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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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Jin X, Chen H, Shi H, Fu K, Li J, Tian L, Teng W. Lipid levels and the risk of hemorrhagic stroke: A dose-response meta-analysis. Nutr Metab Cardiovasc Dis 2021; 31:23-35. [PMID: 33257190 DOI: 10.1016/j.numecd.2020.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Hemorrhagic stroke (HS) could damage human health and impose heavy social and economic burden around the world. An accumulating number of studies revealed the effect of lipid levels on HS, whereas the results were inconsistent. Therefore, we conducted a dose-response meta-analysis to evaluate the relationship between lipid levels and HS. METHODS AND RESULTS We searched the databases for relative cohort studies, which were published before April 2020. We pooled adjusted effect size and performed the dose-response analysis by random-effect model. 31 eligible studies with 2,291,643 participants and 12,147 hemorrhagic stroke cases were included. An inverse association was observed between the risk of hemorrhagic stroke and total cholesterol (TC) (RR: 0.72; 95% CI: 0.64-0.82) or low-density lipoprotein cholesterol (LDL-C) (RR: 0.69; 95% CI: 0.53-0.89). Additionally, in dose-response analysis, the non-linear trend was also found between TC, high-density lipoprotein cholesterol (HDL-C), and risk of HS. When the level of TC and HDL-C was about 6 and 1.3 mmol/L separately, the risk of HS was decreased to the lowest. And we found a linear trend that for every 1 mmol/L triglyceride (TG) increase, the risk of HS decreased by 7%. CONCLUSION TC and LDL-C were both inversely related to the risk of HS. In dose-response analysis of TG, we also found the inverse linear trend. Furthermore, the non-linear trend suggested the level of TC and HDL-C was about 6 and 1.3 mmol/L separately could lead to the lowest risk of HS.
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Affiliation(s)
- Xiaolin Jin
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hanze Chen
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Han Shi
- Clinical Department One, China Medical University, Shenyang, China
| | - Kailei Fu
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Jinwei Li
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Li Tian
- Department of Geriatrics, Shengjing Hospital, China Medical University, Shenyang, China.
| | - Weiyu Teng
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China.
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The Echo of Pulmonary Tuberculosis: Mechanisms of Clinical Symptoms and Other Disease-Induced Systemic Complications. Clin Microbiol Rev 2020; 33:33/4/e00036-20. [PMID: 32611585 DOI: 10.1128/cmr.00036-20] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Clinical symptoms of active tuberculosis (TB) can range from a simple cough to more severe reactions, such as irreversible lung damage and, eventually, death, depending on disease progression. In addition to its clinical presentation, TB has been associated with several other disease-induced systemic complications, such as hyponatremia and glucose intolerance. Here, we provide an overview of the known, although ill-described, underlying biochemical mechanisms responsible for the clinical and systemic presentations associated with this disease and discuss novel hypotheses recently generated by various omics technologies. This summative update can assist clinicians to improve the tentative diagnosis of TB based on a patient's clinical presentation and aid in the development of improved treatment protocols specifically aimed at restoring the disease-induced imbalance for overall homeostasis while simultaneously eradicating the pathogen. Furthermore, future applications of this knowledge could be applied to personalized diagnostic and therapeutic options, bettering the treatment outcome and quality of life of TB patients.
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Association between Serum Lipid and Hematoma Expansion after Spontaneous Intracerebral Hemorrhage in Chinese Patients. J Stroke Cerebrovasc Dis 2020; 29:104793. [PMID: 32224203 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/22/2020] [Accepted: 02/26/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Although several studies have shown that interventions to lower blood lipid concentration may reduce the risk of coronary arterial disease and ischemic stroke, the correlation between serum lipid levels and hemorrhagic stroke remains controversial. To clarify any possible association between serum lipid and hematoma expansion, we examined various serum lipid indices in patients with and without early hematoma expansion. METHODS Data of 572 intracerebral hemorrhage (ICH) patients from the cerebral small vessel disease cohort of Peking Union Medical College Hospital were retrospectively analyzed. Patients who finished the baseline brain computed tomography (CT) examination within 6 h post-ictus and the follow-up CT within 48 h after initial CT were included in the study. Hematoma expansion was delimited as an enlargement of hemorrhage volume over 33% or 12.5 mL between baseline and subsequent CT. Both uni- and multivariate logistic regression analyses were conducted to explore the association between early hematoma growth and various serum lipid indices, including triglycerides, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, ratios of LDL-C/HDL-C and LDL-C/TC, as well as other demographic and clinical features. RESULTS Out of 157 patients included in the analysis, hematoma growth occurred in 45 (28.7%). Only higher baseline systolic blood pressure was found to be correlated with an increased risk of hematoma growth based on both univariate (odds ratio [OR] 1.014, 95% confidence interval [CI]: 1.002-1.026, P = .024) and multivariate logistic regression analyses (OR 1.022, 95%CI: 1.008-1.037, P = .003). No associations were detected between the various serum lipid indices examined and other clinical features with a likelihood of early hematoma growth between groups or within various subgroups defined by different characteristics including age, gender, baseline Glasgow Coma Scale score, systolic blood pressure, intraventricular extension, and hematoma location. CONCLUSIONS No association between various indices of serum lipid and hematoma growth was identified among patients and subgroups with spontaneous ICH in the Chinese population; these findings may help to guide lipid management after ICH. However, further multi-centered, larger scale studies are expected to verify our results.
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Xie Y, Gao J, Guo R, Zheng J, Wang Y, Dai Y, Sun Z, Xing L, Zhang X, Sun YX, Zheng L. Stage 1 hypertension defined by the 2017 ACC/AHA guideline predicts future cardiovascular events in elderly Chinese individuals. J Clin Hypertens (Greenwich) 2019; 21:1637-1644. [PMID: 31556480 PMCID: PMC6900035 DOI: 10.1111/jch.13706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/06/2019] [Accepted: 07/16/2019] [Indexed: 12/02/2022]
Abstract
The 2017 American College of Cardiology and American Heart Association (ACC/AHA) hypertension guideline updated stage 1 hypertension defined as systolic blood pressure (SBP) of 130‐139 mm Hg or diastolic blood pressure (DBP) of 80‐89 mm Hg. However, the impact of 1 hypertension that affects future cardiovascular risk remains unclear among older adults in rural China. The prospective cohort study included 7503 adults aged ≥60 years with complete data and no cardiovascular disease (CVD) at baseline. Follow‐up for the new adverse events was conducted from the end of the baseline survey to the end of the third follow‐up survey (2007.01‐2017.12). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for blood pressure (BP) classifications and adverse events with normal BP as reference (< 120/80 mm Hg). During the 57 290 person‐years follow‐up period, 2261 all‐cause mortality, 1271 CVD mortality, 1159 stroke, and 347 myocardial infarctions (MI) occurred. Patients with stage 1 hypertension versus normal BP had HRs (95% CI) of 1.068 (0.904‐1.261) for all‐cause mortality, 1.304 (1.015‐1.675) for CVD mortality, 1.449 (1.107‐1.899) for stroke, and 1.735 (1.051‐2.863) for MI, respectively. In conclusion, among adults aged ≥60 years, stage 1 hypertension revealed an increased hazard of CVD mortality, stroke, and MI, which is complementary evidence for the application of 2017 ACC/AHA hypertension guidelines in an older Chinese population. Therefore, BP control in patients with stage 1 hypertension may be beneficial to reduce the hazard of CVD in elderly Chinese individuals.
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Affiliation(s)
- Yanxia Xie
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jinyue Gao
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
| | - Rongrong Guo
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jia Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yali Wang
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Dai
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liying Xing
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Xingang Zhang
- Department of Cardiology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ying Xian Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, China
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Rist PM, Buring JE, Ridker PM, Kase CS, Kurth T, Rexrode KM. Lipid levels and the risk of hemorrhagic stroke among women. Neurology 2019; 92:e2286-e2294. [PMID: 30971484 DOI: 10.1212/wnl.0000000000007454] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/14/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To examine the association between lipid levels and hemorrhagic stroke risk among women. METHODS We performed a prospective cohort study among 27,937 women enrolled in the Women's Health Study with measured total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), as well as triglycerides. Strokes were confirmed by medical record review. We used Cox proportional hazards models to analyze associations between lipid categories and hemorrhagic stroke risk. RESULTS During a mean of 19.3 years of follow-up, 137 hemorrhagic strokes occurred. Compared to those with LDL-C levels 100-129.9 mg/dL, after multivariable adjustment, those with LDL-C levels <70 mg/dL had 2.17 times the risk (95% confidence interval [CI] 1.05, 4.48) of experiencing a hemorrhagic stroke. No significant increase in risk was seen for those with LDL-C levels 130-159.9 mg/dL (relative risk [RR] 1.14; 95% CI 0.72, 1.80) or 70-99.9 mg/dL (RR 1.25; 95% CI 0.76, 2.04). There was a suggestion, although not significant, of increased risk for those with LDL-C levels ≥160 mg/dL (RR 1.53; 95% CI 0.92, 2.52). Women in the lowest quartile of triglycerides had a significantly increased risk of hemorrhagic stroke compared to women in the top quartile after multivariable adjustment (RR 2.00; 95% CI 1.18, 3.39). We observed no significant associations between total cholesterol or HDL-C levels and hemorrhagic stroke risk. CONCLUSION LDL-C levels <70 mg/dL and low triglyceride levels were associated with increased risk of hemorrhagic stroke among women.
