health and Family Commission, Beijing, China
| | - Qian Fu
- School of Medicine and Health Management, Tongji Medical College
| | - Shiyi Cao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| | - Wei Zhang
- Department of Medical Ultrasound, Tongji Hospital & Medical College
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Feng Yan
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wenhuan Shi
- Department of Science and Education, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Xiaoli Wang
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Hong Zhang
- Department of Science and Education, People's Hospital of Deyang City, Sichuan, China
| | - Hao Zhang
- Department of Neurology, Rizhao People's Hospital, Rizhao, Shandong, China
| | - Zhihong Wang
- Department of Neurosurgery, Shenzhen Second People's Hospital Shenzhen University, Shenzhen, Guangdong, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
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Huang XY, Fu WJ, Chen ZC, Mei ZZ, Yu YL, Fang HW, Huang YH, Lin H, Chen JJ, Wang MX, Guan SB, Lu WX, Chen XL. Association between FSP, CVHI, inflammatory cytokines and the incidence of primary stroke. J Clin Neurosci 2017; 45:265-269. [PMID: 28917588 DOI: 10.1016/j.jocn.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/12/2017] [Accepted: 08/06/2017] [Indexed: 11/24/2022]
Abstract
This case-control study was designed to establish a new risk-prediction model for primary stroke using Framingham stroke profile (FSP), cerebral vascular hemodynamic indexes (CVHI) and plasma inflammatory cytokines including hs-CRP, IL-6, TNF-α and Lp-PLA2. A total of 101 primary stroke patients admitted to Dongguan Houjie Hospital between August 2014 and June 2015 were assigned into the case group, and 156 age- and gender-matched healthy subjects from the Houjie Community were allocated into the control group. The prognostic values of FSP, CVHI and inflammatory cytokines including high sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and lipoprotein-associated phospholipase A2 (Lp-PLA2) were assessed by multivariate logistic regression analysis. Seven risk-prediction models (FSP, CVHI, inflammatory cytokine, FSP+CVHI, FSP+inflammatory cytokine, CVHI+inflammatory cytokine, CVHI+FSP+inflammatory cytokine) were successfully established and the prognostic values were statistically compared by ROC curve and Z test. For FSP, the stroke risk was significantly elevated by 2.85 times when the FSP score was increased by 1 level (P=0.043), increased by 3.25 times for CVHI (P=0.036), 6.53 times for IL-6 (P=0.003), and 7.75 times for Lp-PLA2 (P=0.000). The sensitivity of FSP+CVHI+inflammatory cytokine and CVHI+inflammatory cytokine models was higher than 90%. For model specificity, the specificity of FSP+CVHI+inflammatory cytokine model alone exceeded 90%. FSP, CVHI, IL-6 and Lp-PLA2 are independent risk factors of stroke. Integrating IL-6 and Lp-PLA2 into the models can significantly enhance the risk prediction accuracy of primary stroke. Combined application of FSP+CVHI+inflammatory cytokine is of potential for risk prediction of primary stroke.
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Affiliation(s)
- Xiao-Yun Huang
- Department of Neurology, The Affiliated Houjie Hospital, Guangdong Medical University, PR China.
| | - Wen-Jin Fu
- Department of Laboratory, The Affiliated Houjie Hospital, Guangdong Medical University, PR China
| | - Zhi-Chang Chen
- The Community Health Service Center of Houjie Town, Dongguan City, Guangdong Province, PR China
| | - Zhi-Zhong Mei
- Department of Neurology, The Affiliated Houjie Hospital, Guangdong Medical University, PR China
| | - Ying-Li Yu
- Department of Neurology, The Affiliated Houjie Hospital, Guangdong Medical University, PR China
| | - Hao-Wei Fang
- Department of Neurology, The Affiliated Houjie Hospital, Guangdong Medical University, PR China
| | - Yi-Hong Huang
- Department of Neurology, The Affiliated Houjie Hospital, Guangdong Medical University, PR China
| | - Han Lin
- Department of Neurology, The Affiliated Houjie Hospital, Guangdong Medical University, PR China
| | - Jian-Jun Chen
- Department of Neurology, The Affiliated Houjie Hospital, Guangdong Medical University, PR China
| | - Ming-Xia Wang
- Department of Neurology, The Affiliated Houjie Hospital, Guangdong Medical University, PR China
| | - Shao-Bing Guan
- Department of Neurology, The Affiliated Houjie Hospital, Guangdong Medical University, PR China
| | - Wan-Xian Lu
- Department of Neurology, The Affiliated Houjie Hospital, Guangdong Medical University, PR China
| | - Xiao-Ling Chen
- Department of Neurology, The Affiliated Houjie Hospital, Guangdong Medical University, PR China
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Clarke R, Du H, Kurmi O, Parish S, Yang M, Arnold M, Guo Y, Bian Z, Wang L, Chen Y, Meijer R, Sansome S, McDonnell J, Collins R, Li L, Chen Z. Burden of carotid artery atherosclerosis in Chinese adults: Implications for future risk of cardiovascular diseases. Eur J Prev Cardiol 2017; 24:647-656. [PMID: 28128654 DOI: 10.1177/2047487317689973] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Population-based studies of ultrasound measures of carotid atherosclerosis are informative about future risks of cardiovascular disease. Design Cross-sectional studies of carotid artery atherosclerosis in 24,822 Chinese adults from the China Kadoorie Biobank and 2579 Europeans from the UK Biobank. Methods Mean intima-media thickness of the common carotid arteries and presence of carotid artery plaque were examined in the China Kadoorie Biobank study. The carotid intima-media thickness (cIMT) findings in Chinese (mean age 59 years) were compared with a European population (mean age 62 years). Results Overall, the mean cIMT in Chinese was 0.70 mm (SD 0.16) and increased with age by 0.08 mm (SE 0.008) per 10-years older age. About 31% of the Chinese had carotid plaques and the prevalence varied 10-fold with age (6% at 40-49 to 63% at 70-89 years) and four-fold by region (range, 14%-57%). After adjustment for age, sex and region, plaque prevalence was higher in smokers than in non-smokers (36% vs. 28%) and two-fold higher in individuals with systolic blood pressure ≥160 mmHg than those with systolic blood pressure <120 mmHg (44% vs. 22%) in the China Kadoorie Biobank study. Mean cIMT was similar in the younger Chinese and European adults, but increased more steeply with age in the Chinese ( p = 0.002). Conclusions About one-third of Chinese adults had carotid plaques. The rate of progression of carotid atherosclerosis with age was more extreme in the Chinese compared with the European population, highlighting the need for more intensive strategies for cardiovascular disease prevention in China.
