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Toyoda K, Koga M, Tanaka K, Uchiyama S, Sunami H, Omae K, Kimura K, Hoshino H, Fukuda-Doi M, Miwa K, Koge J, Okada Y, Sakai N, Minematsu K, Yamaguchi T. Blood pressure during long-term cilostazol-based dual antiplatelet therapy after stroke: a post hoc analysis of the CSPS.com trial. Hypertens Res 2024; 47:2238-2249. [PMID: 38977876 PMCID: PMC11374707 DOI: 10.1038/s41440-024-01742-3] [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: 12/11/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 07/10/2024]
Abstract
We determined the associations of follow-up blood pressure (BP) after stroke as a time-dependent covariate with the risk of subsequent ischemic stroke, as well as those of BP levels with the difference in the impact of long-term clopidogrel or aspirin monotherapy versus additional cilostazol medication on secondary stroke prevention. In a sub-analysis of a randomized controlled trial (CSPS.com), patients between 8 and 180 days after stroke onset were randomly assigned to receive aspirin or clopidogrel alone, or a combination of cilostazol with aspirin or clopidogrel. The percent changes, differences, and raw values of follow-up BP were examined. The primary efficacy outcome was the first recurrence of ischemic stroke. In a total of 1657 patients (69.5 ± 9.3 years, female 29.1%) with median 1.5-year follow-up, ischemic stroke recurred in 74 patients. The adjusted hazard ratio for ischemic stroke of a 10% systolic BP (SBP) increase from baseline was 1.19 (95% CI 1.03-1.36), that of a 10 mmHg SBP increase was 1.14 (1.03-1.28), and that of SBP as the raw value with the baseline SBP as a fixed (time-independent) covariate was 1.14 (1.00-1.31). Such significant associations were not observed in diastolic BP-derived variables. The estimated adjusted hazard ratio curves for the outcome showed the benefit of dual therapy over a wide SBP range between ≈120 and ≈165 mmHg uniformly. Lower long-term SBP levels after ischemic stroke were associated with a lower risk of subsequent ischemic events. The efficacy of dual antiplatelet therapy including cilostazol for secondary stroke prevention was evident over a wide SBP range.
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Affiliation(s)
- Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenta Tanaka
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shinichiro Uchiyama
- Clinical Research Center for Medicine, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Medical Center, Tokyo, Japan
| | - Hisato Sunami
- Department of Biostatistics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Katsuhiro Omae
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Biostatistics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Haruhiko Hoshino
- Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Mayumi Fukuda-Doi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasushi Okada
- Clinical Research Institute and Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuo Minematsu
- Headquarters of the Iseikai Medical Corporation, Osaka, Japan
| | - Takenori Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Wu MN, Liu YP, Fong YO, Lin YH, Yang IH, Chou PS, Hsu CY, Lin HF. The impact of blood pressure variability on the development of parenchymal hematoma in acute cerebral infarction with atrial fibrillation. Hypertens Res 2024; 47:618-627. [PMID: 37872378 DOI: 10.1038/s41440-023-01479-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
Although blood pressure variability (BPV) and reperfusion are associated with parenchymal hematoma (PH) after stroke, the relationship between BPV and PH in atrial fibrillation (AF) patients who are at risk of reperfusion injury with frequent spontaneous recanalization is unknown. This study aimed to investigate whether BPV within the first 48 h is associated with PH within 72 h in patients with AF and stroke in terms of major vessel occlusion status. A total of 131 patients with AF that were admitted within 24 h after stroke onset were enrolled. PH was defined as a confluent hemorrhage with mass effect. The maximum (max), minimum (min), and average blood pressure (BP) during the first 48 h after admission were calculated. BPV was analyzed by using range between maximum and minimum (max-min), successive variation (SV), standard deviation (SD), and coefficient of variation (CV). All parameters were applied for systemic (SBP), diastolic (DBP), and pulse pressure (PP). After adjusting for confounding variables, various BPV parameters were associated with PH, including SBPmax (p = 0.0426), SBPSV (p = 0.0006), DBPmax-min (p = 0.0437), DBPSV (p = 0.0358), DBPSD (p = 0.0393), PPmax-min (p = 0.0478), PPSV (p < 0.0001), PPSD (p = 0.0034), and PPCV (p = 0.0120). The relationship remained significant in patients with a patent major vessel responsible for infarction but not in patients with an occluded major vessel. In conclusion, this study revealed that high BPV was associated with PH in patients with AF and acute stroke, particularly for those with a patent major vessel. The control of BP and BPV after stroke may be considered in patients with AF.
