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Geraghty JR, Testai FD. Advances in neurovascular research: Scientific highlights from the 15th world stroke congress. J Stroke Cerebrovasc Dis 2024; 33:107617. [PMID: 38307467 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/04/2024] Open
Affiliation(s)
- Joseph R Geraghty
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Fernando D Testai
- Department of Neurology & Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
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Feigin VL, Martins SC, Brainin M, Norrving B, Kamenova S, Giniyat A, Kondybayeva A, Aldyngurov DK, Bapayeva M, Zhanuzakov M, Hankey GJ. Twenty years on from the introduction of the high risk strategy for stroke and cardiovascular disease prevention: a systematic scoping review. Eur J Neurol 2024; 31:e16157. [PMID: 38009814 DOI: 10.1111/ene.16157] [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: 10/01/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE Early this century, the high risk strategy of primary stroke and cardiovascular disease (CVD) prevention for individuals shifted away from identifying (and treating, as appropriate) all at-risk individuals towards identifying and treating individuals who exceed arbitrary thresholds of absolute CVD risk. The public health impact of this strategy is uncertain. METHODS In our systematic scoping review, the electronic databases (Scopus, MEDLINE, Embase, Google Scholar, Cochrane Library) were searched to identify and appraise publications related to primary CVD/stroke prevention strategies and their effectiveness published in any language from January 1990 to August 2023. RESULTS No published randomized controlled trial was found on the effectiveness of the high CVD risk strategy for primary stroke/CVD prevention. Targeting high CVD risk individuals excludes a large proportion of the population from effective blood-pressure-lowering and lipid-lowering treatment and effective CVD prevention. There is also evidence that blood pressure lowering and lipid lowering are beneficial irrespective of blood pressure and cholesterol levels and irrespective of absolute CVD risk and that risk-stratified pharmacological management of blood pressure and lipids to only high CVD risk individuals leads to significant underuse of blood-pressure-lowering and lipid-lowering medications in individuals otherwise eligible for such treatment. CONCLUSIONS Primary stroke and CVD prevention needs to be done in all individuals with increased risk of CVD/stroke. Pharmacological management of blood pressure and blood cholesterol should not be solely based on the high CVD risk treatment thresholds. International guidelines and global strategies for primary CVD/stroke prevention need to be revised.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Institute for Health Metrics Evaluation, University of Washington, Seattle, Washington, USA
| | - Sheila C Martins
- Hospital de Clínicas de Porto Alegre, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Michael Brainin
- Department of Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Bo Norrving
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Saltanat Kamenova
- Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
| | - Azhar Giniyat
- Minister of Healthcare of the Republic of Kazakhstan, Astana, Republic of Kazakhstan
| | - Aida Kondybayeva
- Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
| | - Daulet K Aldyngurov
- Department of Science and Human Resource, Ministry of Healthcare of the Republic of Kazakhstan, Astana, Republic of Kazakhstan
| | - Magripa Bapayeva
- Department of Internal Medicine, Kazakhstan Medical University «KSPH», Almaty, Republic of Kazakhstan
| | - Murat Zhanuzakov
- Higher School of Medicine, al-Farabi Kazakh National University, Almaty, Republic of Kazakhstan
| | - Graeme J Hankey
- Perron Institute Chair in Stroke Research, Medical School, University of Western Australia, Perth, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
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Geraghty JR, Testai FD. WITHDRAWN: Advances in Neurovascular Research: Scientific Highlights from the 15 th World Stroke Congress. J Stroke Cerebrovasc Dis 2024:107614. [PMID: 38301748 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2024.107614. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
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Affiliation(s)
- Joseph R Geraghty
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Fernando D Testai
- Department of Neurology & Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
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Feigin VL, Krishnamurthi R, Medvedev O, Merkin A, Nair B, Kravchenko M, Jalili-Moghaddam S, Barker-Collo S, Ratnasabapathy Y, Skinner L, Owolabi M, Norrving B, Sachdev PS, Arroll B, Brainin M, Thrift A, Hankey GJ. Usability and feasibility of PreventS-MD web app for stroke prevention. Int J Stroke 2024; 19:94-104. [PMID: 37485871 DOI: 10.1177/17474930231190745] [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] [Indexed: 07/25/2023]
Abstract
BACKGROUND Most strokes and cardiovascular diseases (CVDs) are potentially preventable if their risk factors are identified and well controlled. Digital platforms, such as the PreventS-MD web app (PreventS-MD) may aid health care professionals (HCPs) in assessing and managing risk factors and promoting lifestyle changes for their patients. METHODS This is a mixed-methods cross-sectional two-phase survey using a largely positivist (quantitative and qualitative) framework. During Phase 1, a prototype of PreventS-MD was tested internationally by 59 of 69 consenting HCPs of different backgrounds, age, sex, working experience, and specialties using hypothetical data. Collected comments/suggestions from the study HCPs in Phase 1 were reviewed and implemented. In Phase 2, a near-final version of PreventS-MD was developed and tested by 58 of 72 consenting HCPs using both hypothetical and real patient (n = 10) data. Qualitative semi-structured interviews with real patients (n = 10) were conducted, and 1 month adherence to the preventive recommendations was assessed by self-reporting. The four System Usability Scale (SUS) groups of scores (0-50 unacceptable; 51-68 poor; 68-80.3 good; >80.3 excellent) were used to determine usability of PreventS-MD. FINDINGS Ninety-nine HCPs from 27 countries (45% from low- to middle-income countries) participated in the study, and out of them, 10 HCPs were involved in the development of PreventS before the study, and therefore were not involved in the survey. Of the remaining 89 HCPs, 69 consented to the first phase of the survey, and 59 of them completed the first phase of the survey (response rate 86%), and 58 completed the second phase of the survey (response rate 84%). The SUS scores supported good usability of the prototype (mean score = 80.2; 95% CI [77.0-84.0]) and excellent usability of the final version of PreventS-MD (mean score = 81.7; 95% CI [79.1-84.3]) in the field. Scores were not affected by the age, sex, working experience, or specialty of the HCPs. One-month follow-up of the patients confirmed the high level of satisfaction/acceptability of PreventS-MD and (100%) adherence to the recommendations. INTERPRETATION The PreventS-MD web app has a high level of usability, feasibility, and satisfaction by HCPs and individuals at risk of stroke/CVD. Individuals at risk of stroke/CVD demonstrated a high level of confidence and motivation in following and adhering to preventive recommendations generated by PreventS-MD.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Oleg Medvedev
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Alexander Merkin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Balakrishnan Nair
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | | | - Shabnam Jalili-Moghaddam
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Luke Skinner
