scholarly journals Small Aneurysms With Low Rupture Risk Account for a Majority of Subarachnoid Hemorrhage

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Caleb Rutledge ◽  
Soren Jonzzon ◽  
Ethan A Winkler ◽  
Kunal P Raygor ◽  
Michael T Lawton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Standard Deviation ◽  
Natural History ◽  
Risk Score ◽  
Clinical Decision Making ◽  
Consecutive Series ◽  
Risk Of Rupture ◽  
The Mean ◽  
Small Aneurysms

Abstract INTRODUCTION Small, unruptured cerebral aneurysms are frequently found incidentally, but management remains controversial because of their uncertain natural history. Based on prospective studies, the rupture rate for small aneurysms is minimal. As a result, in the absence of other high-risk factors, small aneurysms are generally observed. However, subarachnoid hemorrhage (SAH) from small aneurysms is commonly observed in practice. Patient- and aneurysm-related risk factors for rupture, including a risk score (PHASES), help guide clinical decision-making. To determine the usefulness of size and the PHASES risk score as predictors of rupture, we studied a consecutive series of ruptured aneurysms over a 10-yr period. METHODS We identified 629 patients with aneurysmal SAH at our hospital treated by the senior authors between 2008 and 2018. We collected patient data including population, hypertension, age, size of aneurysm, earlier SAH from another aneurysm, and site of aneurysm. A PHASES score was calculated in each case to estimate a predicted risk of rupture. RESULTS The mean aneurysm size was 6.1 mm (standard deviation 3.9). Almost 3 quarters of aneurysms were less than 7 mm. The mean PHASES score was 4.9 (standard deviation 2.6). CONCLUSION In our cohort, small aneurysms < 7 mm accounted for a majority of SAH cases. Furthermore, the mean PHASES score corresponded to a 5-yr risk of rupture of only 1.3%. Many, if not most, of our patients would have been conservatively managed. Natural history studies have selection bias and may underestimate the risk of rupture.

The physiopathology of spontaneous hemorrhagic stroke: a systematic review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Alcivan Batista de Morais Filho ◽  
Thiago Luis de Holanda Rego ◽  
Letícia de Lima Mendonça ◽  
Sulyanne Saraiva de Almeida ◽  
Mariana Lima da Nóbrega ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Natural History ◽  
Hemorrhagic Stroke ◽  
Recent Literature ◽  
Clinical Manifestations ◽  
The Road ◽  
History Of

Abstract Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

Small (< 10-mm) incidentally found intracranial aneurysms, Part 1: reasons for detection, demographics, location, and risk factors in 212 consecutive patients

2011 ◽  
Vol 31 (6) ◽  
pp. E3 ◽  
Author(s):  
Ioannis Loumiotis ◽  
Anne Wagenbach ◽  
Robert D. Brown ◽  
Giuseppe Lanzino
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Imaging Techniques ◽  
Imaging Study ◽  
Consecutive Series ◽  
Common Location ◽  
Unruptured Intracranial Aneurysms ◽  
Paraclinoid Aneurysms ◽  
History Of

