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Nguyen KT, Xu H, Gaynor B, Adebamowo SN, McArdle PF, O'Connor T, Worrall B, Malik R, Boncoraglio GB, Zand R, Kittner SJ, Mitchell BD. The Impact of Conventional Stroke Risk Factors on Early and Late Onset Ischemic Stroke: a Mendelian Randomization Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.31.24308308. [PMID: 38853993 PMCID: PMC11160856 DOI: 10.1101/2024.05.31.24308308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Objective Although stroke incidence is decreasing in older ages, it is increasing in young adults. While these divergent trends in stroke incidence are at least partially attributable to diverging prevalence trends in stoke risk factors, age-dependent differences in the impact of stroke risk factors on stroke may also contribute. To address this issue, we utilized Mendelian Randomization (MR) to assess differences in the association of stroke risk factors between early onset ischemic stroke (EOS) and late onset ischemic stroke (LOS). Methods We employed a two-sample MR design with inverse variance weighting as the primary method of analysis. Using large publicly available genome-wide association summary results, we calculated MR estimates for conventional stroke risk factors (body mass index, total, HDL-and LDL-cholesterol, triglycerides, type 2 diabetes, systolic and diastolic blood pressure, and smoking) in EOS cases (onset 18-59 years, n = 6,728) and controls from the Early Onset Stroke Consortium and in LOS cases (onset ≥ 60 years, n = 9,272) and controls from the Stroke Genetics Network. We then compared odds ratios between EOS and LOS, stratified by TOAST subtypes, to determine if any differences observed between effect sizes could be attributed to differences in the distribution of stroke subtypes. Results EOS was significantly associated with all risk factors except for total cholesterol levels, and LOS was associated with all risk factors except for triglyceride and total cholesterol levels. The associations of BMI, DBP, SBP, and HDL-cholesterol were significantly stronger in EOS than LOS (all p < 0.004). The differential distribution of stroke subtypes could not explain the difference in effect size observed between EOS and LOS. Conclusion These results suggest that interventions targeted at lowering body mass index and blood pressure may be particularly important for reducing stroke risk in young adults.
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Zhang X, Jing J, Wang A, Xie X, Johnston SC, Li H, Bath PM, Xu Q, Lin J, Wang Y, Zhao X, Li Z, Jiang Y, Liu L, Chen W, Gong X, Li J, Han X, Meng X, Wang Y. Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a subgroup analysis of the CHANCE-2 trial. Stroke Vasc Neurol 2024:svn-2023-002450. [PMID: 38286485 DOI: 10.1136/svn-2023-002450] [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: 03/06/2023] [Accepted: 12/16/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES Evidence of the optimal antiplatelet therapy for elderly patients who had a stroke is limited, especially those elder than 80 years. This study aimed to explore the efficacy and safety of dual antiplatelet therapy (DAPT) in old-old patients compared with younger patients in the ticagrelor or Clopidogrel with aspirin in High-risk patients with Acute Non-disabling Cerebrovascular Events-II (CHANCE-2) trial. METHODS CHANCE-2 was a randomised, double-blind, placebo-controlled trial in China involving patients with high-risk transient ischaemic attack or minor stroke with CYP2C19 loss-of-function alleles. In our substudy, all enrolled patients were stratified by age: old-old (≥80 years), young-old (65-80 years) and younger (<65 years). The primary outcomes were stroke recurrence and moderate to severe bleeding within 90 days, respectively. RESULTS Of all the 6412 patients, 406 (6.3%) were old-old, 2755 (43.0%) were young-old and 3251 (50.7%) were younger. Old-old patients were associated with higher composite vascular events (HR 1.41, 95% CI 1.00 to 1.98, p=0.048), disabling stroke (OR 2.43, 95% CI 1.52 to 3.88, p=0.0002), severe or moderate bleeding (HR 8.40, 95% CI 1.95 to 36.21, p=0.004) and mortality (HR 7.56, 95% CI 2.23 to 25.70, p=0.001) within 90 days. Ticagrelor-aspirin group was associated with lower risks of stroke recurrence within 90 days in younger patients (HR 0.68, 95% CI 0.51 to 0.91, p=0.008), which was no differences in old-old patients. CONCLUSION Elderly patients aged over 80 in CHANCE-2 trial had higher risks of composite vascular events, disabling stroke, severe or moderate bleeding and mortality within 90 days. Genotype-guided DAPT might not be as effective in old-old patients as in younger ones. TRIAL REGISTRATION NUMBER NCT04078737.
