scholarly journals Associations between cardiovascular risk factors, stroke severity, and post-stroke cognition: a moderated mediation analysis

2021 ◽  
Author(s):  
Jianian Hua ◽  
YIxiu Zhou ◽  
Licong Chen ◽  
Shanshan Diao ◽  
Qi Fang
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiovascular Risk ◽  
Cognitive Function ◽  
Cardiovascular Risk Factors ◽  
Structural Equation ◽  
Moderated Mediation ◽  
Cognitive Test ◽  
Stroke Severity ◽  
Cross Sectional

Introduction: Cognitive impairment may affect one third of the stroke survivors. Cardiovascular risk factors have been described to be risk factors for lower cognition after stroke. However, most previous studies only used multivariate regression models to learn the association. The aim of our study was to investigate whether the effect of cardiovascular risk factors on cognition after stroke was mediated by stroke severity, the estimated effect of direct and indirect pathways, and the moderated association. Method: In this incident cross-sectional study, 300 stroke patients received cognitive test within seven days after stroke. Cognitive tested was performed by the Chinese version of Mini-Mental State Examination (MMSE). A second stage dual moderated mediation model was used the select moderation variables. Finally, we constructed a structural equation model to test the indirect effects of cardiovascular and demographic factors on cognition stroke severity, the direct effects of predictors on cognition, and the moderated effects of hypertension. Results: Age (estimate, -0.114; 95% bias-corrected CI, -0.205, -0.032; P<0.001), female (estimate, -2.196; 95% bias-corrected CI, -4.359, -0.204; P=0.009), lower education (estimate, -0.893; 95% bias-corrected CI, -1.662, --0.160; P<0.001), stroke severity (estimate, -1.531; 95% bias-corrected CI, -3.015, -0.095), hypertension (estimate, -2.242; 95% bias-corrected CI, -4.436, -0.242; P=0.003) and atrial fibrillation (estimate, -4.930; 95% bias-corrected CI, -12.864, -0.126; P=0.048) were directly associated with lower cognitive function after stroke. We found no evidence that cardiovascular risk factors indirectly correlated cognitive function through stroke severity. The combination of hypertension could alleviate the negative effect of atrial fibrillation on cognition (estimate, -3.928; 95% bias-corrected CI, -7.954, 0.029; P=0.009). Conclusions: We explored the complex relationship between cardiovascular risk factors, stroke severity, and cognitive function after stroke. Using our method, researchers using other dataset could repeat the analysis and achieve a better understanding of the relationship. Future researchers are needed to find whether the moderated associations were casual or modifiable.

Abstract W P121: Stroke Severity in Men and Women: What Proportion of the Disparity Can Be Explained by Differences in Cardiovascular Risk Factors?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Karen C Albright ◽  
Amelia K Boehme ◽  
Bisakha Sen ◽  
Monica Aswani ◽  
Michael T Mullen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Cardiovascular Risk ◽  
Black Women ◽  
Cardiovascular Risk Factors ◽  
Stroke Severity ◽  
Stroke Subtype ◽  
Oaxaca Decomposition ◽  
Nihss Score

Background: Prior studies have shown that women present with more severe stroke. It has been suggested that sex differences in stroke severity are related to age, stroke subtype, or cardiovascular risk factors. We aimed to determine the proportion of sex disparity in stroke severity that can be explained by differences in these variables using Oaxaca decomposition, an econometric technique which quantifies the differences between groups. Methods: White and Black ischemic stroke patients who presented to two academic medical centers in the US (2004-2011) were identified using prospective stroke registries. In-hospital strokes were excluded. Patient demographics and medical history were collected. Stroke severity was measured by NIHSS. Linear regression was used to determine if female sex was associated with NIHSS score. This model was then adjusted for potential confounders including: age, race, stroke subtype, and cardiovascular risk factors. Oaxaca decomposition was then used to determine the proportion of the observed sex differences in stroke severity that can be explained by these variables. Results: 4925 patients met inclusion criteria. Nearly half (n=2346) were women and 39% (n=1942) were Black. Women presented with more severe strokes (median NIHSS 8 vs. 6). In addition, women were older on average (68 vs. 63 years) with more frequent atrial fibrillation (18% vs. 13%), diabetes (34% vs. 30%), and hypertension (78% vs. 72%). Oaxaca decomposition revealed that age, race, atrial fibrillation, large vessel etiology, diabetes, hypertension account for only 63% of the sex differences seen in NIHSS score on presentation. Conclusion: In our biracial sample, women presented with more severe strokes than men. This difference remained significant even after adjustment for age, stroke subtype, and cardiovascular risk factors. Further, over 1/3 of the observed gender difference in stroke severity was unexplained.. Additional study is warranted to investigate the etiology of the gender differences in stroke severity.