Object The widespread use of imaging techniques for evaluating nonspecific symptoms (vertigo, dizziness, memory concerns, unsteadiness, and the like) and focal neurological symptoms related to cerebrovascular disease has led to increased identification of asymptomatic incidentally discovered unruptured intracranial aneurysms (UIAs). The management of these incidental aneurysms is controversial and many factors need to be considered. The authors describe reasons leading to diagnosis, demographics, and risk factors in a large consecutive series of patients with small incidentally found UIAs. Methods The authors prospectively evaluated 335 patients harboring 478 small (< 10-mm) UIAs between January 2008 and May 2011. Patients with known aneurysms, possibly symptomatic aneurysms, arteriovenous malformation–related aneurysms, patients with a history of subarachnoid hemorrhage from another aneurysm, and patients harboring extradural aneurysms were excluded from the analysis. Only truly incidental small aneurysms (272 aneurysms in 212 patients) were considered for the present analysis. Data regarding the reason for detection, demographics, location, and presence of potential risk factors for aneurysm formation were prospectively collected. Results There were 158 female (74.5%) and 54 male (25.5%) patients whose mean age was 60.6 years (median 62 years). The most common reason for undergoing the imaging study that led to a diagnosis of the aneurysms was evaluation for nonspecific spells and symptoms related to focal cerebrovascular ischemia (43.4%), known/possible intracranial or neck pathology (24%), and headache (16%). The most common location (27%) of the aneurysm was the middle cerebral artery; the second most common (22%) was the paraclinoid internal carotid artery (excluding cavernous sinus aneurysms). Sixty-nine percent of patients were current or prior smokers, 60% had a diagnosis of hypertension, and 23% had one or more relatives with a history of intracranial aneurysms with or without subarachnoid hemorrhage. Conclusions Small incidental UIAs are more commonly diagnosed in elderly individuals during imaging performed to investigate ill-defined spells or focal cerebrovascular ischemic symptoms, or during the evaluation of known or probable unrelated intracranial/neck pathology. Hypertension, smoking, and family history of aneurysms are common in this patient population, and the presence of these risk factors has important implications for treatment recommendations. Although paraclinoid aneurysms (excluding intracavernous aneurysms) are uncommon in patients with ruptured intracranial aneurysms, this location is very common in patients with small incidental UIAs.

Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity

2014 ◽  
Vol 21 (6) ◽  
pp. 994-1003 ◽  
Author(s):  
Justin S. Smith ◽  
Ellen Shaffrey ◽  
Eric Klineberg ◽  
Christopher I. Shaffrey ◽  
Virginie Lafage ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Full Length ◽  
Consecutive Series ◽  
Inclusion Criteria ◽  
The Mean ◽  
Spine Radiographs ◽  
Rod Fracture

Object Improved understanding of rod fracture (RF) following adult spinal deformity (ASD) surgery could prove valuable for surgical planning, patient counseling, and implant design. The objective of this study was to prospectively assess the rates of and risk factors for RF following surgery for ASD. Methods This was a prospective, multicenter, consecutive series. Inclusion criteria were ASD, age > 18 years, ≥5 levels posterior instrumented fusion, baseline full-length standing spine radiographs, and either development of RF or full-length standing spine radiographs obtained at least 1 year after surgery that demonstrated lack of RF. ASD was defined as presence of at least one of the following: coronal Cobb angle ≥20°, sagittal vertical axis (SVA) ≥5 cm, pelvic tilt (PT) ≥25°, and thoracic kyphosis ≥60°. Results Of 287 patients who otherwise met inclusion criteria, 200 (70%) either demonstrated RF or had radiographic imaging obtained at a minimum of 1 year after surgery showing lack of RF. The patients' mean age was 54.8 ± 15.8 years; 81% were women; 10% were smokers; the mean body mass index (BMI) was 27.1 ± 6.5; the mean number of levels fused was 12.0 ± 3.8; and 50 patients (25%) had a pedicle subtraction osteotomy (PSO). The rod material was cobalt chromium (CC) in 53%, stainless steel (SS), in 26%, or titanium alloy (TA) in 21% of cases; the rod diameters were 5.5 mm (in 68% of cases), 6.0 mm (in 13%), or 6.35 mm (in 19%). RF occurred in 18 cases (9.0%) at a mean of 14.7 months (range 3–27 months); patients without RF had a mean follow-up of 19 months (range 12–24 months). Patients with RF were older (62.3 vs 54.1 years, p = 0.036), had greater BMI (30.6 vs 26.7, p = 0.019), had greater baseline sagittal malalignment (SVA 11.8 vs 5.0 cm, p = 0.001; PT 29.1° vs 21.9°, p = 0.016; and pelvic incidence [PI]–lumbar lordosis [LL] mismatch 29.6° vs 12.0°, p = 0.002), and had greater sagittal alignment correction following surgery (SVA reduction by 9.6 vs 2.8 cm, p < 0.001; and PI-LL mismatch reduction by 26.3° vs 10.9°, p = 0.003). RF occurred in 22.0% of patients with PSO (10 of the 11 fractures occurred adjacent to the PSO level), with rates ranging from 10.0% to 31.6% across centers. CC rods were used in 68% of PSO cases, including all with RF. Smoking, levels fused, and rod diameter did not differ significantly between patients with and without RF (p > 0.05). In cases including a PSO, the rate of RF was significantly higher with CC rods than with TA or SS rods (33% vs 0%, p = 0.010). On multivariate analysis, only PSO was associated with RF (p = 0.001, OR 5.76, 95% CI 2.01–15.8). Conclusions Rod fracture occurred in 9.0% of ASD patients and in 22.0% of PSO patients with a minimum of 1-year follow-up. With further follow-up these rates would likely be even higher. There was a substantial range in the rate of RF with PSO across centers, suggesting potential variations in technique that warrant future investigation. Due to higher rates of RF with PSO, alternative instrumentation strategies should be considered for these cases.

