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Schiess N, Kulo V, Dearborn JL, Shaban S, Gamaldo CE, Salas RME. Cross-Cultural Chronotypes: Educating Medical Students in America, Malaysia and the UAE. MedEdPublish (2016) 2020; 9:5. [PMID: 38058901 PMCID: PMC10697528 DOI: 10.15694/mep.2020.000005.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
This article was migrated. The article was marked as recommended. Background: Ample data demonstrates that sleep deprivation leads to impaired functioning including cognitive performance, memory and fine motor skills. Medical students represent a professional sector in which optimizing cognitive performance and functioning is critical from a personal, public health and safety perspective. Aims: To characterize chronotypes of an international cohort of medical students and determine if chronotype is affected by demographics or latitude. Samples: 328 students from medical schools in the United States (US), Malaysia and United Arab Emirates (UAE) were assessed for differences in chronotype and sleep habits. Methods: A cross-sectional, questionnaire-based study from medical schools in the US, Malaysia and UAE between 2013 and 2015. Results: There was a significant difference in mean waking times for Malaysian students who reported awakening earlier than US or UAE students. Malaysian students were most likely to feel their best earlier in the day and consider themselves a "morning type." UAE students were more likely to do "hard physical work" later in the day, followed by US and Malaysian. On average, US students were less likely to shift their bedtime later if they had no commitments the next day. Overall, mean chronotype score was "neither" type for all three groups however the Malaysian group showed a significant preference for morning hours in some individual questions. Conclusion: Medical student sleep patterns vary internationally but chronotype may not. Improving sleep education globally, with awareness of the effects of chronotype, could ultimately result in improved sleep awareness, potentially influencing physician wellbeing, patient care and safety.
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Affiliation(s)
| | | | | | - Sami Shaban
- United Arab Emirates University College of Medicine and Health Sciences
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2
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Hu EA, Wu A, Dearborn JL, Gottesman RF, Sharrett AR, Steffen LM, Coresh J, Rebholz CM. Adherence to Dietary Patterns and Risk of Incident Dementia: Findings from the Atherosclerosis Risk in Communities Study. J Alzheimers Dis 2020; 78:827-835. [PMID: 33044177 PMCID: PMC7934551 DOI: 10.3233/jad-200392] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies have suggested that adherence to healthy dietary patterns during late life may be associated with improved cognition. However, few studies have examined the association between healthy dietary patterns during midlife and incident dementia. OBJECTIVE Our study aimed to determine the association between adherence to healthy dietary patterns at midlife and incident dementia. METHODS We included 13,630 adults from the Atherosclerosis Risk in Communities (ARIC) Study in our prospective analysis. We used food frequency questionnaire responses to calculate four dietary scores: Healthy Eating Index-2015 (HEI-2015), Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean (aMed) diet, and Dietary Approaches to Stop Hypertension (DASH). Participants were followed until the end of 2017 for incident dementia. Cox regression models adjusted for covariates were used to estimate risk of incident dementia by quintile of dietary scores. RESULTS Over a median of 27 years, there were 2,352 cases of incident dementia documented. Compared with participants in quintile 1 of HEI-2015, participants in quintile 5 (healthiest) had a 14% lower risk of incident dementia (hazard ratio, HR: 0.86, 95% confidence interval, CI: 0.74-0.99). There were no significant associations of incident dementia with the AHEI-2010, aMed, or DASH scores. There were no significant interactions by sex, age, race, education, physical activity, hypertension, or obesity. CONCLUSION Adherence to the HEI-2015, but not the other dietary scores, during midlife was associated with lower risk of incident dementia. Further research is needed to elucidate whether timing of a healthy diet may influence dementia risk.
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Affiliation(s)
- Emily A. Hu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aozhou Wu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer L. Dearborn
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Rebecca F. Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Casey M. Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Dearborn JL, Viscoli CM, Young LH, Gorman MJ, Furie KL, Kernan WN. Achievement of Guideline-Recommended Weight Loss Among Patients With Ischemic Stroke and Obesity. Stroke 2019; 50:713-717. [PMID: 30786849 DOI: 10.1161/strokeaha.118.024008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background and Purpose- The proportion of patients with acute ischemic stroke or transient ischemic attack (TIA) and obesity who successfully achieve goals for weight reduction recommended by major professional organizations is unknown. Methods- We examined the experience of participants in the placebo group of the IRIS trial (Insulin Resistance Intervention after Stroke) with a body mass index ≥30 kg/m2 at entry. Patients were of age ≥40 years, with a qualifying stroke or TIA within 180 days of randomization and documented insulin resistance without diabetes mellitus. Weights at baseline and at years 1 and 2 after entry were analyzed to determine the proportion of patients achieving a 5% weight loss and achievement of body mass index <27 kg/m2. Results- Of 1937 subjects assigned to placebo, 855 (44%) had obesity at entry. Median age of these 855 subjects was 60 years (interquartile range, 53-68), 41% were women, and median time from stroke/TIA to trial entry was 79 days. Among 788 subjects in the trial at 1 year, 166 (21%) had lost at least 5% of their starting weight and 12 (2%) had achieved a body mass index <27 kg/m2. One hundred nine (14%) participants gained at least 5% of their baseline weight at 1 year. Among 744 subjects in the trial at 2 years, 185 (25%) had lost at least 5% of their baseline weight and 23 (3%) had achieved a body mass index <27 kg/m2. One hundred forty (19%) participants gained at least 5% of their starting weight at 2 years. Conclusions- Only one quarter of obese patients with a recent ischemic stroke or TIA lost a clinically significant amount of weight after their vascular event. Many patients gained weight. Enhancing weight loss after ischemic stroke or TIA may help improve functional outcome and reduce risk for future vascular events, but clinical trials are needed to test and confirm these potential benefits.
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Affiliation(s)
- Jennifer L Dearborn
- From the Department of Neurology (J.L.D.), Yale School of Medicine, New Haven, CT.,Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.L.D.)
| | - Catherine M Viscoli
- Department of Internal Medicine (C.M.V., L.H.Y., W.N.K.), Yale School of Medicine, New Haven, CT
| | - Lawrence H Young
- Department of Internal Medicine (C.M.V., L.H.Y., W.N.K.), Yale School of Medicine, New Haven, CT
| | - Mark J Gorman
- Department of Neurology, Maine Medical Center, Portland, ME (M.J.G.)
| | - Karen L Furie
- Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.L.F.)
