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Yamanie N, Felistia Y, Susanto NH, Lamuri A, Sjaaf AC, Miftahussurur M, Santoso A. Prognostic model of in-hospital ischemic stroke mortality based on an electronic health record cohort in Indonesia. PLoS One 2024; 19:e0305100. [PMID: 38865423 PMCID: PMC11168658 DOI: 10.1371/journal.pone.0305100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/23/2024] [Indexed: 06/14/2024] Open
Abstract
Stroke patients rarely have satisfactory survival, which worsens further if comorbidities develop in such patients. Limited data availability from Southeast Asian countries, especially Indonesia, has impeded the disentanglement of post-stroke mortality determinants. This study aimed to investigate predictors of in-hospital mortality in patients with ischemic stroke (IS). This retrospective observational study used IS medical records from the National Brain Centre Hospital, Jakarta, Indonesia. A theoretically driven Cox's regression and Fine-Gray models were established by controlling for age and sex to calculate the hazard ratio of each plausible risk factor for predicting in-hospital stroke mortality and addressing competing risks if they existed. This study finally included 3,278 patients with IS, 917 (28%) of whom had cardiovascular disease and 376 (11.5%) suffered renal disease. Bivariate exploratory analysis revealed lower blood levels of triglycerides, low density lipoprotein, and total cholesterol associated with in-hospital-stroke mortality. The average age of patients with post-stroke mortality was 64.06 ± 11.32 years, with a mean body mass index (BMI) of 23.77 kg/m2 and a median Glasgow Coma Scale (GCS) score of 12 and an IQR of 5. Cardiovascular disease was significantly associated with IS mortality risk. NIHSS score at admission (hazard ratio [HR] = 1.04; 95% confidence interval [CI]: 1.00-1.07), male sex (HR = 1.51[1.01-2.26] and uric acid level (HR = 1.02 [1.00-1.03]) predicted survivability. Comorbidities, such as cardiovascular disease (HR = 2.16 [1.37-3.40], pneumonia (HR = 2.43 [1.42-4.15] and sepsis (HR = 2.07 [1.09-3.94, had higher hazards for post-stroke mortality. Contrarily, the factors contributing to a lower hazard of mortality were BMI (HR = 0.94 [0.89-0.99]) and GCS (HReye = 0.66 [0.48-0.89]. In summary, our study reported that male sex, NIHSS, uric acid level, cardiovascular diseases, pneumonia, sepsis. BMI, and GCS on admission were strong determinants of in-hospital mortality in patients with IS.
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Affiliation(s)
- Nizar Yamanie
- Doctoral Program of Medical Science, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
- National Brain Centre Hospital, Jakarta, Indonesia
| | | | - Nugroho Harry Susanto
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jakarta, Indonesia
| | - Aly Lamuri
- National Brain Centre Hospital, Jakarta, Indonesia
| | - Amal Chalik Sjaaf
- Department of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Muhammad Miftahussurur
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Airlangga University, Surabaya, Indonesia
| | - Anwar Santoso
- Department of Cardiology–Vascular Medicine, National Cardiovascular Centre–Harapan Kita Hospital, Universitas Indonesia, Jakarta, Indonesia
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Tuccinardi D, Watanabe M, Masi D, Monte L, Bonifazi Meffe L, Cavallari I, Nusca A, Maddaloni E, Gnessi L, Napoli N, Manfrini S, Grigioni F. Rethinking weight loss treatments as cardiovascular medicine in obesity, a comprehensive review. Eur J Prev Cardiol 2024:zwae171. [PMID: 38833329 DOI: 10.1093/eurjpc/zwae171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/27/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024]
Abstract
The global escalation of obesity has made it a worldwide health concern, notably as a leading risk factor for cardiovascular disease (CVD). Extensive evidence corroborates its association with a range of cardiac complications, including coronary artery disease, heart failure, and heightened vulnerability to sudden cardiac events. Additionally, obesity contributes to the emergence of other cardiovascular risk factors including dyslipidaemia, type 2 diabetes, hypertension, and sleep disorders, further amplifying the predisposition to CVD. To adequately address CVD in patients with obesity, it is crucial to first understand the pathophysiology underlying this link. We herein explore these intricate mechanisms, including adipose tissue dysfunction, chronic inflammation, immune system dysregulation, and alterations in the gut microbiome.Recent guidelines from the European Society of Cardiology underscore the pivotal role of diagnosing and treating obesity to prevent CVD. However, the intricate relationship between obesity and CVD poses significant challenges in clinical practice: the presence of obesity can impede accurate CVD diagnosis while optimizing the effectiveness of pharmacological treatments or cardiac procedures requires meticulous adjustment, and it is crucial that cardiologists acknowledge the implications of excessive weight while striving to enhance outcomes for the vulnerable population affected by obesity. We, therefore, sought to overcome controversial aspects in the clinical management of heart disease in patients with overweight/obesity and present evidence on cardiometabolic outcomes associated with currently available weight management interventions, with the objective of equipping clinicians with an evidence-based approach to recognize and address CVD risks associated with obesity.
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Affiliation(s)
- Dario Tuccinardi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
- Research Unit of Endocrinology and Diabetology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
| | - Mikiko Watanabe
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Davide Masi
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Lavinia Monte
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
- Research Unit of Endocrinology and Diabetology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
| | - Luigi Bonifazi Meffe
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
- Research Unit of Endocrinology and Diabetology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
| | - Ilaria Cavallari
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
- Research Unit of Cardiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
| | - Annunziata Nusca
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
- Research Unit of Cardiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
| | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Lucio Gnessi
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Nicola Napoli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
- Research Unit of Endocrinology and Diabetology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
| | - Silvia Manfrini
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
- Research Unit of Endocrinology and Diabetology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
| | - Francesco Grigioni
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
- Research Unit of Cardiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
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Abujaber AA, Imam Y, Albalkhi I, Yaseen S, Nashwan AJ, Akhtar N. Utilizing machine learning to facilitate the early diagnosis of posterior circulation stroke. BMC Neurol 2024; 24:156. [PMID: 38714968 PMCID: PMC11075305 DOI: 10.1186/s12883-024-03638-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Posterior Circulation Syndrome (PCS) presents a diagnostic challenge characterized by its variable and nonspecific symptoms. Timely and accurate diagnosis is crucial for improving patient outcomes. This study aims to enhance the early diagnosis of PCS by employing clinical and demographic data and machine learning. This approach targets a significant research gap in the field of stroke diagnosis and management. METHODS We collected and analyzed data from a large national Stroke Registry spanning from January 2014 to July 2022. The dataset included 15,859 adult patients admitted with a primary diagnosis of stroke. Five machine learning models were trained: XGBoost, Random Forest, Support Vector Machine, Classification and Regression Trees, and Logistic Regression. Multiple performance metrics, such as accuracy, precision, recall, F1-score, AUC, Matthew's correlation coefficient, log loss, and Brier score, were utilized to evaluate model performance. RESULTS The XGBoost model emerged as the top performer with an AUC of 0.81, accuracy of 0.79, precision of 0.5, recall of 0.62, and F1-score of 0.55. SHAP (SHapley Additive exPlanations) analysis identified key variables associated with PCS, including Body Mass Index, Random Blood Sugar, ataxia, dysarthria, and diastolic blood pressure and body temperature. These variables played a significant role in facilitating the early diagnosis of PCS, emphasizing their diagnostic value. CONCLUSION This study pioneers the use of clinical data and machine learning models to facilitate the early diagnosis of PCS, filling a crucial gap in stroke research. Using simple clinical metrics such as BMI, RBS, ataxia, dysarthria, DBP, and body temperature will help clinicians diagnose PCS early. Despite limitations, such as data biases and regional specificity, our research contributes to advancing PCS understanding, potentially enhancing clinical decision-making and patient outcomes early in the patient's clinical journey. Further investigations are warranted to elucidate the underlying physiological mechanisms and validate these findings in broader populations and healthcare settings.
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Affiliation(s)
- Ahmad A Abujaber
- Nursing Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Yahia Imam
- Neurology Section, Neuroscience Institute, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ibrahem Albalkhi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Said Yaseen
- School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdulqadir J Nashwan
- Nursing Department, Hamad Medical Corporation (HMC), Doha, Qatar.
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
| | - Naveed Akhtar
- Neuroradiology Department, Neuroscience Institute, Hamad Medical Corporation (HMC), Doha, Qatar
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Miwa K, Nakai M, Yoshimura S, Sasahara Y, Wada S, Koge J, Ishigami A, Yagita Y, Kamiyama K, Miyamoto Y, Kobayashi S, Minematsu K, Toyoda K, Koga M. Clinical impact of body mass index on outcomes of ischemic and hemorrhagic strokes. Int J Stroke 2024:17474930241249370. [PMID: 38651751 DOI: 10.1177/17474930241249370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND AIM To investigate the prognostic implication of body mass index (BMI) on clinical outcomes after acute ischemic and hemorrhagic stroke. METHODS The subjects of the study included adult patients with available baseline body weight and height data who had suffered an acute stroke and were registered in the Japan Stroke Data Bank-a hospital-based, multicenter stroke registration database-between January 2006 and December 2020. The outcome measures included unfavorable outcomes defined as a modified Rankin Scale (mRS) score of 5-6 and favorable outcomes (mRS 0-2) at discharge, and in-hospital mortality. Mixed effects logistic regression analysis was conducted to determine the relationship between BMI categories (underweight, normal weight, overweight, class I obesity, class II obesity; <18.5, 18.5-23.0, 23.0-25.0, 25-30, ⩾30 kg/m2) and the outcomes, after adjustment for covariates. RESULTS A total of 56,230 patients were assigned to one of the following groups: ischemic stroke (IS, n = 43,668), intracerebral hemorrhage (ICH, n = 9741), and subarachnoid hemorrhage (SAH, n = 2821). In the IS group, being underweight was associated with an increased likelihood of unfavorable outcomes (odds ratio, 1.47 (95% confidence interval (CI):1.31-1.65)) and in-hospital mortality (1.55 (1.31-1.83)) compared to outcomes in those with normal weight. Being overweight was associated with an increased likelihood of favorable outcomes (1.09 (1.01-1.18)). Similar associations were observed between underweight and these outcomes in specific IS subtypes (cardioembolic stroke, large artery stroke, and small-vessel occlusion). Patients with a BMI ⩾30.0 kg/m2 was associated with an increased likelihood of unfavorable outcomes (1.44 (1.01-2.17)) and in-hospital mortality (2.42 (1.26-4.65)) in large artery stroke. In patients with ICH, but not those with SAH, being underweight was associated with an increased likelihood of unfavorable outcomes (1.41 (1.01-1.99)). CONCLUSIONS BMI substantially impacts functional outcomes following IS and ICH. Lower BMI consistently affected post-stroke disability and mortality, while higher BMI values similarly affected these outcomes after large artery stroke.
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Affiliation(s)
- Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yusuke Sasahara
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shinichi Wada
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akiko Ishigami
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan
| | | | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Abujaber AA, Albalkhi I, Imam Y, Nashwan A, Akhtar N, Alkhawaldeh IM. Machine learning-based prognostication of mortality in stroke patients. Heliyon 2024; 10:e28869. [PMID: 38601648 PMCID: PMC11004568 DOI: 10.1016/j.heliyon.2024.e28869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/22/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
Objectives Predicting stroke mortality is crucial for personalized care. This study aims to design and evaluate a machine learning model to predict one-year mortality after a stroke. Materials and methods Data from the National Multiethnic Stroke Registry was utilized. Eight machine learning (ML) models were trained and evaluated using various metrics. SHapley Additive exPlanations (SHAP) analysis was used to identify the influential predictors. Results The final analysis included 9840 patients diagnosed with stroke were included in the study. The XGBoost algorithm exhibited optimal performance with high accuracy (94.5%) and AUC (87.3%). Core predictors encompassed National Institutes of Health Stroke Scale (NIHSS) at admission, age, hospital length of stay, mode of arrival, heart rate, and blood pressure. Increased NIHSS, age, and longer stay correlated with higher mortality. Ambulance arrival and lower diastolic blood pressure and lower body mass index predicted poorer outcomes. Conclusions This model's predictive capacity emphasizes the significance of NIHSS, age, hospital stay, arrival mode, heart rate, blood pressure, and BMI in stroke mortality prediction. Specific findings suggest avenues for data quality enhancement, registry expansion, and real-world validation. The study underscores machine learning's potential for early mortality prediction, improving risk assessment, and personalized care. The potential transformation of care delivery through robust ML predictive tools for Stroke outcomes could revolutionize patient care, allowing for personalized plans and improved preventive strategies for stroke patients. However, it is imperative to conduct prospective validation to evaluate its practical clinical effectiveness and ensure its successful adoption across various healthcare environments.
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Affiliation(s)
| | - Ibrahem Albalkhi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London WC1N 3JH, United Kingdom
| | - Yahia Imam
- Neurology Section, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Naveed Akhtar
- Neurology Section, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
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Hoffman H, Cote JR, Wood J, Jalal MS, Draytsel DY, Gould GC. The Influence of Body Mass Index on Outcomes in Patients Undergoing Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion: Institutional Experience and Meta-analysis. Neurocrit Care 2024; 40:654-663. [PMID: 37498460 DOI: 10.1007/s12028-023-01801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND An obesity paradox, whereby patients with higher body mass index (BMI) experience improved outcomes, has been described for ischemic stroke. It is unclear whether this applies to patients undergoing mechanical thrombectomy (MT) for large vessel occlusion (LVO). METHODS Mechanical thrombectomies for anterior circulation LVO between 2015 and 2021 at a single institution were reviewed. Multivariable logistic regressions were used to determine the association between BMI and favorable functional outcome (90-day modified Rankin Scale 0-2), intracranial hemorrhage, and malignant middle cerebral infarction. A systematic review was performed to identify studies reporting the effect of BMI on outcomes among patients receiving MT for LVO. The data from the systematic review were combined with the institutional data by using a random effects model. RESULTS The institutional cohort comprised 390 patients with a median BMI of 27 kg/m2. Most patients were obese [36.7% (BMI ≥ 30 kg/m2)], followed by overweight [30.5% (BMI ≥ 25 and < 30 kg/m2)], normal [27.9% (BMI ≥ 18.5 and < 25 kg/m2)], and underweight [4.9% (BMI < 18.5 kg/m2)]. As a continuous variable, BMI was not associated with any of the outcomes. When analyzing BMI ordinally, obesity was associated with lower odds of favorable 90-day modified Rankin Scale (odds ratio 0.42, 95% confidence interval 0.20-0.86). The systematic review identified three eligible studies comprising 1,348 patients for a total of 1,738 patients. In the random effects model, there was no association between obesity and favorable outcome (odds ratio 0.89, 95% confidence interval 0.63-1.24). CONCLUSIONS Obesity is not associated with favorable outcomes in patients undergoing MT for LVO.