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Affiliation(s)
- Meng-Ni Wu
- Departments of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Departments of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Peng Liu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-On Fong
- Departments of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Hui Lin
- Departments of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Hsiao Yang
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ping-Song Chou
- Departments of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Departments of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Yao Hsu
- Departments of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Departments of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiu-Fen Lin
- Departments of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Departments of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Tantry US, Singh S, Bliden KP, Gurbel PA, Ashley W. An overview of the utility of prasugrel hydrochloride as a treatment option for ischemic stroke. Expert Rev Neurother 2024; 24:139-144. [PMID: 38159062 DOI: 10.1080/14737175.2023.2295420] [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: 09/13/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Prasugrel, a potent P2Y12 receptor inhibitor, is not currently recommended in patients with stroke due to a higher rate of recurrent stroke. Prasugrel was associated with comparable efficacy to clopidogrel in reducing the risk of ischemic stroke in a recent phase III study. AREAS COVERED The authors provide an overview of the potential role of prasugrel in the management of ischemic stroke. The authors searched PUBMED, MEDLINE, and clinicaltrials.org and recently presented trials at the conferences for clinical trials of prasugrel therapy in patients with stroke and TIA, and important original investigations are reviewed. EXPERT OPINION The recent PRASTRO-trials demonstrated comparable outcomes of lower maintenance dose (3.5 mg daily dose) with clopidogrel in East Asian stroke patients, thus can be a credible option as a P2Y12 receptor inhibitor. It can also be considered as a credible option in other races and ethnicities and in other clinical situations that may require DAPT, such as intracranial or carotid stenting. Since prasugrel is associated with a superior antiplatelet effect and is not influenced by genetic polymorphisms, there is no need for platelet function or genetic testing. More work is needed to establish the safety and efficacy of low-dose prasugrel plus aspirin in comparison with currently used clopidogrel plus aspirin in non-East Asian populations.
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Affiliation(s)
- Udaya S Tantry
- Sinai Center for Thrombosis Research and Drug Development, Lifebridgehealth System, Baltimore, Maryland, USA
| | - Sahib Singh
- Sinai Center for Thrombosis Research and Drug Development, Lifebridgehealth System, Baltimore, Maryland, USA
| | - Kevin P Bliden
- Sinai Center for Thrombosis Research and Drug Development, Lifebridgehealth System, Baltimore, Maryland, USA
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Lifebridgehealth System, Baltimore, Maryland, USA
| | - William Ashley
- Division of Neurointerventional Radiology, Sinai Hospital of Baltimore, LifebridgeHealth Sysyem, Baltimore, Maryland, USA
- The Sandra and Malcolm Berman Brain & Spine Institute, Sinai Hospital of Baltimore, LifeBridge Health System, Maryland, USA
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Xu W, Yan D, Ning Z. Associations between multiple sclerosis and in-hospital outcomes of patients with hemorrhagic stroke. J Stroke Cerebrovasc Dis 2023; 32:107281. [PMID: 37523878 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107281] [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: 03/06/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To determine the influence of multiple sclerosis (MS) on in-hospital outcomes of patients with hemorrhagic strokes using a large, nationally representative database. MATERIALS AND METHODS This population-based, retrospective study extracted data of adults with hemorrhagic stroke from the US Nationwide Inpatient Sample (NIS) database from 2016 to 2018. Patients with/without MS were then compared. Hemorrhagic stroke and MS were identified by the International Classification of Diseases, Tenth editions (ICD-10) codes. In-hospital outcomes (i.e., in-hospital mortality, discharge destination, length of stay [LOS], total hospital cost, and major complications) were compared between subjects with and without MS using logistic regression analysis. RESULTS Among 107,573 patients with hemorrhagic stroke, 0.3% (n=337) had MS. After 1:10 propensity-score (PS) matching, 3,707 patients remained in the analytic sample. Multivariable analysis revealed that patients with MS had significantly shorter LOS (adjusted β=-1.34 days; 95% CI: -2.41 to -0.26, p=0.015), and lower total hospital costs (adjusted β=-28.82; 95% CI: -43.57 to -14.06, p<0.001) than those without MS. No significant different risks of any major complications, in-hospital mortality, or transfer to nursing homes/long-term care facilities were observed. For major complications, patients with MS had a significantly lower risk of cerebral edema than those without MS (adjusted odds ratio [aOR] = 0.66, 95%CI: 0.51 to 0.86, p =0.002) CONCLUSIONS: In hospitalized patients with hemorrhagic stroke, those with MS have shorter LOS, lower costs, and a lower risk of cerebral edema compared to no MS. More relevant experiments and studies are needed to confirm results of this study.
