Ethnic and Racial Variation in Intracerebral Hemorrhage Risk Factors and Risk Factor Burden

ObjectiveGiven the potential therapeutic effect of vascular disease control timing to reduce dementia risk, we investigated the age-related influences of vascular risk factor burden on brain structure throughout the lifespan.MethodsWe studied participants from the community-based prospective Framingham Heart Study. Overall vascular risk factor burden was calculated according to the Framingham Stroke Risk Profile, a validated algorithm that predicts stroke risk. Brain volume was estimated by MRI. We used cross-sectional data to examine how the strength of association between vascular risk factor burden and brain volume changed across each age decade from age 45–54 years through to 85–94 years (N = 2,887). Second, we leveraged up to 40 years of longitudinal data to determine how the strength of association between vascular risk factor burden and brain volume changed when vascular risk factors were examined at progressively earlier ages (N = 7,868).ResultsIn both cross-sectional and longitudinal analyses, higher vascular risk factor burden was associated with lower brain volume across each age decade. In the cross-sectional analysis, the strength of this association decreased with each decade of advancing age (p for trend < 0.0001). In longitudinal analysis, the strength of association between vascular risk factor burden and brain volume was stronger when vascular risk factors were measured at younger ages. For example, vascular risk factor burden was most strongly associated with lower brain volume in later life when vascular risk factors were measured at age 45 years.ConclusionVascular risk factors at younger ages appear to have detrimental effects on current and future brain volume.

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The impact of risk factor trends on intracerebral hemorrhage incidence over the last two decades—The Tromsø Study

International Journal of Stroke ◽

10.1177/1747493018789996 ◽

2018 ◽

Vol 14 (1) ◽

pp. 61-68 ◽

Cited By ~ 2

Author(s):

Maria Carlsson ◽

Tom Wilsgaard ◽

Stein Harald Johnsen ◽

Liv-Hege Johnsen ◽

Maja-Lisa Løchen ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Intracerebral Hemorrhage ◽

Proportional Hazards ◽

Temporal Trends ◽

Population Based ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Intracerebral Hemorrhages ◽

The Impact

Background Studies on the relationship between temporal trends in risk factors and incidence rates of intracerebral hemorrhage are scarce. Aims To analyze temporal trends in risk factors and incidence rates of intracerebral hemorrhage using individual data from a population-based study. Methods We included 28,167 participants of the Tromsø Study enrolled between 1994 and 2008. First-ever intracerebral hemorrhages were registered through 31 December 2013. Hazard ratios (HRs) for intracerebral hemorrhage were analyzed by Cox proportional hazards models, risk factor levels over time by generalized estimating equations, and incidence rate ratios (IRR) by Poisson regression. Results We registered 219 intracerebral hemorrhages. Age, male sex, systolic blood pressure (BP), diastolic BP, and hypertension were associated with intracerebral hemorrhage. Hypertension was more strongly associated with non-lobar intracerebral hemorrhage (HR 5.08, 95% CI 2.86–9.01) than lobar intracerebral hemorrhage (HR 1.91, 95% CI 1.12–3.25). In women, incidence decreased significantly (IRR 0.46, 95% CI 0.23–0.90), driven by a decrease in non-lobar intracerebral hemorrhage. Incidence rates in men remained stable (IRR 1.27, 95% CI 0.69–2.31). BP levels were lower and decreased more steeply in women than in men. The majority with hypertension were untreated, and a high proportion of those treated did not reach treatment goals. Conclusions We observed a significant decrease in intracerebral hemorrhage incidence in women, but not in men. A steeper BP decrease in women may have contributed to the diverging trends. The high proportion of untreated and sub-optimally treated hypertension calls for improved strategies for prevention of intracerebral hemorrhage.

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Acute hematoma expansion after spontaneous intracerebral hemorrhage: risk factors and impact on long-term prognosis

Neurological Sciences ◽

10.1007/s10072-020-04356-y ◽

2020 ◽

Vol 41 (9) ◽

pp. 2503-2509

Author(s):

Agnese Sembolini ◽

Michele Romoli ◽

Umberto Pannacci ◽

Giulio Gambaracci ◽

Piero Floridi ◽

...

