Management of vascular risk factors and co-morbidities in secondary stroke prevention

ESC CardioMed ◽  
2018 ◽  
pp. 971-975
Author(s):  
Martin O’Donnell ◽  
Cliona Small
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Risk Factor ◽  
Ischaemic Stroke ◽  
Stroke Prevention ◽  
Alcohol Intake ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Vascular Events ◽  
Lifestyle Risk

Medical approaches to reducing the risk of recurrent stroke following ischaemic stroke or transient ischaemic attack, and other major vascular events, involves a targeted modification of vascular risk factors, including lifestyle factors (e.g. physical inactivity, smoking, and diet), hypertension, and hyperlipidaemia and glycaemic control. The INTERSTROKE study reported that ten potentially modifiable vascular risk factors were associated with about 90% of the population attributable risk for stroke. Modification of lifestyle risk factors remains a cornerstone of stroke prevention, and includes promoting increased physical activity, smoking cessation, adopting healthier dietary patterns, weight reduction in those who are overweight/obese, and avoiding high alcohol intake (and heavy episode alcohol intake). All patients with blood pressure levels greater than or equal to 140/90 mmHg should be treated with antihypertensive therapy (although some suggest a lower threshold in patients with non-cardioembolic stroke), with a recent trial suggesting that patients with small vessel ischaemic stroke may benefit from lowering blood pressure to less than 130/90 mmHg. Statin therapy in patients with elevated low-density lipoprotein is associated with a reduction in major vascular events after ischaemic stroke, with a more aggressive strategy adopted in patients with ischaemic stroke due to large vessel atherosclerosis. While sleep apnoea is a risk factor for stroke, treatment with continuous positive airway pressure did not reduce the risk of stroke in a recent, large clinical trial. The optimal approach to achieve high rates of vascular risk factor targets following stroke has not been identified, but evaluations of community-based interventions are ongoing.

scholarly journals Sugar-sweetened beverages, vascular risk factors and events: a systematic literature review

2014 ◽  
Vol 18 (7) ◽  
pp. 1145-1154 ◽  
Author(s):  
Amelie Keller ◽  
Berit L Heitmann ◽  
Nanna Olsen
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Blood Sugar ◽  
Blood Lipid ◽  
Vascular Risk Factors ◽  
Current Evidence ◽  
Vascular Risk ◽  
Vascular Events ◽  
Sugar Sweetened Beverages ◽  
Sweetened Beverages

AbstractObjectiveA high intake of sugar-sweetened beverages (SSB) has been linked to weight gain, obesity and type 2 diabetes; however, the influence on CVD risk remains unclear. Therefore, our objective was to summarize current evidence for an association between SSB consumption and cardiovascular risk factors and events.DesignThe article search was performed in August 2013. Two independent researchers performed the article search and selection, data extraction and quality assessment. Eligible studies reported the intake of SSB and one of the following outcomes: change in blood pressure, blood lipid or blood sugar, or CVD events such as stroke or myocardial infarction. Only intervention and longitudinal studies were included.SubjectsOnly studies in adults (aged 18+ years old) were considered.ResultsTwo of four prospective studies found clear direct associations between SSB consumption and CHD, while two of three studies, including both men and women, found direct associations between SSB consumption and stroke; however, the association was significant among women only. All included studies examining vascular risk factors found direct associations between SSB consumption and change in blood pressure, blood lipid or blood sugar.ConclusionsThe reviewed studies generally showed that SSB intake was related to vascular risk factors, whereas associations with vascular events were less consistent. Due to a limited number of published papers, especially regarding vascular events, the strength of the evidence is still limited and hence more studies are needed before firm conclusions can be made.

Abstract P676: Rates of Preventable Thrombectomy in Acute Ischemic Stroke

Stroke ◽  
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.

Abstract 3358: Sex Differences in Vascular Risk Factors in a Multi-ethnic, Medically Underserved Stroke Population

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Daphne Antillon ◽  
Natalie Valle ◽  
Kaiwen Lin ◽  
Waimei Tai ◽  
Mary Ann Gallup ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Sex Differences ◽  
Alcohol Abuse ◽  
Vascular Risk Factors ◽  
Medically Underserved ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Low Hdl ◽  
History Of