| | - Walter N Kernan
- Department of Internal Medicine (C.M.V., L.H.Y., W.N.K.), Yale School of Medicine, New Haven, CT
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Johnson EL, Krauss GL, Lee AK, Schneider ALC, Dearborn JL, Kucharska-Newton AM, Huang J, Alonso A, Gottesman RF. Association Between Midlife Risk Factors and Late-Onset Epilepsy: Results From the Atherosclerosis Risk in Communities Study. JAMA Neurol 2019; 75:1375-1382. [PMID: 30039175 DOI: 10.1001/jamaneurol.2018.1935] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance The incidence of epilepsy is higher in older age than at any other period of life. Stroke, dementia, and hypertension are associated with late-onset epilepsy; however, the role of other vascular and lifestyle factors remains unclear. Objective To identify midlife vascular and lifestyle risk factors for late-onset epilepsy. Design, Setting, and Participants The Atherosclerosis Risk in Communities (ARIC) study is a prospective cohort study of 15 792 participants followed up since 1987 to 1989 with in-person visits, telephone calls, and surveillance of hospitalizations (10 974 invited without completing enrollment). The ARIC is a multicenter study with participants selected from 4 US communities. This study included 10 420 black or white participants from ARIC with at least 2 years of Medicare fee-for-service coverage and without missing baseline data. Data were analyzed betweeen April 2017 and May 2018. Exposures Demographic, vascular, lifestyle, and other possible epilepsy risk factors measured at baseline (age 45-64 years) were evaluated in multivariable survival models including demographics, vascular risk factors, and lifestyle risk factors. Main Outcomes and Measures Time to development of late-onset epilepsy (2 or more International Classification of Diseases, Ninth Revision codes for epilepsy or seizures starting at 60 years or older in any claim [hospitalization or outpatient Medicare through 2013]), with first code for seizures after at least 2 years without code for seizures. Results Of the 10 420 total participants (5878 women [56.4%] and 2794 black participants [26.8%]; median age 55 years at first visit), 596 participants developed late-onset epilepsy (3.33 per 1000 person-years). The incidence was higher in black than in white participants (4.71; 95% CI, 4.12-5.40 vs 2.88; 95% CI, 2.60-3.18 per 1000 person-years). In multivariable analysis, baseline hypertension (hazard ratio [HR], 1.30; 95% CI, 1.09-1.55), diabetes (HR, 1.45; 95% CI, 1.17-1.80), smoking (HR, 1.09; 95% CI, 1.01-1.17), apolipoprotein E ε4 genotype (1 allele HR, 1.22; 95% CI, 1.02-1.45; 2 alleles HR, 1.95; 95% CI, 1.35-2.81), and incident stroke (HR, 3.38; 95% CI, 2.78-4.10) and dementia (HR, 2.56; 95% CI, 2.11-3.12) were associated with an increased risk of late-onset epilepsy, while higher levels of physical activity (HR, 0.90; 95% CI, 0.83-0.98) and moderate alcohol intake (HR, 0.72; 95% CI, 0.57-0.90) were associated with a lower risk. Results were similar after censoring individuals with stroke or dementia. Conclusions and Relevance Potentially modifiable risk factors in midlife and the APOE ε4 genotype were positively associated with risk of developing late-onset epilepsy. Although stroke and dementia were both associated with late-onset epilepsy, vascular and lifestyle risk factors were significant even in the absence of stroke or dementia.
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Affiliation(s)
- Emily L Johnson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregory L Krauss
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexandra K Lee
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Andrea L C Schneider
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer L Dearborn
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Juebin Huang
- Department of Neurology, University of Mississippi Medical Center, Jackson
| | - Alvaro Alonso
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
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de Oliveira Otto MC, Anderson CAM, Dearborn JL, Ferranti EP, Mozaffarian D, Rao G, Wylie-Rosett J, Lichtenstein AH. Dietary Diversity: Implications for Obesity Prevention in Adult Populations: A Science Advisory From the American Heart Association. Circulation 2019; 138:e160-e168. [PMID: 30354383 DOI: 10.1161/cir.0000000000000595] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
"Eat a variety of foods," or dietary diversity, is a widely accepted recommendation to promote a healthy, nutritionally adequate diet and to reduce the risk of major chronic diseases. However, recent evidence from observational studies suggests that greater dietary diversity is associated with suboptimal eating patterns, that is, higher intakes of processed foods, refined grains, and sugar-sweetened beverages and lower intakes of minimally processed foods, such as fish, fruits, and vegetables, and may be associated with weight gain and obesity in adult populations. This American Heart Association science advisory summarizes definitions for dietary diversity and reviews current evidence on its relationship with obesity outcomes, eating behavior, and food-based diet quality measures. Current data do not support greater dietary diversity as an effective strategy to promote healthy eating patterns and healthy body weight. Given the current state of the science on dietary diversity and the insufficient data to inform recommendations on specific aspects of dietary diversity that may be beneficial or detrimental to healthy weight, it is appropriate to promote a healthy eating pattern that emphasizes adequate intake of plant foods, protein sources, low-fat dairy products, vegetable oils, and nuts and limits consumption of sweets, sugar-sweetened beverages, and red meats.
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6
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Dearborn JL, Khera T, Peterson M, Shahab Z, Kernan WN. Diet quality in patients with stroke. Stroke Vasc Neurol 2019; 4:154-157. [PMID: 31709122 PMCID: PMC6812639 DOI: 10.1136/svn-2018-000224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/27/2019] [Accepted: 03/11/2019] [Indexed: 11/04/2022] Open
Abstract
Objective A healthy diet is associated with reduced risk for stroke, myocardial infarction, cancer and death. We examined the prevalence of a healthy diet in patients with a recent stroke or transient ischaemic attack (TIA). Methods We recruited a convenience sample of 95 patients with a recent ischaemic stroke or TIA. Using information from a 125-item Food Frequency Questionnaire, we calculated dietary quality and the percentage of patients meeting recommended daily intake (RDI) for common macronutrients and elements. Results The mean age of patients was 66 years (SD: 16) and 46% were women. 39 patients (41%) were classified as having a healthy diet (35% of men and 48% of women). The majority of patients were within the RDI for carbohydrates (56.8%), total fat (61.1%), long-chain n-3 fats (68.4%), polyunsaturated fats (79.0%) and protein (96.8%). Very few patients consumed the recommended intake for sodium (25.3%), and even fewer consumed the RDI for potassium (4.2%), with the majority of patients consuming too much sodium and too little potassium. Conclusion We found that most patients with recent stroke or TIA were not following a healthy diet before their stroke event. For most patients, sodium intake was much above and potassium intake was much below RDI.