- Te Whatu Ora-Health New Zealand, Waitematā, Auckland, New Zealand
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bo Norrving
- Section of Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW), Sydney, NSW, Australia
- Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, NSW, Australia
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
| | | | - Amanda Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
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Feigin VL, Owolabi MO. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization-Lancet Neurology Commission. Lancet Neurol 2023; 22:1160-1206. [PMID: 37827183 PMCID: PMC10715732 DOI: 10.1016/s1474-4422(23)00277-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 10/14/2023]
Abstract
Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends continue, Sustainable Development Goal 3.4 (reducing the burden of stroke as part of the general target to reduce the burden of non-communicable diseases by a third by 2030) will not be met. In this Commission, we forecast the burden of stroke from 2020 to 2050. We project that stroke mortality will increase by 50%—from 6·6 million (95% uncertainty interval [UI] 6·0 million–7·1 million) in 2020, to 9·7 million (8·0 million–11·6 million) in 2050—with disability-adjusted life-years (DALYs) growing over the same period from 144·8 million (133·9 million–156·9 million) in 2020, to 189·3 million (161·8 million–224·9 million) in 2050. These projections prompted us to do a situational analysis across the four pillars of the stroke quadrangle: surveillance, prevention, acute care, and rehabilitation. We have also identified the barriers to, and facilitators for, the achievement of these four pillars. Disability-adjusted life-years (DALYs) The sum of the years of life lost as a result of premature mortality from a disease and the years lived with a disability associated with prevalent cases of the disease in a population. One DALY represents the loss of the equivalent of one year of full health On the basis of our assessment, we have identified and prioritised several recommendations. For each of the four pillars (surveillance, prevention, acute care, and rehabilitation), we propose pragmatic solutions for the implementation of evidence-based interventions to reduce the global burden of stroke. The estimated direct (ie, treatment and rehabilitation) and indirect (considering productivity loss) costs of stroke globally are in excess of US$891 billion annually. The pragmatic solutions we put forwards for urgent implementation should help to mitigate these losses, reduce the global burden of stroke, and contribute to achievement of Sustainable Development Goal 3.4, the WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders (2022–2031), and the WHO Global Action Plan for prevention and control of non-communicable diseases. Reduction of the global burden of stroke, particularly in low-income and middle-income countries, by implementing primary and secondary stroke prevention strategies and evidence-based acute care and rehabilitation services is urgently required. Measures to facilitate this goal include: the establishment of a framework to monitor and assess the burden of stroke (and its risk factors) and stroke services at a national level; the implementation of integrated population-level and individual-level prevention strategies for people at any increased risk of cerebrovascular disease, with emphasis on early detection and control of hypertension; planning and delivery of acute stroke care services, including the establishment of stroke units with access to reperfusion therapies for ischaemic stroke and workforce training and capacity building (and monitoring of quality indicators for these services nationally, regionally, and globally); the promotion of interdisciplinary stroke care services, training for caregivers, and capacity building for community health workers and other health-care providers working in stroke rehabilitation; and the creation of a stroke advocacy and implementation ecosystem that includes all relevant communities, organisations, and stakeholders. The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Mayowa O Owolabi
- Centre for Genomics and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria; Blossom Specialist Medical Centre, Ibadan, Nigeria.
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Chahine Y, Magoon MJ, Maidu B, del Álamo JC, Boyle PM, Akoum N. Machine Learning and the Conundrum of Stroke Risk Prediction. Arrhythm Electrophysiol Rev 2023; 12:e07. [PMID: 37427297 PMCID: PMC10326666 DOI: 10.15420/aer.2022.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/07/2023] [Indexed: 07/11/2023] Open
Abstract
Stroke is a leading cause of death worldwide. With escalating healthcare costs, early non-invasive stroke risk stratification is vital. The current paradigm of stroke risk assessment and mitigation is focused on clinical risk factors and comorbidities. Standard algorithms predict risk using regression-based statistical associations, which, while useful and easy to use, have moderate predictive accuracy. This review summarises recent efforts to deploy machine learning (ML) to predict stroke risk and enrich the understanding of the mechanisms underlying stroke. The surveyed body of literature includes studies comparing ML algorithms with conventional statistical models for predicting cardiovascular disease and, in particular, different stroke subtypes. Another avenue of research explored is ML as a means of enriching multiscale computational modelling, which holds great promise for revealing thrombogenesis mechanisms. Overall, ML offers a new approach to stroke risk stratification that accounts for subtle physiologic variants between patients, potentially leading to more reliable and personalised predictions than standard regression-based statistical associations.
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Affiliation(s)
- Yaacoub Chahine
- Division of Cardiology, University of Washington, Seattle, WA, US
| | - Matthew J Magoon
- Department of Bioengineering, University of Washington, Seattle, WA, US
| | - Bahetihazi Maidu
- Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Juan C del Álamo
- Department of Mechanical Engineering, University of Washington, Seattle, WA, US
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, US
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, US
| | - Patrick M Boyle
- Department of Bioengineering, University of Washington, Seattle, WA, US
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, US
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, US
| | - Nazem Akoum
- Division of Cardiology, University of Washington, Seattle, WA, US
- Department of Bioengineering, University of Washington, Seattle, WA, US
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Sabayan B. Primary Prevention of Ischemic Stroke. Semin Neurol 2022; 42:571-582. [PMID: 36395819 DOI: 10.1055/s-0042-1758703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ischemic stroke is by far the most common type of cerebrovascular event and remains a major cause of death and disability globally. Despite advancements in acute stroke care, primary prevention is still the most cost-effective approach in reducing the burden of ischemic stroke. The two main strategies for primary stroke prevention include population-wide versus high-risk group interventions. Interventions such as increasing access to primary care, regulation of salt and sugar contents in processed foods, public education, and campaigns to control cerebrovascular risk factors are examples of population-wide interventions. High-risk group interventions, on the other hand, focus on recognition of individuals at risk and aim to modify risk factors in a timely and multifaceted manner. This article provides an overview on conventional modifiable risk factors for ischemic stroke and highlights the emerging risk factors and approaches for high-risk group identification and treatment.
