Relationships between family histories of stroke and of hypertension and stroke mortality: NIPPON DATA80, 1980-1999

Evaluation of Oxidative Status in Elderly Patients with Multiple Cerebral Infarctions and Multiple Chronic Total Coronary Occlusions

Background. Oxidative stress plays a key role in atherosclerosis. Acting via high level of reactive oxygen species, an increase of oxidative stress is involved in the pathogenesis and progression of atherosclerostic stenosis or occlusion of arteries. Oxidative stress leads to an accumulation of oxidized low-density lipoprotein, which plays important roles in steno-occlusion of cerebral and coronary arteries. However, the exact reasons for multiple cerebral and coronary artery steno-occlusion in elderly patients remain unclear. The aim was to evaluate the effects of imbalance of oxidative/antioxidative status on concomitant multiple brain infarcts and multiple chronic total coronary occlusions in elderly patients. Methods. We measured the circulating levels of malondialdehyde (MDA), reactive oxygen species (ROS), thiobarbituric acid reactive substance (TBARS), advanced oxidation protein products (AOPP), superoxide dismutase 1 (SOD 1), superoxide dismutase 2 (SOD 2), superoxide dismutase 3 (SOD 3), and paraoxonase 1 (PON 1) in patients with concomitant multiple cerebral infarcts and multiple chronic total coronary occlusions. Results. Circulating levels of oxidative stress markers (MDA, ROS, TBARS, and AOPP) were increased ( $P<0.001$ ) and antioxidative stress markers (SOD 1, SOD 2, SOD 3, and PON 1) were decreased ( $P<0.001$ ) in elderly patients with concomitant multiple brain infarcts and multiple chronic total coronary occlusions. Conclusions. The findings suggested that the imbalance of oxidative/antioxidative status may be associated with multiple cerebral infarcts and multiple chronic total coronary occlusions and may contribute to the development of concomitant multiple brain infarcts and multiple chronic total coronary occlusions in elderly patients.

The impact of parental risk factors on the risk of stroke in type 1 diabetes

BACKGROUND

Individuals with type 1 diabetes have a markedly increased risk of stroke. In the general population, genetic predisposition has been linked to increased risk of stroke, but this has not been assessed in type 1 diabetes. Our aim was, therefore, to study how parental risk factors affect the risk of stroke in individuals with type 1 diabetes.

METHODS

This study represents an observational follow-up of 4011 individuals from the Finnish Diabetic Nephropathy Study, mean age at baseline 37.6 ± 11.9 years. All strokes during follow-up were verified from medical records or death certificates. The strokes were classified as either ischemic or hemorrhagic. All individuals filled out questionnaires concerning their parents' medical history of hypertension, diabetes, stroke, and/or myocardial infarction.

RESULTS

During a median follow-up of 12.4 (10.9-14.2) years, 188 individuals (4.6%) were diagnosed with their first ever stroke; 134 were ischemic and 54 hemorrhagic. In Cox regression analysis, a history of maternal stroke increased the risk of hemorrhagic stroke, hazard ratio 2.86 (95% confidence interval 1.27-6.44, p = 0.011) after adjustment for sex, age, BMI, retinal photocoagulation, and diabetic kidney disease. There was, however, no association between maternal stroke and ischemic stroke. No other associations between parental risk factors and ischemic or hemorrhagic stroke were observed.

CONCLUSION

A history of maternal stroke increases the risk of hemorrhagic stroke in individuals with type 1 diabetes. Other parental risk factors seem to have limited impact on the risk of stroke.

Characteristics of Cerebral Stroke in the Tibet Autonomous Region of China

It is well known that cerebrovascular disease has become an important cause of adult death and disability. Strikingly, the Tibet Autonomous Region (TAR) ranks on the top in China for the incidence of stroke. To help explain this phenomenon, we have searched for and analyzed stroke-related literature for the TAR in the past 2 decades and have referenced reports from other regions at similar altitudes. This article focuses on epidemiology features, risk factors, and pathogenesis of stroke in the TAR in an effort to generate a better understanding of the characteristics of stroke in this region. The special plateau-related factors such as its high elevation, limited oxygen, the high incidence of hypertension, smoking, and the unique dietary habits of the region are correlated with the high incidence of stroke. In addition to these factors, the pathogenesis of stroke in this high-altitude area is also unique. However, there is no established explanation for the unique occurrence and high incidence of stroke in the TAR. Our study provides an important rationale not only for the clinic to prevent and treat this disease, but also for the government to develop appropriate health policies for the prevention of stroke in the TAR.