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Affiliation(s)
- Jennifer L Dearborn
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Tehmina Khera
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Meghan Peterson
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Zartashia Shahab
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Walter N Kernan
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Viscoli CM, Kent DM, Conwit R, Dearborn JL, Furie KL, Gorman M, Guarino PD, Inzucchi SE, Stuart A, Young LH, Kernan WN. Scoring System to Optimize Pioglitazone Therapy After Stroke Based on Fracture Risk. Stroke 2019; 50:95-100. [PMID: 30580725 PMCID: PMC6557695 DOI: 10.1161/strokeaha.118.022745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background and Purpose- The insulin sensitizer, pioglitazone, reduces cardiovascular risk in patients after an ischemic stroke or transient ischemic attack but increases bone fracture risk. We conducted a secondary analysis of the IRIS trial (Insulin Resistance Intervention After Stroke) to assess the effect of pretreatment risk for fracture on the net benefits of pioglitazone therapy. Methods- IRIS was a randomized placebo-controlled trial of pioglitazone that enrolled patients with insulin resistance but without diabetes mellitus within 180 days of an ischemic stroke or transient ischemic attack. Participants were recruited at 179 international centers from February 2005 to January 2013 and followed for a median of 4.8 years. Fracture risk models were developed from patient characteristics at entry. Within fracture risk strata, we quantified the effects of pioglitazone compared with placebo by estimating the relative risks and absolute 5-year risk differences for fracture and stroke or myocardial infarction. Results- The fracture risk model included points for age, race-ethnicity, sex, body mass index, disability, and medications. The relative increment in fracture risk with pioglitazone was similar in the lower (
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Affiliation(s)
| | | | - Robin Conwit
- National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | | | - Karen L. Furie
- Alpert Medical School of Brown University, Providence, RI
| | | | | | | | - Amber Stuart
- University of Connecticut School of Medicine, Farmington, CT
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8
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Dearborn JL, Viscoli CM, Inzucchi SE, Young LH, Kernan WN. Metabolic syndrome identifies normal weight insulin-resistant stroke patients at risk for recurrent vascular disease. Int J Stroke 2018; 14:639-645. [PMID: 30507360 DOI: 10.1177/1747493018816425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The obesity paradox refers to the finding in observational studies that patients with obesity have a better prognosis after stroke than normal weight patients. AIM To test the hypothesis that there might be important heterogeneity within the obese stroke population, such that those with metabolic syndrome would be at higher risk for stroke or myocardial infarction and all-cause mortality compared to patients without metabolic syndrome. METHODS The Insulin Resistance Intervention after Stroke trial enrolled non-diabetic patients with a recent ischemic stroke or transient ischemic attack and insulin resistance. We examined the association between metabolic syndrome and outcome risk in patients with normal weight at entry (body mass index (BMI) = 18.5-24.9 kg/m2), overweight (BMI = 25-29.9 kg/m2), or obesity (BMI ≥ 30 kg/m2). Analyses were adjusted for demographic features, treatment assignment, smoking, and major comorbid conditions. RESULTS Metabolic syndrome was not associated with greater risk for stroke or myocardial infarction among 1536 patients who were overweight (adjusted hazard ratio (HR), 0.95; 95% confidence interval (CI): 0.69-1.31) or 1626 obese patients (adjusted HR, 1.00; 95% CI: 0.70-1.41). However, among 567 patients with a normal BMI, metabolic syndrome was associated with increased risk for stroke or myocardial infarction (adjusted HR, 2.05; 95% CI: 1.25-3.37), and all-cause mortality (adjusted HR, 1.70; 95% CI: 1.03-2.81) compared to patients without metabolic syndrome. CONCLUSIONS The presence of metabolic syndrome identified normal weight patients with insulin resistance but no diabetes who have a higher risk of adverse cardiovascular outcomes, compared with patients without metabolic syndrome.
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Affiliation(s)
- Jennifer L Dearborn
- 1 Beth Israel Deaconess Medical Center, Boston MA.,2 Yale School of Medicine, New Haven, CT, USA.,3 Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, USA
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de Oliveira Otto M, Anderson CAM, Dearborn JL, Ferranti EP, Mozaffarian D, Rao G, Wylie-Rosett J, Lichtenstein AH. Correction to: Dietary Diversity: Implications for Obesity Prevention in Adult Populations: A Science Advisory From the American Heart Association. Circulation 2018; 138:e712. [PMID: 30763026 DOI: 10.1161/cir.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dearborn JL, Viscoli CM, Kernan WN. Abstract TP389: Achievement of Healthy Weight Loss Among Patients With Recent Ischemic Stroke or TIA and Obesity. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Approximately 30% of patients with a recent ischemic stroke or TIA are obese as defined by a body mass index (BMI) ≥30 kgs/m
2
. Guidelines from professional and governmental organizations recommend that patients with obesity lose weight to improve cardiovascular risk factors including glucose control, diabetes risk, blood pressure, and lipid metabolism. In this study, we examined the proportion of patients with a recent ischemic stroke or TIA who achieve these recommendations and meet two common goals for weight reduction within two years: 1) reduction of weight by 5% from baseline and reduction to a BMI <27 kgs/m
2
.
Methods:
Participants were men and women assigned to placebo treatment in the Insulin Resistance Intervention after Stroke (IRIS) Trial who were obese at the time of enrollment. The IRIS trial was a randomized trial that examined the effectiveness of pioglitazone compared with placebo for prevention of stroke or MI among non-diabetic patients with a recent ischemic stroke or TIA and insulin resistance. The trial enrolled participants from 2005 to 2012. Participants were followed for a minimum of 28 months and were seen in-person and weighed annually.
Results:
Of the 1937 participants in the placebo arm of IRIS, 855 (44%) had BMI≥30 kgs/m
2
at entry. Mean age was 61 years (standard deviation, 10) and 59% were male. At one year, 788 patients with obesity at baseline remained in the trial with weight measured (10 died, 14 dropped-out, and 43 were missing weight). Among these patients, 133 (17%) had lost 5% of their body weight and 12 (2%) had achieved a BMI < 27 kgs/m
2
at 12 months. Two years from randomization, 22% had lost 5% of their body weight and 3% had achieved a BMI <27 kgs/m
2
.
Conclusion:
In this cohort of patients with ischemic stroke or TIA and obesity, less than a quarter achieved even modest goals for weight loss after one or two years. Clinical trials will be required to determine if failure to lose weight represents a lost opportunity for secondary stroke prevention. Trials can determine 1) if weight loss is effective for preventing recurrent stroke, cardiovascular disease and diabetes and for improving function after ischemic stroke or TIA and 2) the amount of weight loss that must be achieved to realize meaningful benefit.
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Kernan WN, Viscoli CM, Dearborn JL, Kent DM, Conwit R, Fayad P, Furie KL, Gorman M, Guarino PD, Inzucchi SE, Stuart A, Young LH. Targeting Pioglitazone Hydrochloride Therapy After Stroke or Transient Ischemic Attack According to Pretreatment Risk for Stroke or Myocardial Infarction. JAMA Neurol 2017; 74:1319-1327. [PMID: 28975241 DOI: 10.1001/jamaneurol.2017.2136] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance There is growing recognition that patients may respond differently to therapy and that the average treatment effect from a clinical trial may not apply equally to all candidates for a therapy. Objective To determine whether, among patients with an ischemic stroke or transient ischemic attack and insulin resistance, those at higher risk for future stroke or myocardial infarction (MI) derive more benefit from the insulin-sensitizing drug pioglitazone hydrochloride compared with patients at lower risk. Design, Setting, and Participants A secondary analysis was conducted of the Insulin Resistance Intervention After Stroke trial, a double-blind, placebo-controlled trial of pioglitazone for secondary prevention. Patients were enrolled from 179 research sites in 7 countries from February 7, 2005, to January 15, 2013, and were followed up for a mean of 4.1 years through the study's end on July 28, 2015. Eligible participants had a qualifying ischemic stroke or transient ischemic attack within 180 days of entry and insulin resistance without type 1 or type 2 diabetes. Interventions Pioglitazone or matching placebo. Main Outcomes and Measures A Cox proportional hazards regression model was created using baseline features to stratify patients above or below the median risk for stroke or MI within 5 years. Within each stratum, the efficacy of pioglitazone for preventing stroke or MI was calculated. Safety outcomes were death, heart failure, weight gain, and bone fracture. Results Among 3876 participants (1338 women and 2538 men; mean [SD] age, 63 [11] years), the 5-year risk for stroke or MI was 6.0% in the pioglitazone group among patients at lower baseline risk compared with 7.9% in the placebo group (absolute risk difference, -1.9% [95% CI, -4.4% to 0.6%]). Among patients at higher risk, the risk was 14.7% in the pioglitazone group vs 19.6% for placebo (absolute risk difference, -4.9% [95% CI, -8.6% to 1.2%]). Hazard ratios were similar for patients below or above the median risk (0.77 vs 0.75; P = .92). Pioglitazone increased weight less among patients at higher risk but increased the risk for fracture more. Conclusions and Relevance After an ischemic stroke or transient ischemic attack, patients at higher risk for stroke or MI derive a greater absolute benefit from pioglitazone compared with patients at lower risk. However, the risk for fracture is also higher. Trial Registration clinicaltrials.gov Identifier: NCT00091949.