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Affiliation(s)
- Behnam Sabayan
- Department of Neurology, HealthPartners Neuroscience Center, St. Paul, Minnesota.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Abstract
A polypill-type strategy for primary prevention was first published at the turn of the century and advised that a multi-ingredient pill applied to an adult population would prevent up to 80% of cardiovascular and stroke events. Such a pill should contain small doses of antihypertensives, lipid-lowering drugs, and some nutrients. The startling increase of the global stroke burden has led to a revival of this concept and the propagation of a population-based prevention strategy. Recent cardiovascular fixed-dose combination trials have shown a significant effect in reducing not only blood pressure and cholesterol levels but also in reducing cardiovascular and stroke events. In most of the studies, the study population was for secondary prevention and the total number of strokes was small. Nevertheless, it is now clear that a large proportion of primary prevention must take this path. It is especially promising when combined with community health workers interventions for modifying risk behavior. While a polypill-type approach seems most efficacious in underserved regions of high-income countries as well as in low- and middle-income countries, it seems to have a large overall effect in spite of some problems with nonadherence or potential side effects. It should be available and affordable for large target populations. Larger phase 4 studies are under way.
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Affiliation(s)
- Michael Brainin
- Department for Clinical Neuroscience and Preventive Medicine, University for Continuing Education Krems, Austria (M.B., Y.T.)
| | - Yvonne Teuschl
- Department for Clinical Neuroscience and Preventive Medicine, University for Continuing Education Krems, Austria (M.B., Y.T.)
| | - Sheila Martins
- Neurology and Neurosurgery Service, Hospital Moinhos de Vento, Brazil (S.M.).,Neurology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (S.M.)
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Wang Y, Wu H, Han Z, Sheng H, Wu Y, Wang Y, Guo X, Zhu Y, Li X, Wang Y. Guhong injection promotes post-stroke functional recovery via attenuating cortical inflammation and apoptosis in subacute stage of ischemic stroke. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 99:154034. [PMID: 35276592 DOI: 10.1016/j.phymed.2022.154034] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/27/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND As a leading cause of death and disability, alternative therapies for stroke are still limited by its complicated pathophysiological manifestations. Guhong injection (GHI), consisting of safflower aqueous extract and aceglutamide, has been widely applied for the clinical treatment of cerebrovascular diseases, especially ischemic stroke and post-stroke recovery, in China. Recently, a series of studies have reported the positive effect of GHI against cerebral ischemia/reperfusion injury via targeting various molecular mechanisms. However, questions remain on whether treatment with GHI contributes to better functional recovery after stroke and if so, the potential mechanisms and active substances. PURPOSE The aim of this work was to explore the potential therapeutic possibilities of GHI for the neurological and behavioral recovery after stroke and to investigate the underlying molecular mechanisms as well as active substances. METHODS The neural and motor deficits as well as cortical lesions after GHI treatment were investigated in a mouse model of transient ischemic stroke. Based on the substance identification of GHI, network pharmacology combined with an experimental verification method was used to systematically decipher the biological processes and signaling pathways closely related to GHI intervention in response to post-stroke functional outcomes. Subsequently, ingenuity pathway analysis (IPA) analysis was performed to determine the anti-stroke active substances targeting to the hub targets involved in the significant molecular pathways regulated by GHI treatment. RESULTS Therapeutically, administration of GHI observably ameliorated the post-stroke recovery of neural and locomotor function as well as reduced infarct volume and histopathological damage to the cerebral cortex in subacute stroke mice. According to 26 identified or tentatively characterized substances in GHI, the compound-target-pathway network was built. Bioinformatics analysis suggested that inflammatory and apoptotic pathways were tightly associated with the anti-stroke effect of GHI. Based on protein-protein interaction network analysis, the hub targets (such as NF-κB p65, TNF-α, IL-6, IL-1β, Bax, Bcl-2, and Caspase-3) involved in inflammation and apoptosis were selected. On the one hand, immunofluorescence and ELISA results showed that GHI (10 ml/kg) treatment obviously reduced NF-κB p65 nuclear translocation as well as decreased the abnormally elevated concentrations of proinflammatory cytokines (TNF-α, IL-6, and IL-1β) in damaged cortex tissues. On the other hand, GHI (10 ml/kg) treatment significantly downregulated the number of TUNEL-positive apoptotic cells in ischemic cortex and effectively restored the abnormal expression of Bax, Bcl-2, and Caspase-3. Based on the results of IPA, hydroxysafflor yellow A, baicalin, scutellarin, gallic acid, syringin, chlorogenic acid, kaempferol, kaempferol-3-O-β-rutinoside, and rutin acted synergistically on core targets, which could be considered as the active substances of GHI. CONCLUSION Overall, the current findings showed that the beneficial action of GHI on improving post-stroke functional recovery of subacute stroke mice partly via the modulation of cortical inflammation and apoptosis. These findings not only provide a reliable reference for the clinical application of GHI, but also shed light on a promising alternative therapeutic strategy for ischemic stroke patients.
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Affiliation(s)
- Yule Wang
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou 310012, China
| | - Huimin Wu
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou 310012, China
| | - Zhu Han
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou 310012, China
| | - Hongda Sheng
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou 310012, China
| | - Yuhan Wu
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou 310012, China
| | - Yingchao Wang
- Innovation Institute for Artificial Intelligence in Medicine of Zhejiang University, 291 Fucheng Road, Qiantang District, Hangzhou 310020, China
| | - Xinran Guo
- School of Humanities and Management, Wannan Medical College, 34 Yinhunan Road, Jinghu District, Wuhu 241001, China
| | - Yan Zhu
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Beihua South Road, Jinghai District, Tianjin 301617, China; Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, 220 Dongting Road, TEDA, Tianjin 300457, China
| | - Xuecai Li
- Tonghua Guhong Pharmaceutical Co., Ltd., 5099 Jianguo Road, Meihekou 135099, China
| | - Yi Wang
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou 310012, China; State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Beihua South Road, Jinghai District, Tianjin 301617, China.