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Affiliation(s)
- Haydn Hoffman
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
| | - John R Cote
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Jacob Wood
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Muhammad S Jalal
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Dan Y Draytsel
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Grahame C Gould
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
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Holland SA, Wellwood I, Kuys S. Effect of abnormal body weight on mortality and functional recovery in adults after stroke: An umbrella review. Int J Stroke 2024; 19:397-405. [PMID: 37897100 DOI: 10.1177/17474930231212972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND Several published systematic reviews have drawn conflicting conclusions on the effect of abnormal body weight (i.e. being underweight, overweight or obese) on outcomes following stroke. The 'obesity paradox' seen in several diseases (wherein obesity, often associated with mortality and morbidity, appears to be protective and improve outcomes) may be evident after stroke, but inconsistent results of existing reviews, and the issue of being underweight, are worth investigating further. AIMS To better understand the impact of body weight on prognosis after stroke, we aimed to answer the following research question: What is the effect of abnormal body weight (underweight, overweight, or obesity) on mortality and functional recovery in adults after stroke? SUMMARY OF REVIEW We conducted an umbrella review to synthesize existing evidence on the effects of abnormal body weight on stroke outcomes. We searched Cumulated Index to Nursing and Allied Health Literature (CINAHL) Complete, COCHRANE Database of Systematic Reviews, PubMed, Medline, PEDro, and EMBASE Classic + EMBASE, from inception until 28 February 2023. Seven systematic reviews (1,136,929 participants) from 184 primary studies (counting duplicates) were included. While the risk of mortality increases with being underweight (body mass index (BMI) < 18.5 kg/m2), excess body weight (being overweight (BMI = 25-29.9 kg/m2) or obese (BMI > 30 kg/m2)) is associated with reduced mortality. The impact of abnormal body weight on functional recovery is less clear; data from studies of being underweight are associated with poor functional outcomes while those from studies of excess body weight are inconclusive. CONCLUSION Abnormal body weight effects post-stroke outcomes and should be considered in clinical decision-making, prognostic research, and clinical trials of rehabilitation interventions. The "obesity paradox" is evident after stroke, and excess body weight is associated with reduced mortality compared to normal body weight. It is recommended that body weight is routinely recorded for stroke patients, and further research, including well-designed cohort studies with reliable weight data, is needed to further investigate the impact of body weight and distribution on post-stroke outcomes.
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Affiliation(s)
- Stephanie A Holland
- Department of Physiotherapy, Sunshine Hospital, Western Health, Saint Albans, VIC, Australia
| | - Ian Wellwood
- Australian Catholic University, Ballarat, VIC, Australia
| | - Suzanne Kuys
- Australian Catholic University, Banyo, QLD, Australia
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Golubnitschaja O, Polivka J, Potuznik P, Pesta M, Stetkarova I, Mazurakova A, Lackova L, Kubatka P, Kropp M, Thumann G, Erb C, Fröhlich H, Wang W, Baban B, Kapalla M, Shapira N, Richter K, Karabatsiakis A, Smokovski I, Schmeel LC, Gkika E, Paul F, Parini P, Polivka J. The paradigm change from reactive medical services to 3PM in ischemic stroke: a holistic approach utilising tear fluid multi-omics, mitochondria as a vital biosensor and AI-based multi-professional data interpretation. EPMA J 2024; 15:1-23. [PMID: 38463624 PMCID: PMC10923756 DOI: 10.1007/s13167-024-00356-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 03/12/2024]
Abstract
Worldwide stroke is the second leading cause of death and the third leading cause of death and disability combined. The estimated global economic burden by stroke is over US$891 billion per year. Within three decades (1990-2019), the incidence increased by 70%, deaths by 43%, prevalence by 102%, and DALYs by 143%. Of over 100 million people affected by stroke, about 76% are ischemic stroke (IS) patients recorded worldwide. Contextually, ischemic stroke moves into particular focus of multi-professional groups including researchers, healthcare industry, economists, and policy-makers. Risk factors of ischemic stroke demonstrate sufficient space for cost-effective prevention interventions in primary (suboptimal health) and secondary (clinically manifested collateral disorders contributing to stroke risks) care. These risks are interrelated. For example, sedentary lifestyle and toxic environment both cause mitochondrial stress, systemic low-grade inflammation and accelerated ageing; inflammageing is a low-grade inflammation associated with accelerated ageing and poor stroke outcomes. Stress overload, decreased mitochondrial bioenergetics and hypomagnesaemia are associated with systemic vasospasm and ischemic lesions in heart and brain of all age groups including teenagers. Imbalanced dietary patterns poor in folate but rich in red and processed meat, refined grains, and sugary beverages are associated with hyperhomocysteinaemia, systemic inflammation, small vessel disease, and increased IS risks. Ongoing 3PM research towards vulnerable groups in the population promoted by the European Association for Predictive, Preventive and Personalised Medicine (EPMA) demonstrates promising results for the holistic patient-friendly non-invasive approach utilising tear fluid-based health risk assessment, mitochondria as a vital biosensor and AI-based multi-professional data interpretation as reported here by the EPMA expert group. Collected data demonstrate that IS-relevant risks and corresponding molecular pathways are interrelated. For examples, there is an evident overlap between molecular patterns involved in IS and diabetic retinopathy as an early indicator of IS risk in diabetic patients. Just to exemplify some of them such as the 5-aminolevulinic acid/pathway, which are also characteristic for an altered mitophagy patterns, insomnia, stress regulation and modulation of microbiota-gut-brain crosstalk. Further, ceramides are considered mediators of oxidative stress and inflammation in cardiometabolic disease, negatively affecting mitochondrial respiratory chain function and fission/fusion activity, altered sleep-wake behaviour, vascular stiffness and remodelling. Xanthine/pathway regulation is involved in mitochondrial homeostasis and stress-driven anxiety-like behaviour as well as molecular mechanisms of arterial stiffness. In order to assess individual health risks, an application of machine learning (AI tool) is essential for an accurate data interpretation performed by the multiparametric analysis. Aspects presented in the paper include the needs of young populations and elderly, personalised risk assessment in primary and secondary care, cost-efficacy, application of innovative technologies and screening programmes, advanced education measures for professionals and general population-all are essential pillars for the paradigm change from reactive medical services to 3PM in the overall IS management promoted by the EPMA.
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Affiliation(s)
- Olga Golubnitschaja
- Predictive, Preventive and Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Jiri Polivka
- Department of Histology and Embryology, Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
- Biomedical Centre, Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
| | - Pavel Potuznik
- Department of Neurology, University Hospital Plzen and Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
| | - Martin Pesta
- Department of Biology, Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
| | - Ivana Stetkarova
- Department of Neurology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alena Mazurakova
- Department of Anatomy, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia
| | - Lenka Lackova
- Department of Histology and Embryology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia
| | - Peter Kubatka
- Department of Histology and Embryology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia
| | - Martina Kropp
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
- Ophthalmology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Gabriele Thumann
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
- Ophthalmology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Carl Erb
- Private Institute of Applied Ophthalmology, Berlin, Germany
| | - Holger Fröhlich
- Artificial Intelligence & Data Science Group, Fraunhofer SCAI, Sankt Augustin, Germany
- Bonn-Aachen International Center for IT (B-It), University of Bonn, 53115 Bonn, Germany
| | - Wei Wang
- Edith Cowan University, Perth, Australia
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Babak Baban
- The Dental College of Georgia, Departments of Neurology and Surgery, The Medical College of Georgia, Augusta University, Augusta, USA
| | - Marko Kapalla
- Negentropic Systems, Ružomberok, Slovakia
- PPPM Centre, s.r.o., Ruzomberok, Slovakia
| | - Niva Shapira
- Department of Nutrition, School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
| | - Kneginja Richter
- CuraMed Tagesklinik Nürnberg GmbH, Nuremberg, Germany
- Technische Hochschule Nürnberg GSO, Nuremberg, Germany
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Alexander Karabatsiakis
- Department of Psychology, Clinical Psychology II, University of Innsbruck, Innsbruck, Austria
| | - Ivica Smokovski
- University Clinic of Endocrinology, Diabetes and Metabolic Disorders Skopje, University Goce Delcev, Faculty of Medical Sciences, Stip, North Macedonia
| | - Leonard Christopher Schmeel
- Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Eleni Gkika
- Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | | | - Paolo Parini
- Cardio Metabolic Unit, Department of Medicine Huddinge, and Department of Laboratory Medicine, Karolinska Institutet, and Medicine Unit of Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Jiri Polivka
- Department of Neurology, University Hospital Plzen and Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
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Fallah N, Noonan VK, Thorogood NP, Kwon BK, Kopp MA, Schwab JM. Effect of body mass index on survival after spinal cord injury. Front Neurol 2024; 14:1269030. [PMID: 38344110 PMCID: PMC10853461 DOI: 10.3389/fneur.2023.1269030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/27/2023] [Indexed: 05/12/2024] Open
Abstract
Introduction Increased mortality after acute and chronic spinal cord injury (SCI) remains a challenge and mandates a better understanding of the factors contributing to survival in these patients. This study investigated whether body mass index (BMI) measured after acute traumatic SCI is associated with a change in mortality. Methods A prospective longitudinal cohort study was conducted with 742 patients who were admitted to the Acute Spine Unit of the Vancouver General Hospital between 2004 and 2016 with a traumatic SCI. An investigation of the association between BMI on admission and long-term mortality was conducted using classification and regression tree (CART) and generalized additive models (spline curves) from acute care up to 7.7 years after SCI (chronic phase). Multivariable models were adjusted for (i) demographic factors (e.g., age, sex, and Charlson Comorbidity Index) and (ii) injury characteristics (e.g., neurological level and severity and Injury Severity Score). Results After the exclusion of incomplete datasets (n = 602), 643 patients were analyzed, of whom 102 (18.5%) died during a period up to 7.7 years after SCI. CART identified three distinct mortality risk groups: (i) BMI: > 30.5 kg/m2, (ii) 17.5-30.5 kg/m2, and (iii) < 17.5 kg/m2. Mortality was lowest in the high BMI group (BMI > 30.5 kg/m2), followed by the middle-weight group (17.5-30.5 kg/m2), and was highest in the underweight group (BMI < 17.5 kg/m2). High BMI had a mild protective effect against mortality after SCI (hazard ratio 0.28, 95% CI: 0.09-0.88, p = 0.029), concordant with a modest "obesity paradox". Moreover, being underweight at admission was a significant risk factor for mortality up to 7.7 years after SCI (hazard ratio 5.5, 95% CI: 2.34-13.17, p < 0.001). Discussion Mortality risk (1 month to 7.7 years after SCI) was associated with differences in BMI at admission. Further research is needed to better understand the underlying mechanisms. Given an established association of BMI with metabolic determinants, these results may suggest unknown neuro-metabolic pathways that are crucial for patient survival.
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Affiliation(s)
- Nader Fallah
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vanessa K. Noonan
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Nancy P. Thorogood
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Brian K. Kwon
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Marcel A. Kopp
- Department of Neurology and Experimental Neurology, Clinical and Experimental Spinal Cord Injury Research, Charité – Universitätsmedizin Berlin, Berlin, Germany
- QUEST-Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Jan M. Schwab
- Department of Neurology and Experimental Neurology, Clinical and Experimental Spinal Cord Injury Research, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Spinal Cord Injury Division, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
- Belford Center for Spinal Cord Injury, Departments of Physical Medicine and Rehabilitation and Neuroscience, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
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10
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Becerril-Gaitan A, Ding D, Ironside N, Southerland AM, Worrall BB, Testai FD, Flaherty ML, Elkind MS, Koch S, Sung G, Kittner SJ, Mayson DJ, Gonzales N, McCauley JL, Malkoff M, Hall CE, Frankel MR, James ML, Anderson CD, Aronowski J, Savitz SI, Woo D, Chen CJ. Association Between Body Mass Index and Functional Outcomes in Patients With Intracerebral Hemorrhage. Neurology 2024; 102:e208014. [PMID: 38165334 PMCID: PMC10870743 DOI: 10.1212/wnl.0000000000208014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/13/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence of the so-called "obesity paradox," which refers to the protective effect and survival benefit of obesity in patients with spontaneous intracerebral hemorrhage (ICH), remains controversial. This study aims to determine the association between body mass index (BMI) and functional outcomes in patients with ICH and whether it is modified by race/ethnicity. METHODS Included individuals were derived from the Ethnic/Racial Variations of Intracerebral Hemorrhage study, which prospectively recruited 1,000 non-Hispanic White, 1,000 non-Hispanic Black, and 1,000 Hispanic patients with spontaneous ICH. Only patients with available BMI were included. The primary outcome was 90-day mortality. Secondary outcomes were mortality at discharge, modified Rankin Scale (mRS), Barthel Index, and self-reported health status measures at 90 days. Associations between BMI and ICH outcomes were assessed using univariable and multivariable logistic, ordinal, and linear regression models, as appropriate. Sensitivity analyses after excluding frail patients and by patient race/ethnicity were performed. RESULTS A total of 2,841 patients with ICH were included. The median age was 60 years (interquartile range 51-73). Most patients were overweight (n = 943; 33.2%) or obese (n = 1,032; 36.3%). After adjusting for covariates, 90-day mortality was significantly lower among overweight and obese patients than their normal weight counterparts (adjusted odds ratio [aOR] = 0.71 [0.52-0.98] and aOR = 0.70 [0.50-0.97], respectively). Compared with patients with BMI <25 kg/m2, those with BMI ≥25 kg/m2 had better 90-day mRS (aOR = 0.80 [CI 0.67-0.95]), EuroQoL Group 5-Dimension (EQ-5D) (aβ = 0.05 [0.01-0.08]), and EQ-5D VAS (aβ = 3.80 [0.80-6.98]) scores. These differences persisted after excluding withdrawal of care patients. There was an inverse relationship between BMI and 90-day mortality (aOR = 0.97 [0.96-0.99]). Although non-Hispanic White patients had significantly higher 90-day mortality than non-Hispanic Black and Hispanic (26.6% vs 19.5% vs 18.0%, respectively; p < 0.001), no significant interactions were found between BMI and race/ethnicity. No significant interactions between BMI and age or sex for 90-day mortality were found, whereas for 90-day mRS, there was a significant interaction with age (pinteraction = 0.004). CONCLUSION We demonstrated that a higher BMI is associated with decreased mortality, improved functional outcomes, and better self-reported health status at 90 days, thus supporting the paradoxical role of obesity in patients with ICH. The beneficial effect of high BMI does not seem to be modified by race/ethnicity or sex, whereas age may play a significant role in patient functional outcomes.