scholarly journals Prevalence of atrial fibrillation and cardiovascular risk factors in a 63–65 years old general population cohort: the Akershus Cardiac Examination (ACE) 1950 Study

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e021704 ◽  
Author(s):  
Trygve Berge ◽  
Magnus Nakrem Lyngbakken ◽  
Håkon Ihle-Hansen ◽  
Jon Brynildsen ◽  
Mohammad Osman Pervez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiovascular Risk ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Population Based ◽  
Degree Relative ◽  
Cross Sectional ◽  
General Population Cohort ◽  
Prospective Longitudinal

ObjectivesTo investigate the sex-specific prevalence of atrial fibrillation (AF), including subclinical AF found by screening in a general population aged 63–65 years. The prevalence of cardiovascular risk factors and their association with AF will also be investigated.DesignCross-sectional analysis of an observational, prospective, longitudinal, population-based cohort study.SettingGeneral population in Akershus county, Norway.ParticipantsWomen and men born in 1950. We included 3706 of 5827 eligible individuals (63.6%); 48.8% were women.MethodsAll participants underwent extensive cardiovascular examinations, including 12-lead ECG. History of AF and other cardiovascular diseases were self-reported. Subsequent validation of all reported or detected AF diagnoses was performed.ResultsMean age was 63.9±0.7 years. Prevalence of ECG-verified AF was 4.5% (women 2.4%, men 6.4%; p<0.001), including screen-detected AF in 0.3% (women 0.1%, men 0.6%; p<0.01). Hypertension was found in 62.0% (women 57.8%, men 66.0%; p<0.001). Overweight or obesity was found in 67.6% (women 59.8%, men 74.9%; p<0.001). By multivariate logistic regression, risk factors associated with AF were height (OR 1.67 per 10 cm; 95% CI 1.26 to 2.22; p<0.001), weight (OR 1.15 per 10 kg; 95% CI 1.01 to 1.30; p=0.03), hypertension (OR 2.49; 95% CI 1.61 to 3.86; p<0.001), heart failure (OR 3.51; 95% CI 1.71 to 7.24; p=0.001), reduced estimated glomerular filtration rate (OR 2.56; 95% CI 1.42 to 4.60; p<0.01) and at least one first-degree relative with AF (OR 2.32; 95% CI 1.63 to 3.31; p<0.001), whereas male sex was not significantly associated (OR 1.00; 95% CI 0.59 to 1.68; p=0.99).ConclusionIn this cohort from the general population aged 63–65 years, we found a higher prevalence of known AF than previously reported below the age of 65 years. The additional yield of single time point screening for AF was low. Body size and comorbidity may explain most of the sex difference in AF prevalence at this age.Trial registration numberNCT01555411; Results.

scholarly journals Cardiovascular Risk Factors in Atrial Fibrillation Associated with Ischaemic Heart Disease

2020 ◽  
pp. 1-6
Author(s):  
Oriol Yuguero Torres ◽  
Jesús Pérez-Mur ◽  
Eric Gutiérrez ◽  
Joan Valls ◽  
Sònia Fornés ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Ischaemic Heart Disease ◽  
Older Patients ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Logistic Regression Models

Objective: To describe cardiovascular risk factors in Atrial Fibrillation (AF) in relation with ischaemic diseases in an emergency service. Methodology: Cross-sectional study of patients with AF attended in the (ES) of the HUAV during 2016. Epidemiological and clinical data and their CVRF were analysed. The statistical association was made through the Chi-Square or Mann-Whitney test. The risk factors associated with AF were adjusted with logistic regression models, calculating OR. Results: We evaluated 552 patients with 46% men and (54%) women with an average age of 72.9 years. In 57 patients (10.3%), the detection of AF was coincidental. The younger patients presented with more frequent palpitations (p <0.05) and the older patients had dyspnea (p <0.05). The older patients are the ones that take longer to consult (p <0.05). 17% (94) of patients with AF have a heart attack before, during or after the episode of AF, with a higher prevalence among men (p <0.05). The probability of diagnosing ischaemic heart disease in a male patient with AF, hypertensive and diabetic is 71%. Conclusion: In men with hypertension and DM a correct diagnostic and therapeutic management, should consider the diagnostic possibility that AF is related to the presence of ischaemic disease. AF can be considered as an anginal equivalent in patients who meet the three conditions: being male, with hypertension and DM.