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Sarfo FS, Akpa O, Ovbiagele B, Akpalu A, Wahab K, Komolafe M, Obiako R, Owolabi L, Osaigbovo GO, Jenkins C, Ogbole G, Fakunle A, Tiwari HK, Arulogun O, Arnett DK, Asowata O, Ogah O, Akinyemi RO, Owolabi MO. Influence of age on links between major modifiable risk factors and stroke occurrence in West Africa. J Neurol Sci 2021; 428:117573. [PMID: 34260999 PMCID: PMC9980381 DOI: 10.1016/j.jns.2021.117573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 01/30/2023]
Abstract
Background The burden of stroke in Africa is high. Understanding how age associates with major modifiable stroke risk factors could inform tailored demographic stroke prevention strategies. Purpose To quantify the magnitude and direction of the effect sizes of key modifiable stroke risk factors according to three age groups: <50 years (young), 50-65 years (middle age) and > 65 years (elderly) in West Africa. Methods This was a case-control study involving 15 sites in Ghana and Nigeria. Cases included adults aged ≥18 years with CT/MRI scan-typed stroke. Controls were age-and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle and psychosocial factors were performed. We estimated adjusted odds ratios (aOR) using conditional logistic regression and population attributable risk (PAR) with 95% Confidence Interval of vascular risk factors by age groups. Results Among 3553 stroke cases, 813 (22.9%) were young, 1441 (40.6%) were middle-aged and 1299 (36.6%) were elderly. Among the 5 co-shared risk factors, dyslipidemia with PAR and aOR (95%CI) of 62.20% (52.82-71.58) and 4.13 (2.64-6.46) was highest among the young age group; hypertension with PAR of 94.31% (91.82-96.80) and aOR of 28.93 (15.10-55.44) was highest among the middle-age group. Diabetes with PAR of 32.29%(27.52-37.05) and aOR of 3.49 (2.56-4.75); meat consumption with PAR of 42.34%(32.33-52.35) and aOR of 2.40 (1.76, 3.26); and non-consumption of green vegetables, PAR of 16.81%(12.02-21.60) and aOR of 2.23 (1.60-3.12) were highest among the elderly age group. However confidence intervals of risk estimates overlapped across age groups. Additionally, among the young age group cigarette smoking, psychosocial stress and cardiac disease were independently associated with stroke. Furthermore, education, stress, physical inactivity and salt intake were associated with stroke in the middle-age group while cardiac disease was associated with stroke in the elderly age group. Conclusion There is a differential influence of age on the associations of major risk factors with stroke in this West African cohort. Targeting modifiable factors predominant within an age group may be more effective as a stroke prevention strategy.
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Affiliation(s)
- Fred S Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Onoja Akpa
- College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
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11
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Brainin M. Polypills for stroke prevention: they work and are effective. Eur J Neurol 2021; 28:3879-3880. [PMID: 34510625 DOI: 10.1111/ene.15100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
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Pandian JD, Sebastian IA. Integrated approach to stroke burden: are we doing enough? Lancet Neurol 2021; 20:774-775. [PMID: 34487724 DOI: 10.1016/s1474-4422(21)00287-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Jeyaraj Durai Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab 141008, India; World Stroke Organisation, Geneva, Switzerland; Indian Stroke Association, Chennai, India.
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13
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Lehmann J, Riedl D, Sztankay M, Boehme C, Fischnaller J, Kiechl S, Holzner B, Knoflach M, Rumpold G. The Attitude towards Polypills Questionnaire (APPQ): a phase I-III development and validation study in patients with cerebrovascular disease. Eur J Neurol 2021; 28:4039-4050. [PMID: 34463018 PMCID: PMC9292587 DOI: 10.1111/ene.15088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/27/2022]
Abstract
Background and purpose The polypill approach has been proposed to reduce patients’ pill burden, increase medication adherence and lower stroke incidence. However, little is known about patients’ attitudes towards polypills for cerebrovascular medication. Methods Based on the European Organization for Research and Treatment of Cancer Quality of Life Group questionnaire development guidelines, a questionnaire to measure patients’ attitudes towards polypills for the secondary prevention of stroke (phase I–III) was developed. In phase I, issues were generated via literature review and interviews with patients and healthcare professionals. The issues were operationalized into items in phase II. In phase III the questionnaire was validated in a large single‐centre sample, and test–retest and internal validity were evaluated. Results In phase I, 34 relevant issues were identified through literature search and interviews. Pre‐testing the questionnaire indicated high applicability and comprehensibility. The final Attitudes towards Polypills Questionnaire was tested in N = 260 patients and showed a two‐factor structure. The factors were labelled ‘concerns’ and ‘benefits’. The scales showed acceptable and good internal validity (concerns, Cronbach's α = 0.85; benefits, α = 0.93), but the scales’ test–retest validity was ambiguous. On a 0 to 3 rating scale, concerns were rated lower than benefits (mean 1.07, SD 0.69 vs. mean 1.87, SD 0.89). Conclusions The Attitudes towards Polypills Questionnaire showed high comprehensibility and content validity to assess German language patients’ attitudes towards a polypill medication. Our data and questionnaire may aid the implementation of polypill treatments in clinical practice and can be used in the design of future clinical trials on polypill therapy. Further validation of the questionnaire is advised.
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Affiliation(s)
- Jens Lehmann
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - David Riedl
- University Clinic of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika Sztankay
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,VASCage-Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Bernhard Holzner
- University Hospital of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria.,Evaluation Software Development GmbH, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,VASCage-Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Gerhard Rumpold
- University Clinic of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria.,Evaluation Software Development GmbH, Innsbruck, Austria
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14
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Chun M, Clarke R, Cairns BJ, Clifton D, Bennett D, Chen Y, Guo Y, Pei P, Lv J, Yu C, Yang L, Li L, Chen Z, Zhu T. Stroke risk prediction using machine learning: a prospective cohort study of 0.5 million Chinese adults. J Am Med Inform Assoc 2021; 28:1719-1727. [PMID: 33969418 PMCID: PMC8324240 DOI: 10.1093/jamia/ocab068] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/22/2021] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare Cox models, machine learning (ML), and ensemble models combining both approaches, for prediction of stroke risk in a prospective study of Chinese adults. MATERIALS AND METHODS We evaluated models for stroke risk at varying intervals of follow-up (<9 years, 0-3 years, 3-6 years, 6-9 years) in 503 842 adults without prior history of stroke recruited from 10 areas in China in 2004-2008. Inputs included sociodemographic factors, diet, medical history, physical activity, and physical measurements. We compared discrimination and calibration of Cox regression, logistic regression, support vector machines, random survival forests, gradient boosted trees (GBT), and multilayer perceptrons, benchmarking performance against the 2017 Framingham Stroke Risk Profile. We then developed an ensemble approach to identify individuals at high risk of stroke (>10% predicted 9-yr stroke risk) by selectively applying either a GBT or Cox model based on individual-level characteristics. RESULTS For 9-yr stroke risk prediction, GBT provided the best discrimination (AUROC: 0.833 in men, 0.836 in women) and calibration, with consistent results in each interval of follow-up. The ensemble approach yielded incrementally higher accuracy (men: 76%, women: 80%), specificity (men: 76%, women: 81%), and positive predictive value (men: 26%, women: 24%) compared to any of the single-model approaches. DISCUSSION AND CONCLUSION Among several approaches, an ensemble model combining both GBT and Cox models achieved the best performance for identifying individuals at high risk of stroke in a contemporary study of Chinese adults. The results highlight the potential value of expanding the use of ML in clinical practice.
