Secondary Stroke Risk Reduction in Black Adults: a Systematic Review

Abstract Objective This systematic review aimed to establish the evidence behind the use of pre-operative calcium, vitamin D or both calcium and vitamin D to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy. Method This review included prospective clinical trials on adult human patients that were published in English and which studied the effects of pre-operative supplementation with calcium, vitamin D or both calcium and vitamin D on the rate of post-operative hypocalcaemia following total thyroidectomy. Results Seven out of the nine trials included reported statistically significantly reduced rates of post-operative laboratory hypocalcaemia (absolute risk reduction, 13–59 per cent) and symptomatic hypocalcaemia (absolute reduction, 11–40 per cent) following pre-operative supplementation. Conclusion Pre-operative treatment with calcium, vitamin D or both calcium and vitamin D reduces the risk of post-operative hypocalcaemia and should be considered in patients undergoing total thyroidectomy.

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EXPRESS: Stroke risk following traumatic brain injury: systematic review and meta-analysis

International Journal of Stroke ◽

10.1177/17474930211004277 ◽

2021 ◽

pp. 174749302110042

Author(s):

Grace Mary Turner ◽

Christel McMullan ◽

Olalekan Lee Aiyegbusi ◽

Danai Bem ◽

Tom Marshall ◽

...

Keyword(s):

Systematic Review ◽

Stroke Risk ◽

Meta Analysis ◽

Vitamin K Antagonists ◽

Cochrane Library ◽

Control Group ◽

Large Sample Size ◽

Hazard Ratios ◽

Increased Risk ◽

The Cochrane Library

Aims To investigate the association between TBI and stroke risk. Summary of review We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4th December 2020. We used random-effects meta-analysis to pool hazard ratios (HR) for studies which reported stroke risk post-TBI compared to controls. Searches identified 10,501 records; 58 full texts were assessed for eligibility and 18 met the inclusion criteria. The review included a large sample size of 2,606,379 participants from four countries. Six studies included a non-TBI control group, all found TBI patients had significantly increased risk of stroke compared to controls (pooled HR 1.86; 95% CI 1.46-2.37). Findings suggest stroke risk may be highest in the first four months post-TBI, but remains significant up to five years post-TBI. TBI appears to be associated with increased stroke risk regardless of severity or subtype of TBI. There was some evidence to suggest an association between reduced stroke risk post-TBI and Vitamin K antagonists and statins, but increased stroke risk with certain classes of antidepressants. Conclusion TBI is an independent risk factor for stroke, regardless of TBI severity or type. Post-TBI review and management of risk factors for stroke may be warranted.

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Modification of the left atrial appendage and its role in stroke risk reduction with non-valvular atrial fibrillation

IJC Heart & Vasculature ◽

10.1016/j.ijcha.2020.100688 ◽

2021 ◽

Vol 32 ◽

pp. 100688

Author(s):

Hashrul N. Rashid ◽

Jamie Layland

Keyword(s):

Atrial Fibrillation ◽

Risk Reduction ◽

Left Atrial ◽

Stroke Risk ◽

Left Atrial Appendage ◽

Atrial Appendage

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Neighborhood Socioeconomic Status and Stroke Incidence: A Systematic Review

Neurology ◽

10.1212/wnl.0000000000011892 ◽

2021 ◽

pp. 10.1212/WNL.0000000000011892

Author(s):

Yeonwoo Kim ◽

Erica Twardzik ◽

Suzanne E. Judd ◽

Natalie Colabianchi

Keyword(s):

United States ◽

Systematic Review ◽

Socioeconomic Status ◽

Stroke Risk ◽

Keyword Search ◽

The United States ◽

Stroke Incidence ◽

Neighborhood Socioeconomic Status ◽

Modifiable Factors ◽

The Impact

ObjectiveTo summarize overall patterns of the impact of neighborhood socioeconomic status (nSES) on incidence stroke and uncover potential gaps in the literature, we conducted a systematic review of studies examining the association between nSES and incident stroke, independent of individual socioeconomic status (SES).MethodsFour electronic databases and reference lists of included articles were searched, and corresponding authors were contacted to locate additional studies. A keyword search strategy included the three broad domains of neighborhood, SES, and stroke. Eight studies met our inclusion criteria (e.g., nSES as an exposure, individual SES as a covariate, and incident stroke as an outcome). We coded study methodology and findings across the eight studies.ResultsThe results provide evidence for the overall nSES and incident stroke association in Sweden and Japan, but not within the United States. Findings were inconclusive when examining the nSES-incident stroke association stratified by race. We found evidence for the mediating role of biological factors in the nSES-incident stroke association.ConclusionsHigher neighborhood disadvantage was found to be associated with higher stroke risk, but it was not significant in all the studies. The relationship between nSES and stroke risk within different racial groups in the United States was inconclusive. Inconsistencies may be driven by differences in covariate adjustment (e.g., individual-level sociodemographic characteristics, neighborhood-level racial composition). Additional research is needed to investigate potential intermediate and modifiable factors of the nSES and incident stroke association, which could serve as intervention points.