scholarly journals Coronary Artery Calcium and Cognitive Function in Dutch Adults: Cross‐Sectional Results of the Population‐Based ImaLife Study

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Congying Xia ◽  
Marleen Vonder ◽  
Grigory Sidorenkov ◽  
Runlei Ma ◽  
Matthijs Oudkerk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Working Memory ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Cognitive Function ◽  
Cardiovascular Risk Factors ◽  
Coronary Artery Calcium ◽  
Population Based ◽  
Cross Sectional ◽  
Back Task

Background The aim of this study was to investigate whether increased severity of coronary artery calcium (CAC), an imaging biomarker of subclinical coronary atherosclerosis, is associated with worse cognitive function independent of cardiovascular risk factors in a large population‐based Dutch cohort with broad age range. Methods and Results A cross‐sectional analysis was performed in 4988 ImaLife participants (aged 45–91 years, 58.3% women) without history of cardiovascular disease. CAC scores were obtained using nonenhanced cardiac computed tomography scanning. The CogState Brief Battery was used to assess 4 cognitive domains: processing speed, attention, working memory, and visual learning based on detection task, identification task, 1‐back task, and 1‐card‐learning task, respectively. Differences in mean scores of each cognitive domain were compared among 4 CAC categories (0, 1–99, 100–399, ≥400) using analysis of covariates to adjust for classical cardiovascular risk factors. Age‐stratified analysis (45–54, 55–64, and ≥65 years) was performed to assess whether the association of CAC severity with cognitive function differed by age. Overall, higher CAC was associated with worse performance on 1‐back task after adjusting for classical cardiovascular risk factors, but CAC was not associated with the other cognitive tasks. Age‐stratified analyses revealed that the association of CAC severity with working memory persisted in participants aged 45 to 54 years, while in the elderly this association lost significance. Conclusions In this Dutch population of ≥45 years, increased CAC severity was associated with worse performance of working memory, independent of classical cardiovascular risk factors. The inverse relationship of CAC score categories with working memory was strongest in participants aged 45 to 54 years.

scholarly journals Urban index and lifestyle risk factors for cardiovascular diseases in China: A cross-sectional study

2021 ◽  
Vol 104 (1) ◽  
pp. 003685042110037
Author(s):  
Zhichong Chen ◽  
Menghui Liu ◽  
Shaozhao Zhang ◽  
Zhenyu Xiong ◽  
Xiangbin Zhong ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Fruits And Vegetables ◽  
Cross Sectional Study ◽  
Nutrition Survey ◽  
Cross Sectional ◽  
Rapid Urbanization ◽  
Lifestyle Risk Factors

China is at a stage of rapid urbanization over the past decades, and the association of urbanization with cardiovascular disease has been confirmed by previous studies. However, few studies assessed the association of urbanization with cardiovascular risk factors, especially in Chinese population. We conducted a cross-sectional, populational-based study, using data from China Health and Nutrition Survey (CHNS) in 2009. The logistic regression was used to assess the association of urbanization measured by urban index with cardiovascular risk factors (diabetes mellitus, hypertension, dyslipidemia, obesity, smoking, physical activity and fruits and vegetables consumption), varied with sex. The current study included 18,887 participants enrolled (mean age 39.8 ± 19.8 years; 52.2% female) who live in China. In regression model, the urban index was significantly associated with the variations of cardiovascular risk factors for male, including diabetes (OR 1.34, 95% CI: 1.22–1.48), hypercholesterolemia (OR 1.15, 95% CI: 1.09–1.22), never smoking (OR 0.92, 95% CI: 0.89–0.96), higher fruits and vegetables consumptions (OR 0.93, 95% CI: 0.87–0.99), higher body mass index (BMI) (OR 1.16, 95% CI: 1.10–1.22), and higher physical activity (OR 0.69, 95% CI: 0.66–0.73). Compared with the male, the associations of urban index with cardiovascular risk factors for female were similar, but not for BMI (OR 1.00, 95% CI: 0.96–1.05). The present finding emphasizes the changes of cardiovascular risk factors associated with urbanization in China, and indicated that close attention should be paid to the risk of hypercholesterolemia, diabetes and men’s obesity in the process of urbanization.

scholarly journals Assessment of cardiovascular risk factors prior to NHS Health Checks in an urban setting: cross-sectional study

2012 ◽  
Vol 3 (3) ◽  
pp. 1-11 ◽  
Author(s):  
Macide Artac ◽  
Andrew R H Dalton ◽  
Azeem Majeed ◽  
Kit Huckvale ◽  
Josip Car ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cross Sectional Study ◽  
Urban Setting ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Checks ◽  
Nhs Health Checks
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