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Affiliation(s)
- Pamela M Rist
- From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), Charité-Universitätsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA.
| | - Julie E Buring
- From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), Charité-Universitätsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA
| | - Paul M Ridker
- From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), Charité-Universitätsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA
| | - Carlos S Kase
- From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), Charité-Universitätsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA
| | - Tobias Kurth
- From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), Charité-Universitätsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA
| | - Kathryn M Rexrode
- From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), Charité-Universitätsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA
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Kinoshita M, Yokote K, Arai H, Iida M, Ishigaki Y, Ishibashi S, Umemoto S, Egusa G, Ohmura H, Okamura T, Kihara S, Koba S, Saito I, Shoji T, Daida H, Tsukamoto K, Deguchi J, Dohi S, Dobashi K, Hamaguchi H, Hara M, Hiro T, Biro S, Fujioka Y, Maruyama C, Miyamoto Y, Murakami Y, Yokode M, Yoshida H, Rakugi H, Wakatsuki A, Yamashita S. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017. J Atheroscler Thromb 2018; 25:846-984. [PMID: 30135334 PMCID: PMC6143773 DOI: 10.5551/jat.gl2017] [Citation(s) in RCA: 497] [Impact Index Per Article: 82.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Koutaro Yokote
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Seiji Umemoto
- Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Hirotoshi Ohmura
- Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
| | - Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Shinji Kihara
- Biomedical Informatics, Osaka University, Osaka, Japan
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Isao Saito
- Department of Community Health Systems Nursing, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhisa Tsukamoto
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama, Japan
| | - Seitaro Dohi
- Chief Health Management Department, Mitsui Chemicals Inc., Tokyo, Japan
| | - Kazushige Dobashi
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine, Kanagawa, Japan
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University, Hyogo, Japan
| | - Chizuko Maruyama
- Department of Food and Nutrition, Faculty of Human Sciences and Design, Japan Women's University, Tokyo, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Masayuki Yokode
- Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akihiko Wakatsuki
- Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan
| | - Shizuya Yamashita
- Department of Community Medicine, Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Rinku General Medical Center, Osaka, Japan
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8
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Siddiqui FM, Langefeld CD, Moomaw CJ, Comeau ME, Sekar P, Rosand J, Kidwell CS, Martini S, Osborne JL, Stutzman S, Hall C, Woo D. Use of Statins and Outcomes in Intracerebral Hemorrhage Patients. Stroke 2017; 48:2098-2104. [PMID: 28663510 PMCID: PMC5659292 DOI: 10.1161/strokeaha.117.017358] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/05/2017] [Accepted: 06/02/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Statin use may be associated with improved outcome in intracerebral hemorrhage patients. However, the topic remains controversial. Our analysis examined the effect of prior, continued, or new statin use on intracerebral hemorrhage outcomes using the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) data set. METHODS We analyzed ERICH (a multicenter study designed to examine ethnic variations in the risk, presentation, and outcomes of intracerebral hemorrhage) to explore the association of statin use and hematoma growth, mortality, and 3-month disability. We computed subset analyses with respect to 3 statin categories (prior, continued, or new use). RESULTS Two thousand four hundred and fifty-seven enrolled cases (mean age, 62 years; 42% females) had complete data on mortality and 3-month disability (modified Rankin Scale). Among those, 1093 cases were on statins (prior, n=268; continued, n=423; new, n=402). Overall, statin use was associated with reduced mortality and disability without any effect on hematoma growth. This association was primarily driven by continued/new statin use. A multivariate analysis adjusted for age and major predictors for poor outcome showed that continued/new statins users had good outcomes compared with prior users. However, statins may have been continued/started more frequently among less severe patients. When a propensity score was developed based on factors that could influence a physician's decision in prescribing statins and used as a covariate, continued/new statin use was no longer a significant predictor of good outcome. CONCLUSIONS Although statin use, especially continued/new use, was associated with improved intracerebral hemorrhage outcomes, this effect may merely reflect the physician's view of a patient's prognosis rather than a predictor of survival.
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Affiliation(s)
- Fazeel M Siddiqui
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.).
| | - Carl D Langefeld
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Charles J Moomaw
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Mary E Comeau
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Padmini Sekar
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Jonathan Rosand
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Chelsea S Kidwell
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Sharyl Martini
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Jennifer L Osborne
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Sonja Stutzman
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Christiana Hall
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Daniel Woo
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
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9
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Cholesterol Levels and Hemorrhagic Stroke Risk in East Asian Versus Non-East Asian Populations. Neurologist 2017. [DOI: 10.1097/nrl.0000000000000126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Nhung BT, Tuyen LD, Linh VA, Anh NDV, Nga TT, Thuc VTM, Yui K, Ito Y, Nakashima Y, Yamamoto S. Rice Bran Extract Reduces the Risk of Atherosclerosis in Post-Menopausal Vietnamese Women. J Nutr Sci Vitaminol (Tokyo) 2017; 62:295-302. [PMID: 27928115 DOI: 10.3177/jnsv.62.295] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We investigated whether pre-germinated brown rice bran extract containing acylated steryl glucosides (PSG) reduces the risk of atherosclerosis in post-menopausal Vietnamese women. A total of 60 post-menopausal Vietnamese women (45-65 y old) with high LDL cholesterol levels (over 140 mg/dL) were randomly divided into PSG (n=30) and placebo (n=30) groups. The subjects in the PSG group were assigned a daily intake of 6 capsules containing 50 mg PSG, and the subjects in the placebo group were assigned a daily intake of 6 capsules containing corn oil for 6 mo. Before baseline and after month 2, month 4, and month 6 of the intervention, we conducted anthropometric measurements, blood biochemical examinations, a nutrition survey, and physical activity, flow-mediated dilation (FMD), and cardio-ankle vascular index (CAVI) measurements. Serum LDL cholesterol concentrations were significantly reduced from 163.6±25.3 (mg/dL) to 135.9±26.8 (mg/dL) compared to the placebo group (p<0.001). FMD values of the placebo group were significantly reduced from 6.6±5.1 (%) to 4.7±2.6 (%) compared to the PSG group (p<0.05). Tumor necrosis factor (TNF)-α concentrations in the PSG group were significantly reduced from 19.8±11 (pg/mL) to 10.6±5.5 (pg/mL) compared to the placebo group (p<0.05). The findings suggest that PSG may improve LDL cholesterol, TNF-α levels, and FMD values. PSG might be considered in reducing the risk of atherosclerosis in post-menopausal Vietnamese women with high LDL cholesterol.
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11
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Zhao D, Zhang Z, Wu GB, Wang HY, Gao F, Duan XD, Lu YY, Wang ZM, You DP, Qu Y, Song J. Apolipoprotein E gene polymorphism and the risk of subarachnoid hemorrhage: a meta-analysis of case-control studies. Acta Neurochir (Wien) 2016; 158:1515-22. [PMID: 27241684 DOI: 10.1007/s00701-016-2824-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/25/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies investigating the association between the apolipoprotein E gene (APOE) polymorphism and the risk of subarachnoid hemorrhage (SAH) have reported inconsistent results. So we performed a meta-analysis to estimate the association between APOE polymorphism and SAH susceptibility. METHODS Relevant studies published before 5 November 2015 were identified by searching PubMed, Embase, EBSCO, and ISI web of knowledge. The strength of relationship between the APOE gene and SAH susceptibility was assessed using odds ratio (OR) and corresponding 95 % confidence interval (95 % CI). RESULTS A total number of six case-control studies including 638 SAH cases and 2,341 controls were identified. No association was found in dominant model or allele contrast genetic model (ε4 dominant model: OR = 1.06, 95 % CI = 0.91-1.25; ε3 dominant model: OR = 0.99, 95 % CI = 0.97-1.01; ε2 dominant model: OR = 0.99, 95 % CI = 0.78-1.25; ε4 versus ε3: OR = 1.14, 95 % CI = 0.96-1.35; ε4 versus ε2: OR = 1.07, 95 % CI = 0.90-1.28; ε3 versus ε2: OR = 1.00, 95 % CI = 0.96-1.04) for APOE polymorphism and SAH susceptibility. In the subgroup analyzed that was stratified by ethnicity, increased risk of SAH was found in Asian subjects when ε4 allele compared with ε3 allele (ε4 vs ε3, OR = 1.55, 95 % CI = 1.07-2.52). CONCLUSIONS Our meta-analysis suggested that there is no association between APOE polymorphism and SAH risk for overall population. Due to several limitations in the present study, well-designed epidemiological studies with large sample size among different ethnicities should be performed in the future.
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Affiliation(s)
- Di Zhao
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenhai Zhang
- Department of Neurosurgery, Affiliated Bayi Brain Hospital, Military General Hospital of Beijing PLA, Beijing, China
| | - Guo-Biao Wu
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hong-Yu Wang
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan City, China
| | - Fei Gao
- Centralized Procurement Center for Medical Instruments of Hebei, Shijiazhuang, China
| | - Xu-Dong Duan
- Department of TCM Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Zhi-Ming Wang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 West Heping Road, Shijiazhuang, 050005, China
| | - Dian-Ping You
- Hebei Medical Science and Technology Development Research Center, Shijiazhuang, China
| | - Yi Qu
- Institute of Medical Information of Hebei, Shijiazhuang, China
| | - Jian Song
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 West Heping Road, Shijiazhuang, 050005, China.
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12
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Umeki Y, Adachi H, Enomoto M, Fukami A, Nakamura S, Nohara Y, Nakao E, Sakaue A, Tsuru T, Morikawa N, Fukumoto Y. Serum Albumin and Cerebro-cardiovascular Mortality During a 15-year Study in a Community-based Cohort in Tanushimaru, a Cohort of the Seven Countries Study. Intern Med 2016; 55:2917-2925. [PMID: 27746426 PMCID: PMC5109556 DOI: 10.2169/internalmedicine.55.6931] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective There is little long-term data on the association between the serum albumin levels and mortality in community-based populations. We aimed to determine whether the serum albumin level is an independent risk factor for all-cause and cause-specific death in a community-based cohort study in Japan. Methods In 1999, we performed a periodic epidemiological survey over a 15-year period in a population of 1,905 healthy subjects (783 males, 1,122 females) who were older than 40 years of age and who resided in Tanushimaru, a rural community, in Japan. Over the course of the study, we periodically examined the blood chemistry of the study subjects, including their serum albumin levels. Their baseline serum albumin levels were categorized into quartiles. Results The baseline albumin levels were significantly associated with age (inversely), body mass index (BMI), diastolic blood pressure, lipid profiles [high density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c) and triglycerides] and estimated glomerular filtration rate (eGFR). After adjusting for confounders, a Cox proportional hazards regression analysis demonstrated that a low serum albumin level was an independent predictor of all-cause death [hazard ratio (HR): 0.39, 95% confidence interval (CI): 0.24-0.65], cancer death (HR: 0.43, 95% CI: 0.18-0.99), death from infection (HR: 0.21, 95% CI: 0.06-0.73) and cerebro-cardiovascular death (HR: 0.19, 95% CI: 0.06-0.63). The HRs for all-cause and cerebro-cardiovascular death in the highest quartile vs. the lowest quartile of albumin after adjusting for confounders were 0.59 (95%CI:0.39-0.88) and 0.15 (95%CI: 0.03-0.66), respectively. Conclusion The serum albumin level was thus found to be a predictor of all-cause and cerebro-cardiovascular death in a general population.
