Traditional risk factors and combined genetic markers of recurrent ischemic stroke in adults

Stroke in young adults may have early impact on quality of life in survivors. Uncontrolled stroke risk factors, lack of treatment facilities and a dense population has made its special significance in South Asia. The main aim of this study is to evaluate incidence, risk factors, etiology and clinical characteristics of young ischemic stroke in South Asia. Incidence of young stroke is more common in South Asian countries than developed western countries and has higher prevalence in rural areas. Traditional risk factors, such as hypertension, smoking, hyperlipidemia and diabetes are associated with majority of cases. Cardioembolism and undetermined etiology contribute to a large proportion of stroke etiology. Appropriate stepwise investigations are suggested to diagnose stroke of other determined etiology. Regular intake of drugs to control risk factors, cessation of smoking, and promote physical activity is suggested to reduce the burden of young stroke. Journal of Advances in Internal Medicine 2013;02(01):27-33 DOI: http://dx.doi.org/10.3126/jaim.v2i1.7636

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Metabolomic Profiles Associated With Incident Ischemic Stroke

Neurology ◽

10.1212/wnl.0000000000013129 ◽

2021 ◽

pp. 10.1212/WNL.0000000000013129

Author(s):

Raji Balasubramanian ◽

Jie Hu ◽

Marta Guasch-Ferre ◽

Jun Li ◽

Farzaneh Sorond ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Risk Prediction ◽

Methionine Sulfoxide ◽

Health Study ◽

Plasma Metabolites ◽

Q Value ◽

Logistic Regression Models ◽

Increased Risk ◽

Traditional Risk Factors

Background:Women have higher lifetime risk of stroke than men, and metabolic factors seem more strongly associated with stroke for women than men. However, few studies in either men or women have evaluated metabolomic profiles and incident stroke.Methods:We applied liquid chromatography-tandem mass spectrometry to measure 519 plasma metabolites in a discovery set of women in the Nurses’ Health Study ([NHS], 454 incident ischemic stroke cases, 454 controls) with validation in two independent, prospective cohorts: Prevención con Dieta Mediterránea ([PREDIMED], 118 stroke cases, 791 controls), and Nurses’ Health Study 2 ([NHS2], 49 ischemic stroke cases, 49 controls). We applied logistic regression models with stroke as the outcome to adjust for multiple risk factors; the false discovery rate (FDR) was controlled through the q value method.Results:Twenty-three metabolites were significantly associated with incident stroke in NHS after adjustment for traditional risk factors (q value <0.05). Of these, 14 metabolites were available in PREDIMED and 3 were significantly associated with incident stroke: methionine sulfoxide, N6-acetyllysine, and sucrose (q value<0.05). In NHS2, one of the 23 metabolites (glucuronate) was significantly associated with incident stroke (q value <0.05). For all four metabolites, higher levels were associated with increased risk. These four metabolites were used to create a stroke metabolite score (SMS) in the NHS and tested in PREDIMED. Per unit of standard deviation of SMS, the odds ratio for incident stroke was 4.12 (95% CI: 2.26 – 7.51) in PREDIMED, after adjustment for risk factors. In PREDIMED, the area under the ROC curve (AUC) for the model including SMS and traditional risk factors was 0.70 (95% CI: 0.75-0.79) versus the AUC for the model including the traditional risk factors only of 0.65 (95% CI: 0.70-75), corresponding to a 5% improvement in risk prediction with SMS (p < 0.005).Discussion:Metabolites associated with stroke included two amino acids, a carboxylic acid and sucrose. A composite SMS including these metabolites was associated with ischemic stroke and showed improvement in risk prediction beyond traditional risk factors.Classification of Evidence:This study provides Class II evidence that a stroke metabolic score accurately predicts incident ischemic stroke risk.