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Affiliation(s)
- Weiguang Xu
- Department of Neurosurgery, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China.
| | - Dajun Yan
- Department of Neurosurgery, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China
| | - Zeqian Ning
- Department of Neurosurgery, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China
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Wang L, Xia X, Liu X, Wu G, Wang Y, Yang D, Liu P, Chen Z, Wang L, Li X. Twenty-four-hour ambulatory blood pressure variability and association with ischemic stroke subtypes in the subacute stage. Front Neurol 2023; 14:1139816. [PMID: 37139058 PMCID: PMC10149864 DOI: 10.3389/fneur.2023.1139816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Background and purpose Blood pressure (BP) variability (BPV) increases the risk of cerebral disease in both hemorrhagic and ischemic strokes. However, whether BPV is associated with different types of ischemic stroke remains unclear. In this study, we explored the relationship between BPV and ischemic stroke subtypes. Methods We enrolled consecutive patients aged 47-95 years with ischemic stroke in the subacute stage. We categorized them into four groups based on their artery atherosclerosis severity, brain magnetic resonance imaging markers, and disease history: large-artery atherosclerosis, branch atheromatous disease, small-vessel disease, and cardioembolic stroke. Twenty-four-hour ambulatory blood pressure monitoring was performed, and the mean systolic blood pressure/diastolic blood pressure, standard deviation, and coefficient of variation were calculated. A multiple logistic regression model and random forest were used to test the relationship between BP and BPV in the different types of ischemic stroke. Results A total of 286 patients, including 150 men (73.0 ± 12.3 years) and 136 women (77.8 ± 9.6 years) were included in the study. Of these, 86 (30.1%) patients had large-artery atherosclerosis, 76 (26.6%) had branch atheromatous disease, 82 (28.7%) had small-vessel disease, and 42 (14.7%) had cardioembolic stroke. There were statistically significant differences in BPV between subtypes of ischemic stroke in 24-h ambulatory blood pressure monitoring. The random forest model showed that BP and BPV were important features associated with ischemic stroke. Multinomial logistic regression analysis demonstrated that systolic blood pressure levels; systolic blood pressure variability at 24 h, daytime and nighttime; and nighttime diastolic blood pressure were independent risk factors for large-artery atherosclerosis after adjustment for confounders. When compared to branch atheromatous disease and small-vessel disease, nighttime diastolic blood pressure and standard deviation of diastolic blood pressure were significantly associated with patients in the cardioembolic stroke group. However, a similar statistical difference was not seen in patients with large-artery atherosclerosis. Conclusion The results of this study indicate a discrepancy in blood pressure variability among different ischemic stroke subtypes during the subacute stage. Higher systolic blood pressure and systolic blood pressure variability during the 24 h, daytime, and nighttime, and nighttime diastolic blood pressure were independent predictors for large-artery atherosclerosis stroke. Increased nighttime diastolic BPV was an independent risk factor for cardioembolic stroke.
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Affiliation(s)
- Lijuan Wang
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Department of Neurology, Beijing Zhongguancun Hospital, Beijing, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xin Liu
- Department of Neurology, Beijing Zhongguancun Hospital, Beijing, China
| | - Guilin Wu
- Beijing Municipal Medical Insurance Bureau, Beijing, China
| | - Yanna Wang
- Department of Computer Teaching and Research Section, Cangzhou Medical College, Hebei, China
| | - Dongliang Yang
- Department of Computer Teaching and Research Section, Cangzhou Medical College, Hebei, China
| | - Peilin Liu
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhuangzhuang Chen
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lin Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
- *Correspondence: Xin Li
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Intensive blood pressure lowering for ischemic stroke patients: does it prevent ischemia or bleeding? Hypertens Res 2022; 45:769-771. [PMID: 35318451 PMCID: PMC9010285 DOI: 10.1038/s41440-022-00892-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 11/24/2022]
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Castello JP, Teo K, Abramson JR, Keins S, Takahashi CE, Leung IYH, Leung WCY, Wang Y, Kourkoulis C, Pavlos Myserlis E, Warren AD, Henry J, Chan K, Cheung RTF, Ho S, Gurol ME, Viswanathan A, Greenberg SM, Anderson CD, Lau K, Rosand J, Biffi A. Long-Term Blood Pressure Variability and Major Adverse Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage. J Am Heart Assoc 2022; 11:e024158. [PMID: 35253479 PMCID: PMC9075304 DOI: 10.1161/jaha.121.024158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
Abstract
Background Survivors of intracranial hemorrhage (ICH) are at increased risk for major adverse cardiovascular and cerebrovascular events (MACCE), in the form of recurrent stroke and myocardial Infarction. We investigated whether long-term blood pressure (BP) variability represents a risk factor for MACCE after ICH, independent of average BP. Methods and Results We analyzed data from prospective ICH cohort studies at Massachusetts General Hospital and the University of Hong Kong. We captured long-term (ie, visit-to-visit) BP variability, quantified as individual participants' variation coefficient. We explored determinants of systolic and diastolic BP variability and generated survival analyses models to explore their association with MACCE. Among 1828 survivors of ICH followed for a median of 46.2 months we identified 166 with recurrent ICH, 68 with ischemic strokes, and 69 with myocardial infarction. Black (coefficient +3.8, SE 1.3) and Asian (coefficient +2.2, SE 0.4) participants displayed higher BP variability. Long-term systolic BP variability was independently associated with recurrent ICH (subhazard ratio [SHR], 1.82; 95% CI, 1.19-2.79), ischemic stroke (SHR, 1.62; 95% CI, 1.06-2.47), and myocardial infarction (SHR, 1.54; 95% CI, 1.05-2.24). Average BP during follow-up did not modify the association between long-term systolic BP variability and MACCE. Conclusions Long-term BP variability is a potent risk factor for recurrent hemorrhage, ischemic stroke, and myocardial infarction after ICH, even among survivors with well-controlled hypertension. Our findings support the hypothesis that combined control of average BP and its variability after ICH is required to minimize incidence of MACCE.