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Affiliation(s)
- Andrea Becerril-Gaitan
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Dale Ding
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Natasha Ironside
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Andrew M Southerland
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Bradford B Worrall
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Fernando D Testai
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Matthew L Flaherty
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Mitchell S Elkind
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Sebastian Koch
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Gene Sung
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Steven J Kittner
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Douglas J Mayson
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Nicole Gonzales
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Jacob L McCauley
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Marc Malkoff
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Christiana E Hall
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Michael R Frankel
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Michael L James
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Christopher D Anderson
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Jaroslaw Aronowski
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Sean I Savitz
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Daniel Woo
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Ching-Jen Chen
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
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Wakisaka K, Matsuo R, Irie F, Wakisaka Y, Ago T, Kamouchi M, Kitazono T. Association between abdominal adiposity and clinical outcomes in patients with acute ischemic stroke. PLoS One 2024; 19:e0296833. [PMID: 38206990 PMCID: PMC10783725 DOI: 10.1371/journal.pone.0296833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND It is unclear whether abdominal adiposity has an additional effect on post-stroke outcomes. This study aimed to determine whether waist circumference (WC) is independently associated with clinical outcomes after acute ischemic stroke. METHODS We enrolled patients with acute ischemic stroke from a multicenter hospital-based stroke registry in Fukuoka, Japan. We measured WC on admission and categorized patients into four groups (Q1-Q4) according to the quartiles in females and males. The clinical outcomes were poor functional outcome (modified Rankin scale score 2-6) and death from any cause. Logistic regression analysis was performed to estimate the odds ratio and 95% confidence interval of the outcomes of interest after adjusting for potential confounding factors, including body mass index (BMI). RESULTS A total of 11,989 patients (70.3±12.2 years, females: 36.1%) were included in the analysis. The risk of poor functional outcome significantly decreased for Q2-Q4 (vs. Q1) at discharge and Q2-Q3 (vs. Q1) at 3 months, even after adjusting for potential confounders, including BMI. In contrast, adjustment of BMI eliminated the significant association between WC and all-cause death at discharge and 3 months. The association between high WC and favorable functional outcome was not affected by fasting insulin levels or homeostatic model assessment for insulin resistance and was only found in patients without diabetes (P = 0.02 for heterogeneity). CONCLUSIONS These findings suggest that abdominal adiposity has an additional impact on post-stroke functional outcome, independent of body weight and insulin action.
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Affiliation(s)
- Kayo Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Neurology, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Ryu Matsuo
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumi Irie
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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12
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Algahtani H, Shirah B, Hachinski V. Primordial and Primary Prevention of Ischemic Stroke in Saudi Arabia: A Combination Approach and Evolving Concepts. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:1-9. [PMID: 38362089 PMCID: PMC10866385 DOI: 10.4103/sjmms.sjmms_62_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/18/2023] [Accepted: 09/20/2023] [Indexed: 02/17/2024]
Abstract
Ischemic stroke is a considerable public health hazard and a significant cause of disability and mortality in Saudi Arabia. Primary prevention strategies in the country are currently limited. With the health sector transformation program that depends on the principles of value-based care and applying the new model of care in disease prevention, aggressive and serious steps for primary stroke prevention are expected to be implemented. This article reviews primordial and primary prevention of ischemic stroke in Saudi Arabia and suggests a combination approach and framework for implementation. We provide a pragmatic solution to implement primordial and primary stroke prevention in Saudi Arabia and specify the roles of the government, health professionals, policymakers, and the entire population. Currently, there are several key priorities for primordial and primary stroke prevention in Saudi Arabia that should target people at different levels of risk. These include an emphasis on a comprehensive approach that includes both individual and population-based strategies and establishing partnerships across health-care providers to share responsibility for developing and implementing both strategies. This is an urgent call for action to initiate different strategies suggested by experts for primary stroke prevention in Saudi Arabia.
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Affiliation(s)
| | - Bader Shirah
- Department of Neuroscience, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Robarts Research Institute, Western University, London, Ontario, Canada
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13
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Tian T, Wang L, Xu J, Jia Y, Xue K, Huang S, Shen T, Luo Y, Li S, Min L. Prediction of early neurological deterioration in acute ischemic stroke patients treated with intravenous thrombolysis. J Cereb Blood Flow Metab 2023; 43:2049-2059. [PMID: 37668997 PMCID: PMC10925869 DOI: 10.1177/0271678x231200117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/06/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023]
Abstract
A proportion of acute ischemic stroke (AIS) patients suffer from early neurological deterioration (END) within 24 hours following intravenous thrombolysis (IVT), which greatly increases the risk of poor prognosis of these patients. Therefore, we aimed to explore the predictors of early neurological deterioration of ischemic origin (ENDi) in AIS patients after IVT and develop a nomogram prediction model. This study collected 244 AIS patients with post-thrombolysis ENDi as the derivation cohort and 155 patients as the validation cohort. To establish a nomogram prediction model, risk factors were identified by multivariate logistic regression analysis. The results showed that neutrophil to lymphocyte ratio (NLR) (OR 2.616, 95% CI 1.640-4.175, P < 0.001), mean platelet volume (MPV) (OR 3.334, 95% CI 1.351-8.299, P = 0.009), body mass index (BMI) (OR 1.979, 95% CI 1.285-3.048, P = 0.002) and atrial fibrillation (AF) (OR 8.012, 95% CI 1.341-47.873, P = 0.023) were significantly associated with ENDi. The area under the curve of the prediction model constructed from the above four factors was 0.981 (95% CI 0.961-1.000) and the calibration curve was close to the ideal diagonal line. Therefore, this nomogram prediction model exhibited good discrimination and calibration power and might be a reliable and easy-to-use tool to predict post-thrombolysis ENDi in AIS patients.
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Affiliation(s)
- Tian Tian
- Department of Neurology, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Lanjing Wang
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiali Xu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yujie Jia
- Department of Neurology, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Kun Xue
- Department of Neurology, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Shuangfeng Huang
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tong Shen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yumin Luo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sijie Li
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Lianqiu Min
- Department of Neurology, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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14
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Sánchez-Bacaicoa C, Santano-Mogena E, Rico-Martín S, Rey-Sánchez P, Juárez-Vela R, Sánchez Muñoz-Torrero JF, López-Espuela F, Calderón-García JF. Association between Asymptomatic Hyperuricemia with Adiposity Indices: A Cross-Sectional Study in a Spanish Population. Nutrients 2023; 15:4798. [PMID: 38004193 PMCID: PMC10675342 DOI: 10.3390/nu15224798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION New anthropometric indices have been developed as an alternative to body mass index (BMI) and waist circumference (WC) to assess body mass and visceral fat. Asymptomatic hyperuricemia is considered an independent cardiovascular risk factor. Currently, little is known about the relationship between asymptomatic hyperuricemia and several new anthropometric indices. This study aimed to assess the association between the presence of asymptomatic hyperuricemia and anthropometric indices, both novel and traditional. METHODS This study analyzed 1094 Spanish subjects who consecutively visited the cardiovascular risk consultation of the University Hospital San Pedro de Alcántara of Cáceres, Spain, between June 2021 and September 2022. Anthropometric measures, including traditional and novel indices, were determined. The asymptomatic hyperuricemia group was defined according to serum uric acid levels. RESULTS All the anthropometric indices studied, including new and traditional, were significantly greater among patients with asymptomatic hyperuricemia, except for WWI. In multiple linear regression analysis, serum uric acid levels were significantly correlated with BMI, WHR, WHtR, AVI, BAI, BRI, CUN-BAE, and WWI but not ABSI or CI. In the univariate analysis, all indices were associated with asymptomatic hyperuricemia (p < 0.05); however, only WHtR (adjusted OR: 2.93; 95% CI: 1.03-8.37; p = 0.044), AVI (adjusted OR: 1.46; 95% CI: 1.04-2.04; p = 0.026), and BRI (adjusted OR: 1.66; 95% CI: 1.19-2.32; p = 0.003) were significantly associated in multivariate analysis. Finally, WHtR, AVI, and BRI provided the largest AUCs. CONCLUSIONS Our findings showed that WHtR, AVI, and BRI were independently positively associated with asymptomatic hyperuricemia and could be good predictors.
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Affiliation(s)
| | - Esperanza Santano-Mogena
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (E.S.-M.); (P.R.-S.); (F.L.-E.); (J.F.C.-G.)
| | - Sergio Rico-Martín
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (E.S.-M.); (P.R.-S.); (F.L.-E.); (J.F.C.-G.)
| | - Purificación Rey-Sánchez
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (E.S.-M.); (P.R.-S.); (F.L.-E.); (J.F.C.-G.)
| | - Raúl Juárez-Vela
- Department of Nursing, Faculty of Health Sciences, University of La Rioja, 26006 Logroño, Spain;
| | | | - Fidel López-Espuela
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (E.S.-M.); (P.R.-S.); (F.L.-E.); (J.F.C.-G.)
| | - Julián F. Calderón-García
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (E.S.-M.); (P.R.-S.); (F.L.-E.); (J.F.C.-G.)
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15
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Fecker AL, Shahin MN, Sheffels S, Nugent JG, Munger D, Miller P, Priest R, Dogan A, Clark W, Wright J, Liu JL. Low body mass index patients have worse outcomes after mechanical thrombectomy. J Neurointerv Surg 2023:jnis-2023-020628. [PMID: 37798104 DOI: 10.1136/jnis-2023-020628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/10/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND There is evidence that frailty is an independent predictor of worse outcomes after stroke. Similarly, although obesity is associated with a higher risk for stroke, there are multiple reports describing improved mortality and functional outcomes in higher body mass index (BMI) patients in a phenomenon known as the obesity paradox. We investigated the effect of low BMI on outcomes after mechanical thrombectomy (MT). METHODS We conducted a retrospective analysis of 231 stroke patients who underwent MT at an academic medical center between 2020-2022. The patients' BMI data were collected from admission records and coded based on the Centers for Disease Control and Prevention (CDC) obesity guidelines. Recursive partitioning analysis (RPA) in R software was employed to automatically detect a BMI threshold associated with a significant survival benefit. Frailty was quantified using the Modified Frailty Index 5 and 11. RESULTS In our dataset, by CDC classification, 2.6% of patients were underweight, 27.3% were normal BMI, 30.7% were overweight, 19.9% were class I obese, 9.5% were class II obese, and 10% were class III obese. There were no significant differences between these groups. RPA identified a clinically significant BMI threshold of 23.62 kg/m2. Independent of frailty, patients with a BMI ≤23.62 kg/m2 had significantly worse overall survival (P<0.001) and 90-day modified Rankin Scale (P=0.027) than patients above the threshold. CONCLUSIONS Underweight patients had worse survival and functional outcomes after MT. Further research should focus on the pathophysiology underlying poor prognosis in underweight MT patients, and whether optimizing nutritional status confers any neuroprotective benefit.
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Affiliation(s)
- Adeline L Fecker
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Maryam N Shahin
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Samantha Sheffels
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph Girard Nugent
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel Munger
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Parker Miller
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Ryan Priest
- Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Aclan Dogan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Wayne Clark
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - James Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Jesse L Liu
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
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16
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Gil-Salcedo A, Dugravot A, Fayosse A, Landré B, Yerramalla MS, Sabia S, Schnitzler A. Role of age and sex in the association between BMI and functional limitations in stroke patients: Cross-sectional analysis in three European and US cohorts. J Stroke Cerebrovasc Dis 2023; 32:107270. [PMID: 37481939 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND A U- or J-shaped association between BMI and different post-stroke outcomes is suggested. Thus, the aim is to evaluate the association between BMI with ADL, IADL and mobility limitations in the ageing post-stroke population at different ages, as well as the differences in this association by sex. METHODS A total of 5,468 participants with stroke and 21,872 without stroke over 50 years of age were assessed for the number of limitations in basic or instrumental activities of daily living (ADL/IADL) as well as mobility tasks. The association between BMI at the interview (continuous time-dependent variable) and the level of limitations was assessed using a linear mixed model stratified by sex and stroke status. RESULTS The association between BMI and ADL/IADL and mobility limitations were found to be significant in both men and women regardless of stroke status (p<0.001 for all). The association differs between those who have suffered a stroke and those who have not (p<0.001 for all). In ADL/IADL limitations, men with stroke showed a transition from an inverted J-shape to a U-shape association with age. In women, the BMI showed a less pronounced association between BMI and ADL/IADL limitations compared to men but with similar trends. A effect of sex was observed in the association between BMI and mobility, with women with and without stroke showing a linear association that differed from the inverted J-shaped or U-shaped association of men. CONCLUSION Our results suggest that BMI is associated with limitations in ADL, IADL and mobility in stroke patients. In addition, this association differs between men and women and is also influenced by age.
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Affiliation(s)
- Andres Gil-Salcedo
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Benjamin Landré
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Manasa S Yerramalla
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Alexis Schnitzler
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France; Université Versailles Saint Quentin en Yvelines, EA 4047 Handi-Resp, Service de neurologie hôpital A. Mignot, Garches, France.
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17
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Patel RB, Dhanesha N, Sutariya B, Ghatge M, Doddapattar P, Barbhuyan T, Kumskova M, Leira EC, Chauhan AK. Targeting Neutrophil α9 Improves Functional Outcomes After Stroke in Mice With Obesity-Induced Hyperglycemia. Stroke 2023; 54:2409-2419. [PMID: 37449422 PMCID: PMC10529694 DOI: 10.1161/strokeaha.123.042714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Obesity-induced hyperglycemia is a significant risk factor for stroke. Integrin α9β1 is expressed on neutrophils and stabilizes adhesion to the endothelium via ligands, including Fn-EDA (fibronectin containing extra domain A) and tenascin C. Although myeloid deletion of α9 reduces susceptibility to ischemic stroke, it is unclear whether this is mediated by neutrophil-derived α9. We determined the role of neutrophil-specific α9 in stroke outcomes in a mice model with obesity-induced hyperglycemia. METHODS α9Neu-KO (α9fl/flMRP8Cre+) and littermate control α9WT (α9fl/flMRP8Cre-) mice were fed on a 60% high-fat diet for 20 weeks to induce obesity-induced hyperglycemia. Functional outcomes were evaluated up to 28 days after stroke onset in mice of both sexes using a transient (30 minutes) middle cerebral artery ischemia. Infarct volume (magnetic resonance imaging) and postreperfusion thrombo-inflammation (thrombi, fibrin, neutrophil, phospho-nuclear factor kappa B [p-NFκB], TNF [tumor necrosis factor]-α, and IL [interleukin]-1β levels, markers of neutrophil extracellular traps) were measured post 6 or 48 hours of reperfusion. In addition, functional outcomes (modified Neurological Severity Score, rota-rod, corner, and wire-hanging test) were measured for up to 4 weeks. RESULTS Stroke upregulated neutrophil α9 expression more in obese mice (P<0.05 versus lean mice). Irrespective of sex, deletion of neutrophil α9 improved functional outcomes up to 4 weeks, concomitant with reduced infarct, improved cerebral blood flow, decreased postreperfusion thrombo-inflammation, and neutrophil extracellular traps formation (NETosis) (P<0.05 versus α9WT obese mice). Obese α9Neu-KO mice were less susceptible to thrombosis in FeCl3 injury-induced carotid thrombosis model. Mechanistically, we found that α9/cellular fibronectin axis contributes to NETosis via ERK (extracellular signal-regulated kinase) and PAD4 (peptidyl arginine deiminase 4), and neutrophil α9 worsens stroke outcomes via cellular fibronectin-EDA but not tenascin C. Obese wild-type mice infused with anti-integrin α9 exhibited improved functional outcomes up to 4 weeks (P<0.05 versus vehicle). CONCLUSIONS Genetic ablation of neutrophil-specific α9 or pharmacological inhibition improves long-term functional outcomes after stroke in mice with obesity-induced hyperglycemia, most likely by limiting thrombo-inflammation.