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Affiliation(s)
- Matthew Chun
- Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Benjamin J Cairns
- Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council, Population Health Research Unit, University of Oxford, Oxford, UK
| | - David Clifton
- Department of Engineering Science, University of Oxford, Oxford, UK
- Oxford-Suzhou Centre for Advanced Research, Suzhou, China
| | - Derrick Bennett
- Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council, Population Health Research Unit, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Sciences Center, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Sciences Center, Beijing, China
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Sciences Center, Beijing, China
| | - Zhengming Chen
- Medical Research Council, Population Health Research Unit, University of Oxford, Oxford, UK
| | - Tingting Zhu
- Department of Engineering Science, University of Oxford, Oxford, UK
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15
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Markus HS, Brainin M, Fisher M. Tracking the global burden of stoke and dementia: World Stroke Day 2020. Int J Stroke 2020; 15:817-818. [DOI: 10.1177/1747493020959186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Michael Brainin
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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16
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Ibraheem M, Goldstein LB. Polypill Trials for Stroke Prevention-Main Results, Critical Appraisal, and Implications for US Population. Curr Neurol Neurosci Rep 2020; 20:10. [PMID: 32296941 DOI: 10.1007/s11910-020-01031-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The polypill, referring to a variety of combinations of low-cost cardiovascular and stroke preventive medications combined in a single tablet, has been evaluated as a population-based approach for cardiovascular disease prevention in several trials. This review summarizes the scope of the problem, main trial results, and their potential applicability to the US population. RECENT FINDINGS Initial trials demonstrated the efficacy of the polypill approach. The most recent, the PolyIran study, showed the effectiveness of one form of a polypill for cardiovascular disease prevention, high medication adherence, and low adverse event rates. None of published polypill trials focused on stroke as the primary outcome and most were conducted in developing countries, limiting generalization to the US population. A US-based randomized trial with stroke as the primary outcome is needed to assess the usefulness of this approach for stroke prevention in the USA.
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Affiliation(s)
- Mam Ibraheem
- Department of Neurology, University of Kentucky, 740 South Limestone KY Clinic, J401, Lexington, KY, 40536, USA. .,The Department of Veterans Affairs Lexington VA Medical Center, Troy Bowling Campus, Lexington, KY, USA.
| | - Larry B Goldstein
- Department of Neurology, University of Kentucky, 740 South Limestone KY Clinic, J401, Lexington, KY, 40536, USA
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17
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The global burden of neurological disorders: translating evidence into policy. Lancet Neurol 2020; 19:255-265. [PMID: 31813850 PMCID: PMC9945815 DOI: 10.1016/s1474-4422(19)30411-9] [Citation(s) in RCA: 346] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 01/13/2023]
Abstract
Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. In the past 30 years, the absolute numbers of deaths and people with disabilities owing to neurological diseases have risen substantially, particularly in low-income and middle-income countries, and further increases are expected globally as a result of population growth and ageing. This rise in absolute numbers of people affected suggests that advances in prevention and management of major neurological disorders are not sufficiently effective to counter global demographic changes. Urgent measures to reduce this burden are therefore needed. Because resources for health care and research are already overstretched, priorities need to be set to guide policy makers, governments, and funding organisations to develop and implement action plans for prevention, health care, and research to tackle the growing challenge of neurological disorders.
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18
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Affiliation(s)
- Graeme J. Hankey
- From the Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth; Neurology Department, Sir Charles Gairdner Hospital, Perth, Australia; and Perkins Institute of Medical Research, QEII Medical Centre, Perth, Australia
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19
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Feigin VL, Brainin M, Norrving B, Gorelick PB, Dichgans M, Wang W, Pandian JD, Martins SCO, Owolabi MO, Wood DA, Hankey GJ. What Is the Best Mix of Population-Wide and High-Risk Targeted Strategies of Primary Stroke and Cardiovascular Disease Prevention? J Am Heart Assoc 2020; 9:e014494. [PMID: 31983323 PMCID: PMC7033901 DOI: 10.1161/jaha.119.014494] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences School of Public Health and Psychosocial Studies Faculty of Health and Environmental Sciences AUT University Auckland New Zealand
| | - Michael Brainin
- Department of Neuroscience and Preventive Medicine President of the World Stroke Organization Danube University Krems Austria
| | - Bo Norrving
- Department of Clinical Sciences Department of Neurology Skåne University Hospital Lund University Lund Sweden
| | - Philip B Gorelick
- Davee Department of Neurology Northwestern University Feinberg School of Medicine Chicago IL.,Population Health Research Institute McMaster University of Health Sciences and Hamilton University Hamilton Ontario Canada
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD) University Hospital Ludwig-Maximilians-Universität LMU Munich Germany.,Munich Cluster of Systems Neurology (SyNergy) Munich Germany
| | - Wenzhi Wang
- Beijing Neurosurgical Institute Capital Medical University Beijing People's Republic of China.,National Office for CVD Prevention and Control National Health Commission Beijing China
| | | | | | - Mayowa O Owolabi
- Center for Genomic and Precision Medicine University of Ibadan Ibadan Oyo Nigeria.,University College Hospital Ibadan Oyo Nigeria.,Blossom Center for Neurorehabilitation Ibadan Nigeria
| | - David A Wood
- National Heart and Lung Institute Imperial College London London United Kingdom.,National Institute for Prevention and Cardiovascular Health National University of Ireland Galway Ireland
| | - Graeme J Hankey
- Medical School The University of Western Australia Perth Australia
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20
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Nasr JJ, Shalan S. Simultaneous estimation of amlodipine and atorvastatin by micelle-augmented first derivative synchronous spectrofluorimetry and multivariate analysis. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2020; 224:117430. [PMID: 31382228 DOI: 10.1016/j.saa.2019.117430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 06/10/2023]
Abstract
Five Selective, rapid and sensitive spectrofluorimetric methods were performed in this study for the simultaneous estimation of amlodipine besylate (AML) and atorvastatin (ATR) in their binary mixtures and combination polypills that are used for management of cardiovascular conditions. The first method depends on micelle-enhanced first derivative synchronous fluorimetric analysis (method I) and the other four methods are multivariate analysis techniques based on the use of factor-based calibration prediction methods comprising partial least squares (PLS), Principal Component Regression (PCR), genetic algorithm PLS (GA-PLS) and genetic algorithm PCR (GA-PCR). The synchronous fluorescence spectra of the solutions were measured at a constant wavelength difference; Δλ = 100 nm. The magnitudes of the peaks of the first derivative spectra (1D) were measured at 292 nm and 387 nm for ATR, and AML correspondingly. The multivariate models were constructed utilizing fifteen mixtures as a calibration set and ten mixtures as a validation set. The linearity of all the methods was in the concentration ranges of (0.1-4.0 μg mL-1, 0.4-10.0 μg mL-1) for AML and ATR, correspondingly. Statistical analysis revealed no significant difference between the proposed methods and the reference method. The validity of the proposed methods allows their suitability for quality control work. All the analysis settings were optimized and all the suggested procedures were applied productively for the determination of both drugs in synthetic mixtures, validation set, and combination polypills.
