WITHDRAWN: Neurological examination, rather than vascular risk factor assessment, serves to distinguish strokes from stroke mimics in a population with high prevalence of vascular risk factors

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 comparison of traditional vascular risk factor between hemorrhagic and non-hemorrhagic stroke

Asian Journal of Medical Sciences ◽

10.3126/ajms.v8i6.18277 ◽

2017 ◽

Vol 8 (6) ◽

pp. 5-8

Author(s):

Rizaldy Taslim Pinzon ◽

Rosa De Lima Renita Sanyasi ◽

Andre Dharmawan Wijono

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Protective Factor ◽

Hemorrhagic Stroke ◽

Sample Size Calculation ◽

Vascular Risk Factor ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Significance Level ◽

Stroke Registry

Background: Understanding about risk factors of stroke based on its pathology is very important. Previous study about the vascular risk factors in patients with stroke in Indonesia is very limited.Aims and Objective: Measure the comparison between traditional vascular risk factors in patients with hemorrhagic stroke and non-hemorrhagic (ischemic) stroke.Materials and Methods: This was a nested case-control study using secondary data from electronic medical record and electronic stroke registry of Bethesda Hospital Yogyakarta Indonesia. The stroke was diagnosed with standard way by well-trained neurologist and confirmed with CT Scan. The traditional risk factors were defined systematically. We used Dupont Power and Sample Size calculation software and StatCal EpiInfo software with significance level 0,05.Result: The data of 200 subjects consisted of 100 patients with hemorrhagic stroke and 100 patients with non-hemorrhagic stroke. Hypertension was main vascular risk factor in both Group but it was more common in hemorrhagic stroke (OR: 2,528, 95% CI: 0,069 ; 0,316, p < 0,002). Dyslipidemia was a protective factor against hemorrhagic stroke (OR: 0,147, 95% CI: 1,415 ; 4,516, p < 0,001). Diabetes was more common in ischemic stroke compared with hemorrhagic stroke (68% and 32%) respectively.Conclusion: Hypertension, dyslipidemia, and diabetes were modifiable traditional vascular risk factors which significantly had effect on stroke. Asian Journal of Medical Sciences Vol.8(6) 2017 5-8

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Predictors for carotid and femoral artery intima-media thickness in a non-diabetic sleep clinic cohort

PLoS ONE ◽

10.1371/journal.pone.0252569 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252569

Author(s):

Christopher Lambeth ◽

Rita Perri ◽

Sharon Lee ◽

Manisha Verma ◽

Nicole Campbell-Rogers ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Intervention Study ◽

Intima Media Thickness ◽

Vascular Risk Factor ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Link Type ◽

Media Thickness ◽

Continuous Positive Pressure

Introduction The impact of sleep disordered breathing (SDB) on arterial intima-media thickness (IMT), a surrogate measure for cardiovascular disease, remains uncertain, in part because of the potential for non-SDB vascular risk factor interactions. In the present study, we determined predictors for common carotid (CCA) and femoral (CFA) artery IMT in an adult, sleep clinic cohort where non-SDB vascular risk factors (particularly diabetes) were eliminated or controlled. Methods We recruited 296 participants for polysomnography (standard SDB severity metrics) and CCA/CFA ultrasound examinations, followed by a 12 month vascular risk factor minimisation (RFM) and continuous positive pressure (CPAP) intervention for participants with a range of SDB severity (RFM Sub-Group, n = 157; apnea hyponea index [AHI]: 14.7 (7.2–33.2), median [IQR]). Univariable and multivariable linear regression models determined independent predictors for IMT. Linear mixed effects modelling determined independent predictors for IMT change across the intervention study. P<0.05 was considered significant. Results Age, systolic blood pressure and waist:hip ratio were identified as non-SDB predictive factors for CCA IMT and age, weight and total cholesterol:HDL ratio for CFA IMT. No SDB severity metric emerged as an independent predictor for either CCA or CFA IMT, except in the RFM Sub-Group, where a 2-fold increase in AHI predicted a 2.4% increase in CFA IMT. Across the intervention study, CCA IMT decreased in those who lost weight, but there was no CPAP use interaction. CFA IMT, however, decreased by 12.9% (95%CI 6.8, 18.7%, p = 0.001) in those participants who both lost weight and used CPAP > = 4hours/night. Conclusion We conclude that SDB severity has little impact on CCA IMT values when non-SDB vascular risk factors are minimised or not present. This is the first study, however, to suggest a potential linkage between SDB severity and CFA IMT values. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12611000250932 and ACTRN12620000694910.

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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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Vascular risk burden is a key player in the early progression of Alzheimer's disease

10.1101/2021.12.18.21267994 ◽

2021 ◽

Author(s):

João Pedro Ferrari-Souza ◽

Wagner S. Brum ◽

Lucas A. Hauschild ◽

Lucas U. Da Ros ◽

Pâmela C. L. Ferreira ◽

...