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Affiliation(s)
- Rakesh B. Patel
- Department of Internal Medicine, Division of Hematology/Oncology, University of Iowa, Iowa City, Iowa, USA
| | - Nirav Dhanesha
- Department of Internal Medicine, Division of Hematology/Oncology, University of Iowa, Iowa City, Iowa, USA
| | - Brijesh Sutariya
- Department of Internal Medicine, Division of Hematology/Oncology, University of Iowa, Iowa City, Iowa, USA
| | - Madankumar Ghatge
- Department of Internal Medicine, Division of Hematology/Oncology, University of Iowa, Iowa City, Iowa, USA
| | - Prakash Doddapattar
- Department of Internal Medicine, Division of Hematology/Oncology, University of Iowa, Iowa City, Iowa, USA
| | - Tarun Barbhuyan
- Department of Internal Medicine, Division of Hematology/Oncology, University of Iowa, Iowa City, Iowa, USA
| | - Mariia Kumskova
- Department of Internal Medicine, Division of Hematology/Oncology, University of Iowa, Iowa City, Iowa, USA
| | - Enrique C. Leira
- Departments of Neurology, Neurosurgery and Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Anil K. Chauhan
- Department of Internal Medicine, Division of Hematology/Oncology, University of Iowa, Iowa City, Iowa, USA
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18
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Srisujikul P, Thiankhaw K, Tanprawate S, Soontornpun A, Wantaneeyawong C, Teekaput C, Sirimaharaj N, Nudsasarn A. Serum NT-proBNP level for predicting functional outcomes after acute ischemic stroke. Sci Rep 2023; 13:13903. [PMID: 37626208 PMCID: PMC10457328 DOI: 10.1038/s41598-023-41233-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/23/2023] [Indexed: 08/27/2023] Open
Abstract
N-terminus pro-brain natriuretic peptide (NT-proBNP) has been studied and recognized as a biomarker of cardiac thrombogenicity and stroke risk. However, the association between NT-proBNP and functional outcomes following acute ischemic stroke is still debated. This study aimed to investigate whether serum NT-proBNP level is associated with functional outcomes in acute ischemic stroke individuals. This prospective cohort study included patients diagnosed with acute ischemic stroke, and serum NT-proBNP levels were measured within 72 h. At 3 months, all patients were followed up for a modified Rankin Scale (mRS), and logistic regression models were used to evaluate the association of NT-proBNP on the primary outcome, in which a score of 3-6 was classified as an unfavorable functional outcome. Sixty-seven patients were enrolled in the study, and 23 (34.3%) patients were identified with an unfavorable functional outcome. Elevated serum NT-proBNP levels (> 100 pg/mL) were observed in 57 (85.1%) patients, and the Youden index demonstrated a cutpoint estimation of poor outcomes at 476 pg/mL with 74% sensitivity and 63% specificity. Multivariate regression analysis showed an elevation of NT-proBNP above the cutpoint level was an independent predictor for unfavorable functional outcomes, odds ratio 3.77, 95% confidence interval (1.04-13.62), P = 0.04. The present study demonstrated that elevated serum NT-proBNP levels were expected among acute ischemic stroke patients and represented the risk of unfavorable functional outcomes, suggesting that NT-proBNP might be a useful biomarker for predicting prognosis after ischemic stroke.
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Affiliation(s)
- Phattheera Srisujikul
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kitti Thiankhaw
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
- The Northern Neuroscience Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Surat Tanprawate
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- The Northern Neuroscience Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Atiwat Soontornpun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- The Northern Neuroscience Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chayasak Wantaneeyawong
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- The Northern Neuroscience Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chutithep Teekaput
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- The Northern Neuroscience Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nopdanai Sirimaharaj
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- The Northern Neuroscience Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Angkana Nudsasarn
- The Northern Neuroscience Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Ruhnau J, Heuer C, Witt C, Ceesay S, Schulze J, Gross S, Waize M, Kromrey ML, Kühn JP, Langner S, Grunwald U, Bröker BM, Petersmann A, Steveling A, Dressel A, Vogelgesang A. Effects of body mass index on the immune response within the first days after major stroke in humans. Neurol Res Pract 2023; 5:42. [PMID: 37587512 PMCID: PMC10433619 DOI: 10.1186/s42466-023-00269-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/11/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Immunological alterations associated with increased susceptibility to infection are an essential aspect of stroke pathophysiology. Several immunological functions of adipose tissue are altered by obesity and are accompanied by chronic immune activation. The purpose of this study was to examine immune function (monocytes, granulocytes, cytokines) as a function of body mass index (BMI: 1st group: 25; 2nd group: 25 BMI 30; 3rd group: 30) and changes in body weight post stroke. METHOD Fat status was assessed using standardized weight measurements on days 1, 2, 3, 4, 5, and 7 after ischemic stroke in a cohort of 40 stroke patients and 16 control patients. Liver fat and visceral fat were assessed by MRI on day 1 or 2 [I] and on day 5 or 7 [II]. Leukocyte subpopulations in peripheral blood, cytokines, chemokines, and adipokine concentrations in sera were quantified. In a second cohort (stroke and control group, n = 17), multiple regression analysis was used to identify correlations between BMI and monocyte and granulocyte subpopulations. RESULTS Weight and fat loss occurred from the day of admission to day 1 after stroke without further reduction in the postischemic course. No significant changes in liver or visceral fat were observed between MRI I and MRI II. BMI was inversely associated with IL-6 levels, while proinflammatory cytokines such as eotaxin, IFN-β, IFN -γ and TNF-α were upregulated when BMI increased. The numbers of anti-inflammatory CD14+CD16+ monocytes and CD16+CD62L- granulocytes were reduced in patients with higher BMI values, while that of proinflammatory CD16dimCD62L+ granulocytes was increased. CONCLUSION A small weight loss in stroke patients was detectable. The data demonstrate a positive correlation between BMI and a proinflammatory poststroke immune response. This provides a potential link to how obesity may affect the clinical outcome of stroke patients.
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Affiliation(s)
- Johanna Ruhnau
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany.
| | - Christin Heuer
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Carl Witt
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Sonya Ceesay
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Juliane Schulze
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Stefan Gross
- Partner site Greifswald, German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Maria Waize
- Department of Mathematics and Informatics, University Medicine Greifswald, Greifswald, Germany
| | - Marie-Luise Kromrey
- Department of Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Jens-Peter Kühn
- Department of Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
- Institute and Policlinic of Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Sönke Langner
- Department of Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Uwe Grunwald
- Internal Medicine C, Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Barbara M Bröker
- Department of Immunology, University Medicine Greifswald, Greifswald, Germany
| | - Astrid Petersmann
- Department of Clinical Diagnostics, University Oldenburg, Oldenburg, Germany
| | - Antje Steveling
- Department of Endocrinology, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Dressel
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany
- Department of Neurology, Carl-Thiem Klinikum, Cottbus, Germany
| | - Antje Vogelgesang
- Department of Neurology, University Medicine Greifswald, F.-Sauerbruch-Str, 17475, Greifswald, Germany.
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20
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Lopez-Espejo M, Poblete R, Bastias G. Social and health determinants related to adverse short-term outcomes after a first-ever stroke in adults younger than 65 years. J Stroke Cerebrovasc Dis 2023; 32:107153. [PMID: 37172471 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Stroke-related mortality and disability-adjusted life years in adults younger than 65 have increased over the last decade. However, geographical differences in distributing these outcomes could reflect dissimilarity in determinants. Therefore, this cross-sectional study of secondary data from Chilean hospitals aims to analyze the association of sociodemographic and clinical factors with in-hospital case-fatality risk or acquired neurologic deficits (adverse outcomes) in inpatients aged 18 to 64 who experienced their first-ever stroke. METHODOLOGY Adjusted multivariable logistic regression models and interaction analysis using multiple imputation for missing data (4.99%) for 1,043 hospital discharge records from the UC-CHRISTUS Health Network International Refined Diagnosis Related Groups (IR-DRG) system database (2010-2021) were conducted. RESULTS Mean age: 51.47 years (SD, 10.79); female: 39.60%. Stroke types: subarachnoid hemorrhage (SAH): 5.66%, intracerebral hemorrhage (ICH): 11.98%, and ischemic: 82.45%. Adverse outcomes: 25.22% (neurological deficit: 23.59%; in-hospital case-fatality risk: 1.63%). After adjusting for confounders, adverse outcomes were associated with stroke type (patients with ICH and ischemic stroke had higher odds than those with SAH), sociodemographic characteristics (age ≥ 40 years, residence in an area of the capital city other than the center-east, and coverage by public health insurance), and discharge diagnoses (obesity, coronary artery and chronic kidney diseases, and mood and anxiety disorders). For hypertension, women had higher odds of adverse outcomes. CONCLUSIONS In this predominantly Hispanic sample, modifiable social and health determinants are related to adverse short-term outcomes after a first-ever stroke. Longitudinal studies are needed to investigate the causal role of these factors.
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Affiliation(s)
- Mauricio Lopez-Espejo
- Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Diagonal Paraguay 362, (postal: 8330077) Santiago, Chile.
| | - Rodrigo Poblete
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Diagonal Paraguay 362, (postal: 8330077) Santiago, Chile.
| | - Gabriel Bastias
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Diagonal Paraguay 362, (postal: 8330077) Santiago, Chile.
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21
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Janes F, Sozio E, Gigli GL, Ripoli A, Sbrana F, Kuris F, Nesi L, Semenzin T, Bertolino G, Deana C, Bagatto D, Ciardi C, Fabris M, Merlino G, Bax F, Nilo A, Pez S, Valente M, Tascini C. Ischemic strokes in COVID-19: risk factors, obesity paradox, and distinction between trigger and causal association. Front Neurol 2023; 14:1222009. [PMID: 37592943 PMCID: PMC10428626 DOI: 10.3389/fneur.2023.1222009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Background and purpose Stroke has been described as a COVID-19 complication. However, its occurrence rate, risk factors, and causal relationships are still not well established. Methods We describe the characteristics of confirmed COVID-19-related strokes among all cases of COVID-19 hospitalized in our health network, from November 1, 2020 to April 30, 2021. Risk factor analysis has been conducted for ischemic stroke (IS), which represents 92% of all confirmed cases of Covid-19-related strokes, and a "causal attribution to infection" classification is provided. Results In all, 62/4105 hospitalized COVID-19 patients had an acute stroke (1.51%). Severe COVID-19 (OR 2.27-CI 1.06-4.77; p = 0.032), atrial fibrillation (OR 3.65-CI 1.63-7.98; p = 0.001), and ischemic heart disease (OR 4.590-CI 1.714-12.137; p = 0.002) proved to be independent risk factors for IS, while obesity was a protective factor (OR 0.90-CI 0.82-0.97; p = 0.012). COVID-19 had a causal role in 32.1% of IS cases, was a relevant cofactor in 28.6% of cases of IS, and was a possible trigger in 39.3% of events. Conclusion Our stroke occurrence rate is consistent with other population-based reports (range 0.34-2.7%). Prespecified peculiar clinical and radiological features allow the distinction between "IS caused by COVID-19" and "IS triggered by COVID-19." Clinical history of vascular diseases and risk factors is crucial in determining the risk of IS in patients with COVID-19. However, the protective effect of a BMI > 30 kg/m2 seems to suggest an obesity paradox.
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Affiliation(s)
- Francesco Janes
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
| | - Emanuela Sozio
- Clinic of Infectious Diseases, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Gian Luigi Gigli
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
| | - Andrea Ripoli
- Cardiology OU, Cardiothoracic Department, G. Monasterio Foundation, Pisa, Italy
| | - Francesco Sbrana
- Cardiology OU, Cardiothoracic Department, G. Monasterio Foundation, Pisa, Italy
| | - Fedra Kuris
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
| | - Lorenzo Nesi
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
| | - Tosca Semenzin
- Clinic of Infectious Diseases, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Giacomo Bertolino
- Clinic of Infectious Diseases, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Daniele Bagatto
- Institute of Neuroradiology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Chiara Ciardi
- Institute of Neuroradiology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Martina Fabris
- Institute of Clinical Pathology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Giovanni Merlino
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Francesco Bax
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Annacarmen Nilo
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Sara Pez
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
| | - Mariarosaria Valente
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
| | - Carlo Tascini
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
- Clinic of Infectious Diseases, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
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22
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Norton CE, Shaw RL, Segal SS. Differential Effects of High Fat Diets on Resilience to H 2O 2-Induced Cell Death in Mouse Cerebral Arteries: Role for Processed Carbohydrates. Antioxidants (Basel) 2023; 12:1433. [PMID: 37507971 PMCID: PMC10376469 DOI: 10.3390/antiox12071433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
High fat, western-style diets increase vascular oxidative stress. We hypothesized that smooth muscle cells and endothelial cells adapt during the consumption of high fat diets to become more resilient to acute oxidative stress. Male C57Bl/6J mice were fed a western-style diet high in fat and processed carbohydrates (WD), a high fat diet that induces obesity (DIO), or their respective control (CD) and standard (SD) diets for 16 weeks. Posterior cerebral arteries (PCAs) were isolated and pressurized for study. During acute exposure to H2O2 (200 µM), smooth muscle cell and endothelial cell death were reduced in PCAs from WD, but not DIO mice. WD selectively attenuated mitochondrial membrane potential depolarization and vessel wall Ca2+ influx during H2O2 exposure. Selective inhibition of transient receptor potential (TRP) V4 or TRPC3 channels reduced smooth muscle cell and endothelial cell death in concert with the vessel wall [Ca2+]i response to H2O2 for PCAs from CD mice and eliminated differences between CD and WD. Inhibiting Src kinases reduced smooth muscle cell death along with [Ca2+]i response to H2O2 only in PCAs from CD mice and eliminated differences between diets. However, Src kinase inhibition did not alter endothelial cell death. These findings indicate that consuming a WD, but not high fat alone, leads to adaptations that limit Ca2+ influx and vascular cell death during exposure to acute oxidative stress.
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Affiliation(s)
- Charles E Norton
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO 65212, USA
| | - Rebecca L Shaw
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO 65212, USA
| | - Steven S Segal
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO 65212, USA
- Dalton Cardiovascular Research Center, Columbia, MO 65211, USA
- Department of Biomedical Sciences, University of Missouri, Columbia, MO 65201, USA
- Department of Biomedical, Biological and Chemical Engineering, University of Missouri, Columbia, MO 65211, USA
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
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23
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Wakisaka K, Matsuo R, Matsumoto K, Nohara Y, Irie F, Wakisaka Y, Ago T, Nakashima N, Kamouchi M, Kitazono T. Non-linear association between body weight and functional outcome after acute ischemic stroke. Sci Rep 2023; 13:8697. [PMID: 37248256 DOI: 10.1038/s41598-023-35894-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/25/2023] [Indexed: 05/31/2023] Open
Abstract
This study aimed to determine whether body weight is associated with functional outcome after acute ischemic stroke. We measured the body mass index (BMI) and assessed clinical outcomes in patients with acute ischemic stroke. The BMI was categorized into underweight (< 18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2), and obesity (≥ 25.0 kg/m2). The association between BMI and a poor functional outcome (modified Rankin Scale [mRS] score: 3-6) was evaluated. We included 11,749 patients with acute ischemic stroke (70.3 ± 12.2 years, 36.1% women). The risk of a 3-month poor functional outcome was higher for underweight, lower for overweight, and did not change for obesity in reference to a normal weight even after adjusting for covariates by logistic regression analysis. Restricted cubic splines and SHapley Additive exPlanation values in eXtreme Gradient Boosting model also showed non-linear relationships. Associations between BMI and a poor functional outcome were maintained even after excluding death (mRS score: 3-5) or including mild disability (mRS score: 2-6) as the outcome. The associations were strong in older patients, non-diabetic patients, and patients with mild stroke. Body weight has a non-linear relationship with the risk of a poor functional outcome after acute ischemic stroke.
