Program to Avoid Cerebrovascular Events through Systematic Electronic Tracking and Tailoring of an Eminent Risk factor: Protocol of a RCT

2021 ◽  
Vol 30 (8) ◽  
pp. 105815
Author(s):  
Ashley M. Wabnitz ◽  
Jessica Chandler ◽  
Frank Treiber ◽  
Souvik Sen ◽  
Carolyn Jenkins ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cerebrovascular Events ◽  
Electronic Tracking

Clinical characteristics and prognosis in patients with premature coronary artery disease of different genders after intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X.F Tang ◽  
Y Yao ◽  
S.D Jia ◽  
Y Liu ◽  
B Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Coronary Intervention ◽  
Premature Coronary Artery Disease ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Cerebrovascular Events ◽  
Independent Risk Factors ◽  
Artery Disease

Abstract Objective To investigate the clinical characteristics and long-term prognosis of coronary intervention in patients with premature coronary artery disease (PCAD) between different genders. Methods From January 2013 to December 2013, 4 744 patients diagnosed as PCAD with percutaneous coronary intervention (PCI) in our hospital were enrolled. The general clinical data, laboratory results and interventional treatment data of all patients were collected, and the occurrence of major adverse cardio-cerebrovascular events (MACCE) within 2 years after PCI was followed up. Results Of the 4 744 patients undergoing PCI, 3 390 (71.5%) were males and 1 354 (28.5%) were females. The 2-year follow-up results showed that the incidence of BARC grade 1 hemorrhage in female patients was significantly higher than that in male patients (6.9% vs. 3.7%; P<0.001); however, there was no significant difference in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), all-cause death, cardiac death, recurrent myocardial infarction, revascularization (target vessel revascularization and target lesion revascularization), stent thrombosis, stroke and BARC grade 2–5 hemorrhage between the two groups (P>0.05). Multivariate COX regression analysis showed that gender was an independent risk factor for BARC grade 1 bleeding events in PCAD patients (HR=2.180, 95% CI: 1.392–3.416, P<0.001), but it was not an independent risk factor for MACCE and BARC grade 2–5 bleeding. Hyperlipidemia, preoperative SYNTAX score, multivessel lesions and NSTE-ACS were the independent risk factors for MACCE in PCAD patients with PCI (HR=1.289, 95% CI: 1.052–1.580, P=0.014; HR=1.030, 95% CI: 1.019–1.042, P<0.001; HR=1.758, 95% CI: 1.365–2.264, P<0.001; HR=1.264, 95% CI: 1.040–1.537, P=0.019); gender, hyperlipidemia, anticoagulant drugs like low molecular weight heparin or sulfonate were the independent risk factors for bleeding events (HR=1.579,95% CI 1.085–2. 297, P=0.017; HR=1.305, 95% CI 1.005–1.695, P=0.046; HR=1.321, 95% CI 1.002–1.741, P=0.048; HR=1.659, 95% CI 1.198–2.298, P=0.002). Conclusion The incidence of minor bleeding in women with PCAD is significantly higher than that in men; After adjusting for various risk factors, gender is an independent risk factor for minor bleeding events, but not an independent risk factor for MACCE in patients with PCAD. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science and Technology Support Program of China

Are Early Seizures Predictive of Epilepsy after a Stroke? Results of a Population-Based Study

2015 ◽  
Vol 45 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Anna Serafini ◽  
Gian Luigi Gigli ◽  
Giorgia Gregoraci ◽  
Francesco Janes ◽  
Iacopo Cancelli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Subarachnoid Hemorrhage ◽  
Population Based ◽  
Hemorrhagic Transformation ◽  
Cerebrovascular Events ◽  
Younger Age ◽  
Study Results ◽  
Intracerebral Hemorrhages ◽  
Early Seizures