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Affiliation(s)
- Jenny Jeehan Nasr
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt.
| | - Shereen Shalan
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
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21
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Blagosklonny MV. Disease or not, aging is easily treatable. Aging (Albany NY) 2019; 10:3067-3078. [PMID: 30448823 PMCID: PMC6286826 DOI: 10.18632/aging.101647] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/02/2018] [Indexed: 12/14/2022]
Abstract
Is aging a disease? It does not matter because aging is already treated using a combination of several clinically-available drugs, including rapamycin. Whether aging is a disease depends on arbitrary definitions of both disease and aging. For treatment purposes, aging is a deadly disease (or more generally, pre-disease), despite being a normal continuation of normal organismal growth. It must and, importantly, can be successfully treated, thereby delaying classic age-related diseases such as cancer, cardiovascular and metabolic diseases, and neurodegeneration.
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22
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Brainin M, Feigin V, Bath PM, Collantes E, Martins S, Pandian J, Sacco R, Teuschl Y. Multi-level community interventions for primary stroke prevention: A conceptual approach by the World Stroke Organization. Int J Stroke 2019; 14:818-825. [DOI: 10.1177/1747493019873706] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The increasing burden of stroke and dementia emphasizes the need for new, well-tolerated and cost-effective primary prevention strategies that can reduce the risks of stroke and dementia worldwide, and specifically in low- and middle-income countries (LMICs). This paper outlines conceptual frameworks of three primary stroke prevention strategies: (a) the “polypill” strategy; (b) a “population-wide” strategy; and (c) a “motivational population-wide” strategy. (a) A polypill containing generic low-dose ingredients of blood pressure and lipid-lowering medications (e.g. candesartan 16 mg, amlodipine 2.5 mg, and rosuvastatin 10 mg) seems a safe and cost-effective approach for primary prevention of stroke and dementia. (b) A population-wide strategy reducing cardiovascular risk factors in the whole population, regardless of the level of risk is the most effective primary prevention strategy. A motivational population-wide strategy for the modification of health behaviors (e.g. smoking, diet, physical activity) should be based on the principles of cognitive behavioral therapy. Mobile technologies, such as smartphones, offer an ideal interface for behavioral interventions (e.g. Stroke Riskometer app) even in LMICs. (c) Community health workers can improve the maintenance of lifestyle changes as well as the adherence to medication, especially in resource poor areas. An adequate training of community health workers is a key point. Conclusion An effective primary stroke prevention strategy on a global scale should integrate pharmacological (polypill) and lifestyle modifications (motivational population-wide strategy) interventions. Side effects of such an integrative approach are expected to be minimal and the benefits among individuals at low-to-moderate risk of stroke could be significant. In the future, pragmatic field trials will provide more evidence.
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Affiliation(s)
- Michael Brainin
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, School of Public Health and Psychosocial Studies, Auckland, New Zealand
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Epifania Collantes
- Department of Neurosciences, Philippine General Hospital, Manila, Philippines
| | - Sheila Martins
- Neurology and Neurosurgery Service, Hospital Moinhos de Vento, Brazil
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Ralph Sacco
- Miller School of Medicine, University of Miami, FL, USA
| | - Yvonne Teuschl
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
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23
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Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, Abd-Allah F, Abdelalim A, Abraha HN, Abu-Rmeileh NME, Adebayo OM, Adeoye AM, Agarwal G, Agrawal S, Aichour AN, Aichour I, Aichour MTE, Alahdab F, Ali R, Alvis-Guzman N, Anber NH, Anjomshoa M, Arabloo J, Arauz A, Ärnlöv J, Arora A, Awasthi A, Banach M, Barboza MA, Barker-Collo SL, Bärnighausen TW, Basu S, Belachew AB, Belayneh YM, Bennett DA, Bensenor IM, Bhattacharyya K, Biadgo B, Bijani A, Bikbov B, Bin Sayeed MS, Butt ZA, Cahuana-Hurtado L, Carrero JJ, Carvalho F, Castañeda-Orjuela CA, Castro F, Catalá-López F, Chaiah Y, Chiang PPC, Choi JYJ, Christensen H, Chu DT, Cortinovis M, Damasceno AAM, Dandona L, Dandona R, Daryani A, Davletov K, de Courten B, De la Cruz-Góngora V, Degefa MG, Dharmaratne SD, Diaz D, Dubey M, Duken EE, Edessa D, Endres M, FARAON EMERITOJOSEA, Farzadfar F, Fernandes E, Fischer F, Flor LS, Ganji M, Gebre AK, Gebremichael TG, Geta B, Gezae KE, Gill PS, Gnedovskaya EV, Gómez-Dantés H, Goulart AC, Grosso G, Guo Y, Gupta