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Affiliation(s)
- Yoko Umeki
- Kurume University Graduate School of Medicine, Japan
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13
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Ito Y, Nakashima Y, Matsuoka S. Rice bran extract containing acylated steryl glucoside fraction decreases elevated blood LDL cholesterol level in obese Japanese men. THE JOURNAL OF MEDICAL INVESTIGATION 2015; 62:80-4. [DOI: 10.2152/jmi.62.80] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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14
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Effect of lipid profile upon prognosis in ischemic and haemorrhagic cerebrovascular stroke. Indian J Clin Biochem 2013; 29:372-6. [PMID: 24966489 DOI: 10.1007/s12291-013-0372-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
Stroke is the third major cause of death worldwide. Elevated plasma concentration of low density lipoproteins and low plasma concentration of high density lipoprotein concentration are associated with an increased risk of atherosclerosis and coronary heart disease but the relation between serum lipids, and cerebrovascular disease is less clear. The aim of this study was to investigate the reliability and accuracy of serum lipid profile in assessing the prognosis/neurological worsening in patients with ischemic and hemorrhagic cerebrovascular stroke. The subjects in the present study comprised of 101 healthy controls and 150 cerebrovascular stroke patients (including 90 with ischemic stroke and 60 with intracerebral hemorrhagic stroke). In both the groups fasting lipid profile was determined within 72 h of the stroke. A statistically significant association was observed (p < 0.001) between the parameters of lipid profile of cases and healthy controls, and also with the prognosis of the stroke.
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15
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Wang X, Dong Y, Qi X, Huang C, Hou L. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. Stroke 2013; 44:1833-9. [PMID: 23704101 DOI: 10.1161/strokeaha.113.001326] [Citation(s) in RCA: 222] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cholesterol levels are inconsistently associated with the risk of hemorrhagic stroke. The purpose of this study is to assess their relationships using a meta-analytic approach. METHODS We searched PubMed and Embase for pertinent articles published in English. Only prospective studies that reported effect estimates with 95% confidential intervals (CIs) of hemorrhagic stroke for ≥3 categories of cholesterol levels, for high and low comparison, or for per 1 mmol/L increment of cholesterol concentrations were included. We used the random-effects model to pool the study-specific results. RESULTS Twenty-three prospective studies were included, totaling 1 430 141 participants with 7960 (5.6%) hemorrhagic strokes. In high versus low analysis, the summary relative risk of hemorrhagic stroke was 0.69 (95% CI, 0.59-0.81) for total cholesterol, 0.98 (95% CI, 0.80-1.19) for high-density lipoprotein cholesterol, and 0.62 (95% CI, 0.41-0.92) for low-density lipoprotein cholesterol. In dose-response analysis, the summary relative risk of hemorrhagic stroke for 1 mmol/L increment of total cholesterol was 0.85 (95% CI, 0.80-0.91), for high-density lipoprotein cholesterol was 1.11 (95% CI, 0.99-1.25), and for low-density lipoprotein cholesterol was 0.90 (95% CI, 0.77-1.05). The pooled relative risk for intracerebral hemorrhage was 1.17 (95% CI, 1.02-1.35) for high-density lipoprotein cholesterol. CONCLUSIONS Total cholesterol level is inversely associated with risk of hemorrhagic stroke. Higher level of low-density lipoprotein cholesterol seems to be associated with lower risk of hemorrhagic stroke. High-density lipoprotein cholesterol level seems to be positively associated with risk of intracerebral hemorrhage.
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Affiliation(s)
- Xiang Wang
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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16
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Cardoso M, Barbosa M, Serra D, Martins E, Fortuna A, Reis-Lima M, Bandeira A, Balreira A, Marques F. Living with inborn errors of cholesterol biosynthesis: lessons from adult patients. Clin Genet 2013; 85:184-8. [DOI: 10.1111/cge.12139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/07/2013] [Accepted: 03/07/2013] [Indexed: 11/30/2022]
Affiliation(s)
- M.L. Cardoso
- Institute for Molecular and Cell Biology (IBMC); University of Porto; Porto Portugal
| | - M. Barbosa
- Gulbenkian Science Institute; Oeiras Portugal
- Medical Genetics Centre Jacinto Magalhães; Porto Portugal
| | - D. Serra
- Dermatology Department; Coimbra University Hospitals; Coimbra Portugal
| | - E. Martins
- Metabolic Unit; Porto Hospital Centre (CHP); Porto Portugal
| | - A. Fortuna
- Medical Genetics Centre Jacinto Magalhães; Porto Portugal
| | | | - A. Bandeira
- Metabolic Unit; Porto Hospital Centre (CHP); Porto Portugal
| | - A. Balreira
- Institute for Molecular and Cell Biology (IBMC); University of Porto; Porto Portugal
| | - F. Marques
- Institute for Molecular and Cell Biology (IBMC); University of Porto; Porto Portugal
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Valappil AV, Chaudhary NV, Praveenkumar R, Gopalakrishnan B, Girija AS. Low cholesterol as a risk factor for primary intracerebral hemorrhage: A case-control study. Ann Indian Acad Neurol 2012; 15:19-22. [PMID: 22412267 PMCID: PMC3299064 DOI: 10.4103/0972-2327.93270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/13/2011] [Accepted: 11/24/2011] [Indexed: 12/04/2022] Open
Abstract
Introduction: An inverse association between serum cholesterol and the risk of hemorrhagic stroke has been noted in epidemiological studies. We performed a case–control study to assess the relationship between primary intracerebral hemorrhage (ICH) and low serum cholesterol. Materials and Methods: Prospectively recruited fully evaluated patients with ICH were compared with a control group based in a primary care practice, i.e. age- and sex-matched individuals attending the routine preventive health check-up. Low cholesterol was defined by the sex-specific lowest quintile of the population. Results: The proportion of ICH patients with low cholesterol was significantly higher than the controls (68% vs. 43%). Mean total cholesterol was also signficantly low in ICH patients compared with controls (177 mg/dL vs. 200 mg/dl; P-value = 0.0006). Low-density lipoprotein cholesterol (LDL-c) and triglycerides were also significantly low in ICH patients compared with controls. Mean LDL-C in the ICH patient group was 114 mg/dL, whereas it was 128.5 mg/dL in the control group (P-value = 0.016). There was no significant difference in the high-density lipoprotein (HDL) levels in both groups. In a subgroup analysis, both men and women in the ICH group had a significantly low mean cholesterol compared with the control group. Although lower mean cholesterol was seen in both young and older individuals in the ICH group than in controls, the difference was significant only in the older group (age >45 years). In multivariate analysis, presence of low cholesterol remained a significant predictor of hemorrhage. The odds ratio of low cholesterol in the hemorrhage cases was 2.75 (95% CI = 1.44–5.49) unadjusted and 2.15 (1.13–4.70) adjusted for age and hypertension. Conclusions: This study confirms an increased risk of primary ICH associated with low cholesterol both in men and women, especially in older individuals.
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Affiliation(s)
- Ashraf V Valappil
- Department of Neurology, Malabar Institute of Medical Sciences, Calicut, Kerala, India
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18
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Gomis M, Ois A, Rodríguez-Campello A, Cuadrado-Godia E, Jiménez-Conde J, Subirana I, Dávalos A, Roquer J. Outcome of intracerebral haemorrhage patients pre-treated with statins. Eur J Neurol 2009; 17:443-8. [PMID: 19912325 DOI: 10.1111/j.1468-1331.2009.02838.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Statins treatment may have potential clinical impact in vascular disease beyond cholesterol lowering. Its benefits have been documented in cerebral ischaemia and in subarachnoid haemorrhage. In intracerebral haemorrhage (ICH), experimental models in statin-treated animals have better outcome than non-treated ones, but in humans the relationship is unclear. We investigated whether patients treated with statins before the onset of intracerebral haemorrhage have a better outcome at 3 months than patients without statins pre-treatment. METHODS Retrospective review of primary intracerebral haemorrhage case series from a prospective stroke register. We recorded demographics, vascular risk factors, previous statin treatment, Glasgow coma scale (GCS) at onset, ICH scale, hematoma volume and location, ventricular extension of the hematoma, and functional outcome at 3 months. The effect of prior statin treatment on good outcome (modified Rankin scale [mRS] 0 to 2) was analysed by logistic regression analysis. RESULTS We included 269 patients (age 71.9 +/- 12.4, mean +/- SD, 152 males). Thirty-four patients (12.6%) were on prior statin treatment when admitted. There were no differences in fasting serum cholesterol and triglycerides levels between the statin pre-treated groups and the group without statin pre-treatment. Multivariate regression analysis showed a significant association between age (OR: 0.95; CI 0.92-0.97), ICH volume (OR: 0.96; CI 0.94-0.98), GCS (OR: 1.55; CI 1.21-1.98), pre-treatment with statins (OR: 4.21; CI 1.47-12.17; P = 0.008), and good outcome at 3 months. CONCLUSIONS Statins pre-treatment of patients with intracerebral haemorrhage may provide better functional outcome at 3 months of acute onset.
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Affiliation(s)
- M Gomis
- Unitat d'Ictus, Servei de Neurologia, Hospital del Mar, Departament de Medicina de la Universitat Autònoma de Barcelona, IMIM-Hospital del Mar, NeuroMar, Barcelona, Spain.
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Bonaventure A, Kurth T, Pico F, Barberger-Gateau P, Ritchie K, Stapf C, Tzourio C. Triglycerides and risk of hemorrhagic stroke vs. ischemic vascular events: The Three-City Study. Atherosclerosis 2009; 210:243-8. [PMID: 19963214 DOI: 10.1016/j.atherosclerosis.2009.10.043] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 10/16/2009] [Accepted: 10/28/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Few studies have assessed the relationship between triglycerides and the risk of hemorrhagic stroke, which contrasts the considerable number of studies about triglycerides and ischemic vascular events. We analyzed the association pattern between triglycerides and incident intracerebral hemorrhage as compared with coronary events and ischemic stroke, in a large cohort of elderly. METHODS Population-based, prospective cohort study among 8393 men and women participating in the Three-City Study, aged > or = 65 years at baseline. Fasting blood lipids, including triglycerides, were measured at baseline. Fatal and non-fatal strokes and coronary events were adjudicated and validated by scientific committees. Cox proportional hazards models were used to adjust for potential confounders. RESULTS During a mean follow-up of 5.0 years, 36 hemorrhagic strokes, 143 ischemic strokes, and 393 coronary events occurred. An increased level of triglycerides was associated with an increased risk of ischemic vascular events. Conversely, a low level of triglycerides (< or = 0.94 mmol/L) was associated with an increased risk of hemorrhagic stroke (adjusted hazard ratio 2.35; 95% confidence interval 1.18-4.70). The relationship with hemorrhagic stroke was mainly apparent in men, in individuals with high blood pressure, and in those with low levels of cholesterol. CONCLUSIONS In this large cohort of elderly men and women, low triglycerides levels were associated with an increased risk of hemorrhagic stroke and a decreased risk of ischemic vascular events. The association between triglycerides and hemorrhagic stroke was particularly strong in men, in subjects with high blood pressure and in those with low cholesterol levels.
