Abstract MP02: N-Terminal Pro-B-type Natriuretic Peptide and Risk of Stroke in Those With and Without Cerebrovascular Disease: The REGARDS Cohort

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Kara Landry ◽  
Suzanne Judd ◽  
Dawn Kleindorfer ◽  
George Howard ◽  
Virginia Howard ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebrovascular Disease ◽  
Racial Differences ◽  
Natriuretic Peptide ◽  
Stroke Recurrence ◽  
Black And White ◽  
Hazard Ratios ◽  
History Of ◽  
Ischemic Attack ◽  
Prior Stroke

Background: N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), a commonly used marker of cardiac function, is associated with presence of stroke symptoms and is a strong risk factor for future atrial fibrillation, stroke and mortality. Little data are available on the association between NT-pro-BNP levels and stroke recurrence. Objective: We studied the relationship between NT-proBNP with the risk of future ischemic stroke across a spectrum of pre-existing cerebrovascular conditions, ranging from history of stroke symptoms, to prior transient ischemic attack (TIA), to prior stroke. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans age 45 years and older in 2003-14. Among a case-cohort study sample including 1109 stroke cases and a 4311-person cohort random sample, we calculated hazard ratios of future ischemic stroke by baseline NT-proBNP stratified by presence of prior cerebrovascular conditions. Results: In the cohort sample, there were 3056 participants without any history of cerebrovascular disease, 738 with prior stroke symptoms, 196 with history of TIA and 338 with history of prior stroke. In a fully adjusted model, elevated NT-proBNP was associated with risk of stroke in participants without a pre-existing cerebrovascular condition (HR 2.32, 95% CI 1.84, 2.94), and in participants with a history of stroke symptoms (HR 1.67 95% CI 1.01, 2.78) or TIA (HR 2.66, 95% CI 1.00, 7.04), but not among those with prior stroke (HR 1.26, 95% CI 0.71, 2.21). Conclusions: These findings further support the potential for NT-proBNP testing to identify patients who are at highest risk for future stroke, although not in those with prior stroke.

scholarly journals Racial differences in statin adherence following hospital discharge for ischemic stroke

Neurology ◽  
2017 ◽  
Vol 88 (19) ◽  
pp. 1839-1848 ◽  
Author(s):  
Karen C. Albright ◽  
Hong Zhao ◽  
Justin Blackburn ◽  
Nita A. Limdi ◽  
T. Mark Beasley ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Discharge ◽  
Racial Differences ◽  
Low Income ◽  
Carotid Artery Disease ◽  
Adjusted Relative Risk ◽  
Black Adults ◽  
Black And White ◽  
History Of ◽  
White Adults

Objective:To compare nonadherence to statins in older black and white adults following an ischemic stroke.Methods:We studied black and white adults ≥66 years of age with Medicare fee-for-service insurance coverage hospitalized for ischemic stroke from 2007 to 2012 who filled a statin prescription within 30 days following discharge. Nonadherence was defined as a proportion of days covered <80% in the 365 days following hospital discharge. In addition, we evaluated factors associated with nonadherence for white and black participants separately.Results:Overall 2,763 beneficiaries met the inclusion criteria (13.5% black). Black adults were more likely than white adults to be nonadherent (49.7% vs 41.5%) even after adjustment for demographics, receipt of a low-income subsidy, and baseline comorbidities (adjusted relative risk [RR] 1.14, 95% confidence interval [CI] 1.01–1.29). Among white adults, receipt of a low-income subsidy (adjusted RR 1.13, 95% CI 1.02–1.26), history of coronary heart disease (adjusted RR 1.15, 95% CI 1.01–1.30), and discharge directly home following stroke hospitalization (adjusted RR 1.26, 95% CI 1.10–1.44) were associated with a higher risk of nonadherence. Among black adults, a 1-unit increase in the Charlson comorbidity index (adjusted RR 1.04, 95% CI 1.01–1.09), history of carotid artery disease (adjusted RR 2.38, 95% CI 1.08–5.25), and hospitalization during the 365 days prior to the index stroke (adjusted RR 1.34, 95% CI 1.01–1.78) were associated with nonadherence.Conclusions:Compared with white adults, black adults were more likely to be nonadherent to statins following hospitalization for ischemic stroke.