Background: Recent nationally representative studies of stroke patients have revealed that vascular risk factors are not as aggressively controlled in women compared to men. Medically underserved minority populations are at particularly high risk for poor control of vascular risk factors; however, little is known about sex differences in this population. Methods: Sex-specific vascular risk factors and admission medications were assessed for 440 consecutive ischemic stroke patients (39% female) admitted to a safety-net public hospital in Los Angeles County. Multivariate logistic regression was used to determine sex differences in vascular risk factors, adjusting for age and race. Results: The mean age was 58.9 (SE 10.6) years, 58% were Hispanic, 7% were white, 13% were black, 20% were Asian, and 1% were Native American. Stroke classification (using modified TOAST) revealed the following distribution: 35% small vessel, 20% large vessel, 7% cardioembolic, 23% cryptogenic, 13% >1 possible etiology, and 3% other mechanisms (e.g. drug use). Women had higher mean glycosylated hemoglobin levels than men (8.0% vs 7.4%, p<0.01) and were more likely than men to have a history of type 2 diabetes (49% vs. 40% male, p=0.04), systolic blood pressure > 140 mm Hg (72% vs. 62%, p=0.03), total cholesterol > 200 mg/dL (46% vs. 36%, p=0.04), and low HDL levels (<40 mg/dL for men and <50 mg/dL for women)(83% vs. 79%, p <0.01). Men were more likely than women to have a previous history of stroke (19% vs. 13%, p = 0.05), smoking (49% vs 19%, p<0.01), and alcohol abuse (28% vs. 7%, p<0.01). After adjustment for race and age, women were more likely than men to have total cholesterol > 200 mg/dL (OR 1.56, 95% CI 1.05-2.31), BMI ≥ 30 kg/m 2 (OR 1.55, 95% CI 1.03-2.34), systolic blood pressure >140 mm Hg (OR 1.46, 95% CI 0.96-2.22), low HDL (1.26, 95% CI 0.76-2.08), and triglyceride level > 150 mg/dL (OR 1.09, 95% CI 0.74-1.63); however, the latter 3 were not significant. After adjustment for race and age, men were more likely than women to have a history of smoking (OR 4.54, 95% CI 2.78-7.14) and alcohol abuse (OR 5.56, 95% CI 2.86-11.11). Conclusions: In this multi-ethnic population with inadequate access to care, women are more likely than men to have obesity, hypertension, and dyslipidemia while men are more likely than women to smoke or abuse alcohol. Larger studies are necessary to validate these findings. In the meantime, interventions aimed at reducing the incidence of metabolic syndrome components among women and smoking and alcohol abuse among men in underserved communities are likely warranted.

scholarly journals Differing Pattern of Ambulatory Blood Pressure in Very Elderly Men Expresses Dynamics in Atherosclerotic Load in the Senescence

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Arkadiusz Siennicki-Lantz ◽  
Sölve Elmståhl
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Measurement ◽  
Ankle Brachial Index ◽  
The Elderly ◽  
Population Based ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Pressure Development

To assess an impact of vascular risk factors on ambulatory blood pressure measurement (ABPM) in the elderly, we followed up a population-based cohort of men from 68 until 82 years, when 104 survivors underwent ABPM.Results. At age 68, hypertension and high clinic blood pressure (CBP) did not predict ABPM level. Smoking and low ankle-brachial index (ABI) predicted higher ABPM variability and pulse pressure (PP), but not absolute ABPM values. At age 82, hypertension, high or increasing CBP, strongly positively correlated with all variables of ABPM. Carotid stenosis, low or declining ABI during followup, correlated with higher nocturnal ABPM and PP.Concluding. Hypertension and vascular risk factors in a cohort of 68-year-old men do not result in higher ABPM at age 82, possibly due to inflection point in their pressure development. Higher ABPM reflects instead an increasing CBP and aggravating atherosclerosis during the preceding decade in that part of the cohort with previously favorable risk factor status.

Vascular risk factors, alcohol intake, and cognitive decline

2008 ◽  
Vol 12 (6) ◽  
pp. 376-381 ◽  
Author(s):  
F. Panza ◽  
C. Capurso ◽  
A. D’Introno ◽  
A. M. Colacicco ◽  
V. Frisardi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Decline ◽  
Alcohol Intake ◽  
Vascular Risk Factors ◽  
Vascular Risk

scholarly journals Aerobic exercise interventions reduce blood pressure in patients after stroke or transient ischaemic attack: a systematic review and meta-analysis

2018 ◽  
Vol 53 (24) ◽  
pp. 1515-1525 ◽  
Author(s):  
Cheng Wang ◽  
Jessica Redgrave ◽  
Mohsen Shafizadeh ◽  
Arshad Majid ◽  
Karen Kilner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Blood Pressure ◽  
Transient Ischaemic Attack ◽  
Meta Analysis ◽  
Vascular Risk Factors ◽  
Cochrane Library ◽  
Vascular Risk ◽  
Exercise Interventions ◽  
Ischaemic Attack