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Affiliation(s)
- Juan Pablo Castello
- Department of NeurologyMassachusetts General HospitalBostonMA
- Henry and Allison McCance Center for Brain HealthMassachusetts General HospitalBostonMA
| | - Kay‐Cheong Teo
- Department of MedicineQueen Mary HospitalLKS Faculty of MedicineThe University of Hong KongHong Kong SAR
| | - Jessica R. Abramson
- Department of NeurologyMassachusetts General HospitalBostonMA
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Henry and Allison McCance Center for Brain HealthMassachusetts General HospitalBostonMA
| | - Sophia Keins
- Department of NeurologyMassachusetts General HospitalBostonMA
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Henry and Allison McCance Center for Brain HealthMassachusetts General HospitalBostonMA
| | | | - Ian Y. H. Leung
- Department of MedicineQueen Mary HospitalLKS Faculty of MedicineThe University of Hong KongHong Kong SAR
| | - William C. Y. Leung
- Department of MedicineQueen Mary HospitalLKS Faculty of MedicineThe University of Hong KongHong Kong SAR
| | - Yujie Wang
- Department of MedicineQueen Mary HospitalLKS Faculty of MedicineThe University of Hong KongHong Kong SAR
| | - Christina Kourkoulis
- Department of NeurologyMassachusetts General HospitalBostonMA
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Henry and Allison McCance Center for Brain HealthMassachusetts General HospitalBostonMA
| | - Evangelos Pavlos Myserlis
- Department of NeurologyMassachusetts General HospitalBostonMA
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Henry and Allison McCance Center for Brain HealthMassachusetts General HospitalBostonMA
| | | | - Jonathan Henry
- Department of NeurologyMassachusetts General HospitalBostonMA
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Henry and Allison McCance Center for Brain HealthMassachusetts General HospitalBostonMA
| | - Koon‐Ho Chan
- Department of MedicineQueen Mary HospitalLKS Faculty of MedicineThe University of Hong KongHong Kong SAR
- Research Center of HeartBrain, Hormone and Healthy AgingLKS Faculty of MedicineThe University of Hong KongHong Kong SAR
| | - Raymond T. F. Cheung
- Department of MedicineQueen Mary HospitalLKS Faculty of MedicineThe University of Hong KongHong Kong SAR
- Research Center of HeartBrain, Hormone and Healthy AgingLKS Faculty of MedicineThe University of Hong KongHong Kong SAR
| | - Shu‐Leong Ho
- Department of MedicineQueen Mary HospitalLKS Faculty of MedicineThe University of Hong KongHong Kong SAR
| | - M. Edip Gurol
- Department of NeurologyMassachusetts General HospitalBostonMA
| | | | | | - Christopher D. Anderson
- Department of NeurologyMassachusetts General HospitalBostonMA
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Henry and Allison McCance Center for Brain HealthMassachusetts General HospitalBostonMA
| | - Kui‐Kai Lau
- Department of MedicineQueen Mary HospitalLKS Faculty of MedicineThe University of Hong KongHong Kong SAR
- Research Center of HeartBrain, Hormone and Healthy AgingLKS Faculty of MedicineThe University of Hong KongHong Kong SAR
- The State Key Laboratory of Brain and Cognitive SciencesThe University of Hong KongHong Kong SAR
| | - Jonathan Rosand
- Department of NeurologyMassachusetts General HospitalBostonMA
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Henry and Allison McCance Center for Brain HealthMassachusetts General HospitalBostonMA
| | - Alessandro Biffi
- Department of NeurologyMassachusetts General HospitalBostonMA
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Henry and Allison McCance Center for Brain HealthMassachusetts General HospitalBostonMA
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