Keyword(s):

Risk Factors ◽

Intracerebral Hemorrhage ◽

Hematoma Expansion ◽

Spontaneous Intracerebral Hemorrhage ◽

Hemorrhage Risk ◽

Long Term Prognosis

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Abstract 357: Comparison of Comorbidities Between Patients Admitted With Index Myocardial Infarction and Recurrent Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.357 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Raunak Nair ◽

Michael Johnson ◽

Kathleen A Kravitz ◽

Moses Anabila ◽

Jeevanantham Rajeswaran ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Risk Factor ◽

Medical Center ◽

Modifiable Risk Factors ◽

Risk Factor Management ◽

Recurrent Myocardial Infarction ◽

Artery Disease ◽

The Relationship ◽

Risk Factor Burden

Background: Several comorbidities are known to increase the risk of coronary artery disease. However, the relationship between modifiable risk factors and recurrent Myocardial Infarction (MI) has not been clearly defined. The purpose of our study was to assess if there were certain comorbidities that increase the risk of recurrent myocardial infarction. Methods: We reviewed 6,626 cases of MI at a single quaternary care medical center from January 1 st , 2010 to January 1 st , 2017 (29% STEMI, 71% NSTEMI), and we identified all cases of readmission with a recurrent MI within 90 days after index MI. All patients with index MI were screened for accompanying comorbidities and compared with patients with recurrent MI. Results: There were a total of 2051 readmissions (31%) within 90-days of index MI, of which 168 readmissions were for recurrent MI. Hypertension and Dyslipidemia appeared to be the most prominent modifiable risk factors in patients with index MI and recurrent MI (86%, 94% for HTN & 81%, 93% for DLP). All comorbidities were substantially more prevalent in patients with recurrent MI than in patients with index MI. Conclusion: Patients with recurrent MI have a higher risk factor burden than the general population with MI. This highlights the importance of risk factor management in patients with acute Myocardial infarction.

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Racial/ethnic variation of APOE alleles for lobar intracerebral hemorrhage

Neurology ◽

10.1212/wnl.0000000000005908 ◽

2018 ◽

Vol 91 (5) ◽

pp. e410-e420 ◽

Cited By ~ 8

Author(s):

Russell P. Sawyer ◽

Padmini Sekar ◽

Jennifer Osborne ◽

Steven J. Kittner ◽

Charles J. Moomaw ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Intracerebral Hemorrhage ◽

Significant Risk ◽

Geographic Location ◽

Significant Risk Factor ◽

Predominately White ◽

Ethnic Populations ◽

Lower Effect ◽

Racial Ethnic

ObjectiveAPOE ε2 and ε4 alleles have been associated with lobar intracerebral hemorrhage (ICH) in predominately white populations; we sought to evaluate whether this held true among black and Hispanic populations.MethodsThe Ethnic/Racial Variations of Intracerebral Hemorrhage study is a prospective, multicenter case-control study of ICH among white, black, and Hispanic participants. Controls were recruited to match cases based on age, ethnicity/race, sex, and geographic location. APOE genotyping and ICH location was determined blinded to clinical data.ResultsThere were 907 cases of lobar ICH and 2,660 controls with APOE results. Both APOE ε2 (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1–2.0, p = 0.01) and APOE ε4 (OR 2.0, 95% CI 1.5–2.6, p < 1 × 10−4) were associated with lobar ICH among white participants. Among black participants, neither APOE ε2 (OR 1.0, 95% CI 0.7–1.5, p = 0.97) nor APOE ε4 (OR 1.0, 95% CI 0.7–1.4, p = 0.90) were independent risk factors for lobar ICH. Similarly, among Hispanic participants, neither APOE ε2 (OR 1.0, 95% CI 0.6–1.8, p = 0.89) nor APOE ε4 (OR 1.2, 95% CI 0.8–1.7, p = 0.36) were associated with lobar ICH. Hypertension was a significant risk factor for lobar ICH in all 3 racial/ethnic groups.ConclusionIn contrast to Caucasian patients, in which amyloid risk factors predominate in lobar ICH, we found that hypertension was the predominant risk factor for lobar ICH. While APOE alleles are a risk factor for lobar ICH in white patients, they appear to have a much lower effect in lobar ICH in African American and Hispanic American populations. This suggests APOE ε2 and APOE ε4 do not affect lobar ICH risk homogeneously across ethnic populations. In addition, hypertension has a prominent role in lobar ICH risk, particularly among minorities.