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Affiliation(s)
- Walter N Kernan
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Catherine M Viscoli
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - David M Kent
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Robin Conwit
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Pierre Fayad
- Department of Neurological Sciences, University of Nebraska Medical School, Omaha
| | - Karen L Furie
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Peter D Guarino
- Statistical Center for HIV/AIDS Research Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Silvio E Inzucchi
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Amber Stuart
- University of Connecticut School of Medicine, Farmington
| | - Lawrence H Young
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Sreekrishnan A, Dearborn JL, Greer DM, Shi FD, Hwang DY, Leasure AC, Zhou SE, Gilmore EJ, Matouk CC, Petersen NH, Sansing LH, Sheth KN. Intracerebral Hemorrhage Location and Functional Outcomes of Patients: A Systematic Literature Review and Meta-Analysis. Neurocrit Care 2017; 25:384-391. [PMID: 27160888 DOI: 10.1007/s12028-016-0276-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage (ICH) has the highest mortality rate among all strokes. While ICH location, lobar versus non-lobar, has been established as a predictor of mortality, less is known regarding the relationship between more specific ICH locations and functional outcome. This review summarizes current work studying how ICH location affects outcome, with an emphasis on how studies designate regions of interest. METHODS A systematic search of the OVID database for relevant studies was conducted during August 2015. Studies containing an analysis of functional outcome by ICH location or laterality were included. As permitted, the effect size of individual studies was standardized within a meta-analysis. RESULTS Thirty-seven studies met the inclusion criteria, the majority of which followed outcome at 3 months. Most studies found better outcomes on the Modified Rankin Scale (mRS) or Glasgow Outcome Score (GOS) with lobar compared to deep ICHs. While most aggregated deep structures for analysis, some studies found poorer outcomes for thalamic ICH in particular. Over half of the studies did not have specific methodological considerations for location designations, including blinding or validation. CONCLUSIONS Multiple studies have examined motor-centric outcomes, with few studies examining quality of life (QoL) or cognition. Better functional outcomes have been suggested for lobar versus non-lobar ICH; few studies attempted finer topographic comparisons. This study highlights the need for improved reporting in ICH outcomes research, including a detailed description of hemorrhage location, reporting of the full range of functional outcome scales, and inclusion of cognitive and QoL outcomes.
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Affiliation(s)
- Anirudh Sreekrishnan
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, 06510, USA
| | - Jennifer L Dearborn
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, 06510, USA
| | - David M Greer
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, 06510, USA
| | - Fu-Dong Shi
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - David Y Hwang
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, 06510, USA
| | - Audrey C Leasure
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, 06510, USA
| | - Sonya E Zhou
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, 06510, USA
| | - Emily J Gilmore
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, 06510, USA
| | - Charles C Matouk
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, 06510, USA
| | - Nils H Petersen
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, 06510, USA
| | - Lauren H Sansing
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, 06510, USA
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, 06510, USA.
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Dearborn JL, Zhang Y, Qiao Y, Suri MFK, Liu L, Gottesman RF, Rawlings AM, Mosley TH, Alonso A, Knopman DS, Guallar E, Wasserman BA. Intracranial atherosclerosis and dementia: The Atherosclerosis Risk in Communities (ARIC) Study. Neurology 2017; 88:1556-1563. [PMID: 28330958 DOI: 10.1212/wnl.0000000000003837] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 01/24/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To explore the association of intracranial atherosclerotic disease (ICAD) with mild cognitive impairment (MCI) and dementia. METHODS From 2011 to 2013, 1,744 participants completed high-resolution vessel wall MRI from the population-based Atherosclerosis Risk in Communities Study by a sampling strategy that allowed weighting back to the cohort. We defined ICAD by plaque features (presence, territory, stenosis, number). Trained clinicians used an algorithm incorporating information from interviews and neuropsychological and neurologic examinations to adjudicate for MCI and dementia. We determined the relative prevalence ratio (RPR) of MCI or dementia after adjusting for risk factors at midlife using multinomial logistic regression. RESULTS A total of 601 (34.5%) participants had MCI (mean age ± SD, 76.6 ± 5.2 years), 83 (4.8%) had dementia (79.1 ± 5.3 years), and 857 (49.1%) were current or former smokers. Anterior cerebral artery (ACA) plaque (adjusted RPR 3.81, 95% confidence interval [CI] 1.57-9.23), >2 territories with plaque (adjusted RPR 2.12, 95% CI 1.00-4.49), and presence of stenosis >50% (adjusted RPR 1.92, 95% CI 1.01-3.65) were associated with increased prevalence of dementia in separate models. Posterior cerebral artery plaque was associated with MCI but did not reach statistical significance for dementia (adjusted RPR MCI 1.43, 95% CI 1.04-1.98; adjusted RPR dementia 1.58, 95% CI 0.79-2.85). There were no associations with middle cerebral artery atherosclerotic lesions or cognitive impairment. Many participants had plaque in >1 territory (n = 291, 46%) and participants with ACA plaques (n = 69) had the greatest number of plaques in other territories (mean 6.0, SD 4.4). CONCLUSIONS This study demonstrates associations between ICAD and clinical MCI and dementia.
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Affiliation(s)
- Jennifer L Dearborn
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Yiyi Zhang
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Ye Qiao
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Muhammad Fareed K Suri
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Li Liu
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Rebecca F Gottesman
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Andreea M Rawlings
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Thomas H Mosley
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Alvaro Alonso
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - David S Knopman
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Eliseo Guallar
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Bruce A Wasserman
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
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Dearborn JL, Viscoli CM, Inzucchi SE, Young LH, Kernan WN. Abstract 74: Obesity and the Risk of Recurrent Vascular Events in Patients with Ischemic Stroke: Insights from the Insulin Resistance Intervention after Stroke (IRIS) Trial. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In epidemiologic research, patients with obesity have, on average, a lower risk for recurrent cardiovascular events after ischemic stroke compared with non-obese patients. Despite this “obesity paradox,” we hypothesized that clinical features associated with more severe metabolic disease would identify overweight and obese stroke patients at high risk for recurrent vascular events.
