Comparison of coronary heart disease and stroke risks attributable to vascular risk factors: results from the PRIME study

Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI.Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI.Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR = 12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively).Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI.

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THE VASCULAR RISK FACTORS ASSOCIATED WITH ANTIPLATELET RESISTANCE IN ISCHEMIC STROKE PATIENTS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i12.38591 ◽

2020 ◽

pp. 144-147

Author(s):

RIZALDY TASLIM PINZON ◽

BULAN MARCHELLIA WIJAYA

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Ischemic Stroke ◽

Ischemic Heart Disease ◽

Vascular Risk Factors ◽

Ischemic Heart ◽

Vascular Risk ◽

Stroke Patients ◽

Elderly Age ◽

Factors Associated

Objectives: This research is to measure the prevalence rate of antiplatelet resistance in ischemic stroke patients and measure the vascular risk factors associated with antiplatelet resistance in patients with ischemic stroke. Methods and Subjects: This was a cross-sectional study with the number of respondents in this study amounted to 155 patients who all had ischemic stroke disease at Bethesda Hospital in Yogyakarta Indonesia used stroke registry to complete the data of the risk factors. VerifyNow method is used to measure the responsiveness of antiplatelet therapy. Results: Among the 155 patients with ischemic stroke, 45 were women (29%), 110 were men (71%), and the elderly (age more than 60 years old) in 81 patients. In total 155 patients with ischemic stroke, 106 of them have hypertensive, with diabetes are 19 patients, dyslipidemia is 90 patients, and ischemic heart disease in 13 patients. The prevalence of antiplatelet resistance in risk factors, for age more than 60 years, is 21 patients (25%, RR=1.06, *p=0.96), in diabetes is 7 patients (36%, RR=1.17, **p=0.74), dyslipidemia is 19 patients (21%, RR=0.68, ***p=0.24), and ischemic heart disease is four patients (30%). Among 127 patients, 22% (28 patients) had aspirin resistance, while from 42 patients, 26.2% (11 patients) were resistant to clopidogrel. Conclusion: Antiplatelet resistance is common in ischemic stroke patients. One of five patients treated with antiplatelet showed non-responsiveness. Vascular risk factors do not increase the risk of antiplatelet resistance in ischemic stroke patients.

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A comparison of the associations between risk factors and cardiovascular disease in Asia and Australasia

European Journal of Cardiovascular Prevention & Rehabilitation ◽

10.1097/01.hjr.0000170264.84820.8e ◽

2005 ◽

Vol 12 (5) ◽

pp. 484-491 ◽

Cited By ~ 59

Author(s):

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

New Zealand ◽

Treatment Strategies ◽

Haemorrhagic Stroke ◽

Vascular Risk ◽

Prevention And Treatment

Background Cardiovascular disease is already the leading cause of death in many Asian populations. Relationships between vascular risk factors and cardiovascular disease may differ in Asian and western populations. Previously, a lack of prospective data has prevented the reliable quantification of such differences, which, if they were shown to exist, would suggest that novel cardiovascular prevention and treatment strategies are required for Asia. Design An individual participant data meta-analysis of 32 studies from the Asia-Pacific region involving 331 100 subjects (75% from Asia; 25% from the predominantly Caucasian populations of Australia and New Zealand). Methods Outcomes were death from coronary heart disease, ischaemic and haemorrhagic stroke. Hazard ratios were estimated from Cox models for systolic blood pressure (SBP), total cholesterol, triglycerides, body mass index, diabetes and current cigarette smoking, stratified by study and sex and adjusted for age, the other risk factors and regression dilution. Results After an average period of follow-up of 4 years there were 2082 deaths from coronary heart disease, 600 from haemorrhagic stroke and 420 from ischaemic stroke. The direction and strength of the associations between risk factors and cardiovascular outcomes were similar in the two regions, although in two cases there were significant differences. Triglycerides were more strongly associated with coronary heart disease in Australia and New Zealand ( P = 0.03), whereas SBP showed a stronger relationship with haemorrhagic stroke in Asia ( P = 0.04). Conclusions Classical vascular risk factors act similarly in Asian and Caucasian populations; prevention and treatment strategies should thus be similar. Blood pressure reduction should be particularly effective in Asia.

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Ischemic Heart Disease in Subjects of Young Age: Current State of the Problem: Prevalence and Cardio-Vascular Risk Factors

Kardiologiia ◽

10.18087/cardio.2018.10.10184 ◽

2018 ◽

Vol 17 (10) ◽

pp. 53-58 ◽

Cited By ~ 3

Author(s):

E. Yu. Andreenko ◽

◽

I. S. YAvelov ◽

M. M. Loukianov ◽

A. N. Vernohaeva ◽

...

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Vascular Risk Factors ◽

Young Age ◽

Ischemic Heart ◽

Vascular Risk ◽

Current State ◽

Cardio Vascular

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Cerebral lesions on magnetic resonance imaging, heart disease, and vascular risk factors in subjects without stroke. A population-based study.