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Affiliation(s)
- Robert Clarke
- 1 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Huaidong Du
- 1 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK.,2 MRC Population Health Research Unit, University of Oxford, UK
| | - Om Kurmi
- 1 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Sarah Parish
- 1 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK.,2 MRC Population Health Research Unit, University of Oxford, UK
| | - Meng Yang
- 3 Division of Ultrasound Diagnosis, Peking Union Medical College Hospital, Beijing, China
| | - Matthew Arnold
- 1 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Yu Guo
- 4 Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- 4 Chinese Academy of Medical Sciences, Beijing, China
| | - Liang Wang
- 3 Division of Ultrasound Diagnosis, Peking Union Medical College Hospital, Beijing, China
| | - Yuexin Chen
- 5 Centre of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Rudy Meijer
- 6 Department of Radiology, University Medical Centre Utrecht, The Netherlands
| | - Sam Sansome
- 1 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - John McDonnell
- 1 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Rory Collins
- 1 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Liming Li
- 4 Chinese Academy of Medical Sciences, Beijing, China.,7 Department of Epidemiology and Statistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Zhengming Chen
- 1 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK.,2 MRC Population Health Research Unit, University of Oxford, UK
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Dai Y, Lv P, Lin J, Luo R, Liu H, Ji A, Liu H, Fu C. Comparison study between multicontrast atherosclerosis characterization (MATCH) and conventional multicontrast MRI of carotid plaque with histology validation. J Magn Reson Imaging 2016; 45:764-770. [PMID: 27556726 DOI: 10.1002/jmri.25444] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To compare Multicontrast ATherosclerosis Characterization (MATCH) with conventional multicontrast magnetic resonance imaging (MRI) in the characterization and quantification of carotid plaque components. MATERIALS AND METHODS Fifty-three consecutive patients underwent carotid plaque 3.0T MRI including conventional multicontrast sequences and MATCH, with 13 of them having carotid endarterectomy for histology validation. The detection of major plaque components including lipid-rich necrotic core (LRNC), loose matrix (LM), intraplaque hemorrhage (IPH), and calcification (CA) and measurement of lumen area, outer wall area, normalized wall index (NWI), and plaque components areas were compared between the two protocols. RESULTS Plaque analysis and comparison were done on 298 matched cross-sectional MRI. MATCH detected significantly more calcifications than conventional consequences (P < 0.01). The difference in detection of IPH (P = 0.07) and LRNC (P = 0.10) approached significance. There was no significant difference in demonstration of LM (P =0.52). A larger area of IPH and CA was measured on MATCH (P < 0.01). The difference nearly reached significance between the two protocols in measuring lumen area (P = 0.09) and outer wall area (P = 0.08). No significant difference was found when measuring the mean area of LRNC (P = 0.15) and LM (P = 0.14) and NWI (P = 0.38). By using receiver operating characteristic curve (ROC) analysis, the accuracy of MATCH and conventional protocols did not differ significantly in the detection of IPH (P = 0.15), LRNC (P = 0.61), LM (P = 0.48), and CA (P = 0.11) when histology served as a reference. CONCLUSION MATCH was comparable if not superior to conventional protocol in identification and quantification of major carotid plaque components. LEVEL OF EVIDENCE 1 J. Magn. Reson. Imaging 2017;45:764-770.