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Noda H, Iso H, Irie F, Sairenchi T, Ohtaka E, Doi M, Izumi Y, Ohta H. Low-density lipoprotein cholesterol concentrations and death due to intraparenchymal hemorrhage: the Ibaraki Prefectural Health Study. Circulation 2009; 119:2136-45. [PMID: 19364982 DOI: 10.1161/circulationaha.108.795666] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few studies have examined the association between low levels of low-density lipoprotein (LDL) cholesterol and risk of intraparenchymal hemorrhage. METHODS AND RESULTS A total of 30 802 men and 60 417 women, 40 to 79 years of age with no history of stroke or coronary heart disease, completed a baseline risk factor survey in 1993 under the auspices of the Ibaraki Prefectural Health Study. Systematic mortality surveillance was performed through 2003, and 264 intraparenchymal hemorrhage deaths were identified. LDL cholesterol levels were calculated with the Friedewald formula. Persons with LDL cholesterol > or =140 mg/dL had half the sex- and age-adjusted risk of death due to intraparenchymal hemorrhage of those with LDL cholesterol <80 mg/dL. After adjustment for cardiovascular risk factors, the multivariable hazard ratio compared with persons with LDL cholesterol <80 mg/dL was 0.65 (95% CI 0.44 to 0.96) for those with LDL cholesterol 80 to 99 mg/dL, 0.48 (0.32 to 0.71) for 100 to 119 mg/dL, 0.50 (0.33 to 0.75) for 120 to 139 mg/dL, and 0.45 (0.30 to 0.69) for >/=140 mg/dL. These inverse associations were not altered substantially after the exclusion of persons with hypertriglyceridemia, after analysis with a Cox proportional hazard model with time-dependent covariates, or in sensitivity analysis for the potential effect of competing risks. CONCLUSIONS Low LDL cholesterol levels are associated with elevated risk of death due to intraparenchymal hemorrhage.
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Affiliation(s)
- Hiroyuki Noda
- Public Health, Department of Social and Environmental Medicine, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Shuita-shi, Osaka 565-0871 Japan
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Grysiewicz RA, Thomas K, Pandey DK. Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurol Clin 2009; 26:871-95, vii. [PMID: 19026895 DOI: 10.1016/j.ncl.2008.07.003] [Citation(s) in RCA: 267] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The epidemiology of ischemic and hemorrhagic stroke is an ongoing exploration to identify risk factors that continue to expand with the advent of technological advancements and preventative medical practices. Identification of risk factors that can or cannot be modified is a crucial step in determining stroke risk. Many of the modifiable risk factors are well established, and specific interventions to reduce stroke risk have been established. Some risk factors are less established, and intervention to reduce risk is yet to be determined by evidence-based medicine. Data from ongoing randomized clinical trials continue to enhance our ability to prevent a first stroke.
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Affiliation(s)
- Rebbeca A Grysiewicz
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, USA
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22
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Cho JH, Hwang JY, Lee SE, Jang SP, Kim WY. Nutritional status and the role of diabetes mellitus in hemodialysis patients. Nutr Res Pract 2008; 2:301-7. [PMID: 20016734 PMCID: PMC2788193 DOI: 10.4162/nrp.2008.2.4.301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 11/19/2008] [Accepted: 11/25/2008] [Indexed: 11/25/2022] Open
Abstract
This study was aimed to investigate the nutritional status and the role of diabetes mellitus in hemodialysis (HD) patients. Anthropometric, biochemical, and dietary assessments for HD 110 patients (46 males and 64 females) were conducted. Mean body mass index (BMI) was 22.1 kg/m(2) and prevalence of underweight (BMI<18.5 kg/m(2)) was 12%. The hypoalbuminemia (<3.5 g/dl) was found in 15.5% of the subject, and hypocholesterolemia (<150 mg/dl) in 46.4%. About half (50.9%) patients had anemia (hemoglobin: <11.0 g/dL). High prevalence of hyperphosphatemia (66.4%) and hyperkalemia (43.5%) was also observed. More than 60 percent of subjects were below the recommended intake levels of energy (30-35 kcal/kg IBW) and protein (1.2 g/kg IBW). The proportions of subjects taking less than estimated average requirements for calcium, vitamin B(1), vitamin B(2), vitamin C, and folate were more than 50%, whereas, about 20% of the subjects were above the recommended intake of phosphorus and potassium. Diabetes mellitus was the main cause of ESRD (45.5%). The diabetic ESRD patients showed higher BMI and less HD adequacy than nondiabetic patients. Diabetic patients also showed lower HDL-cholesterol levels. Diabetic ESRD patients had less energy from fat and a greater percentage of calories from carbohydrates. In conclusion, active nutrition monitoring is needed to improve the nutritional status of HD patients. A follow-up study is needed to document a causal relation between diabetes and its impact on morbidity and mortality in ESRD patients.
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Affiliation(s)
- Ju-Hyun Cho
- Department of Nutritional Science and Food Management, Ewha Womans University, 11-1 Daehyun-dong, Seodaemun-gu, Seoul 120-750, Korea
| | - Ji-Yun Hwang
- Department of Nutritional Science and Food Management, Ewha Womans University, 11-1 Daehyun-dong, Seodaemun-gu, Seoul 120-750, Korea
| | - Sang-Eun Lee
- Department of Nutritional Science and Food Management, Ewha Womans University, 11-1 Daehyun-dong, Seodaemun-gu, Seoul 120-750, Korea
| | - Sang Pil Jang
- Poog Sung Hemodialysis Clinic Center, 392-2, Pungnap 2-dong, Songpa-gu, Seoul 138-040, Korea
| | - Wha-Young Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, 11-1 Daehyun-dong, Seodaemun-gu, Seoul 120-750, Korea
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Ueshima H, Sekikawa A, Miura K, Turin TC, Takashima N, Kita Y, Watanabe M, Kadota A, Okuda N, Kadowaki T, Nakamura Y, Okamura T. Cardiovascular disease and risk factors in Asia: a selected review. Circulation 2008; 118:2702-9. [PMID: 19106393 PMCID: PMC3096564 DOI: 10.1161/circulationaha.108.790048] [Citation(s) in RCA: 535] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hirotsugu Ueshima
- Department of Health Science, Shiga University of Medical Science, Tsukinowa-cho Seta, Otsu, Japan.
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Yamamoto T, Nakamura Y, Hozawa A, Okamura T, Kadowaki T, Hayakawa T, Murakami Y, Kita Y, Okayama A, Abbott RD, Ueshima H. Low-risk profile for cardiovascular disease and mortality in Japanese. Circ J 2008; 72:545-50. [PMID: 18362423 DOI: 10.1253/circj.72.545] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Some studies focusing on low-risk profiles for cardiovascular disease have been reported in Western countries. Yet, few reports have examined, with substantial longevity, the low-risk profile for cardiovascular disease in the Japanese population. This study examines whether having a favorable risk factor profile yields lower all-cause mortality and whether the proportion of those with a low-risk profile is larger in the Japanese population. METHODS AND RESULTS A total of 8,339 men and women aged 30-69 years without a history of cardiovascular diseases for 19 years, who had participated in the 1980 National Survey on Circulatory Disorders after being randomly selected from throughout Japan, were followed. Low risk was defined as having all of the following baseline characteristics: blood pressure (BP) <120/80 mmHg; no antihypertensive medication; serum cholesterol 160-240 mg/dl (4.14-6.22 mmol/L); no history of diabetes; and non-smoker. The long-term mortality of the low-risk group was compared with that of others using the Cox proportional hazard model. The prevalence of low risk was 9.4% of all participants. The multivariate-adjusted hazard ratios for low-risk individuals compared with others were as follows: 0.33 (95% confidence intervals (CI), 0.15-0.74) for cardiovascular disease and 0.63 (95% CI, 0.46-0.88) for all-cause mortality. The most attributable risk factor for all-cause mortality was high BP (>or=120/80 mmHg). CONCLUSION Japanese individuals with favorable cardiovascular disease risk profiles had lower mortality from cardiovascular disease and all-causes than those without.
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Affiliation(s)
- Takako Yamamoto
- Department of Health Science, Shiga University of Medical Science, Seta Tukinowa-cho, Otsu 520-2192, Japan.
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Khan FY, Yasin M, Abu-Khattab M, El Hiday AH, Errayes M, Lotf AK, Ibrahim AS, Abbas MT, Matar I, Alsamawi M, Alhail H. Stroke in Qatar: a first prospective hospital-based study of acute stroke. J Stroke Cerebrovasc Dis 2008; 17:69-78. [PMID: 18346648 DOI: 10.1016/j.jstrokecerebrovasdis.2007.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 11/18/2007] [Accepted: 11/30/2007] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Stroke is a major cause of morbidity and mortality in Qatar. OBJECTIVES The aim of our study was to determine types of strokes, the associated risk factors, clinical presentation, outcome, and time to hospital admission among Qatari and non-Qatari patients as well as young and nonyoung patients. METHODS We conducted a hospital-based prospective observational study including all patients admitted to Hamad Medical Corporation with first-ever stroke from September 15, 2004, to September 14, 2005. A stroke was defined according to World Health Organization criteria. RESULTS Stroke was confirmed in 270 patients of whom 217 (80.4%) had ischemic stroke and 53 (19.6%) had hemorrhagic stroke. Male patients predominated in all types of stroke. The main risk factors for stroke were hypertension and diabetes, whereas lacunar infarct was the most common subtype of ischemic stroke. Risk factor profiles were similar between Qatari and non-Qatari patients except for hypercholesterolemia, which was observed with a higher frequency in Qatari compared with non-Qatari patients with ischemic stroke. There were significant differences between the young and nonyoung patients with ischemic stroke with respect to risk factors, ejection fraction, ventricular wall-motion abnormalities, time to hospital admission, and outcome. Most patients arrived at the hospital more than 3 hours from stroke onset because of unawareness of stroke symptoms. The overall in-hospital mortality was 9.3%. CONCLUSIONS Hypertension and diabetes mellitus were the main risk factors for stroke in Qatar, whereas lacunar infarct was the most common subtype. Significant differences between the young and nonyoung patients were observed with respect to risk factors, ejection fraction, ventricular wall-motion abnormalities, time to hospital admission, and outcome.