High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

2019 ◽  
Vol 16 (3) ◽  
pp. 250-257 ◽  
Author(s):  
Jiann-Der Lee ◽  
Ya-Han Hu ◽  
Meng Lee ◽  
Yen-Chu Huang ◽  
Ya-Wen Kuo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Prior History ◽  
Multivariate Logistic Regression ◽  
Cart Analysis ◽  
Younger Age ◽  
History Of ◽  
One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

scholarly journals Impacts of treatments on recurrence and 28-year survival of ischemic stroke patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ting-Ann Wang ◽  
Tzy-Haw Wu ◽  
Shin-Liang Pan ◽  
Hsiu-Hsi Chen ◽  
Sherry Yueh-Hsia Chiu
Keyword(s):  
Ischemic Stroke ◽  
Cerebrovascular Disease ◽  
Cox Regression ◽  
Controlled Trial ◽  
Stroke Recurrence ◽  
Long Term Effects ◽  
Stroke Patients ◽  
Double Blind ◽  
Term Survival

AbstractAspirin and nicametate are well-established therapies for preventing recurrence and mortality from stroke in patients diagnosed as ischemic stroke. However, their respective effects on the recurrence, making allowance for the duration of recurrence and death without the occurrence of recurrence, and long-term survival have not been well elucidated. We aimed to evaluate long-term effect of two kinds of treatment on cerebrovascular death among ischemic stroke patients with or without the recurrence of stroke. Data used in this study were derived from the cohort based on a multicenter randomized double-blind controlled trial during 1992 to 1995 with the enrollment of a total of 466 patients with first-time non-cardioembolic ischemic stroke who were randomly allocated to receive aspirin (n = 222) or nicametate (n = 244). The trial cohort was followed up over time to ascertain the date of recurrence within trial period and death until Sep of 2019. The time-dependent Cox regression model was used to estimate the long-term effects of two treatments on death from cerebrovascular disease with and without recurrence. A total of 49 patients experienced stroke recurrence and 89 cerebrovascular deaths was confirmed. Patients treated with nicametate were more likely, but non statistically significantly, to have recurrence (aHR: 1.73, 95% CI 0.96–3.13) as compared with those treated by aspirin. Nicametate reduced the risk of cerebrovascular death about 37% (aHR: 0.63, 95% CI 0.41–0.97) compared with aspirin. The aspirin group had a lower recurrence rate than the nicametate group even with recurrence after 1–2 years of follow-up of first stroke but the latter had significantly reduced death from cerebrovascular disease for nicametate group, which requires more research to verify.

2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack

2017 ◽  
Vol 12 (3) ◽  
pp. 302-320 ◽  
Author(s):  
Yongjun Wang ◽  
Ming Liu ◽  
Chuanqiang Pu
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Evidence Based ◽  
Cerebrovascular Disorder ◽  
Level Of Evidence ◽  
Vascular Stenosis ◽  
Ischemic Attack

Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.

EXPRESS: Risk factors for delayed-onset dementia after stroke or transient ischemic attack - A 5-year longitudinal cohort study

2021 ◽  
pp. 174749302110265
Author(s):  
Moamina Ismail ◽  
Vincent CT Mok ◽  
Adrian Wong ◽  
Lisa Au ◽  
Brian Yiu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Early Onset Dementia ◽  
Delayed Onset ◽  
Lower Baseline ◽  
History Of ◽  
Ischemic Attack ◽  
Moca Score

Background Stroke not only substantially increases the risk of incident dementia early after stroke, the risk remains elevated years after. Aim We aimed to determine the risk factors of dementia onset more than 3-6 months after stroke or transient ischemic attack (TIA). Methods This is a single center prospective cohort study. We recruited consecutive subjects with stroke/TIA without early-onset dementia. We conducted an annual neuropsychological assessment for 5 years. We investigated the association between baseline demographic, clinical, genetic (APOEε4 allele), and radiological factors, as well as incident recurrent stroke, with delayed-onset dementia using Cox proportional hazards models. Results 1,007 patients were recruited, of which 88 with early-onset dementia and 162 who lost to follow-ups were excluded. 49 (6.5%) out of 757 patients have incident delayed-onset dementia. The presence of ≥ 3 lacunes, history of ischemic heart disease (IHD), history of ischemic stroke and a lower baseline Hong Kong version of the Montreal Cognitive Assessment (MoCA) score, were significantly associated with delayed-onset dementia. APOEε4 allele, medial temporal lobe atrophy, and recurrent stroke were not predictive. Conclusion The presence of ≥ 3 lacunes, history of IHD, history of ischemic stroke and a lower baseline MoCA score, are associated with delayed-onset dementia after stroke/TIA.