The case for family screening for intracranial aneurysms

2011 ◽  
Vol 31 (6) ◽  
pp. E8 ◽  
Author(s):  
Nohra Chalouhi ◽  
Rohan Chitale ◽  
Pascal Jabbour ◽  
Stavropoula Tjoumakaris ◽  
Aaron S. Dumont ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Natural History ◽  
Intracranial Aneurysms ◽  
Family Screening ◽  
Multiple Factors ◽  
History Of ◽  
The Cost ◽  
Familial Aneurysms ◽  
Risk Of Treatment

Given that relatives of patients with intracranial aneurysms (IAs) or subarachnoid hemorrhage have a greater risk of harboring an aneurysm, family screening has become a common practice in neurosurgery. Unclear data exist regarding who should be screened and at what age and interval screening should occur. Multiple factors including the natural history of IAs, the risk of treatment, the cost of screening, and the psychosocial impact of finding an aneurysm should be taken into account when family screening is considered. In this paper, the authors review the current literature regarding risk factors and natural history of sporadic and familial aneurysms. Based on these data the authors assess current recommendations for screening and propose their own recommendations.

scholarly journals P577 Withdrawal of thiopurines in patients with Ulcerative Colitis in remission

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S534-S534
Author(s):  
C Amor Costa ◽  
C Suárez Ferrer ◽  
J Poza Cordón ◽  
J L Rueda García ◽  
M Sánchez Azofra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ulcerative Colitis ◽  
Standard Deviation ◽  
Adverse Effects ◽  
Medical Decision ◽  
Concomitant Treatment ◽  
Duration Of Treatment ◽  
The Mean ◽  
Time To Relapse

Abstract Background Thiopurines (TP) are widely used in monotherapy in patients with ulcerative colitis (UC), mainly for the maintenance of remission in case of corticodependence or corticoresistance after cyclosporine use. However, these are drugs with significant side effects, especially in the long term. The optimal duration of treatment with TP remains unknown, so it is important to determine the risk factors for relapse in order to identify the group of patients in which treatment can be withdrawn. Methods A retrospective study was performed. Patients with UC in remission, in maintenance treatment with TP, who had discontinued the drug due to either maintained remission or the onset of adverse effects were included. Results 26 patients were included, 1 with proctitis, 9 with left colitis and 16 with pancolitis. 24 (92.31%) were treated with azathioprine and 2 (7.69%) with mercaptopurine. The mean treatment time with TP was 68.09 months (standard deviation 56.65). 11 patients (42.31%) discontinued TP due to adverse effects and the remaining patients (57.69%) discontinued it by medical decision because they were in prolonged remission. After withdrawal of TP, 92.34% of patients continued treatment with mesalazine and the remaining 7.69% without concomitant treatment. During follow-up, 10 patients (38.4%) relapsed and 16 patients (61.53%) had no relapse until the end of follow-up. The mean time from TP withdrawal to the onset of relapse was 69.15 months (standard deviation 52.53). Of the 10 patients who presented a flare, 5 (50%) were controlled by optimizing the dose of mesalazine, 4 (40%) required the addition of oral corticosteroids and 1 (10%) required biologics. No significant differences were found when comparing the time to relapse if the reason for discontinuation of TP was having had an adverse effect (65.05 months) or maintained remission (79.79 months) (p=0.42). No statistically significant differences were found in time to relapse when comparing time on TP treatment, presence of concomitant treatment with mesalazine or active smoking. Conclusion One third of patients relapsed after TP withdrawal. Discontinuation of TP in patients with UC in remission should be individualized according to the patient’s risk factors, the indication and the duration of treatment.