Methods:
The
IRIS
trial examined the efficacy of pioglitazone compared with placebo, for prevention of stroke/ myocardial infarction (MI) among non-diabetic insulin resistant patients with a recent ischemic stroke or TIA. Patients were followed for a median of 4.8 years. Among 3,707 participants, we first examined risk of recurrent stroke/MI by obesity status at baseline (overweight or obese [BMI ≥25] vs <25) using Cox proportional hazards models with and without adjustment for sociodemographic factors, smoking and vascular disease history. Next, for 3,142 participants with BMI ≥ 25, a Cox model including 7 baseline features (systolic blood pressure, C-reactive protein, HOMA-IR, hemoglobin A1C, waist circumference, triglycerides and high density lipoprotein) was used to stratify patients into tertiles of “metabolic risk”. The hazard of stroke/MI was then calculated across risk tertiles(T).
Results:
Overweight and obese participants had a lower incidence of stroke or MI compared with non-obese patients (10.1% vs.12.6%; hazard ratio [HR] 0.77, [0.59-0.99]) and the difference was attenuated after adjustment (HR 0.85 [0.66-1.11]). Among overweight and obese patients, a metabolic risk score identified patients at higher risk of stroke or MI (T3 12.2%, T2 9.2%, T1 9.0%; T3 vs. T1 HR 1.40 [1.08, 1.83]). This association remained significant after adjustments (HR 1.33 [1.02, 1.75]).
Conclusion:
Although overweight and obese patients may on average have lower risk of recurrent stroke or MI after an ischemic stroke or TIA compared with non-obese individuals, those with advanced metabolic impairment also have a high absolute risk of recurrence.
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Dearborn JL, Qiao Y, Guallar E, Steffen LM, Gottesman RF, Zhang Y, Wasserman BA. Polyunsaturated fats, carbohydrates and carotid disease: The Atherosclerosis Risk in Communities (ARIC) Carotid MRI study. Atherosclerosis 2016; 251:361-366. [PMID: 27234460 DOI: 10.1016/j.atherosclerosis.2016.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/21/2016] [Accepted: 05/13/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS Carbohydrates and fat intake have both been linked to development of atherosclerosis. We examined associations between glycemic index (GI) and fat intake with carotid atherosclerosis. METHODS The Atherosclerosis Risk in Communities (ARIC) cohort enrolled participants during the period 1987-1989 and the Carotid MRI sub-study occurred between 2004 and 2006 (1672 participants attending both visits). Measures of carbohydrate quality (usual GI), fat intake (total, polyunsaturated and saturated) and overall dietary quality index (DASH Diet Score) were derived from a 66-item food frequency questionnaire administered at baseline. Trained readers measured lipid core presence and maximum wall thickness. Using multivariate logistic regression, we determined the odds of lipid core presence by quintile (Q) of energy-adjusted dietary components. Restricted cubic spline models were used to examine non-linear associations between dietary components and maximum wall thickness. RESULTS Mean daily polyunsaturated fat intake was 5 g (SD 1.4). GI and polyunsaturated fat intake had a nonlinear relationship with maximum wall thickness. Low (1-4 g) and high (6-12 g) polyunsaturated fat intake were associated with a statistically significant decreased odds of lipid core presence compared to intake in a majority of participants (OR Q5 vs. Q2-4: 0.64, 95% CI 0.42 to 0.98; OR Q1 vs. Q2-4: 0.64, 95% CI 0.42, 0.96), however, the association with lipid core was attenuated by adjustment for maximum wall thickness, hypertension, hyperlipidemia, and diabetes. CONCLUSIONS GI and polyunsaturated fat intake were not associated with high-risk plaque features, such as lipid core presence, independent of traditional vascular risk factors.
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Affiliation(s)
- Jennifer L Dearborn
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eliseo Guallar
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Rebecca F Gottesman
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yiyi Zhang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Dearborn JL, Sheth KN. Stroke in Rural Communities: A Need for Continued Surveillance. Neuroepidemiology 2016; 46:240-1. [PMID: 26974152 DOI: 10.1159/000444987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jennifer L Dearborn
- Divisions of Stroke and Neurocritical Care and Emergency Neurology, The Department of Neurology, Yale University, New Haven, Conn., USA
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Dearborn JL, Schneider ALC, Sharrett AR, Mosley TH, Bezerra DC, Knopman DS, Selvin E, Jack CR, Coker LH, Alonso A, Wagenknecht LE, Windham BG, Gottesman RF. Obesity, Insulin Resistance, and Incident Small Vessel Disease on Magnetic Resonance Imaging: Atherosclerosis Risk in Communities Study. Stroke 2015; 46:3131-6. [PMID: 26451022 DOI: 10.1161/strokeaha.115.010060] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/26/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE The term metabolic syndrome describes the clustering of risk factors found in many individuals with obesity. Because of their pathophysiology, we hypothesized that 2 features of metabolic syndrome, central obesity and insulin resistance (IR), would be associated with cerebrovascular changes on magnetic resonance imaging, and specifically with incident lacunar disease and not white matter hyperintensity (WMH) progression. METHODS Risk factors were defined at study baseline in 934 participants in the Atherosclerosis Risk in Communities (ARIC) study, who completed 2 brain magnetic resonance imagings≈10 years apart. WMH progression and incident lacunes between the 2 magnetic resonance imagings were determined. An IR score for each participant was created using principal component analysis of 11 risk factors, including (among others): insulin, homeostatic model assessment-IR, body mass index, and waist circumference. Metabolic syndrome (presence/absence), using standard clinical definitions, and IR score at the first magnetic resonance imaging, were independent variables, evaluated in multivariate logistic regression to determine odds of WMH progression (Q5 versus Q1-Q4) and incident lacunes. RESULTS Metabolic syndrome (adjusted odds ratio, 1.98; 95% confidence interval, 1.28-3.05) and IR score (adjusted odds ratio per 1-SD increase, 1.33; 95% confidence interval, 1.05-1.68) were associated with incident lacunes but not with WMH progression. Insulin, homeostatic model assessment-IR, and body mass index were not associated with incident lacunes or WMH progression in separate models. CONCLUSIONS The IR score and central obesity are associated with incident lacunar disease but not WMH progression in individuals. Central obesity and IR may be important risk factors to target to prevent lacunar disease.