ObjectiveSecondary vascular risk reduction is critical to preventing recurrent stroke. We aimed to evaluate the effect of exercise interventions on vascular risk factors and recurrent ischaemic events after stroke or transient ischaemic attack (TIA).DesignIntervention systematic review and meta-analysis.Data sourcesOVID MEDLINE, PubMed, The Cochrane Library, Web of Science, The National Institute for Health and Care Excellence, TRIP Database, CINAHL, PsycINFO, SCOPUS, UK Clinical Trials Gateway and the China National Knowledge Infrastructure were searched from 1966 to October 2017.Eligibility criteriaRandomised controlled trials evaluating aerobic or resistance exercise interventions on vascular risk factors and recurrent ischaemic events among patients with stroke or TIA, compared with control.ResultsTwenty studies (n=1031) were included. Exercise interventions resulted in significant reductions in systolic blood pressure (SBP) −4.30 mm Hg (95% CI −6.77 to −1.83) and diastolic blood pressure −2.58 mm Hg (95% CI −4.7 to −0.46) compared with control. Reduction in SBP was most pronounced among studies initiating exercise within 6 months of stroke or TIA (−8.46 mm Hg, 95% CI −12.18 to −4.75 vs −2.33 mm Hg, 95% CI −3.94 to −0.72), and in those incorporating an educational component (−7.81 mm Hg, 95% CI −14.34 to −1.28 vs −2.78 mm Hg, 95% CI −4.33 to −1.23). Exercise was also associated with reductions in total cholesterol (−0.27 mmol/L, 95% CI −0.54 to 0.00), but not fasting glucose or body mass index. One trial reported reductions in secondary vascular events with exercise, but was insufficiently powered.SummaryExercise interventions can result in clinically meaningful blood pressure reductions, particularly if initiated early and alongside education.

scholarly journals Vascular risk at younger ages most strongly associates with current and future brain volume

Neurology ◽  
2018 ◽  
Vol 91 (16) ◽  
pp. e1479-e1486 ◽  
Author(s):  
Matthew P. Pase ◽  
Kendra Davis-Plourde ◽  
Jayandra J. Himali ◽  
Claudia L. Satizabal ◽  
Hugo Aparicio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Brain Volume ◽  
Vascular Risk Factor ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Cross Sectional ◽  
Strength Of Association ◽  
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.

Stroke prevention: Management of modifiable vascular risk factors

2003 ◽  
Vol 250 (9) ◽  
pp. 1125-1126
Author(s):  
D. Leys ◽  
D. Deplanque ◽  
M.-A. Mackowiak-Cordoliani ◽  
C. Lucas ◽  
R. Bordet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stroke Prevention ◽  
Vascular Risk Factors ◽  
Vascular Risk

scholarly journals Vascular Events, Vascular Disease and Vascular Risk Factors—Strongly Intertwined with COVID-19

2020 ◽  
Vol 22 (11) ◽  
Author(s):  
Adrian Scutelnic ◽  
Mirjam R. Heldner
Keyword(s):  
Risk Factors ◽  
Vascular Disease ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Vascular Events ◽  
Increased Risk ◽  
Clinical Benefits ◽  
Infection And Inflammation ◽  
Unhealthy Diet ◽  
New Perspective

Abstract Purpose of review To elucidate the intertwining of vascular events, vascular disease and vascular risk factors and COVID-19. Recent findings Strokes are a leading cause of disability and death worldwide. Vascular risk factors are important drivers of strokes. There are unmodifiable vascular risk factors such as age and ethnicity and modifiable vascular risk factors. According to the INTERSTROKE study, the 10 most frequent modifiable vascular risk factors are arterial hypertension, physical inactivity, overweight, dyslipidaemia, smoking, unhealthy diet, cardiac pathologies, diabetes mellitus, stress/depression and overconsumption of alcohol. Also, infection and inflammation have been shown to increase the risk of stroke. There is high-quality evidence for the clinical benefits of optimal primary and secondary stroke prevention. The COVID-19 pandemic brought a new perspective to this field. Vascular events, vascular disease and vascular risk factors—and COVID-19—are strongly intertwined. An increased risk of vascular events—by multifactorial mechanisms—has been observed in COVID-19 patients. Also, a higher rate of infection with COVID-19, severe COVID-19 and bad outcome has been demonstrated in patients with pre-existing vascular disease and vascular risk factors. Summary At present, we suggest that regular interactions between healthcare professionals and patients should include education on COVID-19 and on primary and secondary vascular prevention in order to reduce the burden of disease in our ageing populations.

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