1106 Difference in vascular risk factor profile between Ischaemic strokes of undetermined aetiology and other stroke subtypes: population-based study and meta-analysis

Introduction: While retrospective studies have shown that poor control of vascular risk factors is associated with progression of white matter hyperintensity (WMH), it has not been studied prospectively. Hypothesis: We hypothesize that higher systolic blood pressure (SBP) mean, LDL cholesterol, and Hgb A1c will be correlated with WMH progression in diabetics. Methods: This is a secondary analysis of the Memory in Diabetes (MIND) substudy of the Action to Control Cardiovascular Risk in Diabetes Follow-on Study (ACCORDION). The primary outcome was WMH progression, evaluated by fitting linear regression models to the WMH volume on the month 80 MRI and adjusting for the WMH volume on the baseline MRI. The primary predictors were the mean values of SBP, LDL, and A1c from baseline to month 80. We defined a good vascular risk factor profile as mean SBP <120 mm Hg and mean LDL <120 mg/dL. Results: We included 292 patients, with a mean (SD) age of 62.6 (5.3) years and 55.8% male. The mean number of SBP, LDL, and A1c measurements per patient was 17, 5, and 12. We identified 86 (29.4%) patients with good vascular risk factor profile. In the linear regression models, mean SBP and LDL were associated with WMH progression and in a second fully adjusted model they both remained associated with WMH progression (Table). Those with a good vascular risk factor profile had less WMH progression (β Coefficient -0.80, 95% CI -1.42, -0.18, p=0.012). Conclusions: Our data reinforce prior research showing that higher SBP and LDL is associated with progression of WMH in diabetics, likely secondary to chronic microvascular ischemia, and suggest that control of these factors may have protective effects. This study has unique strengths, including prospective serial measurement of the exposures, validated algorithmic measurement methodology for WMH, and rigorous adjudication of study data. Clinical trials are needed to investigate the effect of vascular risk factor reduction on WMH progression.

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Abstract TMP98: Could Mobile Health be an Effective Strategy for Enhancing Stroke Prevention?

Stroke ◽

10.1161/str.48.suppl_1.tmp98 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Shimeng Liu ◽

Wuwei Feng ◽

Pratik Y Chhatbar ◽

Bruce I Ovbiagele

Keyword(s):

Risk Factors ◽

Smoking Cessation ◽

Risk Factor ◽

Glycemic Control ◽

Mobile Health ◽

Meta Analysis ◽

Vascular Risk Factor ◽

Smoking Abstinence ◽

Vascular Risk ◽

Risk Factor Control

Background: The overwhelming majority of strokes can be prevented via optimal vascular risk factor control. However, there remains an evidence practice gap with regard to treatment of vascular risk factors. With the rapid growth worldwide in cell-phone use, Internet connectivity, and digital health technology, mobile health (mHealth) technology may offer a promising approach to bridge these treatment gaps and reduce the global burden of stroke. Objective: To evaluate the effectiveness of mHealth in vascular risk factor control through a systemic review and meta-analysis. Methods: We searched PubMed from January 1, 2000 to May 17, 2016 using keywords: mobile health, mhealth, short message, cellular phone, mobile phone, stroke prevention and control, diabetes mellitus, hypertension, hyperlipidemia and smoking cessation. We performed a meta-analysis of all eligible randomized control clinical trials that assessed the long-term (at 6 months) effect of mHealth. Results: Of 79 articles identified, 13 of them met eligibility criteria (6 for glycemic control and 7 for smoking cessation) and were included for the final meta-analysis. There were no eligible studies for dyslipidemia or hypertension. mHealth resulted in greater HbA1c reduction at 6 months (6 studies; 663 subjects; SMD: -0.44; 95% CI: [-0.82, -0.06], P =0.02; Mean difference of decrease in HbA1c: -0.39%; 95% CI: [-0.74,-0.04], P =0.03). mHealth also led to relatively higher smoking abstinence rates at 6 months (7 studies; 9,514 subjects; OR: 1.54; 95% CI: [1.24, 1.90], P <0.0001). Conclusion: Use of mHealth improves glycemic control and smoking abstinence rates, two factors that may lead to better stroke outcomes. Future mHealth studies should focus on modifying premier vascular risk factors like hypertension, specifically in people with or at risk of stroke.