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Traditional and rare causes of ischemic stroke in 18 to 50-year old persons

Consilium Medicum ◽

10.26442/20751753.2021.2.200651 ◽

2021 ◽

Vol 23 (2) ◽

pp. 122-126

Author(s):

Nikolai A. Pizov ◽

◽

Olga A. Skachkova ◽

Nataliia V. Pizova ◽

Natalia S. Baranova ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Young People ◽

Epidemiological Data ◽

Young Age ◽

Traditional Risk Factors ◽

Toast Classification ◽

Diagnostic Capabilities

The article discusses the epidemiological data on the incidence of ischemic stroke (IS) in persons aged 18–50 years, the frequency of various subtypes of IS, depending on the region according to the TOAST classification. Based on recent studies, the frequency of the main traditional risk factors for IS in young people is given, as well as our own data on the frequency of detection of various subtypes of IS on admission and the main risk factors in 145 people aged 18–45 years. The article describes other, moderate causes of stroke at a young age, taking into account modern diagnostic capabilities.

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Prevention of Ischemic Stroke: Overview of Traditional Risk Factors

Current Drug Targets ◽

10.2174/138945007781077373 ◽

2007 ◽

Vol 8 (7) ◽

pp. 794-801 ◽

Cited By ~ 18

Author(s):

Jose Rafael Romero

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Traditional Risk Factors

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Low ADAMTS13 activity is associated with an increased risk of ischemic stroke

Blood ◽

10.1182/blood-2015-05-643338 ◽

2015 ◽

Vol 126 (25) ◽

pp. 2739-2746 ◽

Cited By ~ 66

Author(s):

Michelle A. H. Sonneveld ◽

Moniek P. M. de Maat ◽

Marileen L. P. Portegies ◽

Maryam Kavousi ◽

Albert Hofman ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Stroke Risk ◽

Adamts13 Activity ◽

Increased Risk ◽

Key Points ◽

Ischemic Stroke Risk ◽

Traditional Risk Factors

Key Points Low ADAMTS13 activity is associated with ischemic stroke. ADAMTS13 activity improved the accuracy of ischemic stroke risk predictions beyond the traditional risk factors.

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Assessing the Presence and Position of Carotid Plaque Improves Risk Stratification for Cardiovascular Disease Prediction Among Patients With Hypertension

10.21203/rs.3.rs-574219/v1 ◽

2021 ◽

Author(s):

Hui-Juan Zuo ◽

Xian-Tao Song ◽

Jin-Wen Wang ◽

Hong-Xia Yang ◽

Jie Lin

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

High Risk ◽

Risk Stratification ◽

Carotid Plaque ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Intermediate Risk ◽

Traditional Risk Factors

Abstract Background: Ischemic cardiovascular disease (ISCVD) is a massive public health problem. ISCVD risk prediction models based on traditional risk factors as predictors is limited. Carotid atherosclerosis plays a fundamental value in the occurrence of ISCVD. The aim of this study was to evaluate the value of risk stratification plus carotid plaque improving the prediction of ISCVD. Methods: Between June 2016 and June 2017, 3998 subjects with hypertension were prospectively recruited and completed traditional risk factors survey and carotid ultrasound measurements in Anzhen Hospital, Beijing, China. Results: A total of 2010 (50.3%) subjects were detected carotid plaque. Among patients free from ISCVD (n=3479), there were 884 patients (25.4%) at high risk for ISCVD, and 868 (25.0%), 1727 (49.6%) was classified as intermediate risk or low risk according to Chinese cardiovascular risk score chart. The detected rate of carotid plaque was 64.7%, 53.7%, and 38.5% among patients at high risk to low risk, respectively. Carotid plaques and risk stratification alone or in combination were significantly associated with ischemic stroke, and negatively correlated with coronary heart disease (all P>0.05). Adding carotid plaque to risk stratification, the ischemic stroke prevalence increased from 5.3% to 9.1% in the low-risk group (P=0.001), 5.4% to 12.3% in the intermediate-risk group (P<0.001) and 8.2% to 14.4% than in the high-risk group (P=0.004). Intermediate risk plus carotid plaque (443/3998) were reclassified to a new high-risk group, high risk only (749/3998) and low risk plus carotid plaque (353/3998) were reclassified to a new intermediate risk group; and intermediate risk only (553/3998) were reclassified to a new low risk group. According to the reclassification, there were 1635 subjects (40.9%) at high risk, and 1102 (27.6%), 1261 (31.5%) was classified as intermediate risk or low risk. Conclusions: Carotid plaque has an important position as it plus risk stratification may improve the risk assessment of ischemic stroke and have resulted in reclassification.