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Affiliation(s)
- Jennifer L Dearborn
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.)
| | - Andrea L C Schneider
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.)
| | - A Richey Sharrett
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.)
| | - Thomas H Mosley
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.)
| | - Daniel C Bezerra
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.)
| | - David S Knopman
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.)
| | - Elizabeth Selvin
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.)
| | - Clifford R Jack
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.)
| | - Laura H Coker
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.)
| | - Alvaro Alonso
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.)
| | - Lynne E Wagenknecht
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.)
| | - Beverly G Windham
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.)
| | - Rebecca F Gottesman
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT (J.L.D.); Department of Epidemiology, Bloomberg School of Public Health (A.L.C.S., A.R.S., E.S.), Department of Neurology, School of Medicine (A.L.C.S., R.F.G.), and Welch Center for Prevention, Epidemiology and Clinical Research (E.S., R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Geriatrics, Department of Medicine, The University of Mississippi School of Medicine, Jackson (T.H.M., B.G.W.); Department of Neurology, Pro Cardiaco Hospital, Rio de Janeiro, Brazil (D.C.B.); Departments of Neurology (D.S.K.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Division of Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC (L.H.C., L.E.W.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.).
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Dearborn JL, Gottesman RF, Kurth T, Williams MA, Peterlin L. Adiponectin and leptin levels in migraineurs in the Atherosclerosis Risk in Communities Study--author response. Neurology 2015; 85:482. [PMID: 26468557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
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Nagai T, Dearborn JL, Tabara Y, Igase M, Miki T, Kohara K, Gottesman RF, Kurth T, Williams MA, Peterlin BL. Adiponectin and leptin levels in migraineurs in the Atherosclerosis Risk in Communities StudyAuthor Response. Neurology 2015; 85:482. [DOI: 10.1212/wnl.0000000000001797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Affiliation(s)
- Walter N Kernan
- From the Departments of Internal Medicine (W.N.K.) and Neurology (J.L.D.), Yale School of Medicine, New Haven, CT.
| | - Jennifer L Dearborn
- From the Departments of Internal Medicine (W.N.K.) and Neurology (J.L.D.), Yale School of Medicine, New Haven, CT
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Dearborn JL, Urrutia VC, Kernan WN. The case for diet: a safe and efficacious strategy for secondary stroke prevention. Front Neurol 2015; 6:1. [PMID: 25699006 PMCID: PMC4313694 DOI: 10.3389/fneur.2015.00001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/03/2015] [Indexed: 12/14/2022] Open
Abstract
Diet is strongly associated with risk for first stroke. In particular, observational and experimental research suggests that a Mediterranean-type diet may reduce risk for first ischemic stroke with an effect size comparable to statin therapy. These data for first ischemic stroke suggest that diet may also be associated with risk for recurrent stroke and that diet modification might represent an effective intervention for secondary prevention. However, research on dietary pattern after stroke is limited and direct experimental evidence for a therapeutic effect in secondary prevention does not exist. The uncertain state of science in this area is reflected in recent guidelines on secondary stroke prevention from the American Heart Association, in which the Mediterranean-type diet is listed with only a class IIa recommendation (level of evidence C). To change guidelines and practice, research is needed, starting with efforts to better define current nutritional practices of stroke patients. Food frequency questionnaires and mobile applications for real-time recording of intake are available for this purpose. Dietary strategies for secondary stroke prevention are low risk, high potential, and warrant further evaluation.
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Affiliation(s)
- Jennifer L Dearborn
- Department of Neurology, Yale University School of Medicine , New Haven, CT , USA
| | - Victor C Urrutia
- Department of Neurology, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Walter N Kernan
- Department of Internal Medicine, Yale University School of Medicine , New Haven, CT , USA
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Dearborn JL, Schneider ALC, Gottesman RF, Kurth T, Pankow JS, Couper DJ, Rose KM, Williams MA, Peterlin BL. Adiponectin and leptin levels in migraineurs in the Atherosclerosis Risk in Communities Study. Neurology 2014; 83:2211-8. [PMID: 25378672 PMCID: PMC4277678 DOI: 10.1212/wnl.0000000000001067] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 07/28/2014] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To evaluate adiponectin and leptin levels in older men and women with migraine. METHODS Fasting total and high molecular weight (HMW) adiponectin and leptin levels were evaluated in a case-cohort study of nondiabetic older migraine and nonmigraine control participants from the ongoing, longitudinal, general population, Atherosclerosis Risk in Communities Study at visit 1 (1987-1989). A standardized headache questionnaire was completed at visit 3 (1993-1995). Logistic regression models adjusted for age, sex, race, center, body mass index, and fasting glucose were used to evaluate the association of each adipocytokine with migraine. RESULTS Of the 981 participants, the mean age at baseline was 52.8 years (SE 0.3); 131 fulfilled migraine criteria. Crude, mean total adiponectin levels were greater in men and women with migraine (8.1 µg/mL, SE 0.5) as compared to those without migraine (7.0 µg/mL, SE 0.2) (p = 0.031). After adjustments, the odds of migraine were increased by 88% with each SD increase in total adiponectin in men (odds ratio [OR] 1.86; 95% confidence interval [CI] 1.15, 3.01; p = 0.011), but not in women (OR 1.05; 95% CI 0.80, 1.37; p = 0.728; p interaction = 0.029). Similar results were demonstrated for HMW adiponectin. Crude and adjusted leptin levels were not associated with migraine. CONCLUSIONS Although crude, total adiponectin levels were higher in older men and women with migraine than controls, after adjustments, the prevalence of migraine was significantly associated with total adiponectin only in older men, suggesting the association may be confounded or absent in older women. Leptin was not associated with migraine in older men or women.