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Affiliation(s)
- Xinmiao Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xuewei Xie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | | | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Philip M Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Qin Xu
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jinxi Lin
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Weifeng Chen
- Department of Neurology, Xingyang People's Hospital, Henan, China
| | - Xuhai Gong
- Daqing Oilfield General Hospital, Daqing, Heilongjiang, China
| | - Jianhua Li
- The First Hospital of Fangshan District, Beijing, China
| | | | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
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Li H, Gao M, Song H, Wu X, Li G, Cui Y, Li Y, Xie Z, Ren Q, Zhang H. Predicting ischemic stroke risk from atrial fibrillation based on multi-spectral fundus images using deep learning. Front Cardiovasc Med 2023; 10:1185890. [PMID: 37600060 PMCID: PMC10434281 DOI: 10.3389/fcvm.2023.1185890] [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: 03/17/2023] [Accepted: 06/05/2023] [Indexed: 08/22/2023] Open
Abstract
Background Ischemic stroke (IS) is one of the most common serious secondary diseases of atrial fibrillation (AF) within 1 year after its occurrence, both of which have manifestations of ischemia and hypoxia of the small vessels in the early phase of the condition. The fundus is a collection of capillaries, while the retina responds differently to light of different wavelengths. Predicting the risk of IS occurring secondary to AF, based on subtle differences in fundus images of different wavelengths, is yet to be explored. This study was conducted to predict the risk of IS occurring secondary to AF based on multi-spectrum fundus images using deep learning. Methods A total of 150 AF participants without suffering from IS within 1 year after discharge and 100 IS participants with persistent arrhythmia symptoms or a history of AF diagnosis in the last year (defined as patients who would develop IS within 1 year after AF, based on fundus pathological manifestations generally prior to symptoms of the brain) were recruited. Fundus images at 548, 605, and 810 nm wavelengths were collected. Three classical deep neural network (DNN) models (Inception V3, ResNet50, SE50) were trained. Sociodemographic and selected routine clinical data were obtained. Results The accuracy of all DNNs with the single-spectral or multi-spectral combination images at the three wavelengths as input reached above 78%. The IS detection performance of DNNs with 605 nm spectral images as input was relatively more stable than with the other wavelengths. The multi-spectral combination models acquired a higher area under the curve (AUC) scores than the single-spectral models. Conclusions The probability of IS secondary to AF could be predicted based on multi-spectrum fundus images using deep learning, and combinations of multi-spectrum images improved the performance of DNNs. Acquiring different spectral fundus images is advantageous for the early prevention of cardiovascular and cerebrovascular diseases. The method in this study is a beneficial preliminary and initiative exploration for diseases that are difficult to predict the onset time such as IS.
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Affiliation(s)
- Hui Li
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing, China
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Shenzhen Bay Laboratory, Institute of Biomedical Engineering, Shenzhen, China
- National Biomedical Imaging Center, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
| | - Mengdi Gao
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing, China
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Shenzhen Bay Laboratory, Institute of Biomedical Engineering, Shenzhen, China
- National Biomedical Imaging Center, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiao Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gang Li
- Department of Cardiology, Beijing Yanhua Hospital, Beijing, China
| | - Yiwei Cui
- Department of Cardiology, Beijing Yanhua Hospital, Beijing, China
| | - Yang Li
- Department of Cardiology, Beijing Yanhua Hospital, Beijing, China
| | - Zhaoheng Xie
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Shenzhen Bay Laboratory, Institute of Biomedical Engineering, Shenzhen, China
- National Biomedical Imaging Center, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
| | - Qiushi Ren
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing, China
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Shenzhen Bay Laboratory, Institute of Biomedical Engineering, Shenzhen, China
- National Biomedical Imaging Center, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
| | - Haitao Zhang