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Ueshima H. Explanation for the Japanese paradox: prevention of increase in coronary heart disease and reduction in stroke. J Atheroscler Thromb 2007; 14:278-86. [PMID: 18174657 DOI: 10.5551/jat.e529] [Citation(s) in RCA: 223] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Japan's age-adjusted rate for mortality from stroke increased after the Second World War until 1965 and then showed a significant decline until 1990; however, the age-adjusted rate for mortality from all heart disease and coronary heart disease (CHD) increased until 1970 and then declined slowly. A puzzling question is why the rate of mortality from CHD declined in spite of an increase in serum total cholesterol level following an increase in fat consumption. It was confirmed that CHD incidence was far lower in several Japanese populations compared to Western countries in the " Monitoring Trends and Determinants in Cardiovascular Disease " (MONICA) project; therefore, the lower CHD mortality in Japan stems from the lower CHD incidence. CHD risk factors based on epidemiologic cohort studies in Japan were no different from those of other industrialized countries: hypertension, hypercholesterolemia, smoking and diabetes mellitus (DM). So, how can we explain this phenomenon?There are three possible explanations. One is the decline in population blood pressure level and the prevalence of hypertension during the years 1965-1990; the second is the decline in smoking rate in men and women; the third is that the serum total cholesterol level for middle-aged and elderly populations remains 5-15 mg/dL lower than that of the US elderly counterpart, although men aged 40-49 in Japan and the US had similar serum total cholesterol levels. It was also noted that elderly people in Japan, as observed in the Seven Countries Study, had far lower serum total cholesterol levels in midlife, i.e., around 160 mg/dL in the 1960s. This was not the case for elderly in the US where a higher serum total cholesterol level was observed in midlife. In conclusion, the lower serum cholesterol level in the past of Japanese middle-aged and elderly people compared to Western counterparts helps to maintain the low CHD incidence and mortality supported by the declining trend in blood pressure level and smoking rate for both men and women.
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Affiliation(s)
- Hirotsugu Ueshima
- Department of Health Science, Shiga University of Medical Science, Shiga, Japan.
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Fuentes B, Ortega-Casarrubios MA, Martínez P, Díez-Tejedor E. Action on vascular risk factors: importance of blood pressure and lipid lowering in stroke secondary prevention. Cerebrovasc Dis 2007; 24 Suppl 1:96-106. [PMID: 17971644 DOI: 10.1159/000107384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Secondary stroke prevention comprises a broad spectrum of therapeutic actions that includes the appropriate management of risk factors and the action on blood pressure and serum lipids that are of great importance to decrease stroke recurrences. METHODS We conducted a review of the published studies analyzing the relevance of the treatment of blood pressure and serum lipids, with special attention to recent findings of clinical trials and current guidelines on stroke secondary prevention. RESULTS The relationship between blood pressure and stroke has been widely demonstrated; however, the role of serum lipids has been discussed for a long time. Recent results from epidemiological studies and clinical trials have demonstrated its role as modifiable risk factor for stroke. Blood pressure and lipid lowering are associated with significant reductions in recurrent strokes as well as in other vascular events in transient ischemic attack (TIA) or stroke patients. The PROGRESS and MOSES trials suggest that diuretics, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers could confer additional benefits in stroke patients, and the SPARCL study did so for statins. These drugs are not only efficacious in the reduction of stroke recurrences, but also in other cardiovascular events. CONCLUSIONS Blood pressure and serum lipids are two important and modifiable vascular risk factors that should be taken into consideration when planning secondary stroke prevention measures. This approach should include hypotensive drugs (mainly the combination of diuretics and ACE inhibitors) with the objective to maintain normal blood pressure, avoiding levels >130/80 mm Hg in all stroke patients, and statins (atorvastatin 80 mg) in patients with noncardioembolic TIA or stroke.
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Affiliation(s)
- B Fuentes
- Stroke Unit, Department of Neurology, University Hospital La Paz, Universidad Autónoma de Madrid, Madrid, Spain
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28
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Kaushal R, Woo D, Pal P, Haverbusch M, Xi H, Moomaw C, Sekar P, Kissela B, Kleindorfer D, Flaherty M, Sauerbeck L, Chakraborty R, Broderick J, Deka R. Subarachnoid hemorrhage: tests of association with apolipoprotein E and elastin genes. BMC MEDICAL GENETICS 2007; 8:49. [PMID: 17672902 PMCID: PMC1950089 DOI: 10.1186/1471-2350-8-49] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 07/31/2007] [Indexed: 11/10/2022]
Abstract
Background Apolipoprotein E (APOE) and elastin (ELN) are plausible candidate genes involved in the pathogenesis of stroke. We tested for association of variants in APOE and ELN with subarachnoid hemorrhage (SAH) in a population-based study. We genotyped 12 single nucleotide polymorphisms (SNPs) on APOE and 10 SNPs on ELN in a sample of 309 Caucasian individuals, of whom 107 are SAH cases and 202 are age-, race-, and gender-matched controls from the Greater Cincinnati/Northern Kentucky region. Associations were tested at genotype, allele, and haplotype levels. A genomic control analysis was performed to check for spurious associations resulting from population substructure. Results At the APOE locus, no individual SNP was associated with SAH after correction for multiple comparisons. Haplotype analysis revealed significant association of the major haplotype (Hap1) in APOE with SAH (p = 0.001). The association stemmed from both the 5' promoter and the 3' region of the APOE gene. APOE ε2 and ε 4 were not significantly associated with SAH. No association was observed for ELN at genotype, allele, or haplotype level and our study failed to confirm previous reports of ELN association with aneurysmal SAH. Conclusion This study suggests a role of the APOE gene in the etiology of aneurysmal SAH.
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Affiliation(s)
- Ritesh Kaushal
- Department of Environmental Health, Center for Genome Information, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Woo
- Department of Neurology; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Prodipto Pal
- Department of Environmental Health, Center for Genome Information, University of Cincinnati, Cincinnati, Ohio, USA
| | - Mary Haverbusch
- Department of Neurology; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Huifeng Xi
- Department of Environmental Health, Center for Genome Information, University of Cincinnati, Cincinnati, Ohio, USA
| | - Charles Moomaw
- Department of Neurology; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Padmini Sekar
- Department of Environmental Health, Center for Genome Information, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brett Kissela
- Department of Neurology; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Dawn Kleindorfer
- Department of Neurology; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew Flaherty
- Department of Neurology; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laura Sauerbeck
- Department of Neurology; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ranajit Chakraborty
- Department of Environmental Health, Center for Genome Information, University of Cincinnati, Cincinnati, Ohio, USA
| | - Joseph Broderick
- Department of Neurology; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ranjan Deka
- Department of Environmental Health, Center for Genome Information, University of Cincinnati, Cincinnati, Ohio, USA
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Inagawa T. Risk factors for primary intracerebral hemorrhage in patients in Izumo City, Japan. Neurosurg Rev 2007; 30:225-34; discussion 234. [PMID: 17503099 DOI: 10.1007/s10143-007-0082-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 01/30/2007] [Accepted: 03/04/2007] [Indexed: 11/29/2022]
Abstract
The annual incidence rate of primary intracerebral hemorrhage (ICH) in Izumo City, Japan, appears to be the highest rate among those reported. Despite improvement of management and surgical therapy, the overall morbidity and mortality after ICH are still high. The author investigated the risk factors for ICH in patients in Izumo. A case-control study of 242 patients (137 men and 105 women with ages ranging from 34 to 97 years) with primary ICH was conducted in Izumo between 1991 and 1998. Hypertension, diabetes mellitus, heart disease, liver disease, alcohol consumption, cigarette smoking, and serum levels of total cholesterol, aspartate aminotransferase, and alanine aminotransferase were assessed as possible risk factors for ICH by using conditional logistic regression. The prevalence of hypertension among ICH patients was 77% and the odds ratio (OR) for hypertension was 17.07 (95% CI: 8.30-35.09), which are much higher than figures reported from Western countries. The OR for hypertension was higher in individuals < or = 69 years of age than in those > or = 70 years of age and lower for lobar hemorrhage than for hemorrhages at other sites. High serum total cholesterol (> or = 220 mg/dl) was the second most important risk factor for ICH (OR: 2.52; 95% CI: 1.23-5.14), and low total cholesterol (< 160 mg/dl) decreased the risk of ICH (OR: 0.47; 95% CI: 0.27-0.82). In contrast, heart disease decreased the risk of ICH, and there was no observed association between alcohol consumption, cigarette smoking, or diabetes mellitus and ICH. This study conducted in Izumo suggests that hypertension is the most important risk factor for ICH and contrary to most previous studies indicates that serum total cholesterol concentration is also positively associated with the risk of ICH. In contrast, heart disease may decrease the risk of ICH.
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Affiliation(s)
- Tetsuji Inagawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Himebara 4-1-1, Izumo, Shimane, 693-8555, Japan.
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30
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Fagan SC, Elewa HF, Rychly DJ. Statin Therapy for Secondary Stroke Prevention: Evidence Catches Up to Practice. J Pharm Pract 2007. [DOI: 10.1177/0897190007305131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Current approaches for the secondary prevention of ischemic stroke include the aggressive use of antithrombotic therapy, particularly antiplatelet agents, and carotid endarterectomy for eligible patients. Blood pressure lowering with angiotensin converting enzyme inhibitors and diuretics in hypertensives, glucose control to a hemoglobin A1C of less than 7% in diabetics, and statin therapy in patients with hyperlipidemia and/or cardiovascular disease are also important measures forsecondary prevention of stroke. Support for the routine use of statin therapy in all patients with ischemic stroke, regardless of lipid profile or a history of cardiovascular disease, has been, until recently, of debate. Clinical evidence found in studies such as the SPARCL trial and the Heart Protection Study now support the routine use of statin therapy in all ischemic stroke patients. This article focuses on the potential and proven benefits of statins in ischemic stroke.