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Affiliation(s)
- Kayo Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Koutarou Matsumoto
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Biostatistics Center, Kurume University, Kurume, Japan
| | - Yasunobu Nohara
- Big Data Science and Technology, Faculty of Advanced Science and Technology, Kumamoto University, Kumamoto, Japan
| | - Fumi Irie
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoki Nakashima
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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24
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Li X, Xu Q, Wang A, Zheng P, Zhu H, Guo A, Meng X, Jiang Y. Association of body mass index and waist-to-height ratio with outcomes in ischemic stroke: results from the Third China National Stroke Registry. BMC Neurol 2023; 23:152. [PMID: 37060000 PMCID: PMC10103413 DOI: 10.1186/s12883-023-03165-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/14/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND AND PURPOSE Conflicting reports of obesity paradox have led to confusion about weight management strategies for post-stroke patients. The main purpose of this study is to determine whether the obesity paradox measured by body mass index (BMI) or by waist-to-height ratio (WHtR) is real. METHODS We evaluated the association of general obesity measured by BMI, and abdominal obesity measured by WHtR with 1-year all-cause mortality, recurrence of stroke and combined vascular events of acute ischemic stroke (AIS) patients in a cohort -- the Third China National Stroke Registry (CNSR-III). Cox proportional hazards models and restricted cubic splines were performed to investigate the association between obesity and clinical outcomes. RESULTS A total of 14,146 patients with ischemic stroke were included. When BMI was used as a measure of obesity, compared to the normal weight patients, mortality decreased in overweight patients (hazard ratio [HR] 0.74 [95% confidence interval (CI) 0.61-0.91], P = 0.0035) and obese patients (HR 0.54 [0.40-0.73], P < 0.0001); and increased in underweight patients (HR 2.55 [1.75-3.73], P < 0.0001). After adjustment for confounding factors, the protective effect of obesity and overweight disappeared. BMI had no association with recurrence of stroke or combined vascular events. When WHtR was used as a measure of obesity, obese patients had lower 1-year all-cause mortality (HR 0.64 [0.43-0.97], P = 0.0357). After adjustment for confounding factors, this difference disappeared; overweight patients still had lower all-cause mortality (adjusted hazard ratio [aHR] 0.42 [0.26-0.67], P = 0.0003), recurrence of stroke (aHR 0.77 [0.60-0.99], P = 0.0440) and combined vascular events (aHR 0.75 [0.58-0.95], P = 0.0198). CONCLUSIONS Among Chinese patients with AIS, our study does not support the BMI paradox; overweight patients measured by WHtR had a more favorable prognosis. TOAST subtypes did not modify the association.
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Affiliation(s)
- Xiaolin Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Pei Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Huimin Zhu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ai Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
- Research Unit of Artificial Intelligence in Cerebrovascular Disease (2019RU018), Chinese Academy of Medical Sciences, Beijing, China.
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
- Research Unit of Artificial Intelligence in Cerebrovascular Disease (2019RU018), Chinese Academy of Medical Sciences, Beijing, China.
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
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25
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Costo-Muriel C, Calderón-García JF, Rico-Martín S, Sánchez-Bacaicoa C, Escudero-Sánchez G, Galán-González J, Rodríguez-Velasco FJ, Sánchez Muñoz-Torrero JF. Association of Subclinical Carotid Atherosclerosis Assessed by High-Resolution Ultrasound With Traditional and Novel Anthropometric Indices. Curr Probl Cardiol 2023; 48:101574. [PMID: 36584728 DOI: 10.1016/j.cpcardiol.2022.101574] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
Novel anthropometric indices have been proposed as an alternative to body mass index (BMI) and waist circumference (WC) to determine visceral adipose tissue and body mass. Little is known about the relationship of these new anthropometric indices to subclinical carotid atherosclerosis. The objective of this study was to assess the association of anthropometric indices, both new and traditional, with the presence of subclinical carotid artery arteriosclerosis (SCAA) estimated by Doppler ultrasound. This cross-sectional study analyzed 788 Spanish patients who consecutively attended a vascular risk consultation between June 2021 and September 2022. Traditional anthropometric indices (BMI, WHR and WHtR) and novel indices (ABSI, AVI, BAI, BRI, CI, CUNBAE and WWI) were calculated, and Doppler ultrasound in the carotid artery (cIMT and atherosclerosis plaque) was performed to detect SCAA. All analyzed anthropometric indices, except BMI, BAI and CUNBAE, were significantly higher in patients with SCAA. ABSI, BRI, CI, WHR, WHtR and WWI and were associated with SCAA in the univariate analysis (p<0.05); however, only ABSI (adjusted OR: 1.15; 95% CI: 1.10-2.38; p= 0.042) was significantly associated with SCAA in the multivariate analysis. In conclusion, only ABSI was significantly positively associated with SCAA, independent of other confounders.
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Affiliation(s)
- Clara Costo-Muriel
- Department of Internal Medicine, Hospital Comarcal de la AXARQUÍA, Málaga, Spain
| | - Julián F Calderón-García
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Sergio Rico-Martín
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain.
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26
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Tollár J, Vetrovsky T, SZéPHELYI K, Csutorás B, Prontvai N, Ács P, Hortobágyi T. Effects of 2-Year-Long Maintenance Training and Detraining on 558 Subacute Ischemic Stroke Patients' Clinical-Motor Symptoms. Med Sci Sports Exerc 2023; 55:607-613. [PMID: 36730024 DOI: 10.1249/mss.0000000000003092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE This study aimed to determine the effects of a 2-yr-long maintenance training (MT) exergaming and detraining (DT) on clinical-motor symptoms in subacute ischemic patients with stroke (PwST). The hypothesis was that MT motor rehabilitation program would further increase the effects of the initial rehabilitation. METHODS After high-intensity and high-frequency exergaming twice or once a day, 5 times per week for 5 wk (EX2: 50 sessions; EX1: 25 sessions, results reported previously), 558 PwST were randomized to EX2-MT, EX2-DT, EX1-MT, and EX1-DT. MT exergaming consisted of once a day, 3 times per week for 2 yr, and DT did not train. Outcomes were measured at 6, 12, 18, and 24 months. The data were analyzed using longitudinal linear mixed-effects models and general linear hypotheses testing. RESULTS Modified Rankin Score (primary outcome), body mass, Mini-Mental State Examination score, Beck Depression Inventory, measures of quality of life, Berg Balance Scale, 6-min walk test, and four measures of center of pressure path tended to retain the initial rehabilitation-induced gains in the MT patients in selected outcomes (especially walking capacity). The scores tended to mildly worsen after DT, partially supporting the hypothesis. CONCLUSIONS MT successfully maintained, but only in selected variables did it further increase the initial exergaming rehabilitation-induced robust improvements. DT modestly reduced the initial exergaming rehabilitation-induced improvements. MT programs might be needed after initial stroke rehabilitation to reduce subsequent losses of quality of life and further improve clinical-motor symptoms.
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Affiliation(s)
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, CZECH REPUBLIC
| | - Klaudia SZéPHELYI
- Faculty of Health Sciences, Department of Medical Imaging, University of Pécs, Pécs, HUNGARY
| | - Bence Csutorás
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HUNGARY
| | - Nándor Prontvai
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HUNGARY
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27
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Krasivskyi I, Djordjevic I, Ivanov B, Eghbalzadeh K, Großmann C, Reichert S, Radwan M, Sandoval Boburg R, Sabashnikov A, Schlensak C, Wahlers T, Rustenbach CJ. Consequences of Obesity on Short-Term Outcomes in Patients Who Underwent Off-Pump Coronary Artery Bypass Grafting Surgery. J Clin Med 2023; 12:jcm12051929. [PMID: 36902716 PMCID: PMC10003424 DOI: 10.3390/jcm12051929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
The correlation between off-pump coronary artery bypass (OPCAB) surgery and obesity-related outcomes is still uncertain. The aim of our study was to analyse the pre-, intra-, and postoperative short-term outcomes between obese and non-obese patients after off-pump bypass surgery. We performed a retrospective analysis from January 2017 until November 2022, including a total of 332 (non-obese (n = 193) and obese (n = 139)) patients who underwent an OPCAB procedure due to coronary artery disease (CAD). The primary outcome was all-cause in-hospital mortality. Our results showed no difference regarding mean age of the study population between both groups. The use of the T-graft technique was significantly higher (p = 0.045) in the non-obese group compared to the obese group. The dialysis rate was significantly lower in non-obese patients (p = 0.019). In contrast, the wound infection rate was significantly higher (p = 0.014) in the non-obese group compared to the obese group. The all-cause in-hospital mortality rate did not differ significantly (p = 0.651) between the two groups. Furthermore, ST-elevation myocardial infarction (STEMI) and reoperation were relevant predictors for in-hospital mortality. Therefore, OPCAB surgery remains a safe procedure even in obese patients.
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Affiliation(s)
- Ihor Krasivskyi
- Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany
- Correspondence: ; Tel.: +49-176-353-88-719
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Borko Ivanov
- Department of Cardiothoracic Surgery, Helios Hospital Siegburg, 53721 Siegburg, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Clara Großmann
- Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Stefan Reichert
- Department of Cardiothoracic Surgery, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Medhat Radwan
- Department of Cardiothoracic Surgery, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Rodrigo Sandoval Boburg
- Department of Cardiothoracic Surgery, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Christian Schlensak
- Department of Cardiothoracic Surgery, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany
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28
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Lalo R, Zekja I, Kamberi F. Association of Cardiovascular Disease Risk and Health-Related Behaviors in Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3693. [PMID: 36834389 PMCID: PMC9963426 DOI: 10.3390/ijerph20043693] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 05/29/2023]
Abstract
Brain stroke continues to be a leading cause of mortality and disability in both developed and developing countries, with higher healthcare costs due to the long-term care and rehabilitation that it incurs. The purpose of the current study was to assess the association between brain stroke patients' health-related behaviors and their risk for cardiovascular disease. METHODS A cross-sectional study was carried out from March to August 2022 in the Vlora district regional hospital in Albania. The study included 150 out of 170 participants who met the necessary criteria, achieving an 88% response rate. Measurement tools included the Framingham Cardiovascular Risk Scale (FRS) and the Lifestyle Health Promotion Profile II (HPLP II). RESULTS The patients' average age was 65.9 ± 9.04 years. Over 65% of the stroke patients suffer from diabetes, and 47% from hypertension. About 31% of them have a high risk of hyperlipidemia (mean TC = 179 ± 28.5). About 32% of the brain stroke patients manifested unhealthy behaviors, while 84% of them had a high risk of cardiovascular disease (FRS = 19.5 ± 0.53). Cardiovascular disease (CVD) risk was statistically associated with stress management behaviors (p = 0.008; OR = 0.20; CI = 95%). This risk was highest in the over-70 age group as well as in men. CONCLUSION Brain stroke patients had a high probability of developing CVD. For better health among stroke patients, new evidence-based behavior change approaches must be introduced into preventative and management programs.
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Affiliation(s)
- Rezarta Lalo
- Department of Health Care, Faculty of Health, University of Vlora “Ismail Qemali”, L. Pavarësia, 9400 Vlorë, Albania
| | - Ilirjana Zekja
- Faculty of Technical Medical Sciences, University of Medicine Tirana, 8RRM+W7X, Rruga e Dibrës, 1001 Tirana, Albania
| | - Fatjona Kamberi
- Research Centre for Public Health, Faculty of Health, University of Vlora “Ismail Qemali”, L. Pavarësia, 9400 Vlorë, Albania
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29
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Liu C, Wong PY, Chung YL, Chow SKH, Cheung WH, Law SW, Chan JCN, Wong RMY. Deciphering the "obesity paradox" in the elderly: A systematic review and meta-analysis of sarcopenic obesity. Obes Rev 2023; 24:e13534. [PMID: 36443946 DOI: 10.1111/obr.13534] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
Aging and obesity are two global concerns in public health. Sarcopenic obesity (SO), defined as the combination of age-related sarcopenia and obesity, has become a pressing issue. This systematic review and meta-analysis summarize the current clinical evidence relevant to SO. PubMed, Embase, and Web of Science were searched, and 106 clinical studies with 167,151 elderlies were included. The estimated prevalence of SO was 9% in both men and women. Obesity was associated with 34% reduced risk of sarcopenia (odds ratio [OR] 0.66, 95% CI 0.48-0.91; p < 0.001). The pooled hazard ratio (HR) of all-cause mortality was 1.51 (95% CI 1.14-2.02; p < 0.001) for people with SO compared with healthy individuals. SO was associated with increased risk of cardiovascular disease and related mortality, metabolic disorders, cognitive impairment, arthritis, functional limitation, and lung diseases (all ORs > 1.0, p < 0.05). The attenuated risk of sarcopenia in elderlies with obesity ("obesity paradox") was dependent on higher muscle mass and strength. Apart from unifying the diagnosis of SO, more research is needed to subphenotype people with obesity and sarcopenia for individualized treatment. Meanwhile, the maintenance of proper body composition of muscle and fat may delay or attenuate the adverse outcomes of aging.
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Affiliation(s)
- Chaoran Liu
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Pui Yan Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yik Lok Chung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wing Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sheung Wai Law
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Juliana Chung Ngor Chan
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
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30
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Sinha MK, K V, Maiya AG, K N S, U S, N RS. Association of physical activity and heart rate variability in people with overweight and obesity: A systematic review. F1000Res 2023; 12:156. [PMID: 36875496 PMCID: PMC9982191 DOI: 10.12688/f1000research.124707.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 02/12/2023] Open
Abstract
Background: Obesity is a major public health issue globally which is intrinsically linked to reduced heart rate variability (HRV). Physical inactivity and reduced resting HRV are linked to an increased risk of coronary heart disease, while athletes have a greater HRV. However, the exact correlation between physical activity and HRV remains uncertain. This systematic review aims to collect, report, and critically assess the current scientific literature about the association between physical activity and HRV in individuals with higher weight and obesity. Methods: A systematic search was carried out in electronic databases (Medline/PubMed, SCOPUS and CINAHL Plus) to retrieve studies that evaluated the relationship between physical activity and HRV in individuals with higher weight and obesity. Case-control, longitudinal/cohort, cross-sectional and observational studies were included. Using a critical narrative approach, information about the HRV, and physical activity was extracted and synthesized. The study was registered in PROSPERO: CRD42020208018 on October 9 2020. Results: After removing duplicates, 980 title/abstract records were checked for eligibility, and 12 papers were finally included in the narrative synthesis. The included studies contained physical activity as well as HRV in adults with higher weight or obesity with or without comorbidities. A negative relationship between moderate to vigorous physical activity and HRV indices had been found in two studies. There was also a negative relationship between sedentary time and HF (p = 0.049) and LF/HF (p = 0.036), as well as a positive relationship between sedentary time and LF (p = 0.014). Also dose-response association was found between vigorous exercise and higher SDNN, LF power, and HF power in one of the studies. Conclusions: This systematic review revealed a wide range of responses to physical activity and HRV; however, the current evidence uses a variety of approaches to objectively assess physical activity and measure HRV with different equipment.