Background: In addition to determining the cumulative incidence and risk factors for early seizures (ES), late seizures (LS) and post stroke epilepsy (PSE), we aimed at checking if ES represented a risk factor for epilepsy and if early treatment after ES prevented the occurrence of subsequent seizures. Methods: This study was part of a 2-year prospective community-based registry of all cerebrovascular events in the district of Udine (153,312 inhabitants), North-Eastern Italy, between April 1, 2007 and March 31, 2009. People with transient ischemic attacks (TIAs) were excluded from this study. Results: In all, 782 cases of stroke (79.28% ischemic, 14.83% hemorrhagic, 3.20% subarachnoid hemorrhage and 2.69% undetermined) were identified. The incidence of ES, LS and PSE was 5.10, 3.14 and 2.22%, respectively. Intracerebral hemorrhage, subarachnoid hemorrhage, stroke of undetermined origin and hyponatremia, represented risk factors for ES (p < 0.05). Among ischemic strokes, ES risk factors were hyponatremia (p = 0.024) and hemorrhagic transformation (p = 0.046). LS risk factors were younger age (p = 0.004) and cortical location of stroke (p = 0.004). Within ischemic strokes, LS risk factors were younger age (p = 0.020) and cortical location (p < 0.0001). Within intracerebral hemorrhages, the only risk factor for LS was the presence of a previous ES (p = 0.017). PSE risk factors were the same as for LS. Conclusions: All acute conditions related to the occurrence of stroke are implicated in the pathogenesis of ES, which becomes a risk factor for LS only in the setting of intracerebral hemorrhages. Therefore, early antiepileptic treatment is needed only in this situation.

scholarly journals Improvement of cardiovascular risk prediction by longitudinal risk factor and competing risk data

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Roman Degano ◽  
J Marrugat ◽  
R Elosua ◽  
I Subirana
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Competing Risks ◽  
Competing Risk ◽  
Cerebrovascular Events ◽  
Risk Factor Data ◽  
Coronary Events ◽  
Factor Data

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Spanish Society of Cardiology OnBehalf REGICOR Study Background Cardiovascular risk assessment is the cornerstone of cardiovascular primary prevention. However, most of the recommended or regionally validated risk assessment tools are not updated. Purpose To analyze the effect of including longitudinal information of risk factors as well as competing risks for cardiovascular risk prediction. Methods Data from 10,152 general population individuals from North-Eastern Spain was included. Individuals were recruited in 1995-2000-2005 in three different cohorts of the REGICOR Study. Risk factor data was obtained at baseline and in 2 follow-up visits. Risk factor data included age, sex, education, lipid profile, blood pressure, glucose, smoking, body mass index, and treatment for hypercholesterolemia, hypertension and diabetes. Event data was obtained by cross linkage with healthcare and mortality databases. Cardiovascular events included myocardial infarction, angina and stroke. Cancer mortality and other mortality were included as competing risks. Four cox proportional hazards models developed to model time to coronary/cerebrovascular events with longitudinal or competing risk data. Interactions between age and risk factors were included. Discrimination was assessed with the area under the ROC curve (AUC) and Sommer’s D statistic, and compared with discrimination of Framingham-REGICOR function. Results The variable with the largest effect on coronary/cerebrovascular event incidence was diabetes treatment in the longitudinal models [Hazard ratio -HR- (95% confidence interval -CI-): 3.02 (2.00, 4.58)/2.58 (1.33, 5.00)] as well as in the competing risk models [HR (95% CI): 3.08 (2.09, 4.55)/2.77 (1.48, 5.18)]. In addition to currently used variables, medication for hypertension and diabetes, and interaction between age and diabetes medication were included in all models. Compared to the Framingham-REGICOR function, discrimination improved with the inclusion of longitudinal or competing risk data as shown in the Table. Conclusion Including longitudinal information of cardiovascular risk factors or competing risks improved discrimination of a regionally validated cardiovascular risk function. The availability of these data in healthcare databases would allow its use in primary care cardiovascular risk assessment. Discrimination analysis Models AUC (95% CI) developed models AUC (95% CI) Framingham-REGICORfunction p-value Competing risks - coronary events 0.80 (0.77-0.82) 0.74 (0.71-0.77) &lt; 0.001 Competing risks - cerebrovascular events 0.78 (0.74-0.82) 0.68 (0.63-0.72) &lt; 0.001 Longitudinal data - coronary events 0.79 (0.78-0.81) 0.76 (0.74-0.78) &lt; 0.001 Longitudinal data - cerebrovascular events 0.80 (0.78-0.83) 0.71 (0.69-0.74) &lt; 0.001