Family history of stroke and death or vascular events within one year after ischemic stroke

BACKGROUND AND AIMS

The association between family history of stroke and clinical outcomes after ischemic stroke remains unclear.

METHODS

A total of 3878 acute ischemic stroke patients from CATIS were included. The participants with ischemic stroke were divided into groups according to types of family history of stroke, stroke onset age and stroke subtypes. The primary outcome was a composite outcome of death and vascular events within 1 year after stroke. Multivariable Cox proportional hazard models were used to analyze the association between family history of stroke and other variables and clinical outcomes.

RESULTS

Among 3878 ischemic stroke patients, 708 (18.26%) had a history of stroke in their first-degree relatives and 399 experienced a composite outcome (172 patients died and 227 experienced vascular events) within 1 year after stroke. Overall family history was not associated with the primary outcome (HR, 1.08; 95% CI, 0.37-3.19). However, the patients with maternal stroke history (HR, 1.87; 95% CI, 1.31-2.97), stroke onset age<55 years with family history (HR, 2.02; 95% CI, 1.08-3.80) and thrombotic stroke in the patients with family history (HR, 1.46; 95% CI, 1.00-2.12) were associated with primary outcome, death and vascular events, respectively.

CONCLUSION

This study suggests that maternal stroke history, age<55 years at stroke onset and thrombotic stroke in the patients with a family history are associated with poor outcomes after stroke. Further studies from other samples are needed to replicate our findings due to a reason for excluding some severe stroke patients in this study.

Family History and Stroke Risk in China: Evidence from a Large Cohort Study

BACKGROUND AND PURPOSE

Large cohort studies on relationship between family history of stroke (FHS) and stroke risk are lacking in Asians. We aimed to systematically evaluate the association of FHS with stroke risk in a cohort study of 0.5 million Chinese adults.

METHODS

Information about FHS was self-reported. The median follow-up time was 7.16 years and the end-point of follow-up was incident stroke, which was entered directly into the China Kadoorie Biobank system. Multivariate analyses were performed with Cox proportional hazards model, and interaction analyses were carried using likelihood-ratio tests.

RESULTS

Compared with participants without FHS, the hazard ratio (HR) (95% confidence interval, CI) of stroke for participants with FHS was 1.50 (1.46-1.55). The HRs increased with the number of first degree relatives with stroke (HRs=1.41, 1.98 and 2.47 for 1, 2 and ≥3 relatives, respectively, Ptrend <0.001). The HRs were 1.57 (95% CI: 1.50-1.66) and 1.49 (95% CI: 1.45-1.54) for sibling history and parental history, respectively. Similar associations with offspring stroke risk were observed between paternal history (HR=1.48, 95% CI: 1.43-1.54) and maternal history (HR=1.49, 95% CI: 1.43-1.55). Moreover, significant interactions were detected between FHS and health-risk behaviors (tobacco smoking and alcohol drinking).

CONCLUSIONS

FHS is an independent risk factor for stroke in Chinese. The more first degree relatives are affected by stroke, the higher are individuals' risk of suffering from stroke. The management of the health-risk behaviors for reducing stroke should be highlighted, especially for the individuals with FHS.

Risk Factors for Stroke among Young-Old and Old-Old Community-Dwelling Adults in Japan: The Ohasama Study

AIM

Few studies have addressed stroke risk factors in older populations, particularly among the old-old. We examined differences in traditional risk factors for stroke among the old-old compared with the young-old in community-dwelling Japanese adults.

METHODS

We followed 2,065 residents aged ≥ 60 years who had no history of stroke. Traditional risk factors for stroke were obtained from a self-administered questionnaire at baseline. We classified participants into two age categories, 60-74 years (n=1,502) and ≥ 75 years (n=563), and assessed whether traditional risk factors were differentially associated with stroke incidence according to age category. Hazard ratios were calculated by the Cox proportional hazards model, adjusting for confounding factors and competing risk of death.