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Affiliation(s)
- Yuanyuan Dai
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Peng Lv
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hao Liu
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Aihua Ji
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Hui Liu
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Caixia Fu
- Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
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Saba L, Araki T, Kumar PK, Rajan J, Lavra F, Ikeda N, Sharma AM, Shafique S, Nicolaides A, Laird JR, Gupta A, Suri JS. Carotid inter-adventitial diameter is more strongly related to plaque score than lumen diameter: An automated tool for stroke analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:210-220. [PMID: 26887355 DOI: 10.1002/jcu.22334] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/27/2015] [Accepted: 12/31/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To compare the strength of correlation between automatically measured carotid lumen diameter (LD) and interadventitial diameter (IAD) with plaque score (PS). METHODS Retrospective study on a database of 404 common carotid artery B-mode sonographic images from 202 diabetic patients. LD and IAD were computed automatically using an advanced computerized edge detection method and compared with two distinct manual measurements. PS was computed by adding the maximal thickness in millimeters of plaques in segments taken from the internal carotid artery, bulb, and common carotid artery on both sides. RESULTS The coefficient of correlation was 0.19 (p < 0.007) between LD and PS, and 0.25 (p < 0.0006) between IAD and PS. After excluding 10 outliers, coefficient of correlation was 0.25 (p < 0.0001) between LD and PS, and 0.38 (p < 0.0001) between IAD and PS. The precision of merit of automated versus the two manual measurements was 96.6% and 97.2% for LD, and 97.7% and 98.1%, for IAD, respectively. CONCLUSIONS Our automated measurement system gave satisfying results in comparison with manual measurements. Carotid IAD was more strongly correlated to PS than carotid LD in this population sample of Japanese diabetic patients.
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Affiliation(s)
- Luca Saba
- Department of Radiology, University of Cagliari, Italy
| | - Tadashi Araki
- Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan
| | - P Krishna Kumar
- Department of Computer Science and Engineering, National Institute of Technology, Karnataka, India
- Point-of-Care Devices, Global Biomedical Technologies, Inc, Roseville, CA
| | - Jeny Rajan
- Department of Computer Science and Engineering, National Institute of Technology, Karnataka, India
- Point-of-Care Devices, Global Biomedical Technologies, Inc, Roseville, CA
| | | | - Nobutaka Ikeda
- Cardiovascular Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Aditya M Sharma
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, VA
| | | | | | - John R Laird
- UC Davis Vascular Center, University of California, Davis, CA
| | - Ajay Gupta
- Radiology Department, Brain and Mind Research Institute, Weill Cornell Medical College, NY
| | - Jasjit S Suri
- Point-of-Care Devices, Global Biomedical Technologies, Inc, Roseville, CA
- Monitoring and Diagnostic Division, AtheroPoint, Roseville, CA
- Department of Electrical Engineering, University of Idaho (Affl.), ID
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Li Y, Liu N, Huang Y, Wei W, Chen F, Zhang W. Risk Factors for Silent Lacunar Infarction in Patients with Transient Ischemic Attack. Med Sci Monit 2016; 22:447-53. [PMID: 26864634 PMCID: PMC4754089 DOI: 10.12659/msm.895759] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Lacunar infarctions represent 25% of ischemic strokes. Lacunar stroke and transient ischemic attack (TIA) share a number of symptoms. This study aimed to assess the potential risk factors for lacunar infarction in patients with TIA. Material/Methods This was a retrospective study performed at the Beijing Military General Hospital in patients with TIA admitted between March 2010 and December 2011. Patients were grouped according to lacunar vs. no lacunar infarction. All patients were diagnosed using diffusion-weighted imaging (DWI) on brain magnetic resonance imaging (MRI). Brain angiography (computed tomography and MRI) was used to measure intracranial stenosis. Carotid artery stenosis was measured by ultrasound. Results Patients with TIA and lacunar infarction (n=298) were older than those without lacunar infarction (n=157) (69.4±10.0 vs. 58.9±9.0 years, P<0.001) and showed a higher frequency of males (51.7% vs. 41.4%, P=0.037), hypertension (75.3% vs. 45.9%, P<0.001), diabetes (32.6% vs. 21.0%, P=0.010), hyperlipidemia (53.4% vs. 29.3%, P<0.001), carotid stenosis (73.2% vs. 40.1%, P<0.001), and intracranial stenosis (55.6% vs. 31.9%, P<0.001), but a lower frequency of alcohol drinking (8.1% vs. 14.0%, P=0.045). Lacunar infarction mostly involved the anterior circulation (62.8%). Multivariate analysis showed that age (odds ratio (OR)=1.085, 95% confidence interval (95%CI): 1.054–1.117, P<0.001), hypertension (OR=1.738, 95%CI: 1.041–2.903, P=0.035), hyperlipidemia (OR=2.169, 95%CI: 1.307–3.601, P=0.003), and carotid stenosis (OR=1.878, 95%CI: 1.099–3.206, P=0.021) were independently associated with lacunar infarction. Conclusions Age, hypertension, hyperlipidemia, and carotid stenosis were independently associated with silent lacunar infarction in patients with TIA.