- Cardio-Metabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Yang K, Chen M, Wang Y, Jiang G, Hou N, Wang L, Wen K, Li W. Development of a predictive risk stratification tool to identify the population over age 45 at risk for new-onset stroke within 7 years. Front Aging Neurosci 2023; 15:1101867. [PMID: 37388187 PMCID: PMC10301757 DOI: 10.3389/fnagi.2023.1101867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/09/2023] [Indexed: 07/01/2023] Open
Abstract
Background and purpose With the acceleration of the aging process of society, stroke has become a major health problem in the middle-aged and elderly population. A number of new stroke risk factors have been recently found. It is necessary to develop a predictive risk stratification tool using multidimensional risk factors to identify people at high risk for stroke. Methods The study included 5,844 people (age ≥ 45 years) who participated in the China Health and Retirement Longitudinal Study in 2011 and its follow-up up to 2018. The population samples were divided into training set and validation set according to 1:1. A LASSO Cox screening was performed to identify the predictors of new-onset stroke. A nomogram was developed, and the population was stratified according to the score calculated through the X-tile program. Internal and external verifications of the nomogram were performed by ROC and calibration curves, and the Kaplan-Meier method was applied to identify the performance of the risk stratification system. Results The LASSO Cox regression screened out 13 candidate predictors from 50 risk factors. Finally, nine predictors, including low physical performance and the triglyceride-glucose index, were included in the nomogram. The nomogram's overall performance was good in both internal and external validations (AUCs at 3-, 5-, and 7-year periods were 0.71, 0.71, and 0.71 in the training set and 0.67, 0.65, and 0.66 in the validation set, respectively). The nomogram was proven to excellently discriminate between the low-, moderate-, and high-risk groups, with a prevalence of 7-year new-onset stroke of 3.36, 8.32, and 20.13%, respectively (P < 0.001). Conclusion This research developed a clinical predictive risk stratification tool that can effectively identify the different risks of new-onset stroke in 7 years in the middle-aged and elderly Chinese population.
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Affiliation(s)
- Kang Yang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minfang Chen
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaoling Wang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gege Jiang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Niuniu Hou
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Liping Wang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Wen
- School of Software and Microelectronics, Peking University, Beijing, China
| | - Wei Li
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Simmons CA, Poupore N, Nathaniel TI. Age Stratification and Stroke Severity in the Telestroke Network. J Clin Med 2023; 12:jcm12041519. [PMID: 36836054 PMCID: PMC9963120 DOI: 10.3390/jcm12041519] [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: 12/24/2022] [Revised: 01/30/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Age is one of the most important risk factors for stroke, and an estimated 75% of strokes occur in people 65 years old and above. Adults > 75 years of age experience more hospitalizations and higher mortality. In this study, we aimed to investigate how age and various clinical risk factors affect acute ischemic stroke (AIS) severity in two age categories. METHODS This retrospective data analysis study was conducted using data collected from the PRISMA Health Stroke Registry between June 2010 and July 2016. Baseline clinical and demographic data were analyzed for 65-74-year-old patients and those ≥ 75 years of age. This study aimed to investigate risk factors associated with stroke severity in these two age categories of AIS patients treated in telestroke settings. RESULTS An adjusted multivariate analysis showed that the acute ischemic stroke (AIS) population of 65-74-year-old patients experiencing heart failure (odds ratio (OR) = 4.398, 95% CI = 3.912-494.613, p = 0.002) and elevated high-density lipoprotein (HDL) levels (OR = 1.066, 95% CI = 1.009-1.126, p = 0.024) trended towards worsening neurological function, while patients experiencing obesity (OR = 0.177, 95% CI = 0.041-0.760, p = 0.020) exhibited improved neurological functions. For the patients ≥ 75 years of age, direct admission (OR = 0.270, 95% CI = 0.085-0.856, p = 0.026) was associated with improved functions. CONCLUSIONS Heart failure and elevated HDL levels were significantly associated with worsening neurologic functions in patients aged 65-74. Obese patients and individuals ≥ 75 years of age who were directly admitted were most likely to exhibit improving neurological functions.