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Microenterprise Development Interventions for Sexual Risk Reduction: A Systematic Review

AIDS and Behavior ◽

10.1007/s10461-013-0582-1 ◽

2013 ◽

Vol 17 (9) ◽

pp. 2864-2877 ◽

Cited By ~ 24

Author(s):

Rosa R. Cui ◽

Ramon Lee ◽

Harsha Thirumurthy ◽

Kathryn E. Muessig ◽

Joseph D. Tucker

Keyword(s):

Systematic Review ◽

Risk Reduction ◽

Sexual Risk ◽

Sexual Risk Reduction ◽

Microenterprise Development ◽

Development Interventions

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Abstract 150: Antithrombotic Use in Nonvalvular Atrial Fibrillation (NVAF): Alignment between Guidelines and Emerging Evidence with Clinician Prescribing Preferences

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.150 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Jason Shafrin ◽

Amanda Bruno ◽

Joanna P MacEwan ◽

Avrita Campinha-Bacote ◽

Jeffrey Trocio ◽

...

Keyword(s):

Willingness To Pay ◽

Risk Reduction ◽

Online Survey ◽

Stroke Risk ◽

Treatment Guidelines ◽

Bleeding Risk ◽

Treatment Comparison ◽

Dosing Frequency ◽

Indirect Treatment ◽

Treatment Comparisons

Background: 2014 AHA/ACC/HRS guidelines recommend anticoagulation for NVAF patients with a CHA2DS2-VASc≥2, but do not endorse a specific therapy. Several published indirect treatment comparisons demonstrate similar stroke risk reduction but distinct differences for bleeding risk among novel oral anticoagulants (NOACs) in NVAF patients. Objectives: Survey physicians to determine how their preferences over antithrombotic therapies compare with current treatment guidelines and indirect treatment comparisons. Methods: An online survey was completed by 200 physicians who regularly treat patients with NVAF. Respondents answered 12 questions comparing two hypothetical antithrombotic treatments that varied across five attributes: stroke risk, major bleeding risk, inconvenience (i.e., regular INR blood-testing/dietary restrictions), dosing frequency and patient out-of-pocket (OOP) cost. Physician willingness to trade higher OOP cost for improvements in other attributes was estimated using a logistic regression. Based on these results, we calculated the share of prescriptions that would be written for apixaban, aspirin, dabigatran, rivaroxaban and warfarin using real-world US patient OOP costs. Results: Physicians were willing to trade an increase in monthly OOP cost of $38.21 (95% CI: $22.07-$54.34) for a 1 percentage point (absolute) decrease in annual stroke risk. Physicians also placed a positive value on less inconvenience ($34.46, 95% CI: $8.50-$60.41), and a 1 percentage point reduction in the risk of a major bleed ($14.44, 95% CI: $8.01-$20.88). Physicians did not have a significant willingness to pay to reduce dosing frequency from twice to once per day ($17.16; 95% CI: -0.08-$34.40). Cardiologists and cardiac electrophysiologists had higher willingness to pay for stroke risk reduction than general practitioners ($54.32 vs. $24.74, p<0.001). Based on these preferences, physicians would recommend NOACs to 77% of patients, with apixaban (32%) being the preferred NOAC. Conclusions: Similar to findings from indirect treatment comparison studies, physicians largely prefer NOACs_particularly apixaban_compared to warfarin or aspirin for stroke risk reduction in NVAF patients. Additional research is needed to determine why NOACs are underused in practice.

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Abstract W MP67: Non-traditional Serum Lipid Indices and Recurrent Stroke Risk

Stroke ◽

10.1161/str.46.suppl_1.wmp67 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Jong-Ho Park ◽

Bruce Ovbiagele

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Risk Reduction ◽

Serum Lipid ◽

Stroke Risk ◽

Recurrent Stroke ◽

Density Lipoprotein ◽

Secondary Outcome ◽

Vascular Risk ◽

Vascular Death

Background: Expert consensus guidelines recommend low-density lipoprotein (LDL) cholesterol as the primary serum lipid target for recurrent stroke risk reduction. Indeed, emerging evidence suggests that non-traditional serum lipid indices may be better predictors of vascular risk than LDL. Triglycerides (TG)/high-density lipoprotein (HDL) is a powerful independent predictor of all-cause mortality and cardiovascular events. Furthermore, total cholesterol (TC)/HDL ratio, LDL/HDL and non-HDL have all been independently linked with greater coronary heart disease (CHD) risk. Little is known about the effects non-traditional serum lipid indices on recurrent vascular risk after a recent stroke. Method: We analyzed the Vitamin Intervention for Stroke Prevention study database comprising 3680 recent (<120 days) ischemic stroke patients followed up for 2 years. Independent associations of each 4 lipid index (TG/HDL, TC/HDL, LDL/HDL, and non-HDL) with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcome) were analyzed. Each of the 4 groups was stratified into quintiles according to the distribution of lipid indices. Results: Of all indices evaluated only TG/HDL was consistently and independently related to both outcomes: compared with the lowest quintile (≤1.93), the highest TG/HDL quintile (≥6.22) was associated with stroke [adjusted hazard ratio (AHR), 1.56; 95% CI, 1.05–2.32] and stroke/CHD/vascular death (AHR 1.39, 95% CI, 1.05–1.83), including adjustment for lipid modifier use. Compared with the lowest quintile (≤3.50), the highest TC/HDL quintile (≥5.98) was associated with stroke/CHD/vascular death (AHR 1.44, 95% CI, 1.03–2.01). LDL/HDL, non-HDL, elevated TG alone, and low HDL alone, were not independently linked to either outcome. Conclusions: Of various non-traditional serum lipid indices, elevated baseline TG/HDL and TC/HDL predict future vascular risk after a stroke, but only elevated TG/HDL is related to risk of recurrent stroke. Future studies should assess the role of TG/HDL as a potential therapeutic target for global vascular risk reduction after stroke.

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