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Affiliation(s)
| | - Hazem F. Elewa
- Clinical and Experimental Therapeutics, University of Georgia College of Pharmacy and VA Medical Center, Augusta
| | - David J. Rychly
- Clinical and Experimental Therapeutics, University of Georgia College of Pharmacy and VA Medical Center, Augusta
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Miida T, Takahashi A, Ikeuchi T. Prevention of stroke and dementia by statin therapy: Experimental and clinical evidence of their pleiotropic effects. Pharmacol Ther 2007; 113:378-93. [PMID: 17113151 DOI: 10.1016/j.pharmthera.2006.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 09/25/2006] [Indexed: 12/26/2022]
Abstract
Stroke and dementia are major causes of disability in most countries. Epidemiological studies have demonstrated that statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are likely to reduce the risk for developing these formidable disorders. The favorable outcomes in statin users may be attributable to not only cholesterol-dependent actions, but also various cholesterol-independent actions called "pleiotropic effects." Several clinical trials have suggested that statins decrease the incidence of stroke, especially ischemic stroke. Statins improve endothelial function, inhibit platelet activation, reduce blood coagulability, and suppress inflammatory reactions, all of which may contribute to the beneficial effects of the therapy. Statins also reduce the risk of vasospasm caused by subarachnoid hemorrhage (SAH). In addition, statins might inhibit the development and progression of Alzheimer's disease (AD), the dominant type of dementia in most industrialized countries, upstream of the amyloid cascade. In vitro studies have shown that statins modulate the metabolism of the beta-amyloid precursor protein (APP) and reduce the extracellular level of its proteolytic product, amyloid-beta (Abeta). The aggregated Abeta is cytotoxic, leading to formation of neurofibrillary tangles and neuronal loss in the brain. Inflammatory processes are active in AD and may contribute significantly to AD pathology. We review the experimental background regarding the pleiotropic effects of statins and summarize clinical trials that examined the preventative effects of statin therapy on stroke and dementia. We include current trials in which statin therapy is initiated within 24 hr of onset of acute ischemic stroke.
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Affiliation(s)
- Takashi Miida
- Division of Clinical Preventive Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan.
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Waters DD, LaRosa JC, Barter P, Fruchart JC, Gotto AM, Carter R, Breazna A, Kastelein JJP, Grundy SM. Effects of High-Dose Atorvastatin on Cerebrovascular Events in Patients With Stable Coronary Disease in the TNT (Treating to New Targets) Study. J Am Coll Cardiol 2006; 48:1793-9. [PMID: 17084252 DOI: 10.1016/j.jacc.2006.07.041] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Revised: 06/29/2006] [Accepted: 07/03/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to assess the effects on cerebrovascular events of treating patients with stable coronary disease with low-density lipoprotein cholesterol (LDL-C) levels substantially below 100 mg/dl. BACKGROUND Lowering LDL-C with statins has been shown to reduce the risk of stroke in patients with stable coronary disease. In observational studies, naturally low cholesterol levels have been associated with an increased risk of hemorrhagic stroke. The cerebrovascular benefits of treating patients with stable coronary disease to LDL-C levels substantially below 100 mg/dl have not been previously investigated. METHODS We describe an analysis of cerebrovascular events in the Treating to New Targets study, a trial where 10,001 patients with documented coronary disease were randomized to treatment with atorvastatin at 10 mg/day or 80 mg/day and followed for a median of 4.9 years. RESULTS Mean LDL-C levels were 101 mg/dl on 10 mg atorvastatin and 77 mg/dl on 80 mg. In addition to the reduction in major cardiovascular events (hazard ratio 0.78, 95% confidence interval [CI] 0.69 to 0.89; p = 0.0002), the primary end point of the trial, patients in the 80-mg arm experienced a reduction in cerebrovascular events (hazard ratio 0.77, 95% CI 0.64 to 0.93; p = 0.007) and stroke (hazard ratio 0.75, 95% CI 0.59 to 0.96; p = 0.02). Each 1-mg/dl reduction in LDL-C with treatment was associated with a 0.6% relative risk reduction in cerebrovascular events (p = 0.002) and a 0.5% relative risk reduction in stroke (p = 0.041). The incidence of hemorrhagic stroke was similar in the 80-mg and 10-mg groups, 16 and 18 respectively, and the hemorrhagic strokes were distributed evenly across quintiles of achieved LDL-C during treatment. CONCLUSIONS Among patients with established coronary disease, treating to an LDL-cholesterol substantially below 100 mg/dl with 80 mg/day atorvastatin reduces both stroke and cerebrovascular events by an additional 20% to 25% compared with the 10 mg/day dose. An increase in hemorrhagic stroke was not seen at low LDL-C levels. (Treating to New Targets; http://www.clinicaltrials.gov; NCT00327691).
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Affiliation(s)
- David D Waters
- University of California, San Francisco, California, USA.
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Ho SY, Schooling M, Hui LL, McGhee SM, Mak KH, Lam TH. Soy consumption and mortality in Hong Kong: proxy-reported case-control study of all older adult deaths in 1998. Prev Med 2006; 43:20-6. [PMID: 16631248 DOI: 10.1016/j.ypmed.2006.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Revised: 03/08/2006] [Accepted: 03/08/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study investigates the relation between soy consumption and mortality in a population-based case-control study in Hong Kong of all adult deaths in 1998. METHODS Multivariable logistic regression was used to assess the effect of soy on all-cause and cause-specific mortality in 21,494 deceased cases and 10,968 living controls who were ethnic Chinese aged 60 or above, using proxy reports collected from the person registering the death. Dietary habits were obtained from proxies in both cases and controls, based on a 7-item questionnaire. RESULTS The adjusted odds ratios for all-cause mortality for soy consumption 4 or more times a week compared with less than once a month were 0.77 (95% CI: 0.62, 0.95) for men and 0.66 (0.54, 0.81) for women. Mortality from lung cancer (males P = 0.02, females P = 0.02), colorectal cancer (males P = 0.07, females P < 0.001), stomach cancer (males P = 0.04, females P = 0.03), female breast cancer (P = 0.02) and ischemic heart disease (males P < 0.001, females P = 0.002) was inversely associated with soy consumption. CONCLUSIONS Our study suggests that maintaining traditional levels of soy consumption could be protective for some chronic diseases in China.
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Affiliation(s)
- Sai-Yin Ho
- Department of Community Medicine, The University of Hong Kong, Hong Kong SAR, PR China
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Herzig R, Vlachová I, Mareš J, Křupka B, Gabryš M, Vaverková H, Šaňák D, Schneiderka P, Buřval S, Kaňovský P. Occurrence of dyslipidemia in spontaneous intracerebral hemorrhage. EUR J LIPID SCI TECH 2006. [DOI: 10.1002/ejlt.200500285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
The treatment of hyperlipidemia is aimed at preventing cardiovascular disease (CVD) and coronary heart disease (CHD). As the incidence of CHD in Japan is about one-third lower and that of stroke is two-fold higher compared to Western countries, and the doses of lipid-lowering drugs used in foreign randomized controlled clinical trials (RCTs) are much higher than in general use in Japan, it remains unclear whether the results of RCTs conducted in Western countries could be extrapolated to Japanese patients. Recently, two major large-scale, prospective, RCTs in Japanese hypercholesterolmic patients, the Management of Elevated Cholesterol in the Primary Prevention of Adult Japanese (MEGA) study and the Japan EPA Lipid Intervention Study (JELIS), have been reported. Japanese epidemiological studies and Japanese clinical studies are reviewed. The evidence suggests that hypercholesterolemia, hypertriglyceridemia, and low HDL-cholesterol are strongly associated with increased CHD risk. Lipid-lowering medication shows beneficial effects even in low-risk populations; however, the data did not support that lower cholesterol is better. The safety and efficacy of hyperlipidemia treatment in Japanese patients are discussed.
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Affiliation(s)
- Shinji Koba
- The Third Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
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Labiós M, Martínez M, Gabriel F. Papel de la atorvastatina en la prevención del ictus. ¿Puede estar relacionado con su acción sobre la activación plaquetaria? Consideraciones basadas en nuestra propia experiencia. HIPERTENSION Y RIESGO VASCULAR 2006. [DOI: 10.1016/s1889-1837(06)71650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
INTRODUCTION Intracerebral hemorrhage (ICH) occurs from the rupture of small vessels into the brain parenchyma and accounts for approximately 10% of all strokes in the United States, and carries with it a significantly high morbidity and mortality. SUMMARY This article reviews the course and management of ICH. The most common chronic vascular diseases that lead to ICH are chronic hypertension and cerebral amyloid angiopathy. Additional factors that predispose to ICH include vascular malformations, chronic alcohol use, hypocholesterolemia, and use of anticoagulant medications. The understanding of mechanisms leading to ICH has advanced significantly, but questions regarding site predilection and timing of spontaneous hemorrhage still remain. Management in the acute setting is first focused on reducing hematoma expansion. Although no specific therapy has yet been proven effective, promising agents, particularly recombinant Factor VIIa, are on the horizon. Subsequent care is focused on controlling hemostasis, hemodynamics, and intracranial pressure in efforts to minimize secondary brain injury. CONCLUSION The morbidity and mortality associated with ICH remain high despite recent advances in our understanding of the clinical course of ICH. Novel preventive and acute treatment therapies are needed and may be on the horizon.
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Affiliation(s)
- Neeraj Badjatia
- Neurocritical Care and Acute Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Abstract
This article reviews the safety of statins, with emphasis on high-dose atorvastatin (80 mg), the agent with the most efficacy data for clinical outcomes. Although elevated levels of hepatic enzymes were of concern when statins were first introduced, a review of data from large clinical trials shows that elevations in hepatic enzymes are rare and do not lead to clinically significant liver disease. Despite the withdrawal of cerivastatin because of fatal rhabdomyolysis, the risk of this complication with other statins is extremely low. Mild and often transient myalgia is more commonly reported. The safety of high-dose atorvastatin has been evaluated in >11,000 patients, and rates of clinically significant myopathy and elevated hepatic enzymes were extremely low. Simvastatin at doses up to 40 mg is also associated with low rates of elevated hepatic enzymes and myopathy. However, the 80-mg dose of simvastatin carries a risk of myopathy (muscle symptoms and creatine kinase levels >10,000 U/L) of approximately 1 in 250. The clinical benefits of preventing vascular events, myocardial infarction, stroke, and need for revascularization outweigh the low rates of adverse events associated with high-dose statin therapy in high- and intermediate-risk patients.