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Affiliation(s)
- Cassie A. Simmons
- Department of Biology, North Greenville University, Tigerville, SC 29688, USA
| | - Nicolas Poupore
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Thomas I. Nathaniel
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA
- Correspondence: ; Tel.: +1-44559846; Fax: +1-44558404
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Ahmadabad MA, Naeimi A, Keymoradzadeh A, Faghani S, Ahmadabad MA, Boroujeni NA, Mohammadpour H, Saberi A. Evaluation of De Ritis (AST/ALT), ALP/ALT, and AST/ALP ratios as prognostic factors in patients with acute ischemic stroke. BMC Neurol 2022; 22:450. [PMID: 36463106 PMCID: PMC9719238 DOI: 10.1186/s12883-022-02989-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Stroke is one of the leading causes of disability worldwide. Recently, stroke prognosis estimation has received much attention. This study investigates the prognostic role of aspartate transaminase/alanine transaminase (De Ritis, AAR), alkaline phosphatase/alanine transaminase (ALP/ALT), and aspartate transaminase/alkaline phosphatase (AST/ALP) ratios in acute ischemic stroke (AIS). METHODS This retrospective cohort study involved patients who experienced their first-ever AIS between September 2019 and June 2021. Clinical and laboratory data were collected within the first 24 hours after admission. Functional and mortality outcomes were evaluated 90 days after hospital discharge in clinical follow-up. Functional outcome was assessed by a modified Rankin Scale (mRS). The correlation between the laboratory data and study outcomes was evaluated using univariate analysis. In addition, regression models were developed to evaluate the predictive role of AST/ALP, ALP/ALT, and AAR ratios on the study outcomes. RESULTS Two hundred seventy-seven patients (mean age 69.10 ± 13.55, 53.1% female) were included. According to univariate analysis, there was a weak association between 3-months mRS, and both AST/ALT (r = 0.222, P < 0.001), and AST/ALP (r = 0.164, P = 0.008). Subsequently, higher levels of these ratios and absolute values of AST, ALT, and ALP were reported in deceased patients. Based on regression models adjusted with co-variable (age, gender, underlying disease, and history of smoking) AST/ALT and AST/ALP ratios had a significant independent association with 3-month mRS (CI:1.37-4.52, p = 0.003, and CI: 4.45-11,547.32, p = 0.007, respectively) and mortality (CI: 0.17-1.06, adjusted R2 = 0.21, p = 0.007, and CI: 0.10-2.91, p = 0.035, adjusted R2 = 0.20, respectively). CONCLUSIONS Elevated AST/ALP and AAR ratios at admission were correlated with poorer outcomes at 3 months in patients with first-ever AIS. Prospective studies in larger cohorts are required to confirm our findings and to evaluate further whether the AST/ALP and De Ritis ratios may represent a useful tool for determining the prognosis of AIS patients.
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Affiliation(s)
- Mona Asghari Ahmadabad
- grid.411874.f0000 0004 0571 1549Neurosciences Research Center, Neurology Department, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arvin Naeimi
- grid.411874.f0000 0004 0571 1549Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arman Keymoradzadeh
- grid.411600.2Department of Neurosurgery, School of Medicine Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahriar Faghani
- grid.411705.60000 0001 0166 0922Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Asghari Ahmadabad
- grid.411874.f0000 0004 0571 1549Neurosciences Research Center, Neurology Department, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Nasim Athari Boroujeni
- grid.411874.f0000 0004 0571 1549Neurosciences Research Center, Neurology Department, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hanieh Mohammadpour
- grid.411874.f0000 0004 0571 1549Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Alia Saberi
- grid.411874.f0000 0004 0571 1549Neurosciences Research Center, Neurology Department, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Liu Y, Shang G, Zhang X, Liu F, Zhang C, Li Z, Jia J, Xu Y, Zhang Z, Yang S, Zhou B, Luan Y, Huang Y, Peng Y, Han T, He Y, Zheng H. CAMTA1 gene affects the ischemia-reperfusion injury by regulating CCND1. Front Cell Neurosci 2022; 16:868291. [PMID: 36159397 PMCID: PMC9500443 DOI: 10.3389/fncel.2022.868291] [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: 02/02/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Epigenetic modulations lead to changes in gene expression, including DNA methylation, histone modifications, and noncoding RNAs. In recent years, epigenetic modifications have been related to the pathogenesis of different types of cancer, cardiovascular disease, and other diseases. Emerging evidence indicates that DNA methylation could be associated with ischemic stroke (IS) and plays a role in pathological progression, but the underlying mechanism has not yet been fully understood. In this study, we used human methylation 850K BeadChip to analyze the differences in gene methylation status in the peripheral blood samples from two groups (3 IS patients vs. 3 healthy controls). According to their bioinformatics profiling, we found 278 genes with significantly different methylation levels. Seven genes with the most significant methylation modifications were validated in two expanded groups (100 IS patients vs. 100 healthy controls). The CAMTA1 gene had significantly different methylation changes in patients compared to the controls. To understand the CAMTA1 function in stroke, we generated CAMTA1 knockout in SH-SY5Y cells. RNA seq results in CAMTA1 knockout cells revealed the pathways and gene set enrichments involved in cellular proliferation and cell cycle. Furthermore, a series of experiments demonstrated that in the oxygen-glucose deprivation/re-oxygenation (OGD/R) model system, the expression of cyclin D1, an essential regulator of cell cycle progression, was increased in SH-SY5Y CAMTA1 KO cells. Increasing evidence demonstrated that ischemic stress could inappropriately raise cyclin D1 levels in mature neurons. However, the molecular signals leading to an increased cyclin D1 level are unclear. Our findings demonstrate for the first time that the CAMTA1 gene could regulate cyclin D1 expression and implicate their role in strokes.