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Different vascular risk factor profiles in ischemic stroke subtypes: a study fromthe "Sagrat Cor Hospital of Barcelona Stroke Registry"

Acta Neurologica Scandinavica ◽

10.1034/j.1600-0404.2000.102004264.x ◽

2000 ◽

Vol 102 (4) ◽

pp. 264-270 ◽

Cited By ~ 64

Author(s):

A. Arboix ◽

C. Morcillo ◽

L. Garcia-Eroles ◽

M. Oliveres ◽

J. Massons ◽

...

Keyword(s):

Risk Factor ◽

Ischemic Stroke ◽

Vascular Risk Factor ◽

Vascular Risk ◽

Stroke Registry ◽

Stroke Subtypes

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The Pregravid Vascular Risk Factor Profile of Low-Risk Women Who Develop Pregnancy Outcomes That Predict Future Cardiovascular Disease

Women's Health Reports ◽

10.1089/whr.2021.0006 ◽

2021 ◽

Vol 2 (1) ◽

pp. 62-70

Author(s):

Roslyn Mainland ◽

Shi Wu Wen ◽

Hongzhuan Tan ◽

Shujin Zhou ◽

Chang Ye ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Factor ◽

Pregnancy Outcomes ◽

Vascular Risk Factor ◽

Low Risk ◽

Vascular Risk ◽

Risk Factor Profile ◽

Low Risk Women

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Prevalence, symptoms and risk factor profile of rumination syndrome and functional dyspepsia: a population‐based study

Alimentary Pharmacology & Therapeutics ◽

10.1111/apt.16630 ◽

2021 ◽

Author(s):

Mudar Zand Irani ◽

Michael P. Jones ◽

Magnus Halland ◽

Linda Herrick ◽

Rok Seon Choung ◽

...

Keyword(s):

Risk Factor ◽

Functional Dyspepsia ◽

Population Based ◽

Population Based Study ◽

Risk Factor Profile ◽

Rumination Syndrome

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White matter hyperintensity burden in acute stroke patients differs by ischemic stroke subtype

Neurology ◽

10.1212/wnl.0000000000009728 ◽

2020 ◽

Vol 95 (1) ◽

pp. e79-e88 ◽

Cited By ~ 1

Author(s):

Anne-Katrin Giese ◽

Markus D. Schirmer ◽

Adrian V. Dalca ◽

Ramesh Sridharan ◽

Kathleen L. Donahue ◽

...

Keyword(s):

Risk Factor ◽

Ischemic Stroke ◽

White Matter ◽

Brain Mri ◽

Vascular Risk Factor ◽

White Matter Hyperintensity ◽

Large Artery ◽

Vascular Risk ◽

Stroke Subtypes ◽

Small Artery Occlusion

ObjectiveTo examine etiologic stroke subtypes and vascular risk factor profiles and their association with white matter hyperintensity (WMH) burden in patients hospitalized for acute ischemic stroke (AIS).MethodsFor the MRI Genetics Interface Exploration (MRI-GENIE) study, we systematically assembled brain imaging and phenotypic data for 3,301 patients with AIS. All cases underwent standardized web tool–based stroke subtyping with the Causative Classification of Ischemic Stroke (CCS). WMH volume (WMHv) was measured on T2 brain MRI scans of 2,529 patients with a fully automated deep-learning trained algorithm. Univariable and multivariable linear mixed-effects modeling was carried out to investigate the relationship of vascular risk factors with WMHv and CCS subtypes.ResultsPatients with AIS with large artery atherosclerosis, major cardioembolic stroke, small artery occlusion (SAO), other, and undetermined causes of AIS differed significantly in their vascular risk factor profile (all p < 0.001). Median WMHv in all patients with AIS was 5.86 cm3 (interquartile range 2.18–14.61 cm3) and differed significantly across CCS subtypes (p < 0.0001). In multivariable analysis, age, hypertension, prior stroke, smoking (all p < 0.001), and diabetes mellitus (p = 0.041) were independent predictors of WMHv. When adjusted for confounders, patients with SAO had significantly higher WMHv compared to those with all other stroke subtypes (p < 0.001).ConclusionIn this international multicenter, hospital-based cohort of patients with AIS, we demonstrate that vascular risk factor profiles and extent of WMH burden differ by CCS subtype, with the highest lesion burden detected in patients with SAO. These findings further support the small vessel hypothesis of WMH lesions detected on brain MRI of patients with ischemic stroke.

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