scholarly journals Analysis of Risk Factors Related to Acute Subarachnoid Hemorrhage After Spinal Surgery

2021 ◽  
Author(s):  
Jianquan Zhao ◽  
Heng Jiang ◽  
Yichen Meng ◽  
Rui Gao ◽  
Jun Ma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Spinal Surgery ◽  
Past History ◽  
Control Group ◽  
Binary Logistic Regression Analysis ◽  
Related Factor ◽  
Continuous Drainage ◽  
Csf Leakage ◽  
The Mean

Abstract Study Design: A retrospective single-center study.Background: Subarachnoid hemorrhage (SAH) is a rare complication secondary to cerebrospinal fluid (CSF) leakage during spinal surgery, but the specific cause of the bleeding is still unclear. Objective：In this study, we studied cases of acute SAH after spinal surgery to find the related risk factors for bleeding.Methods: A total of 441 patients with CSF leakage who underwent spinal surgery in [BLINDED FOR REVIEW] from 2011 to 2020 were retrospectively analyzed. According to whether postoperative SAH occurred, they were divided into SAH group and Control group. By comparing the two groups of demographic data, past history, imaging data, intraoperative findings, perioperative complications, treatment conditions to find the risk factors of SAH, to provide guidance for the prevention of SAH after spinal surgery.Results: In SAH group, 17 cases (73.9%) had preoperative hypertension and 3 cases (13.0%) had diabetes. The intraoperative CSF leakage was about 118.4±56.9 ml. The mean postoperative drainage was 15.4±5.8 ml/h; Compared with SAH group, Control group had 123 cases (29.4%) with hypertension before operation, 40 cases (9.6%) with diabetes, intraoperative CSF leakage was about 76.3±23.0ml, and the mean postoperative continuous drainage 9.7±2.1ml/h. Binary logistic regression analysis showed that hypertension, intraoperative CSF leakage, and postoperative CSF continuous drainage speed are related to SAH. Conclusion: The rapid leakage of CSF caused by the rupture of the dural sac during operation and the rapid drainage of CSF after surgery are closely related to the occurrence of such complications. In addition, hypertension is a related factor of SAH during spinal surgery.

Abstract WMP30: Risk Analysis Of Growth And Rupture In Unruptured Intreacranial Aneurysms : Single Institutional Cohort Study

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Yuichi Murayama ◽  
Toshihiro Ishibashi ◽  
Hiroyuki Takao ◽  
Ichiro Yuki ◽  
Hideki Arakawa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Three Dimensional ◽  
Aneurysm Rupture ◽  
Posterior Circulation ◽  
Single Center ◽  
Risk Of Rupture ◽  
Aneurysm Growth ◽  
The Mean ◽  
Small Aneurysms