Clinical Effects of Dual Antiplatelet Therapy or Aspirin Monotherapy after Acute Minor Ischemic Stroke or Transient Ischemic Attack, a Meta-Analysis

2021 ◽  
Vol 27 ◽  
Author(s):  
Francesco Condello ◽  
Gaetano Liccardo ◽  
Giuseppe Ferrante
Keyword(s):  
Ischemic Stroke ◽  
Major Bleeding ◽  
Transient Ischemic Attack ◽  
Hemorrhagic Stroke ◽  
Dual Antiplatelet Therapy ◽  
Meta Analysis ◽  
Stroke Recurrence ◽  
Controlled Trials ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

Background: Evidence about the use of dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors in patients with acute minor ischemic stroke or transient ischemic attack (TIA) is emerging. The aim of our study was to provide an updated and comprehensive analysis about the risks and benefits of DAPT versus aspirin monotherapy in this setting. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov databases, main international conference proceedings were searched for randomized controlled trials comparing DAPT versus aspirin monotherapy in patients with acute ischemic stroke or TIA not eligible for thrombolysis or thrombectomy presenting in the first 24 hours after the acute event. Data were pooled by meta-analysis using a random-effects model. The primary efficacy endpoint was ischemic stroke recurrence, and the primary safety outcome was major bleeding. Secondary endpoints were intracranial hemorrhage, hemorrhagic stroke, and all-cause death. Results: A total of 4 studies enrolling 21,459 patients were included. DAPT with clopidogrel was used in 3 studies, DAPT with ticagrelor in one study. DAPT duration was 21 days in one study, 1 month in one study, and 3 months in the remaining studies. DAPT was associated with a significant reduction in the risk of ischemic stroke recurrence (relative risk [RR], 0.74; 95% confidence interval [CI], 0.67-0.82, P<0.001, number needed to treat 50 [95% CI 40-72], while it was associated with a significantly higher risk of major bleeding (RR, 2.59; 95% CI 1.49-4.53, P=0.001, number needed to harm 330 [95% CI 149-1111]), of intracranial hemorrhage (RR 3.06, 95% CI 1.41-6.66, P=0.005), with a trend towards higher risk of hemorrhagic stroke (RR 1.83, 95% CI 0.83-4.05, P=0.14), and a slight tendency towards higher risk of all-cause death (RR 1.30, 95% CI 0.89-1.89, P=0.16). Conclusions: Among patients with acute minor ischemic stroke or TIA, DAPT, as compared with aspirin monotherapy, might offer better effectiveness in terms of ischemic stroke recurrence at the expense of a higher risk of major bleeding. The trade-off between ischemic benefits and bleeding risks should be assessed in tailoring the therapeutic strategies.

Abstract 207: Vorapaxar in Patients with Prior Ischemic Stroke: Primary Results from the Stroke Cohort of the Multinational TRA 2°P-TIMI 50 Trial

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
David A Morrow ◽  
Mark Alberts ◽  
Jay P Mohr ◽  
Sebastian Ameriso ◽  
Marc Bonaca ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Controlled Trial ◽  
Antiplatelet Agent ◽  
Antiplatelet Agents ◽  
Primary Efficacy ◽  
Background Therapy ◽  
History Of ◽  
Double Blinded ◽  
Prior Stroke

Vorapaxar is an antiplatelet agent that potently inhibits thrombin-mediated activation of the platelet protease-activated receptor (PAR)-1. Phase 2 trials of vorapaxar suggested efficacy with acceptable safety in patients with ischemic stroke. Methods: TRA 2°P–TIMI 50 was a multinational, randomized, double-blinded, placebo-controlled trial of 26449 patients with a history of atherothrombosis randomized to vorapaxar (2.5 mg daily) or matching placebo added to standard therapy, including antiplatelet agents. Patients who qualified with stroke (N=4883) had a history of ischemic stroke in the prior 2 wks to 12 mo. The first efficacy endpoint was the composite of cardiovascular (CV) death, MI, or stroke. After 2 years, the Data and Safety Monitoring Board recommended discontinuation of study treatment in patients with prior stroke. Results: The qualifying stroke was classified as large vessel in 35%, small vessel in 47%, and other in 18%. Background therapy included aspirin in 81%, clopidogrel in 22%, and dipyridamole in 19%. In the stroke cohort, the 3-year rate of CV death, MI, or stroke was not reduced with vorapaxar vs. placebo (13.0% vs. 11.7%, HR 1.03; 95% CI 0.85-1.25), including recurrent ischemic stroke (HR 0.99; 95% CI 0.78-1.25). There were no statistically significant differences in the effect of vorapaxar based on the type or timing of the qualifying stroke, and a borderline interaction based on co-administration of clopidogrel (Figure) The rate of intracranial hemorrhage (ICH) at 3 years was 2.5% with vorapaxar vs. 1.0% with placebo (HR 2.52; 95% CI 1.46-4.36). Conclusions: In patients with prior stroke receiving standard antiplatelet therapy, adding vorapaxar increased the risk of ICH without a reduction in the primary efficacy endpoint or ischemic stroke. These findings add to the accumulating evidence establishing important risks with combination antiplatelet therapy in patients with prior stroke.