Stroke ◽

10.1161/01.str.25.5.929 ◽

1994 ◽

Vol 25 (5) ◽

pp. 929-934 ◽

Cited By ~ 90

Author(s):

A Lindgren ◽

A Roijer ◽

O Rudling ◽

B Norrving ◽

E M Larsson ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Risk Factors ◽

Heart Disease ◽

Magnetic Resonance ◽

Population Based ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Resonance Imaging ◽

Cerebral Lesions ◽

Population Based Study

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Vascular risk factors and stroke risk across the life span: A population-representative study of half a million people

International Journal of Stroke ◽

10.1177/17474930211070682 ◽

2022 ◽

pp. 174749302110706

Author(s):

Raed A Joundi ◽

Scott B Patten ◽

Jeanne VA Williams ◽

Eric E Smith

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Stroke Risk ◽

Population Attributable Fraction ◽

Attributable Fraction ◽

Hazard Ratio ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Younger Age ◽

Over Time

Background: The incidence of stroke in developed countries is increasing selectively in young individuals, but whether this is secondary to traditional vascular risk factors is unknown. Methods: We used the Canadian Community Health Survey from 2000 to 2016 to create a large population-representative cohort of individuals over the age of 30 and free from prior stroke. All analyses were stratified by age decile. We linked with administrative databases to determine emergency department visits or hospitalizations for acute stroke until December 2017. We calculated time trends in risk factor prevalence (hypertension, diabetes, obesity, and smoking) using meta-regression. We used Cox proportional hazard models to evaluate the association between vascular risk factors and stroke risk, adjusted for demographic, co-morbid, and social variables. We used competing risk regression to account for deaths and calculated population-attributable fractions. In a sensitivity analysis, we excluded those with prior heart disease or cancer. Results: We included 492,400 people in the analysis with 8865 stroke events over a median follow-up time of 8.3 years. Prevalence of hypertension, diabetes, and obesity increased over time while smoking decreased. Associations of diabetes, hypertension, and obesity with stroke risk were progressively stronger at younger age (adjusted hazard ratio for diabetes was 4.47, 95% confidence interval (CI) = 1.95–10.28 at age 30–39, vs 1.21, 95% CI = 0.93–1.57 at age 80+), although the obesity association was attenuated with adjustment. Smoking was associated with higher risk of stroke without a gradient across age deciles, although had the greatest population-attributable fraction at younger age. The hazard ratio for stroke with multiple concurrent risk factors was much higher at younger age (adjusted hazard ratio for 3–4 risk factors was 8.60, 95% CI = 2.97–24.9 at age 30–39 vs 1.61, 95% CI = 0.88–2.97 at age 80+) and results were consistent when accounting for the competing risk of death and excluding those with prior heart disease or cancer. Conclusions: Diabetes and hypertension were associated with progressively elevated relative risk of stroke in younger individuals and prevalence was increasing over time. The association of obesity with stroke was not significant after adjustment for other factors. Smoking had the greatest prevalence and population-attributable fraction for stroke at younger age. Our findings assist in understanding the relationship between vascular risk factors and stroke across the life span and planning public health measures to lower stroke incidence in the young.

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Clinical Characteristics of Coronary Heart Disease as Predictors of Ischemic Stroke: A Long-term Prospective Follow-up in the BIP Study.

Stroke ◽

10.1161/str.32.suppl_1.362 ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 362-362

Author(s):

David Tanne ◽

Avraham Shotan ◽

Uri Goldbourt ◽

Valentina Boyko ◽

Henrietta Reicher-Reiss ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Ischemic Stroke ◽

Unstable Angina ◽

Vascular Risk ◽

Increased Risk ◽

Conventional Risk Factors

P126 Objective: To assess characteristics and severity of coronary heart disease (CHD) predisposing to ischemic stroke, beyond conventional vascular risk factors. Methods: We prospectively followed up 3,122 patients with documented CHD included in a secondary prevention trial of lipid modification, the Bezafibrate Infarction Prevention trial. Patients had CHD documented by a history of myocardial infarction ≥6 months and <5 years before enrollment and/or stable angina pectoris confirmed by ancillary diagnostic testing, and a selected lipid profile. Patients with severe heart failure or unstable angina upon enrollment were excluded. Results: During a mean follow-up period of 8.2 years, 186 patients developed an ischemic stroke. The rate of ischemic stroke was 8.8% among patients with an active anginal syndrome[class ≥2 according to the Canadian Cardiovascular Society angina Classification, (CCSC)]vs. 5.1% in patients with a CCSC class of 1 (p<0.001). Patients with heart failure according to class ≥2 of the New York Heart Association classification had a 7.7% rate of ischemic stroke vs. 5.5% among patients with a class of 1 (no limitation of physical activity; p=0.03). In a Cox Proportional Hazard model adjusting for conventional risk factors, CCSC angina class ≥2 remained an independent predictor of ischemic stroke (Hazard ratio 1.43; 95%CI 1.05–1.96) and hospitalization for a confirmed diagnosis of unstable angina during follow-up conferred an additional independent increased risk (Hazard ratio 1.7; 95%CI 1.04–2.87). Hazard ratios of conventional risk factors, for comparison, where 1.49 for a 10 year age increment, 2.29 for diabetes mellitus, 1.75 for current smoking, 1.81 for peripheral vascular disease, and 1.14 for a 10 mmHg increase in systolic blood pressure. Conclusion: Active angina (CCSC class ≥2)and hospitalization for unstable angina during follow-up among CHD patients,confer an independent increased risk of ischemic stroke, beyond conventional vascular risk factors.

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