RESULTS

During a median follow-up of 12.8 and 7.9 years, 163 and 111 participants aged 60-74 and ≥ 75 years, respectively, developed a first stroke. Hypertension was consistently associated with increased risk of stroke, regardless of age category. Diabetes mellitus was associated with increased risk of stroke in those aged 60-74 years (hazard ratio, 1.50; 95% confidence interval, 1.00-2.25), but not in those aged ≥ 75 years (hazard ratio, 0.65; 95% confidence interval, 0.33-1.29), with significant interaction by age (P=0.035). No traditional risk factor other than hypertension was associated with stroke among those aged ≥ 75 years.

CONCLUSION

Those with hypertension had significantly higher stroke risk among old people, while diabetes mellitus was differentially associated with stroke according to age category. Our findings indicate the importance of different prevention strategies for stroke incidence according to age category.

Carotid intima-media thickness and plaque in apparently healthy Japanese individuals with an estimated 10-year absolute risk of CAD death according to the Japan Atherosclerosis Society (JAS) guidelines 2012: the Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA)

AIM

To examine whether subclinical atherosclerosis of the carotid arteries is concordant with the categories in the 2012 atherosclerosis prevention guidelines proposed by the Japan Atherosclerosis Society (JAS guidelines 2012), which adopted the estimated 10-year absolute risk of coronary artery disease (CAD) death in the NIPPON DATA80 Risk Assessment Chart.

METHODS

Between 2006 and 2008, 868 Japanese men 40 to 74 years of age without a history of cardiovascular disease were randomly selected from Kusatsu City, Japan. The intima media thickness (IMT) and plaque number from the common to internal carotid arteries were investigated using ultrasonography. The absolute risk of CAD death was estimated based on the individual risk factor data, and the mean IMT and plaque number in Categories Ⅰ, Ⅱ and Ⅲ of the guidelines were examined.

RESULTS

The estimated 10-year absolute risk of CAD was directly related to the IMT (mean IMT (mean ± SD) (mm) for a 10-year absolute risk of ≥ 2.0% and ≥ 5.0%: 0.88 ± 0.18 and 0.95 ± 0.19, respectively) and the plaque number. These results are compatible with the categories described by the guidelines (mean IMT (mean ± SD) (mm) for Categories Ⅰ, Ⅱ, and Ⅲ: 0.70 ± 0.11, 0.81 ± 0.16 and 0.88 ± 0.18, respectively; mean plaque number: 0.9, 2.1 and 3, respectively). These findings were similar for Category Ⅲ participants with or without DM and CKD.

CONCLUSIONS

Subclinical atherosclerosis of the carotid arteries is concordant with the 10-year absolute risk of CAD and the categories in the JAS guidelines 2012.

Parental history and lifestyle behaviors in relation to mortality from stroke among Japanese men and women: the Japan Collaborative Cohort Study

BACKGROUND

We assessed the impact of parental history of stroke on stroke mortality, as well as the effect modification between lifestyle and stroke mortality, among Japanese.

METHODS

In this community-based, prospective cohort study, 22,763 men and 30,928 women aged 40 to 79 years with no history of cardiovascular disease or cancer at baseline (1988-1990) were followed through 2008. We examined the association between parental history of stroke and stroke mortality and estimated the impact of the combination of lifestyle and parental history on stroke mortality in offspring.

RESULTS

During a mean follow-up period of 15.9 years, there were 1502 stroke deaths. In both sexes, participants with a parental history of stroke had a higher risk of stroke mortality as compared with those without such a history. The respective multivariable hazard ratio (95% CI) and population attributable fraction were 1.28 (1.10-1.49) and 5.4% in men, 1.22 (1.04-1.43) and 4.3% in women, and 1.25 (1.12-1.40) and 4.8% in all participants, for offspring with a maternal and/or paternal history of stroke. There was an inverse association between healthy-lifestyle score and stroke mortality, irrespective of parental history of stroke. The overall multivariable hazard ratio for the highest (6-8) versus the lowest (0-3) score categories was 0.56 (95% CI, 0.43-0.72) for participants with a maternal and/or paternal history of stroke and 0.44 (0.36-0.53) for those without such a history.

CONCLUSIONS

Parental history of stroke was associated with stroke mortality in offspring. The inverse association between healthy lifestyle behaviors and stroke mortality, regardless of parental history, suggests that lifestyle modification is beneficial, even among individuals with a parental history of stroke.