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Affiliation(s)
- Mukesh Kumar Sinha
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Vaishali K
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Arun G Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shivashankar K N
- Department of Medicine, Kasturba Medical college, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shashikiran U
- Department of Medicine, Dr. TMA Pai Hospital, Udupi, MMMC, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ravi Shankar N
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, Delhi, India
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Influence of Oxidative Stress and Inflammation on Nutritional Status and Neural Plasticity: New Perspectives on Post-Stroke Neurorehabilitative Outcome. Nutrients 2022; 15:nu15010108. [PMID: 36615766 PMCID: PMC9823808 DOI: 10.3390/nu15010108] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022] Open
Abstract
Beyond brain deficits caused by strokes, the effectiveness of neurorehabilitation is strongly influenced by the baseline clinical features of stroke patients, including a patient's current nutritional status. Malnutrition, either as a pre-stroke existing condition or occurring because of ischemic injury, predisposes patients to poor rehabilitation outcomes. On the other hand, a proper nutritional status compliant with the specific needs required by the process of brain recovery plays a key role in post-stroke rehabilitative outcome favoring neuroplasticity mechanisms. Oxidative stress and inflammation play a role in stroke-associated malnutrition, as well as in the cascade of ischemic events in the brain area, where ischemic damage leads to neuronal death and brain infarction, and, via cell-to-cell signaling, the alteration of neuroplasticity processes underlying functional recovery induced by multidisciplinary rehabilitative treatment. Nutrition strategies based on food components with oxidative and anti-inflammatory properties may help to reverse or stop malnutrition and may be a prerequisite for supporting the ability of neuronal plasticity to result in satisfactory rehabilitative outcome in stroke patients. To expand nutritional recommendations for functional rehabilitation recovery, studies considering the evolution of nutritional status changes in post-stroke patients over time are required. The assessment of nutritional status must be included as a routine tool in rehabilitation settings for the integrated care of stroke-patients.
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Impact of Obesity on Early In-Hospital Outcomes after Coronary Artery Bypass Grafting Surgery in Acute Coronary Syndrome: A Propensity Score Matching Analysis. J Clin Med 2022; 11:jcm11226805. [PMID: 36431281 PMCID: PMC9698701 DOI: 10.3390/jcm11226805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Recent advances in perioperative care have considerably improved outcomes after coronary artery bypass graft (CABG) surgery. However, obesity can increase postoperative complication rates and can lead to increased morbidity and mortality. Between June 2011 and October 2019, a total of 1375 patients with acute coronary syndrome (ACS) underwent cardiac surgery and were retrospectively analyzed. Patients were divided into 2 groups: non-obese (body mass index (BMI) < 30 kg/m2, n = 967) and obese (BMI ≥ 30 kg/m2, n = 379). Underweight patients (n = 29) were excluded from the analysis. To compare the unequal patient groups, a propensity score-based matching (PSM) was applied (non-obese group (n = 372) vs. obese group (n = 372)). The mean age of the mentioned groups was 67 ± 10 (non-obese group) vs. 66 ± 10 (obese group) years, p = 0.724. All-cause in-hospital mortality did not significantly differ between the groups before PSM (p = 0.566) and after PSM (p = 0.780). The median length of ICU (p = 0.306 before PSM and p = 0.538 after PSM) and hospital stay (p = 0.795 before PSM and p = 0.131 after PSM) was not significantly higher in the obese group compared with the non-obese group. No significant differences regarding further postoperative parameters were observed between the unadjusted and the adjusted group. Obesity does not predict increased all-cause in-hospital mortality in patients undergoing CABG procedure. Therefore, CABG is a safe procedure for overweight patients.
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Kamimoto T, Shindo K, Shimomura T, Akimoto T, Yamada T, Mori N, Nakao K, Tsujikawa M, Honaga K, Kutsuna T, Hiramatsu K, Kondo K, Liu M. Relationship between initial nutritional status and functional independence measures at discharge in subacute stroke. J Stroke Cerebrovasc Dis 2022; 31:106754. [PMID: 36115107 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 08/18/2022] [Accepted: 09/03/2022] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE This retrospective study examined the association between nutritional status at admission and functional independence measure (FIM™) at discharge. MATERIALS AND METHODS This study included 205 patients, aged ≥ 65, discharged from a convalescent ward between April 2017 and March 2018. The primary outcome was discharge FIMTM, and the secondary outcomes were the length of stay (LOS) and FIM efficiency. The explanatory variables included demographic data, stroke type, admission FIMTM, body mass index (BMI), controlling nutritional status (CONUT), and Geriatric Nutritional Risk Index (GNRI). Patients were divided into three groups based on BMI and GNRI scores and four groups based on the CONUT score. Univariate and multiple regression analyses were performed to predict discharge FIMTM. Kruskal-Wallis and Dunn's tests were also performed for intergroup comparisons. RESULTS In the univariate analyses, age, sex, onset-to-admission interval, admission FIMTM, GNRI, and BMI (all factors were p<0.001) were significant explanatory variables for discharge FIMTM. In the multiple linear regression analysis, admission FIMTM, LOS, age, and onset-to-admission interval were significant explanatory variables (adjusted R2 = 0.791; p<0.001). Although those with poor nutritional status required a longer hospital stay, they achieved the same FIM gain as those without poor nutritional status. CONCLUSIONS Nutritional status on admission did not affect the FIMTM at discharge in the convalescent ward. Patients with subacute stroke require adequate rehabilitation regardless of their nutritional status.
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Affiliation(s)
- Takayuki Kamimoto
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Keiichiro Shindo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Hikarigaoka Hospital, Shirankai Medical Corporation Takaoka, Toyama, Japan.
| | - Tadasuke Shimomura
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Saiseikai Yokohama-shi Tobu Hospital, Kanagawa, Japan.
| | - Tomonori Akimoto
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Yamada
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Naoki Mori
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Hatsudai Rehabilitation Hospital, Tokyo, Japan.
| | - Keiko Nakao
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Oriental Medicine Research Center, Kitasato University, Tokyo, Japan.
| | - Masahiro Tsujikawa
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Takeshi Kutsuna
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.
| | - Kazuhisa Hiramatsu
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
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Ramírez-Moreno J, Rebollo B, Macías-Sedas P, Valverde N, Parejo A, Felix Redondo F, Roa Montero A, Constantino A, Gómez Baquero M, Ceberino-Muñoz D, Fernández-Bergés D. Fuerza de asociación de factores de riesgo vascular clásicos en pacientes jóvenes con ictus isquémico: un estudio de casos y controles. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ramírez-Moreno JM, Rebollo B, Macías-Sedas P, Valverde N, Parejo A, Felix-Redondo FJ, Roa Montero AM, Constantino AB, Gómez Baquero MJ, Ceberino-Muñoz D, Fernández-Bergés D. Strength of association of classical vascular risk factors in young patients with ischaemic stroke: a case-control study. Neurologia 2022:S2173-5808(22)00142-0. [PMID: 36309160 DOI: 10.1016/j.nrleng.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/24/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Recent studies have reported an increasing incidence of ischaemic stroke among young adults. However, the strength of the association between traditional vascular risk factors has not been fully established. METHODS We compared 120 patients with a first ischaemic stroke before the age of 55 years admitted to the stroke unit of our centre with 600 healthy non-stroke controls from a population-based cohort study (HERMEX), matched for sex. Risk factors assessed included: hypertension, obesity, auricular fibrillation, current smoking, estimated glomerular filtration rate (eGFR), total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, high-density lipoprotein cholesterol (HDL-C) and diabetes mellitus. We used logistic regression analysis and calculated population attributable risk. We performed an overall analysis, by sex and aetiological subgroup. RESULTS Using logistic regression analysis, we found that overall, the significant risk factors were: hypertension (OR: 1.58; 95%CI: 1.01-2.50), atrial fibrillation (OR: 4.77; 95%CI: 1.20-19.00), low eGFR (OR: 4.74; 95%CI: 1.3-21.94) and low HDL-C (OR: 5.20; 95%CI: 3.29-8.21), as well as smoking for males (OR: 1.86; 95%CI: 1.14-3.03). LDL-C showed an inverse association with stroke. The population attributable risk for HDL-C was 37.8% and for hypertension 21.1%. In terms of aetiological subgroups, only low HDL-C was associated with stroke of undetermined aetiology. CONCLUSIONS Hypertension, auricular fibrillation, low eGFR, and low HDL-C, plus tobacco use in men, are the main risk factors among patients under 55 years of age with a first ischaemic stroke. We believe that it would be of particular interest to further explore the management of low HDL-C levels as part of preventive strategies in young stroke patients.
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Affiliation(s)
- J M Ramírez-Moreno
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain; Departamento de Ciencias Biomédicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, Badajoz, Spain; Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE).
| | - B Rebollo
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - P Macías-Sedas
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - N Valverde
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - A Parejo
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - F J Felix-Redondo
- Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE); Servicio Extremeño de Salud, Spain
| | - A M Roa Montero
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - A B Constantino
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - M J Gómez Baquero
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - D Ceberino-Muñoz
- Servicio de Neurología, Centro de Ictus, Hospital Universitario de Badajoz, Badajoz, Spain
| | - D Fernández-Bergés
- Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE); Servicio Extremeño de Salud, Spain
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Tiedt S, Buchan AM, Dichgans M, Lizasoain I, Moro MA, Lo EH. The neurovascular unit and systemic biology in stroke - implications for translation and treatment. Nat Rev Neurol 2022; 18:597-612. [PMID: 36085420 DOI: 10.1038/s41582-022-00703-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 12/24/2022]
Abstract
Ischaemic stroke is a leading cause of disability and death for which no acute treatments exist beyond recanalization. The development of novel therapies has been repeatedly hindered by translational failures that have changed the way we think about tissue damage after stroke. What was initially a neuron-centric view has been replaced with the concept of the neurovascular unit (NVU), which encompasses neuronal, glial and vascular compartments, and the biphasic nature of neural-glial-vascular signalling. However, it is now clear that the brain is not the private niche it was traditionally thought to be and that the NVU interacts bidirectionally with systemic biology, such as systemic metabolism, the peripheral immune system and the gut microbiota. Furthermore, these interactions are profoundly modified by internal and external factors, such as ageing, temperature and day-night cycles. In this Review, we propose an extension of the concept of the NVU to include its dynamic interactions with systemic biology. We anticipate that this integrated view will lead to the identification of novel mechanisms of stroke pathophysiology, potentially explain previous translational failures, and improve stroke care by identifying new biomarkers of and treatment targets in stroke.
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Affiliation(s)
- Steffen Tiedt
- Consortium International pour la Recherche Circadienne sur l'AVC (CIRCA), . .,Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Alastair M Buchan
- Consortium International pour la Recherche Circadienne sur l'AVC (CIRCA).,Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Martin Dichgans
- Consortium International pour la Recherche Circadienne sur l'AVC (CIRCA).,Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Ignacio Lizasoain
- Consortium International pour la Recherche Circadienne sur l'AVC (CIRCA).,Department of Pharmacology and Toxicology, Complutense Medical School, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Maria A Moro
- Consortium International pour la Recherche Circadienne sur l'AVC (CIRCA).,Centro Nacional de Investigaciones Cardiovasculares, CNIC, Madrid, Spain
| | - Eng H Lo
- Consortium International pour la Recherche Circadienne sur l'AVC (CIRCA), . .,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Baseline Characteristics Associated with Good Collateral Status Using Hypoperfusion Index as an Outcome. Tomography 2022; 8:1885-1894. [PMID: 35894024 PMCID: PMC9330882 DOI: 10.3390/tomography8040159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Abstract
Up to 30% of ischemic stroke cases are due to large vessel occlusion (LVO), causing significant morbidity. Studies have shown that the collateral circulation of patients with acute ischemic stroke (AIS) secondary to LVO can predict their clinical and radiological outcomes. The aim of this study is to identify baseline patient characteristics that can help predict the collateral status of these patients for improved triage. In this IRB approved retrospective study, consecutive patients presenting with AIS secondary to anterior circulation LVO were identified between September 2019 and August 2021. The baseline patient characteristics, laboratory values, imaging features and outcomes were collected using a manual chart review. From the 181 consecutive patients initially reviewed, 54 were confirmed with a clinical diagnosis of AIS and anterior circulation LVO. In patients with poor collateral status, the body mass index (BMI) was found to be significantly lower compared to those with good collateral status (26.4 ± 5.6 vs. 31.7 ± 12.3; p = 0.045). BMI of >35 kg/m2 was found to predict the presence of good collateral status. Age was found to be significantly higher (70.5 ± 9.6 vs. 58.9 ± 15.6; p = 0.034) in patients with poor collateral status and M1 strokes associated with older age and BMI.
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Pekmezi D, Motl R. Targeting Physical Inactivity Using Behavioral Theory in Chronic, Disabling Diseases. Exerc Sport Sci Rev 2022; 50:156-161. [PMID: 35522244 DOI: 10.1249/jes.0000000000000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Physical inactivity and comorbidities (e.g., hypertension) result in poor prognoses among persons with chronic, disabling conditions including multiple sclerosis, Parkinson disease, and stroke. Theory can guide the design of behavior change interventions that can be delivered remotely for broad scale implementation. We hypothesize that theory-based behavior change interventions can increase physical activity and reduce comorbidities and associated consequences among persons with chronic, disabling conditions.
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Affiliation(s)
- Dori Pekmezi
- University of Alabama at Birmingham, Birmingham, AL
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Hallan DR, Freedman Z, Rizk E. Mortality Rate of Ischemic Stroke Patients Undergoing Decompressive Hemicraniectomy With Obesity. Cureus 2022; 14:e24069. [PMID: 35573508 PMCID: PMC9097930 DOI: 10.7759/cureus.24069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Obesity has been shown to have a positive mortality benefit in patients undergoing percutaneous coronary intervention and dialysis and those with rheumatoid arthritis, chronic obstructive pulmonary disease, and various wasting diseases. Studies for this mortality benefit in ischemic stroke patients are conflicting and have not been well studied in hemicraniectomy patients. We sought to determine the impact of obesity on outcomes of hemicraniectomy patients. Methods We performed a retrospective case-control database analysis using a multi-institutional database (TriNetX) looking at obese versus non-obese patients with ischemic stroke undergoing hemicraniectomy. Our primary endpoint was mortality. Secondary endpoints included seizure, pulmonary embolism, myocardial infarction (MI), cerebral infarction, deep vein thrombosis, tracheostomy, and percutaneous endoscopic gastrostomy. Cohorts were propensity-score matched for confounders. Results After propensity score matching for basic demographics and common comorbidities, as well as indicators of stroke severity, 646 patients were identified that were obese and had an ischemic stroke with subsequent hemicraniectomy (cohort 1), and 646 patients were identified who were non-obese with ischemic stroke and hemicraniectomy (cohort 2). Thirty-day survival rate was 98.142% in the obese vs. 87.771% in the non-obese cohorts, 90-day survival was 85.15% vs. 79.35%, 180-day survival was 96.44% vs. 84.52%, 365-day survival was 94.272% vs. 81.734%, and five-year survival was 81.889% vs. 75.077%, respectively. At five years, risk difference was -7.276% (95% CI: -11.757, -2.794) and odds ratio was 0.666 (95% CI: 0.510, 0.871) (p = 0.0029). Despite a higher mortality rate, obese patients had a statistically significant increase in pulmonary embolism (11.61% vs. 5.108, p < 0.0001), deep venous thrombosis (16.873% vs. 9.133%, p < 0.0001), and MI (8.824% vs. 5.882%, p = 0.0428). There was no significant difference in intensive care unit length of stay, ventilator dependence, tracheostomy placement, percutaneous endoscopic gastrostomy placement, or intracerebral hemorrhage. Conclusions Despite the increased risk of ischemic stroke, obese patients who undergo hemicraniectomy have decreased mortality rates compared to their non-obese counterparts.
