Role of Vascular Risk Factors in Lacunar and Unexplained Strokes in Young Adults:A Case-Control Study

1995 ◽  
Vol 5 (3) ◽  
pp. 188-193 ◽  
Author(s):  
José M. Ferro ◽  
Manuela Crespo ◽  
Helena Ferro
BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029164 ◽  
Author(s):  
Jithin K Sajeev ◽  
Anoop N Koshy ◽  
Helen Dewey ◽  
Jonathan M Kalman ◽  
Kevin Rajakariar ◽  
...  

ObjectiveRecent anticoagulation trials in all-comer cryptogenic stroke patients have yielded equivocal results, reinvigorating the focus on identifying reproducible markers of an atrial myopathy. We investigated the role of excessive premature atrial complexes (PACs) in ischaemic stroke, including cryptogenic stroke and its association with vascular risk factors.Methods and resultsA case–control study was conducted utilising a multicentre institutional stroke database to compare 461 patients with an ischaemic stroke or transient ischaemic attack (TIA) with a control group consisting of age matched patients without prior history of ischaemic stroke/TIA. All patients underwent 24-hour Holter monitoring during the study period and atrial fibrillation was excluded. An excessive PAC burden, defined as ≥200 PACs/24 hours, was present in 25.6% and 14.7% (p<0.01), of stroke/TIA and control patients, respectively. On multivariate regression, excessive PACs (OR 1.97; 95% CI 1.29 to 3.02; p<0.01), smoking (OR 1.58; 95% CI 1.06 to 2.36; p<0.05) and hypertension (OR 1.53; 95% CI 1.07 to 2.17; p<0.05) were independently associated with ischaemic stroke/TIA. Excessive PACs remained the strongest independent risk factor for the cryptogenic stroke subtype (OR 1.95; 95% CI 1.16 to 3.28; p<0.05). Vascular risk factors that promote atrial remodelling, increasing age (≥75 years, OR 3.64; 95% CI 2.08 to 6.36; p<0.01) and hypertension (OR 1.54; 95% CI 1.01 to 2.34; p<0.05) were independently associated with excessive PACs.ConclusionsExcessive PACs are independently associated with cryptogenic stroke and may be a reproducible marker of atrial myopathy. Prospective studies assessing their utility in guiding stroke prevention strategies may be warranted.


2015 ◽  
Vol 28 (5) ◽  
pp. 613 ◽  
Author(s):  
Ana Carrilho Romeiro ◽  
Anabela Valadas ◽  
José Marques

<p><strong>Introduction:</strong> It is still unclear whether the etiology of ischemic stroke differs between cancer and non-cancer patients. Stroke and cancer share common modifiable risk factors but evidence suggests that cancer patients have specific conditions that increase the risk of stroke. Our goal was to compare the etiology of ischemic stroke in cancer and non-cancer patients.<br /><strong>Material and Methods:</strong> Case-control study conducted in patients admitted to a stroke unit between January 2007 and December 2012. Cases had a concomitant diagnosis of cancer and acute ischemic stroke, controls of only stroke. Age, gender, vascular risk factors and etiology were compared between groups.<br /><strong>Results:</strong> Fifty-six cases were identified; 64.3% were men with a mean age of 71 years; 21 patients had evidence of active cancer. Gastrointestinal cancer (25.9%) was the most common; 151 controls were included matched for gender and age. Common modifiable vascular risk factors, between groups (cases versus controls) were not significantly different, except for diabetes mellitus, more frequent in the control group (16.1% vs 33.8%, p = 0.02). Previous thrombotic events were more frequent in the cancer cohort (8.9% vs 0.7%, p = 0.007). Other determined etiology subtype (TOAST classification) was more frequent in cancer patients when compared to controls (13.0% vs 0.8%, p &lt; 0.01), and a hypercoagulable state was significantly more prevalent in active cancer patients.<br /><strong>Discussion:</strong> In our case-control study two subsets of cancer patients were delineated. In a subgroup, cancer and stroke co-exist, sharing traditional vascular risk factors. In another subset of patients, stroke appears to be directly related to the presence of a malignancy, where hypercoagulopathy turns out to be a decisive mechanism.<br /><strong>Conclusion: </strong>In clinical grounds, hypercoagulopathy as stroke etiology should prompt the physician to screen the patient for occult cancer.</p>


2000 ◽  
Vol 111 (2) ◽  
pp. 534-539 ◽  
Author(s):  
Christine Heller ◽  
Rosemarie Schobess ◽  
Karin Kurnik ◽  
Ralf Junker ◽  
Gudrun Gunther ◽  
...  

2000 ◽  
Vol 111 (2) ◽  
pp. 534-539 ◽  
Author(s):  
Christine Heller ◽  
Rosemarie Schobess ◽  
Karin Kurnik ◽  
Ralf Junker ◽  
Gudrun Günther ◽  
...  

1992 ◽  
Vol 47 (9) ◽  
pp. 614-615 ◽  
Author(s):  
ANNE SCHUCHAT ◽  
KATHERINE A. DEAVER ◽  
JAY D. WENGER ◽  
BRIAN D. PLIKAYTIS ◽  
LAURENE MASCOLA ◽  
...  

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