R, Haj-Mirzaian A, Haj-Mirzaian A, Hamidi S, Hankey GJ, Hassen HY, Hay SI, Hegazy MI, Heidari B, Herial NA, Hosseini MA, Hostiuc S, Irvani SSN, Islam SMS, Jahanmehr N, Javanbakht M, Jha RP, Jonas JB, Jozwiak JJ, Jürisson M, Kahsay A, Kalani R, Kalkonde Y, Kamil TA, Kanchan T, Karch A, Karimi N, Karimi-Sari H, Kasaeian A, Kassa TD, Kazemeini H, Kefale AT, Khader YS, Khalil IA, Khan EA, Khang YH, Khubchandani J, Kim D, Kim YJ, Kisa A, Kivimäki M, Koyanagi A, Krishnamurthi RK, Kumar GA, Lafranconi A, Lewington S, Li S, Lo WD, Lopez AD, Lorkowski S, Lotufo PA, Mackay MT, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Manafi N, Mansournia MA, Mehndiratta MM, Mehta V, Mengistu G, Meretoja A, Meretoja TJ, Miazgowski B, Miazgowski T, Miller TR, Mirrakhimov EM, Mohajer B, Mohammad Y, Mohammadoo-khorasani M, Mohammed S, Mohebi F, Mokdad AH, Mokhayeri Y, Moradi G, Morawska L, Moreno Velásquez I, Mousavi SM, Muhammed OSS, Muruet W, Naderi M, Naghavi M, Naik G, Nascimento BR, Negoi RI, Nguyen CT, Nguyen LH, Nirayo YL, Norrving B, Noubiap JJ, Ofori-Asenso R, Ogbo FA, Olagunju AT, Olagunju TO, Owolabi MO, Pandian JD, Patel S, Perico N, Piradov MA, Polinder S, Postma MJ, Poustchi H, Prakash V, Qorbani M, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MA, Reis C, Remuzzi G, Renzaho AM, Ricci S, Roberts NLS, Robinson SR, Roever L, Roshandel G, Sabbagh P, Safari H, Safari S, Safiri S, Sahebkar A, Salehi Zahabi S, Samy AM, Santalucia P, Santos IS, Santos JV, Santric Milicevic MM, Sartorius B, Sawant AR, Schutte AE, Sepanlou SG, Shafieesabet A, Shaikh MA, Shams-Beyranvand M, Sheikh A, Sheth KN, Shibuya K, Shigematsu M, Shin MJ, Shiue I, Siabani S, Sobaih BH, Sposato LA, Sutradhar I, Sylaja PN, Szoeke CEI, Te Ao BJ, Temsah MH, Temsah O, Thrift AG, Tonelli M, Topor-Madry R, Tran BX, Tran KB, Truelsen TC, Tsadik AG, Ullah I, Uthman OA, Vaduganathan M, Valdez PR, Vasankari TJ, Vasanthan R, Venketasubramanian N, Vosoughi K, Vu GT, Waheed Y, Weiderpass E, Weldegwergs KG, Westerman R, Wolfe CDA, Wondafrash DZ, Xu G, Yadollahpour A, Yamada T, Yatsuya H, Yimer EM, Yonemoto N, Yousefifard M, Yu C, Zaidi Z, Zamani M, Zarghi A, Zhang Y, Zodpey S, Feigin VL, Vos T, Murray CJL. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18:439-458. [PMID: 30871944 PMCID: PMC6494974 DOI: 10.1016/s1474-4422(19)30034-1] [Citation(s) in RCA: 1659] [Impact Index Per Article: 331.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/17/2018] [Accepted: 01/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. METHODS We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. FINDINGS In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (-39·3 to -33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (-37·2 to -31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (-10·7 to -5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. INTERPRETATION Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. FUNDING Bill & Melinda Gates Foundation.
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24
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Ouriques Martins SC, Sacks C, Hacke W, Brainin M, de Assis Figueiredo F, Marques Pontes-Neto O, Lavados Germain PM, Marinho MF, Hoppe Wiegering A, Vaca McGhie D, Cruz-Flores S, Ameriso SF, Camargo Villareal WM, Durán JC, Fogolin Passos JE, Gomes Nogueira R, Freitas de Carvalho JJ, Sampaio Silva G, Cabral Moro CH, Oliveira-Filho J, Gagliardi R, Gomes de Sousa ED, Fagundes Soares F, de Pinho Campos K, Piza Teixeira PF, Gonçalves IP, Santos Carquin IR, Muñoz Collazos M, Pérez Romero GE, Maldonado Figueredo JI, Barboza MA, Celis López MÁ, Góngora-Rivera F, Cantú-Brito C, Novarro-Escudero N, Velázquez Blanco MÁ, Arbo Oze de Morvil CA, Olmedo Bareiro AB, Meza Rojas G, Flores A, Hancco-Saavedra JA, Pérez Jimenez V, Abanto Argomedo C, Rodriguez Kadota L, Crosa R, Mora Cuervo DL, de Souza AC, Carbonera LA, Álvarez Guzmán TF, Maldonado N, Cabral NL, Anderson C, Lindsay P, Hennis A, Feigin VL. Priorities to reduce the burden of stroke in Latin American countries. Lancet Neurol 2019; 18:674-683. [PMID: 31029579 DOI: 10.1016/s1474-4422(19)30068-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 01/06/2023]
Abstract
The large and increasing burden of stroke in Latin American countries, and the need to meet the UN and WHO requirements for reducing the burden from non-communicable disorders (including stroke), brought together stroke experts and representatives of the Ministries of Health of 13 Latin American countries for the 1st Latin American Stroke Ministerial meeting in Gramado, Brazil, to discuss the problem and identify ways of cooperating to reduce the burden of stroke in the region. Discussions were focused on the regional and country-specific activities associated with stroke prevention and treatment, including public stroke awareness, prevention strategies, delivery and organisation of care, clinical practice gaps, and unmet needs. The meeting culminated with the adoption of the special Gramado Declaration, signed by all Ministerial officials who attended the meeting. With agreed priorities for stroke prevention, treatment, and research, an opportunity now exists to translate this Declaration into an action plan to reduce the burden of stroke.