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Affiliation(s)
- Ying Li
- Postgraduate School, The Third Millitary Medical University, Chongqing, China (mainland)
| | - Nan Liu
- Postgraduate School, Third Military Medical University, Chongqing, China (mainland)
| | - Yonghua Huang
- Department of Neurology, Beijing Military General Hospital, Beijing, China (mainland)
| | - Wei Wei
- Department of Neurology, Beijing Military General Hospital, Beijing, China (mainland)
| | - Fei Chen
- Department of Neurology, Beijing Military 254 Hospital, Tianjin, China (mainland)
| | - Weiwei Zhang
- Department of Neurology, Beijing Military General Hospital, Beijing, China (mainland)
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Tong LS, Hu HT, Zhang S, Yan SQ, Lou M. Statin withdrawal beyond acute phase affected outcome of thrombolytic stroke patients: an observational retrospective study. Medicine (Baltimore) 2015; 94:e779. [PMID: 25929921 PMCID: PMC4603028 DOI: 10.1097/md.0000000000000779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Statin withdrawal is associated with deleterious outcome on stroke patients. Whether risk changes over time, depends on concomitant treatment of intravenous thrombolysis, or both remains to be clarified. We assessed the influence of statin withdrawal within 3 weeks while initiated in acute phase (72 hours) among patients receiving intravenous thrombolysis.This was a monocentered retrospective observational study enrolling intravenous thrombolytic stroke patients from June 2009 to May 2014. Consecutive patients were distinguished into 3 groups according to the initiation and withdrawal of statin: the reference group (not received statin in 72 hours after stroke onset); the continued group (initiated statin therapy in 72 hours and continued for at least 3 weeks); the withdrawal group (initiated statin in 72 hours and discontinued within 3 weeks). All reasons for cessation were recorded. The effects of statin withdrawal on short-, mid-, and long-term outcomes were evaluated as neurologic improvement (NIH Stroke Scale [NIHSS] score improvement ≥4 from baseline or later NIHSS = 0), death or poor outcome (modified Rankin Scale [mRS] ≥4), and favorable outcome (mRS ≤2). We further evaluate statin withdrawal effects in cardioembolic stroke patients for these outcomes.Among 443 IVT patients enrolled, 367 were included in the final study population. There were 88, 188, and 91 patients in the reference, continued, and withdrawal groups, respectively. Multivariable logistic regression showed that statin withdrawal compared with the reference was related to a lower possibility of long-term favorable outcome (OR = 0.45, 95% CI [0.22, 0.90], P = 0.024). Compared with the continued group, the adjusted OR of statin withdrawal was 0.40 (95% CI [0.22, 0.72], P = 0.002) and 2.52 (95% CI [1.34, 4.75], P = 0.004) for long-term favorable and poor/death outcomes, respectively. Also, results were similar for cardioembolic stroke patients (OR = 0.35, 95% CI [0.14, 0.89], P = 0.027 of favorable outcome and OR = 3.62, 95% CI [1.37, 9.62], P = 0.010 of poor/death outcome).In a real-world setting, for stroke patients receiving intravenous thrombolysis, statin withdrawal within 3 weeks initiating in 72 hours may have a harmful effect on the long-term neurologic outcome, even in cardioembolic stroke patients.
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Affiliation(s)
- Lu-Sha Tong
- From the Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Rosvall M, Persson M, Östling G, Nilsson P, Melander O, Hedblad B, Engström G. Risk factors for the progression of carotid intima-media thickness over a 16-year follow-up period: The Malmö Diet and Cancer Study. Atherosclerosis 2015; 239:615-21. [DOI: 10.1016/j.atherosclerosis.2015.01.030] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/09/2015] [Accepted: 01/27/2015] [Indexed: 12/24/2022]
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Hermann DM, Lehmann N, Gronewold J, Bauer M, Mahabadi AA, Weimar C, Berger K, Moebus S, Jöckel KH, Erbel R, Kälsch H. Thoracic aortic calcification is associated with incident stroke in the general population in addition to established risk factors. Eur Heart J Cardiovasc Imaging 2014; 16:684-90. [PMID: 25550362 DOI: 10.1093/ehjci/jeu293] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/26/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS The aorta is a major source of cerebral thromboembolism, but its role in stroke pathogenesis is not well understood due to its poor accessibility for non-invasive imaging. We examined whether thoracic aortic calcification (TAC), a marker of aortic plaque load, is associated with stroke in addition to established risk factors. METHODS AND RESULTS A total of 3930 subjects from the population-based Heinz Nixdorf Recall study (45-75 years; 47.1% men) without previous stroke, coronary heart disease, or myocardial infarction were evaluated for incident stroke events over 109.0 ± 23.3 months. Cox proportional hazards regressions were used to examine associations with stroke of TAC in addition to established risk factors (age, sex, systolic blood pressure, LDL, HDL, diabetes, and smoking) and coronary artery calcification (CAC). 101 incident strokes occurred during the follow-up period. Subjects suffering a stroke had significantly higher TAC values at baseline than the remaining subjects (median = 83.1 [Q1;Q3 = 4.7;472.9] vs. 15.7 [0.0;117.1]; P < 0.001). In a multivariable Cox proportional hazards regression, log(TAC + 1) (hazards ratio [HR] = 1.09 [95% confidence interval = 1.00-1.19]; P = 0.044) was associated with stroke in addition to established risk factors. Further analyses revealed that log(DTAC + 1), i.e. calcification of the descending aorta (1.11 [1.02-1.20]; P = 0.016), but not log(ATAC + 1), i.e. calcification of the ascending aorta (1.02 [0.93-1.11]; P = 0.713), was associated with stroke. The HR for log(TAC + 1) decreased to 1.06 (0.97-1.16; P = 0.202), when log(CAC + 1) was also inserted into multivariable analyses. CONCLUSION Calcification of the thoracic aorta, more specifically its descending segment, is associated with incident stroke in addition to established risk factors. CAC outperforms aortic calcification as a stroke predictor.
