Abstract 057: Increased Incidence of Ischemic Stroke in HIV-Infected Women in a Clinical Care Cohort

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Felicia C Chow ◽  
Susan Regan ◽  
Steven Feske ◽  
James B Meigs ◽  
Steven K Grinspoon ◽  
...  

Introduction: Coronary heart disease rates are increased among HIV-infected patients compared to control groups, with a relatively greater increase in women compared to men. Whether a similar pattern with respect to gender is true for ischemic stroke is not known. We assessed the hypothesis that the adjusted hazard ratio for ischemic stroke given HIV infection is greater among women compared to men. Methods: The study was conducted using data from an HIV observational clinical care cohort at a large Boston-based health care system. A control cohort of non-HIV-infected patients was matched in a 10:1 ratio to the HIV cohort based on age, gender, and race. The observation period was between 1996 and 2009, with right censoring at the initial stroke event or last encounter if prior to 2009. Ischemic stroke events were identified by pre-specified and validated ICD-9-CM codes. Gender-specific stroke incidence rates were calculated. To assess the association of HIV and ischemic stroke within each gender, Cox proportional hazard modeling was employed. Results: The cohorts consisted of 4,308 HIV-infected patients (31% women) and 32,423 non-HIV-infected patients (35% women). Among women, ischemic stroke event rates were 5.02 per 1000 person years (PY) in HIV-infected versus 2.31 per 1000 PY in non-HIV-infected patients (40 events in HIV and 177 events in non-HIV) with an unadjusted hazard ratio (HR) of 2.16 (95% confidence interval [CI] 1.53–3.04, P <0.001). In contrast, among men ischemic stroke rates were 5.38 per 1000 PY in HIV-infected versus 4.59 per 1000 PY in non-HIV-infected patients (92 events in HIV and 605 events in non-HIV patients) with an unadjusted HR of 1.18 (95% CI 0.95–1.47, P =0.14). Comparing HIV-infected to non-HIV-infected patients, incidence rates were significantly increased among women in the 18–29, 30–39, and 40–49 age groups and among men in the 30–39 age group. In a gender-stratified, multivariate regression model adjusting for age, race, hypertension, diabetes, dyslipidemia, smoking, structural heart disease, atrial fibrillation, aspirin use, and warfarin use, the adjusted HR for stroke associated with HIV infection was 1.76 (95% CI 1.24–2.52, P =0.002) among women compared with 1.05 (95% CI 0.84–1.32, P =0.639) among men. Conclusions: Ischemic stroke incidence rates were significantly increased in HIV-infected patients compared to non-HIV-infected patients among young women (< 50) and a subset of young men. HIV infection remained independently associated with stroke among women after adjusting for demographic and traditional stroke risk factors. While further studies are merited investigating causality and potential mechanisms for stroke among HIV-infected women, this group may represent a uniquely at-risk population for accelerated cerebrovascular aging.

2021 ◽  
Vol 23 (3) ◽  
pp. 233-239
Author(s):  
Woo Yup Kim ◽  
Hakyung Kim ◽  
Je Beom Hong ◽  
Seung Hun Sheen ◽  
In-bo Han ◽  
...  

Objective: The aim of this nationwide age- and sex- matched longitudinal follow up study is to determine the risk of Parkinson’s disease (PD) associated with ischemic stroke in Korea.Methods: Patient data were collected from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS). PD was identified using the International Classification of Diseases (ICD) 10-CM code G 20. In total, 6,475 patients were enrolled in the PD group from the NHISS. After subtracting 1,039 patients who underwent hospitalization less than once or those who visited an outpatient clinic less than two times, 5,259 patients who were diagnosed after January 1, 2004 ultimately participated in this study. After case-control match was done through 1:5 age- and sex- stratified matching, 26,295 individuals were chosen as control. Kaplan-Meier method and Cox proportional hazard regression analysis were performed to evaluate the risk of ischemic stroke in PD.Results: The hazard ratio of ischemic stroke in the PD group was 3.848 (95% confidence interval (confidence interval [CI]): 3.14-4.70) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in PD group was 3.885 (95% CI: 3.17-4.75) after adjusting for comorbidities. According to subgroup analysis, in male and female and non-diabetes and diabetes and non-hypertension and hypertension and dyslipidemia and non-dyslipidemia subgroups, ischemic stroke incidence rates were significantly higher in the PD group than those in the control group.Conclusions: This nationwide longitudinal study suggests an increased risk of ischemic stroke in PD patients.


Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Malik M Adil ◽  
Mariam Suri ◽  
Basit Rahim ◽  
Sarwat I Gilani ◽  
Adnan I Qureshi

BACKGROUND: Regular physical activities, including light-to-moderate activities, such as walking, have well-established benefits for reducing the risk of ischemic stroke. It remains unknown whether certain area characteristics can influence the risk of stroke through promoting such activities. OBJECTIVES: We tested the hypothesis that how walkable an area is will be negatively associated with the risk of ischemic stroke in persons residing in the area. METHODS: We calculated the age- adjusted annual incidence rates of ischemic stroke among residents in each of the 63 cities in Minnesota between 2007 and 2011. The walk score, an online database, provides a numerical walkability score for any location within the United States, ranging between 0 and 100 that is computed by using exclusive algorithms. The route to amenities is sorted into nine different categories: grocery, restaurants, shopping, coffee, banks, parks, schools, books, and entertainment, which are weighed according to their prominence. RESULTS: There are 2,901,389 persons residing in 63 cities in Minnesota (average population per town is 46053). The average walk score of the 63 towns in Minnesota was 37, ranging from 14 to 69. The average median age of residents was similar in tertiles of towns based on walk score as follows: ≤25 (n=9) 36 years; 26-50(n=46) 36 years; and 51-100(n=8) 34 years. The age adjusted incidence of ischemic stroke was similar in tertiles of towns based on walk score as follows: ≤25 (n=9) 2157 per 100,000; 26-50(n=46) 1924 per 100,000; and 51-100(n=8) 2856 per 100,000 residents. The correlation between age adjusted ischemic stroke incidence and walk score was low (R2=0.32) within Minnesota. CONCLUSIONS: The ready availability of indices such as walk score makes it an attractive option but currently such indices lack the sensitivity to measure the magnitude and health benefits of light-to-moderate activities performed within a town.


Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Christine K Fox ◽  
Adam L Numis ◽  
Steve Sidney ◽  
Heather J Fullerton

Background: Over 2 million people under age 50 are seen in a U.S. emergency room monthly for non-fatal injuries. Our objective was to measure ischemic stroke incidence after traumatic injury in young patients and identify stroke risk factors. Methods: We performed a population-based study of ischemic stroke after trauma among people <50 years old in a Northern Californian integrated health care system. We electronically identified a cohort of patients with diagnostic codes for trauma (ICD-9 800-959.9) in emergency and inpatient encounters from 1997-2011, then identified ischemic stroke outcomes within 4 weeks. To determine stroke, we required an ICD-9 stroke code (433-438) plus a radiology report of brain imaging containing a keyword: stroke, infarct#, thromb#, ischemi#, lacun#, or dissect#. A neurologist reviewed the reports to exclude those inconsistent with ischemic stroke. We obtained clinical data such as injury type from electronic databases to calculate stratified incidence rates and risk ratios. Results: From 1.5 million trauma encounters, we identified 197 ischemic strokes. The 4-week stroke incidence after any traumatic injury was 0.013% (95% CI 0.011, 0.015). Patients with stroke had a mean age of 37.7 years (SD 12.2) versus 24.0 years (SD 13.8) in those without stroke (P<0.0001). Patients with injury to the head or neck were more likely to have a stroke compared to those with other types of injuries (Table). The 4-week stroke incidence after head or neck injury was 0.07% (95% CI 0.05, 0.09) among adults and 0.005% (95% CI 0.001, 0.01) among children (P<0.0001). Of the 197 stroke cases, 16% (95% CI 11, 22) had a diagnostic code for cranio-cervical dissection. Conclusions: A 4-week stroke incidence of 0.013% suggests that 260 young people have an ischemic stroke after a traumatic injury every month in the U.S. Further research is needed to identify the highest risk groups, such as those with head or neck injury, and opportunities for stroke prevention.


Neurology ◽  
2020 ◽  
Vol 95 (17) ◽  
pp. e2343-e2353
Author(s):  
Adelina Yafasova ◽  
Emil Loldrup Fosbøl ◽  
Mia Nielsen Christiansen ◽  
Naja Emborg Vinding ◽  
Charlotte Andersson ◽  
...  