Introduction: Risk of growth and rupture in unruptured intracranial saccular aneurysm (UIA) are still unclear. Hypothesis: Gowth and risk of UIA may be correlated and they were evaluated our single center large cohort. Methods: Between January 2003 and March 2011, a total of 2122 patients with 2756 UIA were referred to our institution. 1403 patients with 2037 UIAs were assigned for conservative management. The mean follow up duration was 6201 aneurysm-years. Bi-annual three-dimensional computed tomography angiography (3D CTA) was performed and aneurysm growth was evaluated using 3D workstation. The aneurysm growth was defined as size increase more than 1mm. Results: During observation, 14.6% aneurysms increased their size. Female and male growth rate were 16% and 11% respectively. 130 patients stopped observation and therapeutic intervention was performed due to increase their size or anxiety. During observation 50 UIAs ruptured resulting in a 0.8% rupture rate per year. Aneurysm growth, IC-pcom aneurysms, posterior circulation, female, and SAH associated multiple aneurysms were risk factor for aneurysm rupture. Growing aneurysm was 10 times higher relative risk of rupture compare to stable aneurysm. No aneurysm demonstrated reduction of their size after rupture. Conclusions: Risk of Aneurysm growth and rupture may be correlated. Risk of rupture of UIAs was similar that was reported before but even small aneurysms can be rupture during observation. Growing UIAs should be considered to treat as soon as possible even in small size.

Abstract 155: Prevalence of Self-Reported Risk Factors for Myocardial Infarction Among Patients With Venous Thromboembolism

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Julie Vanderpoel ◽  
Brahim Bookhart ◽  
Hillary J Gross ◽  
Marco DiBonaventura
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Venous Thromboembolism ◽  
Potential Risk ◽  
Clinical Decision Making ◽  
Smoking Status ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
Family Medical History ◽  
The Mean

Objective: To identify the prevalence of risk factors that may be associated with a future myocardial infarction (MI) among patients with venous thromboembolism (VTE). Methods: This study was conducted using the 2010 wave of the National Health and Wellness Survey (NHWS). The NHWS is a self-administered, Internet-based questionnaire from a nationwide sample of adults (N=75,000). Only patients with a diagnosis of VTE, defined as a self-reported diagnosis of deep vein thrombosis (DVT), pulmonary embolism (PE), or both, were included in the analysis. Self-reported patient characteristics that may be potential risk factors for MI were collected, including sociodemographic characteristics, family medical history, and health behaviors (such as smoking status), as well as comorbidities. Included risk factors were based on a literature search. The risk factors were not weighted based on the strength of their potential association with a future MI. Thus, risk factors of varying significance were included and weighted equally. Findings: A total of 814 patients with VTE (519 with DVT, 196 with PE, and 99 with DVT and PE) were included in the analysis. Approximately 53% of the patients were female, and the mean age was 57 years. Among these patients, the mean number of reported risk factors that may be associated with a future MI was 5.6. Approximately 23% (n=189) of patients reported ≤3 risk factors, 55% (n=446) of patients had 4-7 risk factors, and 22% (n=179) of patients had ≥8 risk factors. Some of the more commonly reported risk factors included male gender (47%, n=381), obesity (53%, n=428), hypertension (53%, n=427), hyperlipidemia (49%, n=401), type 2 diabetes (21%, n=167), a family history of cardiovascular disease (81%, n=663), and currently smoking (22%, n=175). Conclusions: A high proportion of patients with VTE have risk factors for a future MI. Awareness of the prevalence of MI risk factors among patients with VTE may support optimal clinical decision-making for these patients. Providers should be cognizant of the potential risk for MI among patients with VTE when selecting treatment approaches. Additional research that considers the relative importance of each potential risk factor is needed to elucidate these findings.

scholarly journals Urinary N-telopeptide: The New Diagnostic Test for Osteoporosis

2019 ◽  
Vol 05 (01) ◽  
pp. e1-e4 ◽  
Author(s):  
Ganesan Ganesan ◽  
Phagal Vijayaraghavan
Keyword(s):  
Risk Factors ◽  
Standard Deviation ◽  
Diagnostic Tool ◽  
Categorical Variables ◽  
Control Group ◽  
Mineral Density ◽  
Exclusion Criteria ◽  
Dxa Scan ◽  
Significant Difference ◽  
The Mean