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Affiliation(s)
- Jennifer L Dearborn
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; the Department of Epidemiology (A.L.C.S.), Johns Hopkins University School of Public Health; the Department of Neurology (R.F.G., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Team Neuroepidemiology (T.K.), INSERM Research Center for Epidemiology and Biostatistics (U897), Bordeaux; France College of Health Sciences (T.K.), University of Bordeaux; the School of Public Health, Division of Epidemiology and Community Health (J.S.P.), University of Minnesota, Minneapolis; the Departments of Biostatistics (D.J.C.) and Epidemiology (K.M.R.), University of North Carolina at Chapel Hill; Social and Scientific Systems, Inc. (K.M.R.), Durham, NC; and the Department of Epidemiology (M.A.W.), Harvard School of Public Health, Boston, MA
| | - Andrea L C Schneider
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; the Department of Epidemiology (A.L.C.S.), Johns Hopkins University School of Public Health; the Department of Neurology (R.F.G., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Team Neuroepidemiology (T.K.), INSERM Research Center for Epidemiology and Biostatistics (U897), Bordeaux; France College of Health Sciences (T.K.), University of Bordeaux; the School of Public Health, Division of Epidemiology and Community Health (J.S.P.), University of Minnesota, Minneapolis; the Departments of Biostatistics (D.J.C.) and Epidemiology (K.M.R.), University of North Carolina at Chapel Hill; Social and Scientific Systems, Inc. (K.M.R.), Durham, NC; and the Department of Epidemiology (M.A.W.), Harvard School of Public Health, Boston, MA
| | - Rebecca F Gottesman
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; the Department of Epidemiology (A.L.C.S.), Johns Hopkins University School of Public Health; the Department of Neurology (R.F.G., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Team Neuroepidemiology (T.K.), INSERM Research Center for Epidemiology and Biostatistics (U897), Bordeaux; France College of Health Sciences (T.K.), University of Bordeaux; the School of Public Health, Division of Epidemiology and Community Health (J.S.P.), University of Minnesota, Minneapolis; the Departments of Biostatistics (D.J.C.) and Epidemiology (K.M.R.), University of North Carolina at Chapel Hill; Social and Scientific Systems, Inc. (K.M.R.), Durham, NC; and the Department of Epidemiology (M.A.W.), Harvard School of Public Health, Boston, MA
| | - Tobias Kurth
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; the Department of Epidemiology (A.L.C.S.), Johns Hopkins University School of Public Health; the Department of Neurology (R.F.G., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Team Neuroepidemiology (T.K.), INSERM Research Center for Epidemiology and Biostatistics (U897), Bordeaux; France College of Health Sciences (T.K.), University of Bordeaux; the School of Public Health, Division of Epidemiology and Community Health (J.S.P.), University of Minnesota, Minneapolis; the Departments of Biostatistics (D.J.C.) and Epidemiology (K.M.R.), University of North Carolina at Chapel Hill; Social and Scientific Systems, Inc. (K.M.R.), Durham, NC; and the Department of Epidemiology (M.A.W.), Harvard School of Public Health, Boston, MA
| | - James S Pankow
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; the Department of Epidemiology (A.L.C.S.), Johns Hopkins University School of Public Health; the Department of Neurology (R.F.G., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Team Neuroepidemiology (T.K.), INSERM Research Center for Epidemiology and Biostatistics (U897), Bordeaux; France College of Health Sciences (T.K.), University of Bordeaux; the School of Public Health, Division of Epidemiology and Community Health (J.S.P.), University of Minnesota, Minneapolis; the Departments of Biostatistics (D.J.C.) and Epidemiology (K.M.R.), University of North Carolina at Chapel Hill; Social and Scientific Systems, Inc. (K.M.R.), Durham, NC; and the Department of Epidemiology (M.A.W.), Harvard School of Public Health, Boston, MA
| | - David J Couper
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; the Department of Epidemiology (A.L.C.S.), Johns Hopkins University School of Public Health; the Department of Neurology (R.F.G., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Team Neuroepidemiology (T.K.), INSERM Research Center for Epidemiology and Biostatistics (U897), Bordeaux; France College of Health Sciences (T.K.), University of Bordeaux; the School of Public Health, Division of Epidemiology and Community Health (J.S.P.), University of Minnesota, Minneapolis; the Departments of Biostatistics (D.J.C.) and Epidemiology (K.M.R.), University of North Carolina at Chapel Hill; Social and Scientific Systems, Inc. (K.M.R.), Durham, NC; and the Department of Epidemiology (M.A.W.), Harvard School of Public Health, Boston, MA
| | - Kathryn M Rose
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; the Department of Epidemiology (A.L.C.S.), Johns Hopkins University School of Public Health; the Department of Neurology (R.F.G., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Team Neuroepidemiology (T.K.), INSERM Research Center for Epidemiology and Biostatistics (U897), Bordeaux; France College of Health Sciences (T.K.), University of Bordeaux; the School of Public Health, Division of Epidemiology and Community Health (J.S.P.), University of Minnesota, Minneapolis; the Departments of Biostatistics (D.J.C.) and Epidemiology (K.M.R.), University of North Carolina at Chapel Hill; Social and Scientific Systems, Inc. (K.M.R.), Durham, NC; and the Department of Epidemiology (M.A.W.), Harvard School of Public Health, Boston, MA
| | - Michelle A Williams
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; the Department of Epidemiology (A.L.C.S.), Johns Hopkins University School of Public Health; the Department of Neurology (R.F.G., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Team Neuroepidemiology (T.K.), INSERM Research Center for Epidemiology and Biostatistics (U897), Bordeaux; France College of Health Sciences (T.K.), University of Bordeaux; the School of Public Health, Division of Epidemiology and Community Health (J.S.P.), University of Minnesota, Minneapolis; the Departments of Biostatistics (D.J.C.) and Epidemiology (K.M.R.), University of North Carolina at Chapel Hill; Social and Scientific Systems, Inc. (K.M.R.), Durham, NC; and the Department of Epidemiology (M.A.W.), Harvard School of Public Health, Boston, MA
| | - B Lee Peterlin
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; the Department of Epidemiology (A.L.C.S.), Johns Hopkins University School of Public Health; the Department of Neurology (R.F.G., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Team Neuroepidemiology (T.K.), INSERM Research Center for Epidemiology and Biostatistics (U897), Bordeaux; France College of Health Sciences (T.K.), University of Bordeaux; the School of Public Health, Division of Epidemiology and Community Health (J.S.P.), University of Minnesota, Minneapolis; the Departments of Biostatistics (D.J.C.) and Epidemiology (K.M.R.), University of North Carolina at Chapel Hill; Social and Scientific Systems, Inc. (K.M.R.), Durham, NC; and the Department of Epidemiology (M.A.W.), Harvard School of Public Health, Boston, MA.
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Dearborn JL, Knopman D, Sharrett AR, Schneider ALC, Jack CR, Coker LH, Alonso A, Selvin E, Mosley TH, Wagenknecht LE, Windham BG, Gottesman RF. The metabolic syndrome and cognitive decline in the Atherosclerosis Risk in Communities study (ARIC). Dement Geriatr Cogn Disord 2014; 38:337-46. [PMID: 25171458 PMCID: PMC4201882 DOI: 10.1159/000362265] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Midlife metabolic syndrome (MetS) may impact cognitive health as a construct independently of hypertension, hyperlipidemia and other components. METHODS 10,866 participants aged 45-64 years at baseline were assessed for MetS and completed cognitive testing at two later time points (3 and 9 years from the baseline visit). RESULTS MetS is associated with increased odds of low cognitive performance in the domains of executive function and word fluency, but not with 6-year cognitive decline. Individual MetS components explained this association (hypertension, diabetes, low HDL, elevated triglycerides and increased waist circumference). CONCLUSIONS A focus on the individual risk factors as opposed to MetS during midlife is important to reduce the incidence of cognitive impairment in later life.
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Affiliation(s)
- Jennifer L. Dearborn
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Andrea L. C. Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | | | - Laura H. Coker
- Department of Neurology, The Wake Forest School of Medicine, Winston-Salem NC
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, the University of Minnesota, Minneapolis MN
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Thomas H. Mosley
- Department of Medicine, Division of Geriatrics, the University of Mississippi School of Medicine, Jackson MS
| | - Lynne E. Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem NC
| | - Beverly G. Windham
- Department of Medicine, Division of Geriatrics, the University of Mississippi School of Medicine, Jackson MS
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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Dearborn JL, Urrutia VC, Zeiler SR. Stroke and Cancer- A Complicated Relationship. J Neurol Transl Neurosci 2014; 2:1039. [PMID: 26322334 PMCID: PMC4550304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The interrelationship between stroke and cancer is complex. Cancer and stroke may occur independently in a given patient, or cancer may directly or indirectly lead to stroke via: hypercoaguability, non-bacterial thrombotic endocarditis (NBTE), direct tumor compression of blood vessels, or treatment-related effects which potentiate stroke. Patients with cryptogenic stroke are relatively common, and under the right circumstances, may provide an opportunity to screen for occult malignancy. In this review, we discuss relevant data linking stroke and cancer as well as propose a testable algorithm for cancer screening in the patient with cryptogenic stroke. Future directions should focus on validating patient-care algorithms in prospective clinical trials to provide an evidence base for this important issue.