Keyword(s):

Risk Factors ◽

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Risk Factor ◽

Cognitive Decline ◽

Vascular Risk Factor ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Preclinical Alzheimer’S Disease ◽

Risk Factor Burden

Understanding whether vascular risk factors synergistically potentiate Alzheimer's disease progression is important in the context of emerging treatments for preclinical Alzheimer's disease. The existence of a synergistic relationship could suggest that the combination of therapies targeting Alzheimer's disease pathophysiology and vascular risk factors might potentiate treatment outcomes. In the present retrospective cohort study, we tested whether vascular risk factor burden interacts with Alzheimer's disease pathophysiology to accelerate neurodegeneration and cognitive decline in cognitively unimpaired subjects. We evaluated 503 cognitively unimpaired participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. Baseline vascular risk factor burden was calculated considering the history of cardiovascular disease, hypertension, diabetes mellitus, hyperlipidemia, stroke or transient ischemic attack, smoking, atrial fibrillation, and left ventricular hypertrophy. Alzheimer's disease pathophysiology was evaluated using cerebrospinal fluid (CSF) amyloid-β1-42 (Aβ1-42) reflecting brain amyloidosis (A) and tau phosphorylated at threonine 181 (p-tau181) reflecting brain tau pathology (T). Individuals were dichotomized as having an elevated vascular risk factor burden (V+ if having two or more vascular risk factors) and as presenting preclinical Alzheimer's disease [(AT)+ if having abnormal CSF p-tau181 and Aβ1-42 levels]. Neurodegeneration was assessed with plasma neurofilament light (NfL) and global cognition with the modified version of the Preclinical Alzheimer's Cognitive Composite. Linear mixed-effects models revealed that an elevated vascular risk factor burden synergistically interacted with Alzheimer's disease pathophysiology to drive longitudinal increases in plasma NfL levels (β = 5.08, P = 0.016) and cognitive decline (β = -0.43, P = 0.020). Additionally, we observed that vascular risk factor burden was not associated with CSF Aβ1-42 or p-tau181 changes over time. Survival analysis demonstrated that individuals with preclinical Alzheimer's disease and elevated vascular risk factor burden [(AT)+V+] had a significantly greater risk of clinical progression to cognitive impairment (adjusted Hazard Ratio = 3.5, P < 0.001). Our results support the notion that vascular risk factor burden and Alzheimer's disease pathophysiology are independent processes; however, they synergistically lead to neurodegeneration and cognitive decline. These findings can help in providing the blueprints for the combination of vascular risk factor management and Alzheimer's disease pathophysiology treatment in preclinical stages. Moreover, we observed plasma NfL as a robust marker of disease progression that may be used to track therapeutic response in future trials.

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The Age-Dependent Association Between Vascular Risk Factors and Depressed Mood

10.31219/osf.io/u2j8h ◽

2019 ◽

Author(s):

Maria Blöchl ◽

H. Lina Schaare ◽

Ute Kunzmann ◽

Steffen Nestler

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Depressed Mood ◽

Growth Models ◽

Later Life ◽

Vascular Risk Factor ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Latent Growth ◽

Risk Factor Burden

Objectives: Cumulative burden from multiple vascular risk factors has been linked to depressed mood but whether this association becomes stronger or weaker from mid- to later life is still unclear. This study investigated whether vascular risk factor burden is associated with levels and longitudinal changes in depressed mood and whether these associations are dependent on age. Method: Our sample included 6,835 individuals (52–89 years) from the English Longitudinal Study of Ageing (ELSA), who were free of vascular disease at baseline and underwent up to five bi-yearly follow-up assessments of depressed mood. A composite score incorporated the presence of five vascular risk factors: hypertension, diabetes, smoking, obesity, and hypercholesterolemia. We used second-order latent growth models to test whether levels and changes of depressed mood differed as a function of baseline vascular risk factor burden, and how these associations were moderated by age. Results: Baseline vascular risk factor burden was associated with higher levels of depressed mood, and this association varied with age, such that it was stronger in midlife compared to later life. Vascular risk factor burden was not associated with changes in depressed mood. Discussion: Our findings suggest that vascular risk factor burden in midlife, but less so in later life, predicts individual differences in depressed mood. These findings are consistent with reports on the importance of midlife vascular risk and support the idea that prevention of vascular risk in this age period may be critical to maintain mental health.