ObjectiveTo examine whether the incidence, comorbidity, and mortality of first-time ischemic stroke changed in Denmark between 1996 and 2016 overall and according to age and sex using a nationwide cohort design.MethodsIn this cohort study, 224,617 individuals ≥18 years of age admitted with first-time ischemic stroke between 1996 and 2016 were identified through Danish nationwide registries. We calculated annual age-standardized incidence rates and absolute 30-day and 1-year mortality risks. Furthermore, we calculated annual incidence rate ratios using Poisson regression, odds ratios for 30-day mortality using logistic regression, and hazard ratios for 1-year mortality using Cox regression.ResultsThe overall age-standardized incidence rates of ischemic stroke per 1,000 person-years increased from 1996 (2.70 [95% confidence interval [CI] 2.65–2.76]) to 2002 (3.25 [95% CI 3.20–3.31]) and then gradually decreased to below the initial level until 2016 (1.99 [95% CI 1.95–2.02]). Men had higher incidence rates than women in all age groups except 18 to 34 and ≥85 years. Absolute mortality risk decreased between 1996 and 2016 (30-day mortality from 17.1% to 7.6% and 1-year mortality from 30.9% to 17.3%). Women between 55 and 64 and ≥85 years of age had higher mortality than men. Similar trends were observed for all analyses after multivariable adjustment. The prevalence of atrial fibrillation, hypertension, diabetes mellitus, and use of lipid-lowering medication increased during the study period.ConclusionsThe age-standardized incidence of first-time hospitalization for ischemic stroke increased from 1996 to 2002 and then gradually decreased to below the initial level until 2016. Absolute 30-day and 1-year mortality risks decreased between 1996 and 2016. These findings correspond to increased stroke prevention awareness and introduction of new treatments during the study period.


Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1364-1371
Author(s):  
Charlotte Andreasen ◽  
Gunnar H. Gislason ◽  
Lars Køber ◽  
Jawdat Abdulla ◽  
Andreas Martinsson ◽  
...  

Background and Purpose— Aortic valve stenosis may lead to atrial and ventricular remodeling, predisposes to atrial fibrillation, and may also be an independent risk factor of ischemic stroke. However, information on stroke rates among persons with aortic valve stenosis are sparse. We aimed to determine the incidence rates and relative risks of ischemic stroke in individuals with diagnosed aortic valve stenosis compared with age- and sex-matched controls. Methods— All patients with incident aortic valve stenosis aged >18 years (n=79 310) and age- and sex-matched controls were identified using the Danish nationwide registries (1997–2017). Incidence rates per 1000 person-years (PY) and multivariable adjusted hazard ratios with 95% CIs were reported. Results— In total, 873 373 individuals (median age 77 years, 51.5% men, 9.1% with aortic valve stenosis) were included. Ischemic stroke occurred in 70 205 (8.0%) individuals during 4 880 862 PY of follow-up. Incidence rates of ischemic stroke were 13.3/1000 PY among the controls compared with 30.4/1000 PY in patients with aortic valve stenosis, corresponding to a hazard ratio of 1.31 (95% CI, 1.28–1.34). In all age-groups, the incidence rates and relative risks were significantly increased in patients with aortic valve stenosis compared with controls, but the relative risk was greater for younger individuals (eg, age group, 18–45 years: hazard ratio, 5.94 [95% CI, 4.10–8.36]). In patients with aortic valve stenosis above 65 years of age, the risk of ischemic stroke was markedly lower after aortic valve replacement (30.3 versus 19.6/1000 PY before and after valve replacement). Among people with atrial fibrillation the incidence rate of ischemic stroke was 1.5 times higher when aortic valve stenosis was present (33.0/1000 PY versus 49.9/1000 PY). Conclusions— People with aortic valve stenosis have a significantly increased risk of ischemic stroke compared with age- and sex-matched controls. Future studies are warranted to explore whether antithrombotic therapy may be beneficial in some individuals.


2017 ◽  
Vol 12 (8) ◽  
pp. 835-843 ◽  
Author(s):  
Hamidreza Saber ◽  
Amanda G Thrift ◽  
Moira K Kapral ◽  
Ashkan Shoamanesh ◽  
Amin Amiri ◽  
...  