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Affiliation(s)
- David R Hallan
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Zachary Freedman
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Elias Rizk
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Iglesias-Rey R, Custodia A, Alonso-Alonso ML, López-Dequidt I, Rodríguez-Yáñez M, Pumar JM, Castillo J, Sobrino T, Campos F, da Silva-Candal A, Hervella P. The Smoking Paradox in Stroke Patients Under Reperfusion Treatment Is Associated With Endothelial Dysfunction. Front Neurol 2022; 13:841484. [PMID: 35401421 PMCID: PMC8987913 DOI: 10.3389/fneur.2022.841484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to explore the association between smoking habit and the serum levels of soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK), in relation with the functional outcome of patients with acute ischemic stroke undergoing reperfusion treatment. Methods Observational and retrospective study of a series of patients with acute ischemic stroke subjected to reperfusion treatments. Clinical, analytical, and neuroimaging parameters were analyzed. The main endpoint was the functional outcome at 3 months, measured by the modified Ranking Scale (mRS). Logistic regression models were used to analyze the association between smoking and sTWEAK levels with functional outcome and leukoaraiosis. Results The results showed that smoking habit was associated with a good functional outcome at 3 months in patients with stroke (OR: 3.52; 95% CI: 1.03–11.9; p = 0.044). However, this independent association was lost after adjusting by sTWEAK levels (OR 1.73; 95% CI: 0.86–13.28; p = 0.116). sTWEAK levels were significantly lower in smoker patients [4015.5 (973.66–7921.83) pg/ml vs. 5,628 (2,848–10,202) pg/ml, p < 0.0001], while sTWEAK levels were significantly higher in patients with poor functional outcomes at 3 months [10,284 (7,388–13.247) pg/ml vs. 3,405 (2,329–6,629) pg/ml, p < 0.0001]. Conclusion The decrease in sTWEAK levels was associated with a good functional outcome in smoker patients with stroke undergoing reperfusion therapy.
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Affiliation(s)
- Ramón Iglesias-Rey
- Neuroimaging and Biotechnology Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Ramón Iglesias-Rey
| | - Antía Custodia
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- NeuroAging Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Maria Luz Alonso-Alonso
- Neuroimaging and Biotechnology Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Iria López-Dequidt
- Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Rodríguez-Yáñez
- Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Santiago de Compostela, Spain
| | - José M. Pumar
- Neuroimaging and Biotechnology Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Neuroradiology, Hospital Clínico Universitario de Santiago de Compostela, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - José Castillo
- Neuroimaging and Biotechnology Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- NeuroAging Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Andres da Silva-Candal
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Neurovascular Diseases Laboratory, Neurology Service, University Hospital Complex of A Coruña, Biomedical Research Institute, A Coruña, Spain
- Andres da Silva-Candal
| | - Pablo Hervella
- Neuroimaging and Biotechnology Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- *Correspondence: Pablo Hervella
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The Obesity Paradox in Real-World Nation-Wide Cohort of Patients Admitted for a Stroke in the U.S. J Clin Med 2022; 11:jcm11061678. [PMID: 35330003 PMCID: PMC8950130 DOI: 10.3390/jcm11061678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/10/2022] [Accepted: 03/06/2022] [Indexed: 12/19/2022] Open
Abstract
Background: Obesity has been associated with increased incidence and severity of various cardiovascular risk factors and increased risk for stroke. However, the evidence of its effect on outcomes in stroke victims have been equivocal. We aimed to investigate the distribution of BMI in a nation-wide cohort of individuals, admitted for a stroke, and the relationship between BMI and in-hospital mortality. Methods: Data from the U.S. National Inpatient Sample (NIS) was collected, to identify hospitalizations for stroke, between October 2015 and December 2016. The patients were sub-divided into six groups based on their BMI: underweight, normal weight, overweight, obese I, obese II and extremely obese groups. Various sociodemographic and clinical parameters were gathered, and incidence of mortality and the length of hospital stay were analyzed. Multivariable analysis was performed to identify independent predictors of in-hospital mortality. Results: A weighted total of 84,185 hospitalizations for stroke were included in the analysis. The approximate mean patients aged was 65.5 ± 31 years, the majority being female (55.3%) and white (63.1%). The overall in-hospital mortality during the study period was 3.6%. A reverse J-shaped relationship between the body mass index and in-hospital mortality was documented, while patients with elevated BMI showed significantly lower in-hospital mortality compared to the underweight and normal weight study participants, 2.8% vs. 7.4%, respectively, p < 0.001. Age and several comorbidities, as well as the Deyo Comorbidity Index, were found to predict mortality in a multivariable analysis. Conclusion: A reverse J-shaped relationship between body mass index and in-hospital mortality was documented in patients admitted for a stroke in the U.S. during the study period. The above findings support the existence of an “obesity paradox” in patients hospitalized following a stroke, similar to that described in other cardiovascular conditions.
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Influence of BMI on adenosine deaminase and stroke outcomes in mechanical thrombectomy subjects. Brain Behav Immun Health 2022; 20:100422. [PMID: 35141572 PMCID: PMC8814768 DOI: 10.1016/j.bbih.2022.100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Emergent Large Vessel Occlusion (ELVO) strokes are ischemic vascular events for which novel biomarkers and therapies are needed. The purpose of this study is to investigate the role of Body Mass Index (BMI) on protein expression and signaling at the time of ELVO intervention. Additionally, we highlight the protein adenosine deaminase (ADA), which is a deaminating enzyme that degrades adenosine, which has been shown to be neuroprotective in ischemia. We investigate the relationship between ADA and BMI, stroke outcomes, and associated proteomic networks which might aid in personalizing prognosis and future treatment of ELVO stroke. Methods The Blood And Clot Thrombectomy And Collaboration (BACTRAC) study is a continually enrolling tissue bank (clinicaltrials.gov NCT03153683) and registry from stroke patients undergoing mechanical thrombectomy (MT). N = 61 human carotid plasma samples were analyzed for inflammatory and cardiometabolic protein expression by Olink Proteomics. Statistical analyses used t-tests, linear, logistic, and robust regressions, to assess the relationship between BMI, proteomic expression, and stroke-related outcomes. Results The 61 subjects studied were broken into three categories: normal weight (BMI 18.5–24.9) which contained 19 subjects, overweight (BMI 25–30) which contained 25 subjects, and obese (BMI ≥30) which contained 17 subjects. Normal BMI group was a significantly older population (mean 76 years) when compared to overweight (mean 66 years) and obese (mean 61 years) with significance of p = 0.041 and p = 0.005, respectively. When compared to normal weight and overweight categories, the obese category had significantly higher levels of adenosine deaminase (ADA) expression (p = 0.01 and p = 0.039, respectively). Elevated levels of ADA were found to have a significant positive correlation with both infarct volume and edema volume (p = 0.013 and p = 0.041, respectively), and were associated with a more severe stroke (NIHSS on discharge) and greater stroke related disability (mRS on discharge) with significance of p = 0.053 and p = 0.032, respectively. Conclusions When examined according to BMI, subjects undergoing MT for ELVO demonstrate significant differences in the expression of certain plasma proteins, including ADA. Levels of ADA were found to be significantly higher in the obese population when compared to normal or overweight groups. Increased levels of ADA in the obese group were predictive of increased infarct volume, edema volume, and worse NIHSS scores and mRS at discharge. These data provide novel biomarker candidates as well as treatment targets while increasing the personalization of stroke prognosis and treatment. Adenosine deaminase is minimally reported on in the stroke literature. In our cohort of ischemic ELVO stroke patients treated with mechanical thrombectomy: Subjects with higher BMI had higher ADA expression. Higher ADA is predictive of larger infarct volume, edema volume, and increased mRS and NIHSS on discharge. ADA and related proteins may serve as novel and personalized prognostic biomarkers as well as potential therapeutic targets.
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Maharjan J, Ektefaie Y, Ryan L, Mataraso S, Barnes G, Shokouhi S, Green-Saxena A, Calvert J, Mao Q, Das R. Enriching the Study Population for Ischemic Stroke Therapeutic Trials Using a Machine Learning Algorithm. Front Neurol 2022; 12:784250. [PMID: 35145468 PMCID: PMC8823366 DOI: 10.3389/fneur.2021.784250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Strokes represent a leading cause of mortality globally. The evolution of developing new therapies is subject to safety and efficacy testing in clinical trials, which operate in a limited timeframe. To maximize the impact of these trials, patient cohorts for whom ischemic stroke is likely during that designated timeframe should be identified. Machine learning may improve upon existing candidate identification methods in order to maximize the impact of clinical trials for stroke prevention and treatment and improve patient safety. Methods A retrospective study was performed using 41,970 qualifying patient encounters with ischemic stroke from inpatient visits recorded from over 700 inpatient and ambulatory care sites. Patient data were extracted from electronic health records and used to train and test a gradient boosted machine learning algorithm (MLA) to predict the patients' risk of experiencing ischemic stroke from the period of 1 day up to 1 year following the patient encounter. The primary outcome of interest was the occurrence of ischemic stroke. Results After training for optimization, XGBoost obtained a specificity of 0.793, a positive predictive value (PPV) of 0.194, and a negative predictive value (NPV) of 0.985. The MLA further obtained an area under the receiver operating characteristic (AUROC) of 0.88. The Logistic Regression and multilayer perceptron models both achieved AUROCs of 0.862. Among features that significantly impacted the prediction of ischemic stroke were previous stroke history, age, and mean systolic blood pressure. Conclusion MLAs have the potential to more accurately predict the near risk of ischemic stroke within a 1-year prediction window for individuals who have been hospitalized. This risk stratification tool can be used to design clinical trials to test stroke prevention treatments in high-risk populations by identifying subjects who would be more likely to benefit from treatment.
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Potasso L, Refardt J, De Marchis GM, Wiencierz A, Wright PR, Wagner B, Dittrich T, Polymeris AA, Gensicke H, Bonati LH, Christ-Crain M. Impact of Sodium Levels on Functional Outcomes in Patients With Stroke - A Swiss Stroke Registry Analysis. J Clin Endocrinol Metab 2022; 107:e672-e680. [PMID: 34480576 DOI: 10.1210/clinem/dgab650] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Correction of hyponatremia might represent an additional treatment for improving stroke patients' clinical outcomes. OBJECTIVE Admission hyponatremia is associated with worse clinical outcome in stroke patients, but whether normalization of hyponatremia improves outcome is unknown. We investigated whether normalization of hyponatremia affects patients' disability, mortality, and stroke recurrence within 3 months; length of hospitalization; and discharge destination. DESIGN This was a registry-based analysis of data collected between January 2016 and December 2018. We linked data from Swiss Stroke Registry (SSR) with electronic patients' records for extracting sodium values. SETTING We analyzed data of hospitalized patients treated at University Hospital of Basel. PATIENTS Stroke patients whose data and informed consent were available. MAIN OUTCOME MEASURE Modified Rankin Scale (mRS) score at 3 months. The tested hypothesis was formulated after SSR data collection but before linkage with electronic patients' records. RESULTS Of 1995 patients, 144 (7.2%) had hyponatremia on admission; 102 (70.8%) reached normonatremia, and 42 (29.2%) remained hyponatremic at discharge. An increase of initial sodium was associated with better functional outcome at 3 months (odds ratio [OR] 0.94; 95% CI, 0.90-0.99, for a shift to higher mRS per 1 mmol/L sodium increase). Compared with normonatremic patients, patients who remained hyponatremic at discharge had a worse functional outcome at 3 months (odds ratio 2.46; 95% CI, 1.20-5.03, for a shift to higher mRS). No effect was found on mortality, recurrence, or length of hospitalization. CONCLUSIONS In hospitalized acute stroke patients, persistent hyponatremia is associated with worse functional outcome. Whether active correction of hyponatremia improves outcome remains to be determined in prospective studies.
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Affiliation(s)
- Laura Potasso
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Julie Refardt
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital of Basel, 4031 Basel, Switzerland
| | - Andrea Wiencierz
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Patrick R Wright
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Benjamin Wagner
- Department of Neurology and Stroke Center, University Hospital of Basel, 4031 Basel, Switzerland
| | - Tolga Dittrich
- Department of Neurology and Stroke Center, University Hospital of Basel, 4031 Basel, Switzerland
| | - Alexandros A Polymeris
- Department of Neurology and Stroke Center, University Hospital of Basel, 4031 Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital of Basel, 4031 Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital of Basel, 4031 Basel, Switzerland
| | - Mirjam Christ-Crain
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
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Kautzky-Willer A, Harreiter J, Thomas A, Burger J, Schneeweiß U, Deischinger C, Klein W, Moser H. Women With Cerebral Infarction Feature Worse Clinical Profiles at Admission but Comparable Success to Men During Long-Term Inpatient Neurorehabilitation. Front Aging Neurosci 2021; 13:663215. [PMID: 34867261 PMCID: PMC8637730 DOI: 10.3389/fnagi.2021.663215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 10/27/2021] [Indexed: 12/25/2022] Open
Abstract
Objective: Little is known about possible sex and gender differences in post-stroke neurorehabilitation outcomes. We aimed to analyze if functional performance, prevalence and impact of comorbidities at admission, and success of inpatient stroke-neurorehabilitation differ between men and women. Methods: Retrospective cohort analysis of 1,437 men and 907 women with prior cerebral infarction treated at a neurorehabilitation clinic between 2012 and 2017; multiple linear regression was used to examine the influence of sex/gender as well as multiple confounders on health and functional outcomes. The main outcome measures were Barthel index (BI) at admission and its change during 4 weeks inpatient neurorehabilitation. Results: Men had been diagnosed with osteoporosis less frequently than women but more often with type 2 diabetes mellitus, coronary artery or chronic kidney disease (p ≤ 0.01). Although twice as many women presented with pre-stroke depression compared to men, the risk of post-stroke depression detected during rehabilitation was comparable. Men were more likely to have less than 30 days between diagnosis and neurorehabilitation start than women (p < 0.03). At admission, women exhibited less autonomy, a lower BI, a higher pain score and worse 2-min walk test (2′WT) compared to men (p < 0.001). Among males osteoporosis and peripheral artery disease independently predicted BI at admission, in women it was pre-stroke depression, dementia, and arterial fibrillation. During neurorehabilitation, both sexes improved regarding BI, pain and walk tests (p < 0.001). Despite comparable rehabilitation effectiveness, women still had worse functional outcomes than males at discharge. Time after stroke to start of neurorehabilitation and length of the stay but, most strongly, the simple 2′WT at admission, and in women, pain intensity independently predicted post-stroke functional status and recovery. Conclusion: Women presented with worse functional status at admission to neurorehabilitation. Although men and women showed similar rehabilitation effectiveness, women still displayed worse clinical outcome measures and higher levels of pain at discharge. Early access and gender-sensitive, personalized post-stroke care with more focus on different comorbidities and psychosocial factors like pain levels and management, could further improve neurorehabilitation outcomes.