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Affiliation(s)
- Yang Liu
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Guohui Shang
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Xuran Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Henan University of CM, Henan University of CM, Zhengzhou, China
| | - Fuyong Liu
- Department of Pathogenic Biology and Immunology, School of Life Sciences, Sanquan College of Xinxiang Medical University, Xinxiang, China
| | - Chi Zhang
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Zhihao Li
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Jing Jia
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Yan Xu
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Zhaojing Zhang
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Shangdong Yang
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Baixue Zhou
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Yingying Luan
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Yanyang Huang
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Yue Peng
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Tianyi Han
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Ying He
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
- Ying He
| | - Hong Zheng
- Department of Medical Genetics and Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
- *Correspondence: Hong Zheng
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Nawata K. An Analysis of Risk Factors Affecting Cerebrovascular Disease. Health (London) 2022. [DOI: 10.4236/health.2022.148061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ford CD, Gray MS, Crowther MR, Wadley VG, Austin AL, Crowe MG, Pulley L, Unverzagt F, Kleindorfer DO, Kissela BM, Howard VJ. Depressive Symptoms and Risk of Stroke in a National Cohort of Black and White Participants From REGARDS. Neurol Clin Pract 2021; 11:e454-e461. [PMID: 34484944 DOI: 10.1212/cpj.0000000000000983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022]
Abstract
Objective The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke and determine whether depressive symptomatology was differentially predictive of stroke among Black and White participants. Methods The study comprised 9,529 Black and 14,516 White stroke-free participants, aged 45 and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (2003-2007). Incident stroke was the first occurrence of stroke. Association between baseline depressive symptoms (assessed via the 4-item Center for Epidemiologic Studies Depression Scale [CES-D-4]: 0, 1-3, or ≥4) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographics, stroke risk factors, and social factors. Results There were 1,262 strokes over an average follow-up of 9.21 (SD 4.0) years. Compared to participants with no depressive symptoms, after demographic adjustment, participants with CES-D-4 scores of 1-3 had 39% increased stroke risk (hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 1.23-1.57), with slight attenuation after full adjustment (HR = 1.27, 95% CI = 1.11-1.43). Participants with CES-D-4 scores of ≥4 experienced 54% higher risk of stroke after demographic adjustment (HR = 1.54, 95% CI = 1.27-1.85), with risk attenuated in the full model similar to risk with 1-3 symptoms (HR = 1.25, 95% CI = 1.03-1.51). There was no evidence of a differential effect by race (p = 0.53). Conclusions The association of depressive symptoms with increased stroke risk was similar among a national sample of Black and White participants. These findings suggest that assessment of depressive symptoms should be considered in primary stroke prevention for both Black and White participants.
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Affiliation(s)
- Cassandra D Ford
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Marquita S Gray
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Martha R Crowther
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Virginia G Wadley
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Audrey L Austin
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Michael G Crowe
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - LeaVonne Pulley
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Frederick Unverzagt
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Dawn O Kleindorfer
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Brett M Kissela
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Virginia J Howard
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
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10
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Obesity, Vascular Disease and Frailty in Aging Women with HIV. ACTA ACUST UNITED AC 2021; 3. [PMID: 34368807 PMCID: PMC8345026 DOI: 10.20900/agmr20210014] [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] [Indexed: 11/30/2022]
Abstract
Women with chronic HIV infection (WWH) living in the United States,
experience a disproportionately high rate of obesity compared to uninfected
populations. Both overweight and obesity, particularly central obesity, are
major contributors to insulin resistance, hypertension, and
dyslipidemia—the major components of metabolic syndromes, including type
2 diabetes, and leading to increased cardiovascular risk, including coronary
heart disease, and cerebrovascular diseases. Notably, declining physical
performance and frailty co-occur with vascular morbidities as well as changes in
bone. These factors tend to exacerbate each other and accelerate the aging
trajectory, leading to poorer quality of life, cognitive impairments, dementia,
and eventually, death. In WWH, persistent HIV infection, sustained treatment for
HIV infection, and concomitant obesity, may accelerate aging-related morbidities
and poorer aging outcomes. Furthermore, health disparities factors common among
some WWH, are independently associated with obesity and higher vascular risk.