Background Incidence, risk factors, case fatality and survival rates of ischemic stroke subtypes are unknown in the Middle East due to the lack of community-based incidence stroke studies in this region. Aim To characterize ischemic stroke subtypes in a Middle Eastern population. Methods The Mashad Stroke Incidence Study is a community-based study that prospectively ascertained all cases of stroke among the 450,229 inhabitants of Mashhad, Iran between 2006 and 2007. We identified 512 cases of first-ever ischemic stroke [264 men (mean age 65.5 ± 14.4) and 248 women (mean age 64.14 ± 14.5)]. Subtypes of ischemic stroke were classified according to the TOAST criteria. Incidence rates were age standardized to the WHO and European populations. Results The proportion of stroke subtypes was distributed as follows: 14.1% large artery disease, 15% cardioembolic, 22.5% small artery disease, 43.9% undetermined and 4.5% other. The greatest overall incidence rates were attributed to undetermined infarction (49.97/100,000) followed by small artery disease (25.54/100,000). Prevalence of hypertension, diabetes and atrial fibrillation differed among ischemic stroke subtypes. Overall, there were 268 (52.34%) deaths and 73 (14.25%) recurrent strokes at five years after incident ischemic stroke, with the greatest risk of recurrence seen in the large artery disease (35.6%) and cardioembolic (35.5%) subgroups. Survival was similar in men and women for each stroke subtype. Conclusions We observed markedly greater incidence rates of ischemic stroke subtypes than in other countries within the Mashad Stroke Incidence Study after age standardization. Our findings should be considered when planning prevention and stroke care services in this region.


Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3363-3368 ◽  
Author(s):  
Arleen F. Brown ◽  
Li-Jung Liang ◽  
Stefanie D. Vassar ◽  
Sharon Stein-Merkin ◽  
W.T. Longstreth ◽  
...  

Background and Purpose— Neighborhood characteristics may influence the risk of stroke and contribute to socioeconomic disparities in stroke incidence. The objectives of this study were to examine the relationship between neighborhood socioeconomic status and incident ischemic stroke and examine potential mediators of these associations. Methods— We analyzed data from 3834 whites and 785 blacks enrolled in the Cardiovascular Health Study, a multicenter, population-based, longitudinal study of adults ages ≥65 years from 4 US counties. The primary outcome was adjudicated incident ischemic stroke. Neighborhood socioeconomic status was measured using a composite of 6 census tract variables. Race-stratified multilevel Cox proportional hazard models were constructed adjusted for sociodemographic, behavioral, and biological risk factors. Results— Among whites, in models adjusted for sociodemographic characteristics, stroke hazard was significantly higher among residents of neighborhoods in the lowest compared with the highest neighborhood socioeconomic status quartile (hazard ratio, 1.32; 95% CI, 1.01–1.72) with greater attenuation of the hazard ratio after adjustment for biological risk factors (hazard ratio, 1.16; 0.88–1.52) than for behavioral risk factors (hazard ratio, 1.30; 0.99–1.70). Among blacks, we found no significant associations between neighborhood socioeconomic status and ischemic stroke. Conclusions— Higher risk of incident ischemic stroke was observed in the most disadvantaged neighborhoods among whites, but not among blacks. The relationship between neighborhood socioeconomic status and stroke among whites appears to be mediated more strongly by biological than behavioral risk factors.


Stroke ◽  
2020 ◽  
Vol 51 (4) ◽  
pp. 1100-1106
Author(s):  
Mitsuaki Sawano ◽  
Ya Yuan ◽  
Shun Kohsaka ◽  
Taku Inohara ◽  
Takeki Suzuki ◽  
...  

Background and Purpose— In previous studies, isolated nonspecific ST-segment and T-wave abnormalities (NSSTTAs), a common finding on ECGs, were associated with greater risk for incident coronary artery disease. Their association with incident stroke remains unclear. Methods— The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a population-based, longitudinal study of 30 239 white and black adults enrolled from 2003 to 2007 in the United States. NSSTTAs were defined from baseline ECG using the standards of Minnesota ECG Classification (Minnesota codes 4-3, 4-4, 5-3, or 5-4). Participants with prior stroke, coronary heart disease, and major and minor ECG abnormalities other than NSSTTAs were excluded from analysis. Multivariable Cox proportional hazards regression was used to examine calculate hazard ratios of incident ischemic stroke by presence of baseline NSSTTAs. Results— Among 14 077 participants, 3111 (22.1%) had NSSTTAs at baseline. With a median of 9.6 years follow-up, 106 (3.4%) with NSSTTAs had ischemic stroke compared with 258 (2.4%) without NSSTTAs. The age-adjusted incidence rates (per 1000 person-years) of stroke were 2.93 in those with NSSTTAs and 2.19 in those without them. Adjusting for baseline age, sex, race, geographic location, and education level, isolated NSSTTAs were associated with a 32% higher risk of ischemic stroke (hazard ratio, 1.32 [95% CI, 1.05–1.67]). With additional adjustment for stroke risk factors, the risk of stroke was increased 27% (hazard ratio, 1.27 [95% CI, 1.00–1.62]) and did not differ by age, race, or sex. Conclusions— Presence of NSSTTAs in persons with an otherwise normal ECG was associated with a 27% increased risk of future ischemic stroke.