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Affiliation(s)
- Dirk M Hermann
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany
| | - Nils Lehmann
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen Essen, Germany
| | - Janine Gronewold
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany
| | - Marcus Bauer
- Department of Cardiology, University Hospital Essen, Essen, Germany
| | - Amir A Mahabadi
- Department of Cardiology, University Hospital Essen, Essen, Germany
| | - Christian Weimar
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Susanne Moebus
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen Essen, Germany
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen Essen, Germany
| | - Raimund Erbel
- Department of Cardiology, University Hospital Essen, Essen, Germany
| | - Hagen Kälsch
- Department of Cardiology, University Hospital Essen, Essen, Germany
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Moghtaderi A, Sanei-Sistani S, Abdollahi G, Dahmardeh H. Comparison of intima-media thickness of common and internal carotid arteries of patients with ischemic stroke and intracerebral hemorrhage. IRANIAN JOURNAL OF NEUROLOGY 2014; 13:226-30. [PMID: 25632335 PMCID: PMC4300798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 08/30/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Role of atherosclerosis in the pathogenesis of ischemic and hemorrhagic infarctions is still matter of debate. Intima-media thickness (IMT) of the common carotid artery (CCA) and internal carotid artery (ICA) are markers of atherosclerosis. The aim of this study was to compare CCA IMT and ICA IMT of patients with ischemic and hemorrhagic infarction. METHODS Two equal groups of 80 patients with small and large vessel ischemic stroke and 80 patients with non-traumatic intracerebral hemorrhage (ICH) who referred to our central teaching hospital of Zahedan were assessed in this descriptive study. IMT of four arteries (right and left CCA and ICA) were measured, and collected data were analysis using Student's t-test. RESULTS There were 137 males (57.1%) and 103 (42.9%) female with mean age of 62.7 ± 11.7. Mean right CCA IMT of patients with small vessel diseases (SVD), large vessel diseases (LVD), and ICH were 0.564 ± 0.130, 0.623 ± 0.150, and 0.580 ± 0.140 mm, respectively (P = 0.032). Mean left CCA IMT of patients with SVD, LVD, and ICH were 0.569 ± 0.120, 0.618 ± 0.120, and 0.573 ± 0.130 mm, respectively (P = 0.039). The above findings for right ICA were 0.572 ± 0.120, 0.569 ± 0.140, and 0.522 ± 0.130 mm, respectively (P = 0.145). Those findings for left ICA IMT were 0.525 ± 0.110, 0.554 ± 0.120, and 0.527 ± 0.120 mm, respectively (P = 0.257). CONCLUSION Our findings showed that by using CCA IMT, differentiation between small and large vessel infarctions and hemorrhagic infarctions can be made.
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Affiliation(s)
- Ali Moghtaderi
- Department of Neurology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sharareh Sanei-Sistani
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ghassem Abdollahi
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamid Dahmardeh
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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29
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Ferket BS, van Kempen BJH, Wieberdink RG, Steyerberg EW, Koudstaal PJ, Hofman A, Shahar E, Gottesman RF, Rosamond W, Kizer JR, Kronmal RA, Psaty BM, Longstreth WT, Mosley T, Folsom AR, Hunink MGM, Ikram MA. Separate prediction of intracerebral hemorrhage and ischemic stroke. Neurology 2014; 82:1804-12. [PMID: 24759844 DOI: 10.1212/wnl.0000000000000427] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES To develop and validate 10-year cumulative incidence functions of intracerebral hemorrhage (ICH) and ischemic stroke (IS). METHODS We used data on 27,493 participants from 3 population-based cohort studies: the Atherosclerosis Risk in Communities Study, median age 54 years, 45% male, median follow-up 20.7 years; the Rotterdam Study, median age 68 years, 38% male, median follow-up 14.3 years; and the Cardiovascular Health Study, median age 71 years, 41% male, median follow-up 12.8 years. Among these participants, 325 ICH events, 2,559 IS events, and 9,909 nonstroke deaths occurred. We developed 10-year cumulative incidence functions for ICH and IS using stratified Cox regression and competing risks analysis. Basic models including only established nonlaboratory risk factors were extended with diastolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, body mass index, waist-to-hip ratio, and glomerular filtration rate. The cumulative incidence functions' performances were cross-validated in each cohort separately by Harrell C-statistic and calibration plots. RESULTS High total cholesterol/high-density lipoprotein cholesterol ratio decreased the ICH rates but increased IS rates (p for difference across stroke types <0.001). For both the ICH and IS models, C statistics increased more by model extension in the Atherosclerosis Risk in Communities and Cardiovascular Health Study cohorts. Improvements in C statistics were reproduced by cross-validation. Models were well calibrated in all cohorts. Correlations between 10-year ICH and IS risks were moderate in each cohort. CONCLUSIONS We developed and cross-validated cumulative incidence functions for separate prediction of 10-year ICH and IS risk. These functions can be useful to further specify an individual's stroke risk.
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Affiliation(s)
- Bart S Ferket
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Bob J H van Kempen
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Renske G Wieberdink
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Ewout W Steyerberg
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Peter J Koudstaal
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Albert Hofman
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Eyal Shahar
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Rebecca F Gottesman
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Wayne Rosamond
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Jorge R Kizer
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Richard A Kronmal
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Bruce M Psaty
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - W T Longstreth
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Thomas Mosley
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - Aaron R Folsom
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - M G Myriam Hunink
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA
| | - M Arfan Ikram
- From the Departments of Epidemiology (B.S.F., B.J.H.v.K., R.G.W., A.H., M.G.M.H., M.A.I.), Radiology (B.S.F., B.J.H.v.K., M.G.M.H., M.A.I.), Neurology (R.G.W., P.J.K., M.A.I.), and Public Health (E.W.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Epidemiology and Biostatistics (E.S.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (W.R.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Medicine, and Department of Epidemiology of Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, NY; Departments of Biostatistics (R.A.K.), Neurology (W.T.L.), and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, WA; Departments of Medicine (Geriatrics) and Neurology (T.M.), University of Mississippi Medical Center, Jackson; Division of Epidemiology and Community Health (A.R.F.), University of Minnesota, Minneapolis; and Department of Health Policy and Management (M.G.M.H.), Harvard School of Public Health, Boston, MA.