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Affiliation(s)
- David D Waters
- Division of Cardiology, San Francisco General Hospital and the School of Medicine, University of California, San Francisco, California 94110, USA.
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Woo D, Haverbusch M, Sekar P, Kissela B, Khoury J, Schneider A, Kleindorfer D, Szaflarski J, Pancioli A, Jauch E, Moomaw C, Sauerbeck L, Gebel J, Broderick J. Effect of untreated hypertension on hemorrhagic stroke. Stroke 2004; 35:1703-8. [PMID: 15155969 DOI: 10.1161/01.str.0000130855.70683.c8] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke is the third leading cause of death and the leading cause of disability in the United States. Intracerebral hemorrhage and subarachnoid hemorrhage represent approximately 20% of all stroke cases and have a mortality rate of 40% to 50%. Hypertension is an important risk factor for these subtypes of stroke. We sought to determine whether untreated hypertension carries a different risk from treated hypertension for hemorrhagic stroke. METHODS Cases of hemorrhagic stroke in the greater Cincinnati region were identified by screening all area hospital emergency rooms, radiology reports, and International Classification of Diseases 9 codes. Medical records were reviewed for risk factors and medication use. Cases of hemorrhagic stroke were approached for enrollment into the genetic sampling and interview arm. If subjects agreed, the case was matched by age, race, and gender to population-based controls. RESULTS Between May 1997 and December 2002, we recruited 549 cases of hemorrhagic stroke, of which 322 were intracerebral hemorrhage and 227 were subarachnoid hemorrhage. Untreated hypertension was found to be a significant risk factor for hemorrhagic stroke (odds ratio [OR]=3.5 [2.3 to 5.2]; P<0.0001) as was treated hypertension (OR=1.4 [1.0 to 1.9]; P=0.03). Insurance status of "self-pay" or Medicaid was a significant risk factor for untreated hypertension (OR=2.7 [1.6 to 4.4]). We estimate that 17% to 28% of hemorrhagic strokes among hypertensive patients would have been prevented if they had been on hypertension treatment. CONCLUSIONS Untreated hypertension is highly prevalent and an important risk factor for hemorrhagic stroke. We estimate that among hypertensive subjects, approximately one fourth of hemorrhagic strokes would be prevented if all hypertensive subjects received treatment.
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Affiliation(s)
- Daniel Woo
- University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0525, Cincinnati, OH 45267-0525, USA.
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Woo D, Kissela BM, Khoury JC, Sauerbeck LR, Haverbusch MA, Szaflarski JP, Gebel JM, Pancioli AM, Jauch EC, Schneider A, Kleindorfer D, Broderick JP. Hypercholesterolemia, HMG-CoA reductase inhibitors, and risk of intracerebral hemorrhage: a case-control study. Stroke 2004; 35:1360-4. [PMID: 15087556 DOI: 10.1161/01.str.0000127786.16612.a4] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Several studies have demonstrated an association between hypocholesterolemia and intracerebral hemorrhage (ICH). We tested the hypothesis that hypercholesterolemia or use of HMG-CoA reductase inhibitors (statin) agents, or both, are associated with ICH. METHODS This study was part of the preplanned midway analysis of an ongoing, population-based, case-control study of the genetic and environmental risk factors of hemorrhagic stroke. Conditional stepwise logistic regression modeling was used to determine if self-reported hypercholesterolemia or statin use, or both, were independent risk factors for ICH. RESULTS Between December 1, 1997, and June 30, 2000, 188 cases of ICH and 366 age-, race-, and gender-matched controls were enrolled. Hypercholesterolemia and statin use were less common among cases than controls: 25% versus 38% (P=0.003) and 9% versus 17% (P=0.03), respectively. Hypercholesterolemia with statin use was associated with less risk of ICH (OR=0.30; P=0.0008) in multivariable analysis after controlling for alcohol use, hypertension, previous stroke, first-degree relative with ICH, education level, and apolipoprotein E alleles. CONCLUSIONS Hypercholesterolemia was associated with a lower risk of ICH. We have not found an increased risk of ICH with the widespread use of statins in our population. Given the lack of cholesterol levels in the current study, further studies are needed to determine if lower cholesterol levels secondary to statin use bear the same risk as low cholesterol levels for ICH.
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Affiliation(s)
- Daniel Woo
- Department of Neurology and the Neuroscience Institute, University of Cincinnati, College of Medicine, 231 Bethesda Avenue ML 0525, Cincinnati, Ohio 45267-0525, USA.
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Takeuchi T, Adachi H, Ohuchida M, Nakamura T, Satoh A, Jacobs DR, Imaizumi T. A case–control study found that low albumin and smoking were associated with aortic dissection. J Clin Epidemiol 2004; 57:386-91. [PMID: 15135840 DOI: 10.1016/j.jclinepi.2003.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Hypertension is a risk factor for aortic dissection. Besides hypertension, associated factors for incidence of aortic dissection are not clear. The aim of this study was to examine whether other factors exist by an epidemiologic case-control approach. STUDY DESIGN AND SETTING 240 consecutive cases suffering from acute aortic dissection were hospitalized in our university from 1989 to 2000. Blood chemistries and other information obtained immediately after admissions for the first attack were available in 226 patients. A case-control approach was performed by frequency matching age, sex, and history of hypertension in the remaining 226 cases with those of 226 healthy controls drawn from a similar geographic catchment area and all observed in 1989. RESULTS The mean albumin (3.6 +/- 0.5 vs. 4.3 +/- 0.2 g/dL: P<.001) level of cases was significantly lower than that of controls (odds ratio: 0.004 per g/dL). The frequency with which cases of current smokers was significantly higher than that of controls (odds ratio: 3.475). The above parameters of cases compared with controls were statistically significant after adjustments for age, sex, and history of hypertension. CONCLUSION Low albumin levels and smoking in addition to hypertension are significantly associated with aortic dissection.
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Affiliation(s)
- Tomohiro Takeuchi
- The Third Department of Internal Medicine and The Cardiovascular Research Institute, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
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McCarty MF. IGF-I activity may be a key determinant of stroke risk--a cautionary lesson for vegans. Med Hypotheses 2003; 61:323-34. [PMID: 12944100 DOI: 10.1016/s0306-9877(02)00241-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
IGF-I acts on vascular endothelium to activate nitric oxide synthase, thereby promoting vascular health; there is reason to believe that this protection is especially crucial to the cerebral vasculature, helping to ward off thrombotic strokes. IGF-I may also promote the structural integrity of cerebral arteries, thereby offering protection from hemorrhagic stroke. These considerations may help to explain why tallness is associated with low stroke risk, whereas growth hormone deficiency increases stroke risk--and why age-adjusted stroke mortality has been exceptionally high in rural Asians eating quasi-vegan diets, but has been declining steadily in Asia as diets have become progressively higher in animal products. There is good reason to suspect that low-fat vegan diets tend to down-regulate systemic IGF-I activity; this effect would be expected to increase stroke risk in vegans. Furthermore, epidemiology suggests that low serum cholesterol, and possibly also a low dietary intake of saturated fat--both characteristic of those adopting low-fat vegan diets--may also increase stroke risk. Vegans are thus well advised to adopt practical countermeasures to minimize stroke risk--the most definitive of which may be salt restriction. A high potassium intake, aerobic exercise training, whole grains, moderate alcohol consumption, low-dose aspirin, statin or policosanol therapy, green tea, and supplementation with fish oil, taurine, arginine, and B vitamins--as well as pharmacotherapy of hypertension if warranted--are other practical measures for lowering stroke risk. Although low-fat vegan diets may markedly reduce risk for coronary disease, diabetes, and many common types of cancer, an increased risk for stroke may represent an 'Achilles heel'. Nonetheless, vegans have the potential to achieve a truly exceptional 'healthspan' if they face this problem forthrightly by restricting salt intake and taking other practical measures that promote cerebrovascular health.
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Affiliation(s)
- M F McCarty
- Pantox Laboratories, San Diego, California 92109, USA
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Sauvaget C, Nagano J, Allen N, Grant EJ, Beral V. Intake of animal products and stroke mortality in the Hiroshima/Nagasaki Life Span Study. Int J Epidemiol 2003; 32:536-43. [PMID: 12913025 DOI: 10.1093/ije/dyg151] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To determine whether intake of animal products was associated with a reduced risk of stroke mortality in a large-scale population-based cohort in Japan. METHODS A self-administered questionnaire, including questions on dietary habits, was mailed to the members of the Life Span Study, a cohort of people exposed and non-exposed to atomic bomb radiation, who were alive as of 1 September 1979. Animal products included frequency intake of beef/pork, chicken, ham/sausage, milk, dairy products, eggs, fish, and broiled fish. Responses were obtained from 40 349 people (72%): 15 350 men (mean age 54 years) and 24 999 women (mean age 58 years). The subjects were followed for 16 years, and deaths were ascertained by linkage to the nationwide family registration system of Japan. The associations between diet and stroke mortality were examined using a Cox proportional hazard model. RESULTS During the follow-up period, 1462 stroke deaths occurred. Four animal products comprising eggs, dairy products, fish, and broiled fish were independently associated with a decreased risk of stroke mortality; while beef/pork, chicken, ham/ sausage, and milk consumption were not associated with stroke death. A composite measure of eggs, dairy products, fish, and broiled fish intake was calculated, and the highest tertile was significantly inversely associated with total stroke mortality (Hazards Ratio [HR] = 0.80, 95% CI: 0.68, 0.93) compared with the lowest tertile. The protective effect of animal product intake on total stroke death was largely confined to intracerebral haemorrhage death; the RH of intracerebral haemorrhage death for the highest tertile of consumption was 0.72 (95% CI: 0.53-0.98) compared with the lowest tertile; animal products intake was not related to cerebral infarction mortality (HR = 0.84; 95% CI: 0.67-1.06). CONCLUSIONS Intake of animal products such as eggs, dairy products, and fish may be protective against intracerebral haemorrhage, but is not related to cerebral infarction mortality.