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255918
Author(s):  
Alyssa DeWyer ◽  
Amy Scheel ◽  
Jenipher Kamarembo ◽  
Rose Akech ◽  
Allan Asiimwe ◽  
...  

Introduction To address workforce shortages and expand access to care, we developed a telemedicine program incorporating existing infrastructure for delivery of cardiovascular care in Gulu, Northern Uganda. Our study had three objectives: 1) assess feasibility and clinical impact 2) evaluate patient/parent satisfaction and 3) estimate costs. Methods All cardiology clinic visits during a two-year study period were included. All patients received an electrocardiogram and echocardiogram performed by a local nurse in Gulu which were stored and transmitted to the Uganda Heart Institute in the capital of Kampala for remote consultation by a cardiologist. Results were relayed to patients/families following cardiologist interpretation. The following telemedicine process was utilized: 1) clinical intake by nurse in Gulu; 2) ECG and echocardiography acquisition in Gulu; 3) echocardiography transmission to the Uganda Heart Institute in Kampala, Uganda; 4) remote telemedicine consultation by cardiologists in Kampala; and 5) communication of results to patients/families in Gulu. Clinical care and technical aspects were tracked. Diagnoses and recommendations were analyzed by age groups (0–5 years, 6–21 years, 22–50 years and > 50 years). A mixed methods approach involving interviews and surveys was used to assess patient satisfaction. Healthcare sector costs of telemedicine-based cardiovascular care were estimated using time-driven activity-based costing. Results Normal studies made up 47%, 55%, 76% and 45% of 1,324 patients in the four age groups from youngest to oldest. Valvular heart disease (predominantly rheumatic heart disease) was the most common diagnosis in the older three age groups. Medications were prescribed to 31%, 31%, 24%, and 48% of patients in the four age groups. The median time for consultation was 7 days. A thematic analysis of focus group transcripts displayed an overall acceptance and appreciation for telemedicine, citing cost- and time-saving benefits. The cost of telemedicine was $29.48/visit. Conclusions Our data show that transmission and interpretation of echocardiograms from a remote clinic in northern Uganda is feasible, serves a population with a high burden of heart disease, has a significant impact on patient care, is favorably received by patients, and can be delivered at low cost. Further study is needed to better assess the impact relative to existing standards of care and cost effectiveness.


2020 ◽  
pp. 1-8
Author(s):  
Petra Sedova ◽  
Robert D. Brown ◽  
Miroslav Zvolsky ◽  
Silvia Belaskova ◽  
Michaela Volna ◽  
...  

<b><i>Background:</i></b> There are few contemporary epidemiological data on stroke for Central Europe. We performed a population-based study evaluating the incidence of stroke, stroke types, and ischemic stroke (IS) subtypes in Brno, the second biggest city in the Czech Republic (CR). <b><i>Methods:</i></b> Using the National Registry of Hospitalized Patients, and hospital databases, we identified all patients hospitalized with a stroke diagnosis in Brno hospitals in 2011. For Brno residents with validated stroke diagnosis, we calculated (a) the overall incidence of hospitalized stroke, (b) incidence rates for IS, subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), and (c) incidence rates for IS subtypes. We calculated the average annual age- and sex-standardized incidence (European Standard Population and World Health Organization), to compare our results with other studies. <b><i>Results:</i></b> The overall crude incidence of stroke in Brno was 213/100,000 population. The incidence of stroke for stroke types were as follows: SAH, 6.9; ICH, 26.4; and IS, 180 cases per 100,000 population, respectively. The WHO-standardized annual stroke incidence was 107 for all strokes and 88 for IS, 14.4 for ICH, and 5 for SAH. For IS subtypes, the WHO-standardized incidence was large artery atherosclerosis 25.8, cardioembolism 27.8, lacunar 21.6, other determined etiology 6.2, and undetermined etiology 6.5 cases per 100,000 population. <b><i>Conclusions:</i></b> The stroke incidence is lower than that previously reported for the CR and Eastern Europe probably reflecting socioeconomic changes in post-communistic countries in the region. These findings could contribute to stroke prevention strategies and influence health policies.


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