scholarly journals SAT-545 Diabetes Mellitus Is the Risk Factor of Cardiovascular and Cerebrovascular Events in Primary Aldosteronism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Michio Otsuki ◽  
Aya Saiki ◽  
Daisuke Tamada ◽  
Tetsuhiro Kitamura ◽  
Iichiro Shimomura ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Primary Aldosteronism ◽  
Odds Ratio ◽  
University Hospitals ◽  
Cross Sectional ◽  
Renal Disorder ◽  
Cerebrovascular Events ◽  
Sectional Analysis ◽  
The Relationship

Abstract The prevalence of diabetes mellitus (DM) in primary aldosteronism (PA) patients is higher than essential hypertension patients and general population. Though both DM and PA play an important role in the progression of cardiovascular and cerebrovascular (CCV) diseases, the relationship between DM and these diseases in PA patients have not been evaluated.The aim of this study was to investigate whether DM was involved in the risk of CCV events and the progression of renal disorder in PA patients. This study was conducted as a part of the Japan Primary Aldosteronism Study/ Japan Rare Intractable Adrenal Diseases Study (JPAS/JRAS) study and retrospective cross-sectional analysis. The nationwide PA registry in Japan was established at 29 centers, including 15 university hospitals and 14 city hospitals. Patients, who were diagnosed PA between January 2006 and October 2016 and had available data of CCV events and DM, were enrolled (n=2,524). Logistic and liner-regression analysis for CCV events and renal parameters were performed. DM significantly increased the odds ratio of CCV events (OR 1.59, 95% CI: 1.05-2.41). DM also significantly increased the odds ratio of proteinuria (OR 2.25, 95% CI: 1.59-3.16) and had significant positive correlation with declines in eGFR (β=0.05, p=0.02). In conclusion, DM is an independent risk factor for CCV events and proteinuria in PA patients. We should pay attention to whether DM coexists with PA and treat both DM and PA to prevent the exacerbation of CCV diseases and kidney disease. (Supported by AMED grants No. JP17ek0109112/ JP19ek0109352; National Center for Global Health and Medicine, Japan (27-1402/ 30-1008)).

scholarly journals As patients get older, we should be aware of salt levels in factor products

2016 ◽  
Vol 3 (1) ◽  
pp. 67-70
Author(s):  
Sharon Alavian ◽  
Wendy Hutchinson
Keyword(s):  
Health Care ◽  
Risk Factor ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Health Care Professionals ◽  
Salt Intake ◽  
Sodium Content ◽  
Cerebrovascular Events ◽  
High Prevalence ◽  
Replacement Factor

Abstract Hypertension is a well-known risk factor for ischaemic heart disease and cerebrovascular events. Globally, there is a drive to try to reduce salt intake. In an older population, where hypertension is likely to have a high prevalence, are health care professionals aware of the sodium content in replacement factor?

Asymptomatic Carotid T1-High-Intense Plaque as a Risk Factor for a Subsequent Cerebrovascular Ischemic Event

2017 ◽  
Vol 43 (5-6) ◽  
pp. 250-256 ◽  
Author(s):  
Yoshitaka Kurosaki ◽  
Kazumichi Yoshida ◽  
Hitoshi Fukuda ◽  
Akira Handa ◽  
Masaki Chin ◽  
...  
Keyword(s):  
Risk Factor ◽  
Signal Intensity ◽  
High Signal Intensity ◽  
High Signal ◽  
Asymptomatic Carotid ◽  
Ischemic Event ◽  
Cox Regression Analysis ◽  
Carotid Mri ◽  
Cerebrovascular Events