Context Osteoporosis is a silent disease until it is complicated by trivial fall fractures. There is an increasing interest within the orthopaedic community in the noninvasive cost-effective measurement of the bone mineral density. Aims The aim of the study is to assess whether urinary N-telopeptide level can be a new diagnostic tool in diagnosing osteoporosis. Methods and Material This prospective study was done at Sri Ramachandra Medical Centre (SRMC) hospital from October 2015 to October 2017. The study was conducted among patients who comes to SRMC as inpatient or outpatient with suspected osteoporosis and underwent dual-energy X-ray absorptiometry (DXA) scan and urinary N-telopeptide. The inclusion criteria were women aged 65 or older, women aged less than 65 with risk factors, younger postmenopausal women with one or more risk factors, men aged 70 or older, men less than 70 with risk factors, and any above group patients who comes within 24 hours following trivial fall fractures. The exclusion criteria were pathological fracture, history of any illness affecting bone metabolism. The results from DXA scan were taken as gold standard against urinary N-telopeptide. Then the patients were divided into two groups control and study. The control group contains patients who had normal DXA, while study group contains patients having either osteopenia or osteoporosis. Based on our inclusion and exclusion criteria, 110 persons were included in the study. We had 60 study and 50 controls patients. We had 88 females and 22 males. The results obtained were statistically analyzed. Statistical Analysis Used The collected data were analyzed with IBM SPSS statistics software 23.0 version. To describe about the data descriptive statistics frequency analysis, percentage analysis was used for categorical variables and the mean and standard deviation were used for continuous variables. To find the significant difference between the bivariate samples in independent groups, the unpaired sample t-test was used. To find the significance in categorical data, chi-square test was used. In both the earlier statistical tools, the probability value of 0.05 is considered as significant level. Results In our study, we had 18.2% osteopenic and 36.4% osteoporotic patients. The mean value of urinary N-telopeptide in control was 49.8 and in case was 182.5. The standard deviation of urinary N-telopeptide value in case was 159.9. Conclusion Urinary N-telopeptide can give reproducible results and be able to assist in the evaluation of the quantity as well as the quality and be a good judge of someone's risk of fracture. Hence, urinary N-telopeptide can be used as a diagnostic tool for diagnosing osteoporosis.

Abstract WP220: The Effect of Self-Reported Optimism on the Incidence of Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ahmed Malik ◽  
Haseeb Rahman ◽  
Adnan Qureshi ◽  
Martha A Wojtowycz
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Standard Deviation ◽  
Confidence Interval ◽  
Stroke Prevention ◽  
Odds Ratio ◽  
Categorical Variables ◽  
The Mean ◽  
Baseline Characteristics

Purpose: The purpose of this study is to determine whether having an optimistic outlook on life decreases the risk of developing incident stroke. Methods: Participants who developed incident stroke in Americans’ Changing Lives study, and participants who did not develop incident stroke (dependent variable) in were compared for demographics, baseline characteristics, comorbidities, and optimistic outlook on life. Numbers and proportions of respondents in both groups were reported for all categorical variables, while mean and standard deviation were reported for age. All statistically significant variables from the above analyses were entered into a logistic regression analysis to ascertain the association between optimistic outlook on life and stroke. Results: Of the 98,577,928 participants, 73,040,055 did not have stroke at baseline. There were 599,190 who developed incident stroke and 1,104,751 who did not develop incident stroke. The mean age (standard deviation) was lower in those who developed incident stroke compared to those who did not [45.9 (13.8) vs. 46.4 (9.9) p<.0001], and participants with an optimistic outlook on life, were 0.20 times less likely to develop stroke as those who did not have an optimistic outlook on life [OR (Odds ratio) 0.20 95% CI (95% confidence interval) 0.20,0.21], after adjusting for confounders. Conclusions: People who have an optimistic outlook on life are less likely to develop incident stroke. The protective value of optimism lends credence to the value of targeting unconventional risk factors in stroke prevention.

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