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PRELIMINARY FINDINGS OF TASHKENT HOSPITAL BASED STUDY OF RISK FACTORS FOR DIFFERENT ISCHEMIC STROKE SUBTYPES

European Medical Health and Pharmaceutical Journal ◽

10.12955/emhpj.v7i2.510 ◽

2014 ◽

Vol 7 (2) ◽

Author(s):

Khurshidakhon Abduboriyevna Rasulova

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Underlying Disease ◽

Vascular Risk Factors ◽

Aetiological Factor ◽

Vascular Risk ◽

Lacunar Stroke ◽

Stroke Incidence ◽

High Prevalence

Objective: To determine risk factors in different pathogenic subtypes of ischemic stroke in Tashkent hospital registry and to compare with the data of other stroke registers.Design: Prospective observational study.Participants: 300 adults aged 18 years or over who suffered first-ever acute ischemic stroke, of them, the data of 100 patients with atherothrombotic, lacunar and cardioembolic strokes were analyzed.Main outcome measures: Mathematically significant differences and not significant differences but interesting from other point of view. Categorical variables are expressed as frequencies and percentages. Differences were regarded as statistically significant when the P value was less than 0.05 (P<0.05).Results: Of 100 patients with acute first-ever ischemic stroke at the median age of 62.63±4.68 (interquartile range 25-92) years, 57% were men and 43% were women. Depending on aetiology and stroke subtype, all the patients were divided into three groups: 42 patients with atherothrombotic stroke, 41 – with lacunar stroke, and 17 patients with cardioembolic stroke. Atherothrombotic stroke developed often in people over 60 years old, while lacunar stroke prevailed at the younger age. Stroke cases increased in people over 51 years old. Although men were more likely to suffer strokes than women, stroke incidence was equal in both sexes with increasing of age (over 60 years old), especially in atherothrombotic stroke, testifying to that women live longer. Combination of cerebral atherosclerosis and hypertension was the most significant risk factor for stroke. Atherosclerosis was the main aetiological factor for ischemic stroke, independently of its pathogenic heterogeneity. Diabetes mellitus was an independent risk factor for all stroke subtypes, which in most cases worsened the course and outcome of stroke. Hypertension was the leader aetiological factor for lacunar stroke. In these patients, we also should consider the presence of other risk factors, e.g. severe large vessel obstructions, se-triglycerol ≥2 mmol/L, etc. Cardioembolic stroke developed mainly because of cardiac thrombosis and valve pathology, which were often associated with chronic diseases of other organs, worsening the course and outcome of stroke. Despite of high prevalence of myocardial infarction in men, women were more likely to develop cardioembolic stroke.Conclusions: This study found simultaneous influence of many risk factors (multifactorial disease) in the development of ischemic stroke. The more course and influence of the underlying disease and risk factor, the higher stroke risk and severity, especially in the absence or inadequate previous therapy of underlying disease before the stroke index. We have noted a high prevalence of under-diagnosis of vascular risk factors at levels of primary and secondary care. We recommend for improved public awareness of vascular risk factors and better diagnostic and treatment facilities aimed at addressing those factors at levels of primary and secondary healthcare. Larger population-based studies may provide additional data on stroke incidence and outcome among Uzbeks.

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Abstract P676: Rates of Preventable Thrombectomy in Acute Ischemic Stroke

Stroke ◽

10.1161/str.52.suppl_1.p676 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Rakhee Lalla ◽

Ryan Dunlow ◽

Karen L Yarbrough ◽

Prachi Mehndiratta ◽

Michael S Phipps ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Vascular Disease ◽

Antiplatelet Agent ◽

Left Ventricular ◽

Vascular Risk Factors ◽

Large Vessel ◽

Favorable Outcome ◽

Vascular Risk ◽

History Of

Introduction: The AHA notes that more than 76% of strokes are the first occurrence. There are class 1 recommendations for the management of common risk factors such as atrial fibrillation (AF), hyperlipidemia (HLD), hypertension (HTN), diabetes (DM), and vascular disease. The purpose of this study is to investigate the percentage of large vessel strokes that are potentially preventable with adequate management of vascular risk factors. Methods: A retrospective chart review was conducted on all patients undergoing endovascular therapy (EVT) from 2012-2019. Data was collected on vascular risk factors present prior to admission including HTN, DM, HLD, AF, and smoking. Preventable stroke was defined as having at least one of the following: untreated AF, untreated HLD, poorly controlled HTN (presence of left ventricular hypertrophy on transthoracic echo), history of vascular disease not on an antiplatelet agent, poorly controlled DM (A1c>10), current smoking. Groups were compared based on age, sex and 90 day functional outcomes, with favorable outcome defined as mRS ≤ 2. Results: Our sample included 396 patients who underwent EVT (mean age 65, 50% female). 42% of patients with Afib were not on anticoagulation, 31% of patients with HLD were untreated, 39% of patients with HTN were poorly controlled, 27% of patients with a history of vascular disease were not on an antiplatelet, 14% of patients with DM were poorly controlled, and 46% of all patients were smokers. In total, 78% of patients had at least 1 poorly controlled risk factor and 37% had at least 2. There was no difference in rates of preventable stroke between males and females (48% vs 52%, p=0.30) and between age groups above and below 70 (40% vs 60%, p=0.68). 64% of patients with well controlled risk factors had a favorable outcome compared to 51% with at least one poorly controlled risk factor (p=0.03). Conclusions: Our data suggests that despite guidelines on management of vascular risk factors, a large number of these are poorly controlled prior to admission for large vessel stroke, leading to a potentially preventable procedure. Not only could improved primary prevention save the wide array of resources utilized in EVT, but it could also influence long term outcomes in this cohort of patients.