Relationship Between N-Terminal Probrain Natriuretic Peptide (NT-Pro BNP) Level, Infarct Type and Infarct Volume in Ischemic Cerebrovascular Disease

2020 ◽  
Vol 3 (2) ◽  
pp. 100-105
Author(s):  
Selma Tekin ◽  
Çağatay Hilmi Öncel ◽  
Mehmet Bülent Özdemir ◽  
Yalın Tolga Yaylalı ◽  
Işık Tekin ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Natriuretic Peptide ◽  
Transient Ischemic Attack ◽  
Infarct Volume ◽  
Lacunar Infarct ◽  
Ischemic Cerebrovascular Disease ◽  
Valuable Marker ◽  
Disease Subtypes ◽  
Ischemic Attack ◽  
Relationship Of

Background: N-terminal probrain natriuretic peptide, which is a neurohormone produced mainly by the heart, is increased in acute ischemic cerebrovascular disease. Here we aimed to investigate the relationship of N-terminal probrain natriuretic peptide levels with cerebrovascular disease subtypes, infarct volume, and prognosis in cerebrovascular disease, and to determine if N-terminal probrain natriuretic peptide could be a biomarker for ischemic cerebrovascular disease. Methods: Consecutive 105 patients with a diagnosis of acute ischemic cerebrovascular disease and 50 healthy controls were examined for serum N-terminal probrain natriuretic peptide concentration, cerebrovascular disease subtypes, infarct volumes, and clinical outcomes with the National Institute of Health Stroke Scale assessment. Results: Mean N-terminal probrain natriuretic peptide values of cardioembolic group were significantly higher than lacunar infarct group ( P < .005) and transient ischemic attack group ( P = .005). There was a relation between worsening in the National Institute of Health Stroke Scale and elevation at N-terminal probrain natriuretic peptide ( P = .001). However, between N-terminal probrain natriuretic peptide levels and infarct volume, significant correlation was not detected ( P = .44). Conclusion: N-terminal probrain natriuretic peptide can be used as a valuable marker to distinguish between cardioembolic infarct and lacunar infarct. In addition, N-terminal probrain natriuretic peptide levels might be used as a biomarker for differential diagnosis of transient ischemic attack group and to provide insight into the prognosis.

Symptomatic Intracranial Atherosclerosis: Natural History of Medical Management Beyond the Hyperacute Stage of Ischemic Stroke in the Post-SAMMPRIS Era

2018 ◽  
Vol 1 (1) ◽  
pp. 68-72
Author(s):  
Anand G. Vaishnav ◽  
Radhika A. Vaishnav
Keyword(s):  
Ischemic Stroke ◽  
Natural History ◽  
Recurrent Stroke ◽  
Imaging Techniques ◽  
Tertiary Care ◽  
Unfavorable Outcome ◽  
Stroke Recurrence ◽  
Atherosclerotic Stenosis ◽  
History Of

Background: A major cause of ischemic stroke (IS) worldwide, especially in Asia, is intracranial atherosclerotic stenosis (ICAS), which is also associated with the high risk of recurrent stroke. Objective: The aim of our study was to determine the natural history of symptomatic ICAS ischemic stroke (ICAS IS) patients. Materials and Methods: We collected data on acute ICAS IS patients beyond the hyperacute IS phase to determine stroke recurrence and mortality at a tertiary care neurology hospital. Data were collected on basic demographics and traditional risk factors such as hypertension, coronary artery disease, diabetes mellitus, tobacco abuse, and hyperlipidemia, and statistical analysis was done. The primary endpoint was to measure the unfavorable outcome as defined by recurrent stroke or death from any cause. Results: The mean follow-up time for the total 87 patients was 24.5 months. Nine patients (10.3%) had an unfavorable outcome in the follow-up period; 2 (2.3%) of them had recurrent IS. Age was a predictor of the unfavorable outcome ( P = .0025), whereas hyperlipidemia was present more in patients with the favorable outcome ( P = .033). There was a tendency for patients with poor outcomes to have a higher National Institutes of Health Stroke Scale at their onset of stroke. Conclusions: Aggressive medical treatment was associated with a relatively low risk of recurrent stroke in our ICAS IS population. This study provides groundwork for larger studies that can take into account clinical and newer imaging techniques to improve secondary prevention in ICAS IS patients.

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