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Microvascular Angina : A Diagnosis Hidden in Plain Sight

10.37191/mapsci-jccr-2(2)-030 ◽

2021 ◽

Author(s):

Curtis D. Samuels

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Diseases ◽

Endothelial Dysfunction ◽

Coronary Angiography ◽

Coronary Disease ◽

Microvascular Dysfunction ◽

African Caribbean ◽

Caribbean Population ◽

Risk Factor Burden

Background: Patients who are initially suspected of having ischemic heart disease, but in whom normal coronaries are discovered at angiography, are frequently believed to have pain of a non-cardiac aetiology. Micro vascular angina is hardly ever diagnosed save in peri-menopausal women. Physicians traditionally tend to view coronary microvascular disease and obstructive coronary artery disease as two separate entities. Notwithstanding, recent studies have begun to focus on endothelial dysfunction as being a key component in all cardiovascular diseases, with or without obstructive coronary lesions. Hypothesis: Patients suspected of having obstructive coronary disease associated with a significant risk factor burden, but in whom normal coronaries are found at angiography, in reality possess microvascular dysfunction. Objectives: • To determine the prevalence of normal coronaries at elective angiography compared to subjects with significant obstructive lesions. • To examine the influence of risk factor burden in patients who present normal coronaries in comparison with those who demonstrate obstructive lesions at angiography. • To suggest endothelial dysfunction as the common nexus underlying the disparities in cardiovascular morbidity observed among population samples. Methods: A group of 90 patients were randomly selected from clinical files of those who underwent elective coronary angiography between January, 2013 and May, 2017. The study cohort was comprised of 55 males and 35 females between the ages of 43 to 84 years. All subjects presented chest pain suspected of being coronary in origin. Coronary risk factors were recorded for each patient and the results were compared with findings at coronary angiography and then correlated with those encountered in medical literature. Results: Normal coronary angiograms were more prevalent in the African-Caribbean population (54.16%), than within the Mestizo-Mayan population (37.5%) Conversely, the finding of an obstructive lesion was more common in the Mestizo-Mayan population (56.25%), than within the African-Caribbean group (31.25%). The African-Caribbean group generally possessed a greater risk factor burden than their Mestizo-Mayan counterparts. Mayan counterparts. The percentage of women with normal coronaries (52.94%) showed a slight increase over that of men (47.05%). Males possessed a prevalence for obstructive disease of almost 4 times greater (79.48% vs. 20.5%) than females, yet females demonstrated a greater risk factor burden than males in most risk parameters. Hypertension was the most prevalent risk factor followed by dyslipidaemia and diabetes mellitus but these factors were more commonly encountered in patients with “normal” coronaries, than in those with obstructive lesions. Conclusion: Our study reported a significant number (56.66%) of “normal” coronaries at angiography. The majority (54.16%) of this figure pertained to the African-Caribbean sub-group, which in other studies also appeared to have a lesser coronary disease morbidity and mortality than their white counterparts despite having a greater risk factor burden. This is particularly true in the female African-Caribbean population. Several research papers have made reference to racial, ethnic and gender disparities in the manifestation of cardiovascular diseases. Paradoxically in some cases risk factor burden may be higher in the non-obstructive group rather than in the obstructive population. Convincing research has led us to believe that the vascular endothelium in its state of dysfunction plays a key role in explaining these disparities. Wherever cardiovascular risk factors exert their damage, endothelial injury and dysfunction ensues. Therefore, having an established risk factor burden portends microvascular dysfunction independently of any angiographic result.

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Atrial Fibrillation: Are Associated Risk Factors Surrogates for an Inflammatory State?