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Gutierrez J, Koch S, Dong C, Casanova T, Modir R, Katsnelson M, Ortiz GA, Sacco RL, Romano JG, Rundek T. Racial and ethnic disparities in stroke subtypes: a multiethnic sample of patients with stroke. Neurol Sci 2013; 35:577-82. [PMID: 24122024 DOI: 10.1007/s10072-013-1561-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/03/2013] [Indexed: 10/26/2022]
Abstract
Stroke subtypes have been reported to differ by race and ethnic subgroups and have not been adequately explained. We aim to evaluate if the prevalence of vascular risk factors accounts for differences observed in stroke subtypes by race/ethnicity. Patients with acute stroke were prospectively enrolled in the Miami Stroke Registry. Patients' demographic, clinical and radiological characteristics were systematically collected. Stroke subtypes were ascertained using TOAST criteria. The sample was divided into Non-Hispanic Whites (NHW), Hispanics, African Americans (AA), and Non-Hispanic Black Caribbean (NHBC). Univariable and multivariable logistic regression analyses were performed to assess differences among groups. Among 473 stroke patients (mean age 64 ± 14 years; 63.7% were men) of which 52.9% were Hispanic, 22.6% were AA, 13.5% NHBC and 11.0% were NHW. Large artery atherosclerosis was more prevalent in NHBC (OR 1.74, 95% CI 1.02-2.97) than in the other groups. Adjusting for covariates rendered the association not significant (OR 1.71, 95% CI 0.93-3.16). Cardioembolism was more frequent in Hispanics (OR 1.94, 95% CI 1.28-2.96) and NHW (OR 2.66, 95% CI 1.42-4.96) as compared to NHBC and AA combined. Adjusting for covariates, the association was no longer significant for Hispanics but was further strengthened for NHW (OR 3.02, 95% CI 1.42-6.42). Our results suggest that the vascular risk factors prevalence among different racial and ethnic groups partially explains disparities found in the prevalence of some stroke subtypes. Addressing health disparities remains an important public health aspect of stroke prevention.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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Affiliation(s)
- Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, TX (V.N., G.B., C.M.B.)
- The Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX (V.N., G.B., C.M.B.)
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (V.N.)
- Ben Taub General Hospital, Houston, TX (V.N.)
| | - Gerd Brunner
- Department of Medicine, Baylor College of Medicine, Houston, TX (V.N., G.B., C.M.B.)
- The Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX (V.N., G.B., C.M.B.)
| | - Christie M. Ballantyne
- Department of Medicine, Baylor College of Medicine, Houston, TX (V.N., G.B., C.M.B.)
- The Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX (V.N., G.B., C.M.B.)
- Correspondence to: Christie M. Ballantyne, MD, FACC, FACP, FNLA, 6565 Fannin St., MS‐A601, Houston, TX 77030. E‐mail:
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Hermann DM, Gronewold J, Lehmann N, Moebus S, Jöckel KH, Bauer M, Erbel R. Coronary artery calcification is an independent stroke predictor in the general population. Stroke 2013; 44:1008-13. [PMID: 23449263 DOI: 10.1161/strokeaha.111.678078] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Coronary artery calcification (CAC) is a noninvasive marker of plaque load that predicts myocardial infarcts in the general population. Herein, we investigated whether CAC predicts stroke events in addition to established risk factors that are part of the Framingham risk score. METHODS A total of 4180 subjects from the population-based Heinz Nixdorf Recall study (45-75 years of age; 47.1% men) without previous stroke, coronary heart disease, or myocardial infarction were evaluated for stroke events over 94.9 ± 19.4 months. Cox proportional hazards regressions were used to examine CAC as stroke predictor in addition to established vascular risk factors (age, sex, systolic blood pressure, low-density lipoprotein, high-density lipoprotein, diabetes mellitus, smoking, and atrial fibrillation). RESULTS Ninety-two incident strokes occurred (82 ischemic, 10 hemorrhagic). Subjects suffering a stroke had significantly higher CAC values at baseline than the remaining subjects (median, 104.8[Q1;Q3, 14.0;482.2] vs 11.2[0;106.2]; P<0.001). In a multivariable Cox regression, log10(CAC+1) was an independent stroke predictor (hazards ratio, 1.52 [95% confidence interval, 1.19-1.92]; P=0.001) in addition to age (1.35 per 5 years [1.15-1.59]; P<0.001), systolic blood pressure (1.25 per 10 mm Hg [1.14-1.37]; P<0.001), and smoking (1.75 [1.07-2.87]; P=0.025). CAC predicted stroke in men and women, particularly in subjects <65 years of age and independent of atrial fibrillation. CAC discriminated stroke risk specifically in participants belonging to the low (<10%) and intermediate (10%-20%) Framingham risk score categories. CONCLUSIONS CAC is an independent stroke predictor in addition to classical risk factors in subjects at low or intermediate vascular risk.