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Affiliation(s)
- Sheila C Ouriques Martins
- Brazilian Stroke Network, Porto Alegre, Brazil; Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil; Neurology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Claudio Sacks
- Ibero-American Stroke Organization, Porto Alegre, Brazil; Neurology Department, Universidad de Valparaíso, Valparaíso, Chile
| | - Werner Hacke
- World Stroke Organization, Geneva, Switzerland; Neurology Department, University of Heidelberg, Heidelberg, Germany
| | - Michael Brainin
- World Stroke Organization, Geneva, Switzerland; Department of Neurosciences and Preventive Medicine, Danube University Krems, Krems an der Donau, Austria
| | | | | | - Pablo M Lavados Germain
- Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Vitacura, Chile; Neurology and Psychiatry Clinic, Universidad del Desarrollo, Concepción, Chile; Department of Neurological Sciences, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Maria F Marinho
- NonCommunicable Diseases and Health Promotion, Ministry of Health, Brasília, Brazil
| | - Arnold Hoppe Wiegering
- Ibero-American Stroke Organization, Porto Alegre, Brazil; Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Vitacura, Chile; Neurology and Psychiatry Clinic, Universidad del Desarrollo, Concepción, Chile
| | - Diana Vaca McGhie
- American Heart Association and American Stroke Association, Dallas, Texas, TX, USA
| | - Salvador Cruz-Flores
- Department of Neurology, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center, EL Paso, TX, USA
| | - Sebastian F Ameriso
- Ibero-American Stroke Organization, Porto Alegre, Brazil; Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Buenos Aires, Argentina
| | | | | | | | | | | | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Rubens Gagliardi
- Brazilian Academy of Neurology, Santa Casa de São Paulo, São Paulo, Brazil
| | | | | | - Katia de Pinho Campos
- Determinants of Health, Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Brasília, Brazil
| | | | | | - Irving R Santos Carquin
- Noncommunicable Diseases Department, Ministry of Health, Santiago, Chile; Emergency Hospital Public Assistance, Santiago, Chile; Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Germán E Pérez Romero
- Colombian Stroke Network, Bogota, Colombia; Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia; Servicio de Neurología, Fundación Hospital San Carlos, Bogotá, Colombia
| | | | - Miguel A Barboza
- Neuroscience department, Hospital Dr Rafael A Calderon, CCSS-HRACG, San José, Costa Rica
| | - Miguel Á Celis López
- Instituto Nacional de Neurologia e Neurocirurgia Dr Manuel Velasco Suarez, Ministry of Health of Mexico, Mexico City, Mexico
| | - Fernando Góngora-Rivera
- Asociación Mexicana de Enfermedad Vascular Cerebral. Monterrey, Mexico; Hospital Universitario José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | | | - Miguel Á Velázquez Blanco
- National System of Telemedicine, Ministry of Public Health and Social Welfare of Paraguay, Asunción, Paraguay
| | - Carlos A Arbo Oze de Morvil
- National System of Telemedicine, Ministry of Public Health and Social Welfare of Paraguay, Asunción, Paraguay
| | | | | | - Alan Flores
- Hospital de Clínicas, Asunción, Paraguay; Stroke Unit Universidad Nacional de Asunción, Asunción, Paraguay
| | | | | | - Carlos Abanto Argomedo
- Departamento de Enfermedades Neurovasculares, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Liliana Rodriguez Kadota
- Servicio de Enfermedades vasculares y Epilepsia, Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins Lima, Peru
| | | | | | - Ana C de Souza
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Leonardo A Carbonera
- Neurology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Nelson Maldonado
- Department of Neurology, School of Medicine, Universidad San Francisco de Quito, Hospital de los Valles, Quito, Ecuador
| | - Norberto L Cabral
- Joinville Stroke Registry, University of Joinville, Joinville, Brazil
| | - Craig Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Anselm Hennis
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
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25
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Feigin VL. Anthology of stroke epidemiology in the 20th and 21st centuries: Assessing the past, the present, and envisioning the future. Int J Stroke 2019; 14:223-237. [DOI: 10.1177/1747493019832996] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This narrative overview of stroke epidemiology shows dramatic changes in stroke incidence, prevalence, mortality, disability, and the understanding of risk factors and primary stroke prevention strategies over the last few decades. Likely future directions of stroke epidemiology and prevention are outlined.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
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26
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Licher S, Darweesh SKL, Wolters FJ, Fani L, Heshmatollah A, Mutlu U, Koudstaal PJ, Heeringa J, Leening MJG, Ikram MK, Ikram MA. Lifetime risk of common neurological diseases in the elderly population. J Neurol Neurosurg Psychiatry 2019; 90:148-156. [PMID: 30279211 DOI: 10.1136/jnnp-2018-318650] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/28/2018] [Accepted: 10/02/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To quantify the burden of common neurological disease in older adults in terms of lifetime risks, including their co-occurrence and preventive potential, within a competing risk framework. METHODS Within the prospective population-based Rotterdam Study, we studied lifetime risk of dementia, stroke and parkinsonism between 1990 and 2016. Among 12 102 individuals (57.7% women) aged ≥45 years free from these diseases at baseline, we studied co-occurrence, and quantified the combined, and disease-specific remaining lifetime risk of these diseases at various ages for men and women separately. We also projected effects on lifetime risk of hypothetical preventive strategies that delay disease onset by 1, 2 and 3 years, respectively. RESULTS During follow-up of up to 26 years (156 088 person-years of follow-up), 1489 individuals were diagnosed with dementia, 1285 with stroke and 263 with parkinsonism. Of these individuals, 438 (14.6%) were diagnosed with multiple diseases. Women were almost twice as likely as men to be diagnosed with both stroke and dementia during their lifetime. The lifetime risk for any of these diseases at age 45 was 48.2% (95% CI 47.1% to 51.5%) in women and 36.2% (35.1% to 39.3%) in men. This difference was driven by a higher risk of dementia as the first manifesting disease in women than in men (25.9% vs 13.7%; p<0.001), while this was similar for stroke (19.0%vs18.9% in men) and parkinsonism (3.3% vs 3.6% in men). Preventive strategies that delay disease onset with 1 to 3 years could theoretically reduce lifetime risk for developing any of these diseases by 20%-50%. CONCLUSION One in two women and one in three men will develop dementia, stroke or parkinsonism during their life. These findings strengthen the call for prioritising the focus on preventive interventions at population level which could substantially reduce the burden of common neurological diseases in the ageing population.
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Affiliation(s)
- Silvan Licher
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sirwan K L Darweesh
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lana Fani
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alis Heshmatollah
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Unal Mutlu
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Heeringa
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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