10.37191/mapsci-jccr-2(2)-032 ◽

2021 ◽

Author(s):

Curtis D Samuels

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Risk Factor ◽

Predominantly White ◽

Racial Differences ◽

Oxygen Species ◽

Inflammatory State ◽

Atherosclerotic Process ◽

Associated Risk Factors ◽

Risk Factor Burden

Today’s understanding of the inflammatory process has evolved far beyond what was initially described by Celsus in the 1st Century A.D [1]. Terms like oxidative stress, reactive oxygen species (ROS), cytokines, and fibrosis have been thrown around in everyday scientific discussions for some time now. Well-known pathways of the “inflammatory state” have underpinned many common cardiovascular diseases such as the atherosclerotic process. However, there are less recognized entities where inflammation seems to play a key role in their mechanisms of origin. The concept of inflammation in atrial fibrillation (AF) is not a novel one, but this characteristic of its pathophysiology seems to have been overshadowed by the inherent dangers of its complications. More emphasis has been placed instead on its associated risk factors, which alone, or in combination, contribute to the development of AF. The risk factor burden and the arrhythmia it produces are generally considered uniform in a presentation in most studies. Some researchers, however, allude to ethnic or racial differences in AF [2,3]. This small retrospective study of an Afro-Mestizo Caribbean cohort of patients with AF will corroborate findings of associated risk factors with those commonly encountered globally in predominantly White populations. It will also point out, through numerous bibliographical references, how an “inflammatory state” may be identified in each AF-associated risk factor. If it holds true that the whole is nothing more than a sum of its parts, we should then accept the oversimplified view that AF, like atherosclerosis, is indeed inflammatory in nature. To this end, a fresh focus could be placed on new upstream therapeutic opportunities designed to complement our current downstream interventions, in an effort to prevent the occurrence and recurrence of AF.

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Location-specific risk factors for intracerebral hemorrhage

Neurology ◽

10.1212/wnl.0000000000010418 ◽

2020 ◽

Vol 95 (13) ◽

pp. e1807-e1818

Author(s):

Wilmar M.T. Jolink ◽

Kim Wiegertjes ◽

Gabriël J.E. Rinkel ◽

Ale Algra ◽

Frank-Erik de Leeuw ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Risk Factor ◽

Intracerebral Hemorrhage ◽

Meta Analysis ◽

Spontaneous Intracerebral Hemorrhage ◽

Case Control Studies ◽

White Participant ◽

Male Sex ◽

Hypertensive Intracerebral Hemorrhage

ObjectiveTo conduct a systematic review and meta-analysis of studies reporting on risk factors according to location of the intracerebral hemorrhage.MethodsWe searched PubMed and Embase for cohort and case-control studies reporting ≥100 patients with spontaneous intracerebral hemorrhage that specified the location of the hematoma and reported associations with risk factors published until June 27, 2019. Two authors independently extracted data on risk factors. Estimates were pooled with the generic variance-based random-effects method.ResultsAfter screening 10,013 articles, we included 42 studies totaling 26,174 patients with intracerebral hemorrhage (9,141 lobar and 17,033 nonlobar). Risk factors for nonlobar intracerebral hemorrhage were hypertension (risk ratio [RR] 4.25, 95% confidence interval [CI] 3.05–5.91, I2 = 92%), diabetes mellitus (RR 1.35, 95% CI 1.11–1.64, I2 = 37%), male sex (RR 1.63, 95% CI 1.25–2.14, I2 = 61%), alcohol overuse (RR 1.48, 95% CI 1.21–1.81, I2 = 19%), underweight (RR 2.12, 95% CI 1.12–4.01, I2 = 31%), and being a Black (RR 2.83, 95% CI 1.02-7.84, I2 = 96%) or Hispanic (RR 2.95, 95% CI 1.69-5.14, I2 = 71%) participant compared with being a White participant. Hypertension, but not any of the other risk factors, was also a risk factor for lobar intracerebral hemorrhage (RR 1.83, 95% CI 1.39–2.42, I2 = 76%). Smoking, hypercholesterolemia, and obesity were associated with neither nonlobar nor lobar intracerebral hemorrhage.ConclusionsHypertension is a risk factor for both nonlobar and lobar intracerebral hemorrhage, although with double the effect for nonlobar intracerebral hemorrhage. Diabetes mellitus, male sex, alcohol overuse, underweight, and being a Black or Hispanic person are risk factors for nonlobar intracerebral hemorrhage only. Hence, the term hypertensive intracerebral hemorrhage for nonlobar intracerebral hemorrhage is not appropriate.