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Affiliation(s)
- Dirk M Hermann
- Department of Neurology, University Hospital Essen, Essen, Germany.
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Autenrieth CS, Evenson KR, Yatsuya H, Shahar E, Baggett C, Rosamond WD. Association between physical activity and risk of stroke subtypes: the atherosclerosis risk in communities study. Neuroepidemiology 2012; 40:109-16. [PMID: 23095721 DOI: 10.1159/000342151] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 07/21/2012] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The relationship between stroke subtypes and physical activity is unclear. METHODS Using data from 13,069 men and women aged 45-64 years who participated in the Atherosclerosis Risk in Communities Study, physical activity was assessed by self-report using the Baecke questionnaire at baseline (1987-1989). The American Heart Association's ideal cardiovascular health guidelines served as a basis for the calculation of three physical activity categories: poor, intermediate, and ideal. Stroke and its subtypes were ascertained from physician review of medical records. Multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox regression models. RESULTS During a median follow-up of 18.8 years, a total of 648 incident ischemic strokes occurred. Significant inverse associations were found between physical activity categories and total, total ischemic, and nonlacunar stroke in adjusted models (age, sex, race-center, education, cigarette-years). Compared with poor physical activity, the adjusted HR (95% CI) for ideal physical activity were 0.78 (0.62-0.97) for total, 0.76 (0.59-0.96) for total ischemic, 0.85 (0.51-1.40) for lacunar, 0.77 (0.47-1.27) for cardioembolic, and 0.71 (0.51-0.99) for nonlacunar stroke. Additional adjustments for waist-to-hip ratio, systolic blood pressure, antihypertensive medication, diabetes, left ventricular hypertrophy and laboratory parameters attenuated the HR. Further sex- and race-specific analyses revealed that the association was predominantly observed among males and among African-Americans. CONCLUSION These data suggest a tendency toward a reduced risk of total, total ischemic, and nonlacunar stroke with higher levels of physical activity.
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Affiliation(s)
- Christine S Autenrieth
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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Hsieh CY, Lai ECC, Yang YHK, Lin SJ. Comparative stroke risk of antiepileptic drugs in patients with epilepsy. Epilepsia 2012; 54:172-80. [PMID: 23030457 DOI: 10.1111/j.1528-1167.2012.03693.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Patients with epilepsy have higher stroke-related morbidity and mortality, leading to the suspicion that the increased stroke events may be associated with antiepileptic drug (AED) exposure. We evaluated the comparative risk of stroke in adult patients with epilepsy receiving phenytoin (PHT), valproic acid (VPA), or carbamazepine (CBZ) to help determine the stroke risk for Asian patients with specific AED exposure. METHODS We conducted a population-based, retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD). The cohort consists of adult patients with epilepsy who were new to PHT, CBZ, or VPA monotherapy and without prior stroke history. Patients were followed for 5 years. The event of interest was a hospitalization or emergency visit due to stroke. Cox proportional hazard models were used to estimate the comparative risk of AEDs. Subanalyses included an evaluation of different subtypes of stroke, the propensity score matched technique, the intention-to-treat approach, and stratification analyses. KEY FINDINGS Patients receiving PHT had a significantly higher stroke risk (adjusted hazard ratio [HR] 1.72; 95% confidence interval [CI] 1.20-2.47), followed by VPA (adjusted HR 1.27; 95% CI 0.78-2.07), when compared with CBZ. The results of all subanalyses showed a consistent trend of higher stroke risk with PHT use. In addition, there appeared to be a dose-response relationship between stroke risk and PHT prescriptions. SIGNIFICANCE The stroke risk was higher in PHT but not significantly different in VPA as compared to CBZ. Physicians should reconsider using PHT for patients with epilepsy who already have a higher risk of stroke.
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Affiliation(s)
- Cheng-Yang Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
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Fava C, Montagnana M, Guidi GC, Melander O. From circulating biomarkers to genomics and imaging in the prediction of cardiovascular events in the general population. Ann Med 2012; 44:433-47. [PMID: 21623699 DOI: 10.3109/07853890.2011.582511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. In the last decades numerous markers have been considered and investigated for the prediction of CV events, but only a few of them resulted in improved global risk assessment beyond traditional risk factors when incorporated into coronary evaluation scores. Recent genetic studies have pointed out a few but consistent loci or genes which are independently associated with CV risk. The idea is fascinating that these genetic markers could lead to improved individual CV risk assessment and tailored pharmacological interventions. In this brief review we will not make a systematic review of all non-genetic and genetic markers of CV risk but we will try to make a brief overview of the most interesting ones with the aim to underline potential 'pros' and 'cons' of their implementation in clinical practice.