The purpose of this review is to describe the constellation of obesity, cardio-
and cerebrovascular diseases, bone health and frailty among aging WWH, a 21st
century emergence.
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11
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Wang CY, Miyoshi S, Chen CH, Lee KC, Chang LC, Chung JH, Shi HY. Walking ability and functional status after post-acute care for stroke rehabilitation in different age groups: a prospective study based on propensity score matching. Aging (Albany NY) 2020; 12:10704-10714. [PMID: 32482912 PMCID: PMC7346049 DOI: 10.18632/aging.103288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/27/2020] [Indexed: 12/26/2022]
Abstract
Few studies have compared how rehabilitative post-acute care affects recovery of walking ability and other functions after stroke in different age groups. After propensity score matching (1:1), 316 stroke patients were separated into an aged group (age ≥65 years, n=158) and a non-aged group (age <65 years, n=158). Both groups significantly improved in Barthel index, EuroQol-5 dimension, Berg balance scale, 6-minute walking distance and 5-meter walking speed (P<0.001). The non-aged group had significantly larger improvements in Berg balance scale, instrumental activities of daily living, EuroQol-5 dimension and 6-minute walking distance (P<0.001) compared to the aged group. The two groups did not significantly differ in Barthel index, 5-meter walking speed, length of stay, and cost. The aged group had poorer walking ability and poorer instrumental activities of daily living compared to the non-aged group. After intensive rehabilitative post-acute care, however, the aged group improved in walking ability, functional performance and mental health. Intensive strength training for unaffected lower limbs in the stroke patients achieved good recovery of walking ability and other functions. Overall, intensive rehabilitative post-acute care improved self-care ability and decreased informal care costs. Rehabilitative PAC under per-diem reimbursement is efficient and economical for stroke patients in an aging society.
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Affiliation(s)
- Chung-Yuan Wang
- Department of Physical Medicine and Rehabilitation, Pingtung Christian Hospital, Pingtung, Taiwan.,Department of Beauty Science, Meiho University, Pingtung, Taiwan
| | - Seido Miyoshi
- Department of Rehabilitation, Asagi Hospital, Fukuoka, Japan
| | - Chang-Hung Chen
- Department of Neurology, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Kai-Chun Lee
- Department of Physical Medicine and Rehabilitation, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Long-Chung Chang
- Superintendent Office, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Jo-Hsuan Chung
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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12
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Zeng M, Zhen J, Zheng X, Qiu H, Xu X, Wu J, Lin Z, Hu J. The Role of DNA Methylation in Ischemic Stroke: A Systematic Review. Front Neurol 2020; 11:566124. [PMID: 33193003 PMCID: PMC7652818 DOI: 10.3389/fneur.2020.566124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Knowledge about the classic risk and protective factors of ischemic stroke is accumulating, but the underlying pathogenesis has not yet been fully understood. As emerging evidence indicates that DNA methylation plays a role in the pathological process of cerebral ischemia, this study aims to summarize the evidence of the association between DNA methylation and ischemic stroke. Methods: MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials were searched for eligible studies. The results reported by each study were summarized narratively. Results: A total of 20 studies with 7,014 individuals finally met the inclusion criteria. Three studies focused on global methylation, 11 studies on candidate-gene methylation, and six on epigenome-wide methylation analysis. Long-interspersed nuclear element 1 was found to be hypomethylated in stroke cases in two studies. Another 16 studies reported 37 genes that were differentially methylated between stroke cases and controls. Individuals with ischemic stroke were also reported to have higher acceleration in Hanuum 's epigenetic age compared to controls. Conclusion: DNA methylation might be associated with ischemic stroke and play a role in several pathological pathways. It is potentially a promising biomarker for stroke prevention, diagnosis and treatment, but the current evidence is limited by sample size and cross-sectional or retrospective design. Therefore, studies on large asymptomatic populations with the prospective design are needed to validate the current evidence, explore new pathways and identify novel risk/protective loci.
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Affiliation(s)
- Minyan Zeng
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Juanying Zhen
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
- Department of Clinical Medicine, Shantou University Medical College, Shantou, China
| | - Xiaodan Zheng
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
- Department of Clinical Medicine, Shantou University Medical College, Shantou, China
| | - Hongyan Qiu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaonan Xu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun Wu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zhijian Lin
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
- *Correspondence: Zhijian Lin
| | - Jun Hu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
- Jun Hu
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