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Prolonged Mechanical Ventilation in Patients with Deep-Seated Intracerebral Hemorrhage: Risk Factors and Clinical Implications

Journal of Clinical Medicine ◽

10.3390/jcm10051015 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1015

Author(s):

Felix Lehmann ◽

Lorena M. Schenk ◽

Inja Ilic ◽

Christian Putensen ◽

Alexis Hadjiathanasiou ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Multivariate Analysis ◽

Intracerebral Hemorrhage ◽

Prolonged Mechanical Ventilation ◽

Clinical Implications ◽

Adequate Treatment ◽

Hemorrhage Risk ◽

Associated Risk Factors ◽

Scarce Data

While management of patients with deep-seated intracerebral hemorrhage (ICH) is well established, there are scarce data on patients with ICH who require prolonged mechanical ventilation (PMV) during the course of their acute disease. Therefore, we aimed to determine the influence of PMV on mortality in patients with ICH and to identify associated risk factors. From 2014 to May 2020, all patients with deep-seated ICH who were admitted to intensive care for >3 days were included in further analyses. PMV is defined as receiving mechanical ventilation for more than 7 days. A total of 42 out of 94 patients (45%) with deep-seated ICH suffered from PMV during the course of treatment. The mortality rate after 90 days was significantly higher in patients with PMV than in those without (64% versus 22%, p < 0.0001). Multivariate analysis identified “ICH volume >30 mL” (p = 0.001, OR 5.3) and “admission SOFA score > 5” (p = 0.007, OR 4.2) as significant and independent predictors for PMV over the course of treatment in deep-seated ICH. With regard to the identified risk factors for PMV occurrence, these findings might enable improved guidance of adequate treatment at the earliest possible stage and lead to a better estimation of prognosis in the course of ICH treatment.

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The effect of vascular risk factor burden on the severity of COVID-19 illness, a retrospective cohort study

Respiratory Research ◽

10.1186/s12931-020-01510-0 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Houwei Du ◽

◽

Xiaobin Pan ◽

Nan Liu ◽

Junnian Chen ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cox Regression ◽

Vascular Risk Factor ◽

Vascular Risk Factors ◽

Hospital Treatment ◽

Vascular Risk ◽

Laboratory Findings ◽

Increasing Risk ◽

Risk Factor Burden

Abstract Background Patients with cardiovascular comorbidities are at high risk of poor outcome from COVID-19. However, how the burden (number) of vascular risk factors influences the risk of severe COVID-19 disease remains unresolved. Our aim was to investigate the association of severe COVID-19 illness with vascular risk factor burden. Methods We included 164 (61.8 ± 13.6 years) patients with COVID-19 in this retrospective study. We compared the difference in clinical characteristics, laboratory findings and chest computed tomography (CT) findings between patients with severe and non-severe COVID-19 illness. We evaluated the association between the number of vascular risk factors and the development of severe COVID-19 disease, using a Cox regression model. Results Sixteen (9.8%) patients had no vascular risk factors; 38 (23.2%) had 1; 58 (35.4%) had 2; 34 (20.7%) had 3; and 18 (10.9%) had ≥4 risk factors. Twenty-nine patients (17.7%) experienced severe COVID-19 disease with a median (14 [7–27] days) duration between onset to developing severe COVID-19 disease, an event rate of 4.47 per 1000-patient days (95%CI 3.10–6.43). Kaplan-Meier curves showed a gradual increase in the risk of severe COVID-19 illness (log-rank P < 0.001) stratified by the number of vascular risk factors. After adjustment for age, sex, and comorbidities as potential confounders, vascular risk factor burden remained associated with an increasing risk of severe COVID-19 illness. Conclusions Patients with increasing vascular risk factor burden have an increasing risk of severe COVID-19 disease, and this population might benefit from specific COVID-19 prevention (e.g., self-isolation) and early hospital treatment measures.

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