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Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Institute, Gars am Kamp, Austria.,Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Anita Thomas
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Johannes Burger
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Ulrich Schneeweiß
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Carola Deischinger
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Wolfhard Klein
- Neurologisches Therapiezentrum Gmundnerberg, Altmünster, Austria
| | - Hermann Moser
- Neurologisches Therapiezentrum Gmundnerberg, Altmünster, Austria
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Akyea RK, Doehner W, Iyen B, Weng SF, Qureshi N, Ntaios G. Obesity and long-term outcomes after incident stroke: a prospective population-based cohort study. J Cachexia Sarcopenia Muscle 2021; 12:2111-2121. [PMID: 34581015 PMCID: PMC8718037 DOI: 10.1002/jcsm.12818] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/16/2021] [Accepted: 09/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The association between obesity, major adverse cardiovascular events (MACE), and mortality in patients with incident stroke is not well established. We assessed the relationship between body mass index (BMI) and MACE in patients with incident stroke. METHODS The population-based cohort study identified 30 702 individuals from the Clinical Practice Research Datalink (CPRD GOLD) and Hospital Episode Statistics (HES) databases from the United Kingdom. Individuals were aged ≥18 years with incident stroke between 1-1-1998 and 31-12-2017, a BMI recorded within 24 months before incident stroke, and no prior history of MACE. BMI was categorized as underweight (<18.5 kg/m2 ), normal (18.5-24.9 kg/m2 ), overweight (25.0-29.9 kg/m2 ), obesity class I (30.0-34.9 kg/m2 ), class II (35.0-39.9 kg/m2 ) and class III (≥40 kg/m2). MACE was defined as a composite of incident coronary heart disease, recurrent stroke, peripheral vascular disease (PVD), heart failure, and cardiovascular-related mortality. Multivariable Cox regression was used to assess differences in MACE risk between BMI categories. RESULTS At baseline, 1217 (4.0%) were underweight, 10 783 (35.1%) had a normal BMI, 10 979 (35.8%) had overweight, 5206 (17.0%) had obesity Class I, 1749 (5.7%) Class II, and 768 (2.5%) Class III. In multivariable analysis, higher BMI were associated with lower risk of subsequent MACE [overweight: HR 0.96, 95% CI 0.93-0.99)]; PVD [overweight: 0.65 (0.49-0.85); obesity Class III: 0.19 (0.50-0.77)]; cardiovascular-related death [overweight: 0.80 (0.74-0.86); obesity Class I: 0.79 (0.71-0.88); Class II: 0.80 (0.67-0.96)]; and all-cause mortality [overweight: 0.75 (0.71-0.79); obesity Class I: 0.75 (0.70-0.81); Class II: 0.77 (0.68-0.86)] when compared to those with normal BMI. The results were similar irrespective of sex, diabetes mellitus, smoking or cancer at time of incident stroke. CONCLUSIONS In patients with incident stroke, overweight or obesity were associated with a more favourable prognosis for subsequent MACE, PVD, and mortality, irrespective of sex, diabetes mellitus, smoking, or cancer at baseline. As with other cohort studies, our study demonstrates an association. Randomized control trials should be considered to robustly evaluate the impact of weight management recommendations on subsequent cardiovascular outcomes in stroke survivors.
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Affiliation(s)
- Ralph K Akyea
- Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Wolfram Doehner
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany.,Department of Internal Medicine and Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, and German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Barbara Iyen
- Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Stephen F Weng
- Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nadeem Qureshi
- Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Chang WH, Lee J, Chung JW, Kim YH, Bang OY. Probable Factors Associated with Response to Mesenchymal Stem Cell Therapy in Stroke Patients: A Post Hoc Analysis of the STARTING-2 Trial. J Pers Med 2021; 11:jpm11111137. [PMID: 34834489 PMCID: PMC8621313 DOI: 10.3390/jpm11111137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to identify factors associated with improved motor function of the lower extremities in response to mesenchymal stem cell (MSC) therapy in patients with ischemic stroke. This study was a post hoc analysis of data from a prospective, open-label, randomized controlled trial of MSC therapy for patients with ischemic stroke patients associated with severe middle cerebral artery territory (STARTING-2 trial). Lower limb motor function was scored based on the lower limb of Fugl-Meyer assessment (FMA-LL) score before MSC therapy and at 3 months after stroke. All FMA-LL changes greater than or equal to six points were considered clinically significant. Univariate and multivariate binary logistic regression models were used to determine possible predictors of clinically significant lower limb motor response to MSC therapy. Twelve (33%) of the thirty-six patients receiving MSC therapy reached a minimal clinically important difference (MCID) of FMA-LL. The two independent factors with the greatest impact on response to MSC therapy for achieving an MCID in FMA-LL score were: (1) the time from stroke onset to MSC therapy, and (2) age (p < 0.05). In addition, obese stroke patients responded better to MSC therapy than stroke patients with normal weight. In conclusion, this post hoc analysis might suggest the need for recruiting stroke patients at younger and early after stroke onset in future clinical trials of MSC therapy for stroke.
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Affiliation(s)
- Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (W.H.C.); (J.L.)
| | - Jungsoo Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (W.H.C.); (J.L.)
| | - Jong-Won Chung
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Translational and Stem Cell Research Laboratory on Stroke, Samsung Medical Center, Seoul 06351, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (W.H.C.); (J.L.)
- Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
- Correspondence: (Y.-H.K.); (O.Y.B.); Tel.: +82-2-3410-2824 (Y.-H.K.); +82-2-3410-3599 (O.Y.B.)
| | - Oh Young Bang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Translational and Stem Cell Research Laboratory on Stroke, Samsung Medical Center, Seoul 06351, Korea
- Correspondence: (Y.-H.K.); (O.Y.B.); Tel.: +82-2-3410-2824 (Y.-H.K.); +82-2-3410-3599 (O.Y.B.)
| | - The STARTING-2 Collaborators
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
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Kinter KJ, Alfaro R, Kinter C, Suder L, Davis Z, Rodriguez P, Ruiz JG, Zevallos JC, Elkbuli A. The Effects of Body Mass Index on In-hospital mortality following first ischemic or hemorrhagic stroke events: Does the "obesity paradox" apply? Ann Med Surg (Lond) 2021; 70:102839. [PMID: 34691415 PMCID: PMC8519764 DOI: 10.1016/j.amsu.2021.102839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background While it is widely held that obesity is a risk factor for stroke, its role in mortality after stroke is less understood. We aim to examine effects of Body Mass Index (BMI) on in-hospital mortality after non-subarachnoid, subarachnoid, and ischemic stroke. Methods Retrospective cohort study. Patients aged ≥18 years, who were hospitalized in Florida hospitals between 2008 and 2012 with a diagnosis of first-time stroke as reported by the Agency for Health Care Administration (AHCA). The main independent variable was BMI category, which was divided into non-overweight/non-obese, obese, and morbidly obese. The primary outcome was the adjusted odds ratio (aOR) for in-hospital mortality for subarachnoid and non-subarachnoid hemorrhagic stroke, and ischemic stroke. Logistic regression modeling was utilized to examine the association between each BMI category and in-hospital mortality, while controlling for several potential confounders. This study was reported in line with the STROCSS criteria. Results Of the 333,367 patients included in the database, 150,153 (45.0%) patients met inclusion criteria. After adjusting for age, gender, ethnicity and other possible confounders, obese patients were 21% less likely to die during their hospitalization following a first ischemic stroke (0.79 aOR, 0.69–0.92, 95% CI, p = 0.002), and 32% less likely following a first non-subarachnoid hemorrhage (0.68 aOR, 0.57–0.82, 95% CI, p = 0.0001) compared to non-overweight/non-obese counterparts. Conclusion Obese patients are less likely to die during hospitalization following first-time non-subarachnoid hemorrhage and ischemic stroke than non-overweight/non-obese patients. These findings support the “obesity paradox” concept, though more research is needed for recurrent stroke patients. Obese patients were less likely to die in the hospital after first-time ischemic stroke and non-subarachnoid hemorrhage compared to non-overweight/non-obese patients. Future studies should further Investigate the “obesity paradox” in relation to BMI classifications and hemorrhagic stroke.
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Affiliation(s)
- Kevin J Kinter
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Robert Alfaro
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Christopher Kinter
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Lucas Suder
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Zachary Davis
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Pura Rodriguez
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Juan Gabriel Ruiz
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Juan Carlos Zevallos
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
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Zabala A, Darsalia V, Lind M, Svensson AM, Franzén S, Eliasson B, Patrone C, Jonsson M, Nyström T. Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study. Cardiovasc Diabetol 2021; 20:202. [PMID: 34615525 PMCID: PMC8495918 DOI: 10.1186/s12933-021-01394-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/29/2021] [Indexed: 12/17/2022] Open
Abstract
Background and aims Insulin resistance contributes to the development of type 2 diabetes (T2D) and is also a cardiovascular risk factor. The aim of this study was to investigate the potential association between insulin resistance measured by estimated glucose disposal rate (eGDR) and risk of stroke and mortality thereof in people with T2D. Materials and methods Nationwide population based observational cohort study that included all T2D patients from the Swedish national diabetes registry between 2004 and 2016 with full data on eGDR and categorised as following: < 4, 4–6, 6–8, and ≥ 8 mg/kg/min. We calculated crude incidence rates and 95% confidence intervals (CIs) and used multiple Cox regression to estimate hazard ratios (HRs) to assess the association between the risk of stroke and death, according to the eGDR categories in which the lowest category < 4 (i.e., highest grade of insulin resistance), served as a reference. The relative importance attributed of each factor in the eGDR formula was measured by the R2 (± SE) values calculating the explainable log-likelihoods in the Cox regression. Results A total of 104 697 T2D individuals, 44.5% women, mean age of 63 years, were included. During a median follow up-time of 5.6 years, 4201 strokes occurred (4.0%). After multivariate adjustment the HRs (95% CI) for stroke in patients with eGDR categories between 4–6, 6–8 and > 8 were: 0.77 (0.69–0.87), 0.68 (0.58–0.80) and 0.60 (0.48–0.76), compared to the reference < 4. Corresponding numbers for the risk of death were: 0.82 (0.70–0.94), 0.75 (0.64–0.88) and 0.68 (0.53–0.89). The attributed relative risk R2 (± SE) for each variable in the eGDR formula and stroke was for: hypertension (0.045 ± 0.0024), HbA1c (0.013 ± 0.0014), and waist (0.006 ± 0.0009), respectively. Conclusion A low eGDR (a measure of insulin resistance) is associated with an increased risk of stroke and death in individuals with T2D. The relative attributed risk was most important for hypertension. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01394-4.
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Affiliation(s)
- Alexander Zabala
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 11883, Stockholm, Sweden.
| | - Vladimer Darsalia
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 11883, Stockholm, Sweden
| | - Marcus Lind
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - Ann-Marie Svensson
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - Stefan Franzén
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - Björn Eliasson
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Cesare Patrone
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 11883, Stockholm, Sweden
| | - Magnus Jonsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Nyström
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 11883, Stockholm, Sweden
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Gago-Dominguez M, Sobrino T, Torres-Español M, Calaza M, Rodríguez-Castro E, Campos F, Redondo CM, Castillo J, Carracedo Á. Obesity-related genetic determinants of stroke. Brain Commun 2021; 3:fcab069. [PMID: 34550115 DOI: 10.1093/braincomms/fcab069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
As obesity, circulating lipids and other vascular/metabolic factors influence the risk of stroke, we examined if genetic variants associated with these conditions are related to risk of stroke using a case-control study in Galicia, Spain. A selection of 200 single-nucleotide polymorphisms previously found to be related to obesity, body mass index, circulating lipids, type 2 diabetes, heart failure, obesity-related cancer and cerebral infarction were genotyped in 465 patients diagnosed with stroke and 480 population-based controls. An unsupervised Lasso regression procedure was carried out for single-nucleotide polymorphism selection based on their potential effect on stroke according to obesity. Selected genotypes were further analysed through multivariate logistic regression to study their association with risk of stroke. Using unsupervised selection procedures, nine single-nucleotide polymorphisms were found to be related to risk of stroke overall and after stratification by obesity. From these, rs10761731, rs2479409 and rs6511720 in obese subjects [odds ratio (95% confidence interval) = 0.61 (0.39-0.95) (P = 0.027); 0.54 (0.35-0.84) (P = 0.006) and 0.42 (0.22-0.80) (P = 0.0075), respectively], and rs865686 in non-obese subjects [odds ratio (95% confidence interval) = 0.67 (0.48-0.94) (P = 0.019)], were independently associated with risk of stroke after multivariate logistic regression procedures. The associations between the three single-nucleotide polymorphisms found to be associated with stroke risk in obese subjects were more pronounced among females; for rs10761731, odds ratios among obese males and females were 1.07 (0.58-1.97) (P = 0.84), and 0.31 (0.14-0.69) (P = 0.0018), respectively; for rs2479409, odd ratios were 0.66 (0.34-1.27) (P = 0.21), and 0.49 (0.24-0.99) (P = 0.04), for obese males and females, respectively; the stroke-rs6511720 association was also slightly more pronounced among obese females, odds ratios were 0.33 (0.13-0.87) (P = 0.022), and 0.28 (0.09-0.85) (P = 0.02) for obese males and females, respectively. The rs865686-stroke association was more pronounced among non-obese males [odds ratios = 0.61 (0.39-0.96) (P = 0.029) and 0.72 (0.42-1.22) (P = 0.21), for non-obese males and females, respectively]. A combined genetic score of variants rs10761731, rs2479409 and rs6511720 was highly predictive of stroke risk among obese subjects (P = 2.04 × 10-5), particularly among females (P = 4.28 × 10-6). In summary, single-nucleotide polymorphisms rs1076173, rs2479409 and rs6511720 were found to independently increase the risk of stroke in obese subjects after adjustment for established risk factors. A combined score with the three genomic variants was an independent predictor of risk of stroke among obese subjects in our population.
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Affiliation(s)
- Manuela Gago-Dominguez
- Fundación Pública Galega de Medicina Xenómica (FPGMX), Servicio Galego de Saúde (SERGAS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Grupo de Medicina Xenómica, Centro en Red de Enfermedades Raras (CIBERER), Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,International Cancer Genetics and Epidemiology Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - María Torres-Español
- Fundación Pública Galega de Medicina Xenómica (FPGMX), Servicio Galego de Saúde (SERGAS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Manuel Calaza
- Conselleria de Educación, Xunta de Galicia, Santiago de Compostela, Spain
| | - Emilio Rodríguez-Castro
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmen M Redondo
- Oncology and Genetics Unit, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ángel Carracedo
- Fundación Pública Galega de Medicina Xenómica (FPGMX), Servicio Galego de Saúde (SERGAS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Grupo de Medicina Xenómica, Centro en Red de Enfermedades Raras (CIBERER), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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