Background: Intraplaque hemorrhage, detected as a high-signal intensity on carotid MRI, is also strongly associated with ischemic events in symptomatic patients. However, in asymptomatic patients, the relationship of the T1-high intense plaque and the subsequent stroke is not clear. The aim of this study is to test the hypothesis that asymptomatic carotid T1-high intense plaque is a risk factor for a subsequent cerebrovascular ischemic event. Methods: Of the 1,353 consecutive patients, who underwent head and carotid MRI as part of their annual medical check-up, the imaging quality of 13 was poor and 150 did not present for follow-up examination, thus leaving 1,190 subjects for evaluation. Of the 1,190 patients, 96 patients had findings of high-signal intensity on carotid MRI and 1,094 patients did not. Cerebrovascular events were retrospectively evaluated. Results: During a mean follow-up period of 53 months, 4 patients with high-signal intensities on carotid MRI (4%) and 3 with no findings (0.3%) had a cerebrovascular ischemic event, with the occurrences significantly higher in the high-signal-intensity group. (p < 0.01) Cox regression analysis indicated that the presence of the high-intense plaque on carotid MRI (hazard ratio [HR] 4.2; 95% CI 1.0-17.1; p = 0.04), age (HR 1.1; 95% CI 1.0-1.2; p = 0.003), and diabetes mellitus (HR 7.2; 95% CI 1.8-27.4; p = 0.004) were associated with the occurrence of subsequent ischemic cerebrovascular events. Conclusions: Asymptomatic carotid T1-high-intense plaque might be a potential high-risk factor for a subsequent cerebrovascular ischemic event.

Abstract 17806: The Prognostic Importance of Frequent Premature Atrial Contractions Following Ischemic Cerebrovascular Events

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
John J Keaney ◽  
Layan Akijian ◽  
Doug Mulholland ◽  
Niamh Hannon ◽  
Danielle M Ní Chróinín ◽  
...  
Keyword(s):  
Risk Factor ◽  
Recurrent Events ◽  
Cox Regression ◽  
Holter Monitoring ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Cerebrovascular Events ◽  
Significant Difference ◽  
Prognostic Importance

Background: Following ischemic cerebrovascular accident (CVA) or transient ischemic attack (TIA) aggressive risk factor modification is undertaken to reduce the risk of recurrent events. Holter monitoring is advocated to facilitate the detection and treatment of Atrial Fibrillation (AF). Frequent Premature Atrial Contractions (PACs) are associated with the development of AF, but to date it is unknown whether the burden of PACs on Holters is of any prognostic importance following CVA/TIA. Objective: PACs on Holter monitoring may be a marker for recurrent cerebrovascular events post CVA/TIA. Methods: Retrospective analysis was performed on Holters of patients with CVA/TIA enrolled in a prior population based stroke study. Frequent PACs were defined as a rate of PACs ≥ 100 per 24 hours. The primary endpoint was recurrent CVA or TIA. Results: 84 cases (61.0% male) were reviewed. Mean age was 69.7 ± 12.4 years. Mean time to follow-up was 2514.6 ± 91.2 days. The average number of PACs in the frequent group (Hi-PAC, 21 patients) was 1610.8 ± 4541.4 compared with 21.8 ± 27.6 in those with less than 100 PACs (Lo-PAC, 63 patients). There was no statistically significant difference in age, gender, hypertension or diabetes between the two groups. On follow-up there were 20 recurrent events and 33 patients died. In the Hi-PAC group there were 8 (38.1%) recurrent events, and 16 (76.2%) patients died versus 12 (18.8%) and 17 (26.6%) respectively in Lo-PAC group. On Cox regression analysis the Hazard ratio (HR) for recurrent events was 2.75 (95% confidence interval (CI) 1.08 to 7.01). Kaplan Meier curves revealed a statistically significant difference in recurrance rates between the two groups (p < 0.05). There was also a statistically significant difference in overall mortality on Kaplan Meier survival analysis (p < 0.001), and with a hazard ratio on Cox regression analysis of 3.47 (95% CI 1.74 [[Unable to Display Character: &#8211;]] 6.91). There was no significant difference in incidence of MI or AF. Conclusion: Frequent PACs on Holter monitor represent a significant risk factor for both recurrent events and mortality following CVA/TIA. Further prospective studies should be performed to assess whether these patients may benefit from more aggressive anticoagulation, similar to those with AF.

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