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Abstract TMP98: Could Mobile Health be an Effective Strategy for Enhancing Stroke Prevention?

Stroke ◽

10.1161/str.48.suppl_1.tmp98 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Shimeng Liu ◽

Wuwei Feng ◽

Pratik Y Chhatbar ◽

Bruce I Ovbiagele

Keyword(s):

Risk Factors ◽

Smoking Cessation ◽

Risk Factor ◽

Glycemic Control ◽

Mobile Health ◽

Meta Analysis ◽

Vascular Risk Factor ◽

Smoking Abstinence ◽

Vascular Risk ◽

Risk Factor Control

Background: The overwhelming majority of strokes can be prevented via optimal vascular risk factor control. However, there remains an evidence practice gap with regard to treatment of vascular risk factors. With the rapid growth worldwide in cell-phone use, Internet connectivity, and digital health technology, mobile health (mHealth) technology may offer a promising approach to bridge these treatment gaps and reduce the global burden of stroke. Objective: To evaluate the effectiveness of mHealth in vascular risk factor control through a systemic review and meta-analysis. Methods: We searched PubMed from January 1, 2000 to May 17, 2016 using keywords: mobile health, mhealth, short message, cellular phone, mobile phone, stroke prevention and control, diabetes mellitus, hypertension, hyperlipidemia and smoking cessation. We performed a meta-analysis of all eligible randomized control clinical trials that assessed the long-term (at 6 months) effect of mHealth. Results: Of 79 articles identified, 13 of them met eligibility criteria (6 for glycemic control and 7 for smoking cessation) and were included for the final meta-analysis. There were no eligible studies for dyslipidemia or hypertension. mHealth resulted in greater HbA1c reduction at 6 months (6 studies; 663 subjects; SMD: -0.44; 95% CI: [-0.82, -0.06], P =0.02; Mean difference of decrease in HbA1c: -0.39%; 95% CI: [-0.74,-0.04], P =0.03). mHealth also led to relatively higher smoking abstinence rates at 6 months (7 studies; 9,514 subjects; OR: 1.54; 95% CI: [1.24, 1.90], P <0.0001). Conclusion: Use of mHealth improves glycemic control and smoking abstinence rates, two factors that may lead to better stroke outcomes. Future mHealth studies should focus on modifying premier vascular risk factors like hypertension, specifically in people with or at risk of stroke.

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Normative video head impulse test data in subjects with and without vascular risk factors

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-020-06332-w ◽

2020 ◽

Author(s):

Anders Hansson ◽

Jonatan Salzer

Keyword(s):

Risk Factors ◽

Healthy Subjects ◽

Vascular Risk Factor ◽

Vascular Risk Factors ◽

Healthy Adults ◽

University Hospital ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Vascular Risk ◽

Head Impulse

Abstract Purpose There is a paucity of age- and vascular risk factor-stratified video head impulse test (vHIT) vestibulo-ocular reflex (VOR) data in the literature. The aim of this study was to investigate the vHIT VOR properties in healthy subjects of different ages and subjects with vascular risk factors. Methods This was a prospective observational single-center study at a tertiary referral university hospital in northern Sweden. Healthy participants and subjects with vascular risk factors were investigated with a floor standing external camera vHIT device. Age-stratified mean VOR gain among healthy adults and between group gain and gain asymmetry differences were calculated. Results We included eighty-eight healthy adults with a mean (range) age of 50 (22–85) years and n = 48 stroke ward patients with vascular risk factors (but without vestibular disease) with a mean (range) age of 74 (42–92) years. The mean VOR gain of horizontal canals decreased at higher ages in healthy subjects (r = − 0.32, p < 0.01, n = 167 canals). The age-stratified mean (SD) VOR gains were < 30 years: 0.98 (0.07), 30–39 years: 0.97 (0.07), 40–49 years: 0.98 (0.06), 50–59 years: 0.99 (0.06), 60–69 years: 0.93 (0.08), ≥ 70 years: 0.89 (0.15). No consistent differences between healthy subjects and subjects with vascular risk factors were seen except for a trend towards more pronounced gain asymmetries in the latter group. Conclusions Age, but not vascular risk factors influence VOR gain. Age-adjusted vHIT-measurements may be useful in acute vertigo stroke risk differentiation.

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