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Affiliation(s)
- Jennifer L. Dearborn
- Corresponding author, Jennifer L. Dearborn, Department of Neurology, the Johns Hopkins Hospital, Phipps 4th floor, 600 N Wolfe St, Baltimore, MD 21287, Tel: 410-955-6626; Fax: 410-614-1008;
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Dearborn JL, Knopman D, Sharrett R, Schneider AL, Jack C, Coker L, Alonso A, Selvin E, Mosley T, Gottesman RF. Abstract WMP115: The Metabolic Syndrome Components and Cognitive Decline: The Atherosclerosis Risk in Communities (ARIC) Study. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.awmp115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Midlife obesity is associated with dementia in later life, but how the metabolic syndrome (MetS) relates to cognitive change is less understood. We hypothesized that MetS would be more predictive of 6-year cognitive decline than its individual components in a large biethnic cohort (the ARIC study) and that combinations of risk factors would further increase likelihood of change.
Methods:
The MetS was defined in 1987-89 on 10,687 participants with two cognitive assessments at two time points. In subjects aged 44 to 66, obesity measures included body mass index (BMI) and waist-to-hip ratio (WTHR). The main outcome measure was change in 1990-92 to 96-99 of three cognitive tests: Delayed Word Recall (DWR), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT). Linear and logistic regressions were all adjusted for age, combined race-center, sex, education, smoking, drinking, coronary artery disease and prior stroke. Change was measured as the difference divided by the number of years between visits.
Results:
At baseline, the prevalence of MetS was 22% (mean age 54 years, 27% black, 55% female, and 28% BMI>30 kg/m2). Subjects with MetS performed in the lowest test quintile (adjusted ORs: DWR 1.3 95% CI 1.1-1.4) in 1996-99, and much of this effect size was explained by an elevated WTHR (DWR OR 1.3 CI 1.1-1.5) and diabetes (DWR OR 1.4 CI 1.2-1.7). MetS was not associated with annual cognitive change, and diabetes was the only significant component associated with change (adjusted beta: DWR 0.03 p=.01, DSST 0.2 p<.001, WFT 0.09 p=.01).
Conclusion:
MetS at ages 44 to 66 was associated with worse cognitive function at follow-up, but not with annual cognitive decline over several years. Elevated WTHR and diabetes explained most of the association of MetS with cognitive function measures, and diabetes with cognitive decline. Until we have a definition of the MetS more based on pathophysiology, the components of the MetS should be the focus of analysis in future studies.
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Abstract
An important step in preventing mother-to-child transmission is testing pregnant women for HIV. Health literacy measures, such as HIV knowledge and risk perception, may determine which women are tested in prenatal clinics where routine opt-out testing is not available. A survey was conducted in Guayaquil, Ecuador in 2006 (n=485), where approximately 0.7% of HIV tests in prenatal clinics were positive. Pregnant women over the age of 18 were invited to complete the survey in the waiting rooms at four city hospitals. There were 67.2% of women reported being tested previously for HIV. The most notable finding was that women who perceived a risk were 1.74 times more likely to request testing (p=0.021), but a woman's risk perception was not related to established risk factors. In addition, a physician's recommendation would result in the testing of nearly all women (94.3%). This data suggest that interventions in prenatal care clinics should incorporate educational strategies to increase accurate perception of personal risk. These efforts must occur in conjunction with increasing the access to HIV tests to achieve the goal of universal prenatal testing.
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Affiliation(s)
- J L Dearborn
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, CT, USA
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Abstract
BACKGROUND AND PURPOSE Women face a higher mortality after stroke and have different risk factors than men. Despite educational campaigns, women continue to underestimate their own risk for stroke. We present a theoretical model to understand risk perception in high-risk women. METHODS Eight hundred five women, ages 50 to 70 years, were selected from the University of Connecticut Cardiology Center with at least one risk factor for stroke. A 5-part questionnaire addressed stroke knowledge, risk perception, risk factors, access to health care, and demographics. Two hundred fifteen women responded by mail (28% response rate) and deidentified data were entered in SPSS. Descriptive, bivariate, and multivariate techniques assessed the proposed model. RESULTS The cohort was predominantly white (91.5%), higher income (33.1% of the population earned >$75,000), and well-educated (28.6% attended graduate or professional school). Only 2 of the 37 (5.4%) women with atrial fibrillation and 11 of the 71 women with heart disease (15.5%) identified their health condition as a risk factor for stroke. Predictors of risk perception included: other women's risk (B=0.336, P<0.001), worrying about stroke (B=0.734, P<0.001), having hypertension (B=0.686, P=0.037), and having diabetes (B=0.893, P=0.004). Only 63.9% of women with atrial fibrillation (n=23) reported taking warfarin. CONCLUSIONS Women were often unable to identify their health condition as a risk factor for stroke. In addition, many women were not undertaking primary prevention behaviors. Risk perception was low, and high-risk women perceived their risk of stroke to be the same as their peers. Educational strategies must advocate for and target high-risk women.
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Affiliation(s)
- Jennifer L Dearborn
- Department of Neurology, The University of Connecticut Health Center, Farmington, CT 06030-1840, USA
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Abstract
OBJECTIVES To examine the effect of gender on three key elements of communication with elderly individuals: effectiveness of the communication, perceived relevance to the individual, and effect of gender-stereotyped content. DESIGN Survey. SETTING University of Connecticut Health Center. PARTICIPANTS Thirty-three subjects (17 female); aged 69 to 91 (mean+/-standard deviation 82+/-5.4). MEASUREMENTS Older adults listened to 16 brief narratives randomized in order and by the sex of the speaker (Narrator Voice). Effectiveness was measured according to ability to identify key features (Risks), and subjects were asked to rate the relevance (Plausibility). Number of Risks detected and determinations of plausibility were analyzed according to Subject Gender and Narrator Voice. Narratives were written for either sex or included male or female bias (Neutral or Stereotyped). RESULTS Female subjects identified a significantly higher number of Risks across all narratives (P=.01). Subjects perceived a significantly higher number of Risks with a female Narrator Voice (P=.03). A significant Voice-by-Stereotype interaction was present for female-stereotyped narratives (P=.009). In narratives rated as Plausible, subjects detected more Risks (P=.02). CONCLUSION Subject Gender influenced communication effectiveness. A female speaker resulted in identification of more Risks for subjects of both sexes, particularly for Stereotyped narratives. There was no significant effect of matching Subject Gender and Narrator Voice. This study suggests that the sex of the speaker influences the effectiveness of communication with older adults. These findings should motivate future research into the means by which medical providers can improve communication with their patients.
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