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Affiliation(s)
- Catherine Sauvaget
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan.
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Waters DD, Schwartz GG, Olsson AG, Zeiher A, Oliver MF, Ganz P, Ezekowitz M, Chaitman BR, Leslie SJ, Stern T. Effects of atorvastatin on stroke in patients with unstable angina or non-Q-wave myocardial infarction: a Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) substudy. Circulation 2002; 106:1690-5. [PMID: 12270864 DOI: 10.1161/01.cir.0000031568.40630.1c] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This report describes the effect of intensive cholesterol lowering with atorvastatin on the incidence of nonfatal stroke, a secondary end point, in a randomized, placebo-controlled trial of patients with unstable angina or non-Q-wave myocardial infarction. The primary end point, a composite of death, nonfatal myocardial infarction, resuscitated cardiac arrest, or recurrent symptomatic myocardial ischemia with objective evidence requiring emergency rehospitalization, was reduced from 17.4% in the placebo group to 14.8% in the atorvastatin group over the 16 weeks of the trial (P=0.048). METHODS AND RESULTS Strokes were adjudicated by a blinded end-point committee using standard clinical and imaging criteria. The outcomes of nonfatal stroke and fatal plus nonfatal stroke were analyzed by time to first occurrence during the 16-week trial. Of 38 events (in 36 patients) adjudicated as fatal or nonfatal strokes, 3 were classified as hemorrhagic, one as embolic, and 29 as thrombotic or embolic; 5 could not be categorized. Nonfatal stroke occurred in 9 patients in the atorvastatin group and 22 in the placebo group (relative risk, 0.40; 95% confidence intervals, 0.19 to 0.88; P=0.02). Fatal or nonfatal stroke occurred in 12 atorvastatin patients and 24 placebo patients (relative risk, 0.49; 95% confidence intervals, 0.24 to 0.98; P=0.04). All 3 hemorrhagic strokes occurred in the placebo group. CONCLUSION Intensive cholesterol lowering with atorvastatin over 16 weeks in patients with acute coronary syndromes reduced the overall stroke rate by half and did not cause hemorrhagic stroke. These findings need to be confirmed in future trials.
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Affiliation(s)
- David D Waters
- Division of Cardiology, San Francisco General Hospital, and the University of California, San Francisco School of Medicine, San Francisco, Calif 94110, USA.
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Abstract
There is a significant variation in the management of ICH by neurologists, neurosurgeons, and emergency physicians. Most of the randomized clinical therapeutic trials have focused on subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS). Well-organized practice guidelines are now available for the management of ICH. Exciting research areas are being aggressively explored. Medical and surgical interventions for SAH, AIS, and ICH are always time-dependent, which places additional responsibility on the EP to correctly and promptly recognize these conditions to prevent further injury. The time-dependent care of these patients places the EP on the front lines of future stroke care. Special thanks to Dr. Daniel Woo and Dr. Stewart Wright for their assistance in reviewing the manuscript and Amy Hess for preparation of the manuscript.
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Affiliation(s)
- Peter D Panagos
- Department of Emergency Medicine, University of Cincinnati Medical Center, P.O. Box 67069, Cincinnati, OH 45267-0769, USA.
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Woo D, Broderick JP. Spontaneous intracerebral hemorrhage: epidemiology and clinical presentation. Neurosurg Clin N Am 2002; 13:265-79, v. [PMID: 12486917 DOI: 10.1016/s1042-3680(02)00011-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The advent of widespread CT availability has dramatically changed our understanding of the incidence and risk factors regarding intracerebral hemorrhage (ICH). In the pre-CT era, many patients with a small ICH were misclassified having had ischemic strokes and patients with massive ICH or subarachnoid hemorrhage (SAH) were often difficult to classify correctly. The fact that the precise mechanism of spontaneous ICH is often difficult to ascertain without pathologic evidence continues to hamper epidemiologic studies. This article reviews the incidence rates, natural history, epidemiology, and clinical presentations of nontraumatic ICH.
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Affiliation(s)
- Daniel Woo
- Department of Neurology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO Box 670525, Cincinnati, OH 45267-0525, USA.
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Iseki K, Yamazato M, Tozawa M, Takishita S. Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients. Kidney Int 2002; 61:1887-93. [PMID: 11967041 DOI: 10.1046/j.1523-1755.2002.00324.x] [Citation(s) in RCA: 236] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although hypocholesterolemia is common in chronic hemodialysis patients, its effect on survival has not been studied in a large patients population. METHODS A cohort of chronic hemodialysis patients (N = 1167) was prospectively followed from January 1991 to January 2001. The survival impact of this cohort, who were divided according to different baseline levels of serum cholesterol, were calculated with the multivariate Cox proportional hazard analysis after adjusting for baseline clinical and laboratory variables. RESULTS During the study period, 567 (48.6%) patients died. The mean (SD) baseline level of serum cholesterol was 171.0 (40.8) mg/dL and ranged from 76 to 378 mg/dL. The five-year survival rate was highest (0.812) in the subgroup that had a serum cholesterol range of 200 to 219 mg/dL and was lowest (0.608) in the subgroup with serum cholesterol values of <140 mg/dL. The five-year survival rate was 0.735 in the subgroup with serum cholesterol of > or =220 mg/dL. Serum cholesterol was a significant predictor of death with an adjusted hazards ratio (95% confidence interval) was 0.939 (0.891 to 0.989). In a subgroup of patients with serum albumin values > or =4.5 g/dL (N = 128), the adjusted hazards ratio was even greater at 1.370 (1.105 to 1.692). Other than sex, body mass index and serum albumin were significant determinants of baseline levels of serum cholesterol. CONCLUSIONS Hypocholesterolemia was an independent predictor of death in patients on chronic hemodialysis. This impact of hypercholesterolemia on survival was only evident in a subgroup of patients whose serum albumin was more than 4.5 g/dL.
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Affiliation(s)
- Kunitoshi Iseki
- Dialysis Unit and Third Department of Internal Medicine, University of The Ryukyus, Okinawa, Japan.
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Abstract
It has been clearly established that lipid-lowering treatments [such as 3-hydroxyl-3-methylglutamyl coenzyme A reductase inhibitors ('statins') or fibrates] can reduce cardiovascular events, and with one of the statins even total mortality, in high-risk populations. Intervention studies have not included the very old, but it is generally assumed that this patient group would benefit from these treatments to an extent similar to younger patients. Worries about the associations seen in observational studies between low cholesterol levels and cancer, cerebral haemorrhage or mood and behaviour change have been largely overcome by findings from the latest large drug intervention trials, which do not show any increase in these conditions with statin or fibrate treatments. The common adverse effects associated with these drugs are relatively mild and often transient in nature. Potentially more serious adverse effects, which are more clearly related to drug treatment and are probably dose-dependent, include elevations in hepatic transaminase levels and myopathy; however, these effects are uncommon and generally resolve rapidly when treatment is stopped. The risk of myopathy with fibrate treatment is increased in patients with renal impairment, and the risk of myopathy with statin treatment increases with co-administration of drugs that inhibit statin metabolism or transport. Other adverse effects are related to specific drugs, for example, clofibrate is associated with an increased risk of gallstones. Studies in elderly patients have not shown an increased risk of adverse effects with lipid-lowering drugs compared with younger patients, but in clinical practice there may be some increased risk, particularly with regards to drug interactions. Therefore, lipid-lowering drugs should be administered with extra caution to elderly patients.
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Affiliation(s)
- B Tomlinson
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.
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49
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Abstract
Hypercholesterolaemia is a chronic condition that often requires life-long treatment, making the safety of lipid-lowering drugs a critical issue. 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors ('statins') are commonly used as the pharmacotherapeutic treatment of choice for patients with hypercholesterolaemia. These agents have consistently demonstrated a positive safety and tolerability profile, and are recommended by the US National Cholesterol Education Program guidelines and by the European Joint Task Force for Prevention of Coronary Heart Disease to be used after, or in addition to, a first-line approach with diet. Several large-scale clinical trials have shown HMG-CoA reductase inhibitors to be efficacious and well tolerated, and to be associated with a low rate of treatment withdrawal due to adverse events. These studies included mortality and morbidity end-points, and comprised both primary- and secondary-prevention trials. Hepatic, renal and muscular systems are rarely affected during HMG-CoA reductase inhibitor therapy and the few drug interactions that can occur with concomitantly administered drugs are well documented. There is no conclusive evidence linking HMG-CoA reductase inhibitors to the development of cancer in humans. In long term studies with various HMG-CoA reductase inhibitors, there was no increase in cancer rates compared with placebo. Thus, it can be concluded that HMG-CoA reductase inhibitors are well tolerated, effective treatments for hypercholesterolaemia.
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Affiliation(s)
- M H Davidson
- Chicago Center for Clinical Research, Illinois 60610, USA.
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Adachi H, Hirai Y, Tsuruta M, Fujiura Y, Imaizuml T. Is insulin resistance or diabetes mellitus associated with stroke? An 18-year follow-up study. Diabetes Res Clin Pract 2001; 51:215-23. [PMID: 11269894 DOI: 10.1016/s0168-8227(00)00236-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Insulin resistance and/or diabetes are risk factors for coronary artery disease. However, it is still controversial whether they are associated with the development of stroke. A total of 304 Japanese men and women, aged 20-69 years, were selected on the basis of casual high blood glucose concentrations from 2732 participants of a population-based health examination in 1980. They all underwent a 50 g oral glucose tolerance test in 1981. Homa IR (index of insulin resistance) and Homa beta-cells (index of beta-cell function) were calculated from their fasting insulin and glucose using the formulas for the homeostasis model. They were followed-up for 18 years. Incidence of stroke was investigated by computed tomography. During 18 years, 28 subjects had a stroke; 21 had ischemic and nine had hemorrhagic strokes (two had both). Baseline variables, which showed an independent association with the incidence of stroke in the Cox proportional hazard model, were blood pressure, use of anti-hypertensive medications, and Homa beta-cell index (inversely) after adjustments for age and sex. After further adjustment for blood pressure using a step-forward method, Homa beta-cell was significantly related to the incidence of stroke (Hazard ratio: 0.65, 95% confidence interval: 0.44-0.95). In addition to hypertension, diabetes but not insulin resistance, is a risk factor for stroke.
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Affiliation(s)
- H Adachi
- Third Department of Internal Medicine, Cardiovascular Research Institute, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
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