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Multimodal Retinal Imaging for Detection of Ischemic Stroke

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.615813 ◽

2021 ◽

Vol 13 ◽

Author(s):

Lu Zhao ◽

Hui Wang ◽

Xiufen Yang ◽

Bin Jiang ◽

Hongyang Li ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Ischemic Stroke ◽

Choroidal Thickness ◽

Control Group ◽

Stroke Group ◽

Retinal Artery ◽

The Difference ◽

Traditional Risk Factors ◽

Doppler Color

Background: This study aims to evaluate ocular changes in patients with ischemic stroke using multimodal imaging and explore the predictive value of ocular abnormalities for ischemic stroke.Methods: A total of 203 patients (ischemic stroke group, 62; control group, 141) were enrolled in this study. Basic data from patients, including age; gender; height; weight; history of hypertension, hyperlipidemia, diabetes, alcohol use, and coronary heart disease; and smoking status, were collected. Consequently, Doppler color ultrasound, color fundus photography, and optical coherence tomography (OCT) examinations were conducted. Differences in traditional risk factors and ocular parameters between the two groups were compared, and binary logistic regression was used for multivariate analysis.Results: The central retinal artery equivalent (CRAE) in the ischemic stroke group was 150.72 ± 20.15 μm and that in the control group was 159.68 ± 20.05 μm. The difference was statistically significant (P = 0.004). Moreover, the subfoveal choroidal thickness (SFChT) in the ischemic stroke group was 199.90 ± 69.27 μm and that in the control group was 227.40 ± 62.20 μm. The difference was statistically significant (P = 0.006). Logistic regression results showed that smoking [odds ratio (OR) = 2.823; 95% confidence interval (95% CI) = 1.477–5.395], CRAE (OR = 0.980; 95% CI = 0.965–0.996), and SFChT (OR = 0.994; 95% CI = 0.989–0.999) are associated with increased risk of ischemic stroke when ocular parameters were combined with traditional risk factors. The area under the receiver operating characteristic (ROC) curve was 0.726, which shows good diagnostic accuracy.Conclusion: SFChT may be a diagnostic marker for early detection and monitoring of ischemic stroke. Combined with traditional risks, retinal artery diameter, and choroidal thickness, the prediction model can improve ischemic stroke prediction.

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Plasma Protein Profile of Incident Myocardial Infarction, Ischemic Stroke, and Heart Failure in 2 Cohorts

Journal of the American Heart Association ◽

10.1161/jaha.120.017900 ◽

2021 ◽

Author(s):

Lars Lind ◽

Johan Ärnlöv ◽

Johan Sundström

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Heart Failure ◽

Ischemic Stroke ◽

Meta Analysis ◽

Protein Profile ◽

Study Cohort ◽

Adult Men ◽

Traditional Risk Factors

Background The aim is to study common etiological pathways for 3 major cardiovascular diseases (CVD), as reflected in multiple proteins. Methods and Results Eighty‐four proteins were measured using the proximity extension technique in 870 participants in the PIVUS (Prospective Investigation of Uppsala Seniors Study) cohort on 3 occasions (age 70, 75, and 80 years). The sample was followed for incident myocardial infarction, ischemic stroke or heart failure. The same proteins were measured in an independent validation sample, the ULSAM (Uppsala Longitudinal Study of Adult Men) cohort in 595 participants at age 77. During a follow‐up of up to 15 years in PIVUS and 9 years in ULSAM, 222 and 167 individuals experienced a CVD. Examining associations with the 3 outcomes separately in a meta‐analysis of the 2 cohorts, 6 proteins were related to incident myocardial infarction, 25 to heart failure, and 8 proteins to ischemic stroke following adjustment for traditional risk factors. Growth differentiation factor 15 and tumor necrosis factor‐related apoptosis‐inducing ligand receptor 2 were related to all 3 CVDs. Including estimated glomerular filtration rate in the models attenuated some of these relationships. Fifteen proteins were related to a composite of all 3 CVDs using a discovery/validation approach when adjusting for traditional risk factors. A selection of 7 proteins by lasso in PIVUS improved discrimination of incident CVD by 7.3% compared with traditional risk factors in ULSAM. Conclusions We discovered and validated associations of multiple proteins with incident CVD. Only a few proteins were associated with all 3 diseases: myocardial infarction, ischemic stroke, and heart failure.

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