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Affiliation(s)
- Cristiano Fava
- Department of Clinical Sciences, Lund University, University Hospital of Malmö, Sweden
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Whincup PH, Nightingale CM, Owen CG, Rapala A, Bhowruth DJ, Prescott MH, Ellins EA, Donin AS, Masi S, Rudnicka AR, Sattar N, Cook DG, Deanfield JE. Ethnic differences in carotid intima-media thickness between UK children of black African-Caribbean and white European origin. Stroke 2012; 43:1747-54. [PMID: 22569936 PMCID: PMC7612306 DOI: 10.1161/strokeaha.111.644955] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 03/14/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE UK black African-Caribbean adults have higher risks of stroke than white Europeans and have been shown to have increased carotid intima-media thickness (cIMT). We examined whether corresponding ethnic differences in cIMT were apparent in childhood and, if so, whether these could be explained by ethnic differences in cardiovascular risk markers. METHODS We conducted a 2-stage survey of 939 children (208 white European, 240 black African-Caribbean, 258 South Asian, 63 other Asian, 170 other ethnicity), who had a cardiovascular risk assessment and measurements of cIMT at mean ages of 9.8 and 10.8 years, respectively. RESULTS Black African-Caribbean children had a higher cIMT than white Europeans (mean difference, 0.014 mm; 95% CI, 0.008-0.021 mm; P<0.0001). cIMT levels in South Asian and other Asian children were however similar to those of white Europeans. Among all children, cIMT was positively associated with age, systolic and diastolic blood pressure and inversely with combined skinfold thickness and serum triglyceride. Mean triglyceride was lower among black African-Caribbeans than white Europeans; blood pressure and skinfold thickness did not differ appreciably. However, adjustment for these risk factors had little effect on the cIMT difference between black African-Caribbeans and white Europeans. CONCLUSIONS UK black African-Caribbean children have higher cIMT levels in childhood; the difference is not explained by conventional cardiovascular risk markers. There may be important opportunities for early cardiovascular prevention, particularly in black African-Caribbean children.
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Affiliation(s)
- Peter H Whincup
- Population Health Research Centre, Division of Population Health Sciences and Education, St George's, University of London, Cranmer Terrace, London, UK SW17 ORE.
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Hermann DM, Gronewold J, Lehmann N, Seidel UK, Möhlenkamp S, Weimar C, Kälsch H, Moebus S, Jöckel KH, Erbel R, Bauer M. Intima-media thickness predicts stroke risk in the Heinz Nixdorf Recall study in association with vascular risk factors, age and gender. Atherosclerosis 2012; 224:84-9. [PMID: 22809448 DOI: 10.1016/j.atherosclerosis.2012.06.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 04/16/2012] [Accepted: 06/13/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Individual risk stratification requires reliable information on preexisting vascular disease. The intima-media thickness of the common carotid artery (CIMT) is a non-invasively accessible marker of atherosclerosis, which can be used for risk evaluation. METHODS In a sample of 3669 initially stroke-free subjects aged 45-75 years belonging to the population-based Heinz Nixdorf Recall cohort, the predictive value of CIMT for incident stroke was evaluated over 85.3 ± 17.4 months in addition to established risk factors. RESULTS In a multivariable Cox regression analysis with traditional cardiovascular risk factors including age, gender, systolic blood pressure, LDL and HDL, diabetes, body mass index, smoking and CIMT, CIMT was a moderate stroke predictor (hazard ratio = 1.20 per 0.1 mm, 95% confidence interval = 1.01-1.44; p = 0.043), additional to e.g. age (1.46 per 5 years, 1.21-1.75; p < 0.001), systolic blood pressure (1.16 per 10 mm Hg, 1.04-1.30; p = 0.008) and current smoking (1.93, 1.12-3.31; p = 0.014). CIMT was associated with stroke risk in subjects above but not below 65 years. CIMT predicted stroke events in men, but not women. CIMT discriminated stroke incidence specifically in subjects belonging to the highest Framingham risk score tercile. CONCLUSIONS CIMT is a moderate independent stroke predictor, which discriminates stroke incidence in subjects at high vascular risk.
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Affiliation(s)
- Dirk M Hermann
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany.
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Associations of anger, anxiety, and depressive symptoms with carotid arterial wall thickness: the multi-ethnic study of atherosclerosis. Psychosom Med 2012; 74:517-25. [PMID: 22511725 PMCID: PMC4966673 DOI: 10.1097/psy.0b013e31824f6267] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Carotid arterial wall thickness, measured as intima-media thickness (IMT), is an early subclinical indicator of cardiovascular disease. Few studies have investigated the association of psychological factors with IMT across multiple ethnic groups and by sex. METHODS We included 6561 men and women (2541 whites, 1790 African Americans, 1436 Hispanics, and 794 Chinese) aged 45 to 84 years who took part in the first examination of the Multi-Ethnic Study of Atherosclerosis. Associations of trait anger, trait anxiety, and depressive symptoms with mean values of common carotid artery (CCA) and internal carotid artery (ICA) IMTs were investigated using multivariable regression and logistic models. RESULTS In age-, sex-, and race/ethnicity-adjusted analyses, the trait anger score was positively associated with CCA and ICA IMTs (mean differences per 1-standard deviation increment of trait anger score were 0.014 [95% confidence interval {CI} = 0.003-0.025, p = .01] and 0.054 [95% CI = 0.017-0.090, p = .004] for CCA and ICA IMTs, respectively). Anger was also associated with the presence of carotid plaque (age-, sex-, and race/ethnicity-adjusted odds ratio per 1-standard deviation increase in trait anger = 1.27 [95% CI = 1.06-1.52]). The associations of the anger score with thicker IMT were attenuated after adjustment for covariates but remained statistically significant. Associations were stronger in men than in women and in whites than in other race/ethnic groups, but heterogeneity was only marginally statistically significant by race/ethnicity. There was no association of depressive symptoms or trait anxiety with IMT. CONCLUSIONS Only one of the three measures examined was associated with IMT, and the patterns seemed to be heterogeneous across race/ethnic groups.
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