scholarly journals Elevated Pulse Pressure and Recurrent Hemorrhagic Stroke Risk in Stroke With Cerebral Microbleeds or Intracerebral Hemorrhage

2021 ◽  
Author(s):  
Jong‐Ho Park ◽  
Juneyoung Lee ◽  
Sun U. Kwon ◽  
Hyuk Sung Kwon ◽  
Min Hwan Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Cardiovascular Events ◽  
Operating Characteristic ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Characteristic Curve ◽  
Cerebral Microbleeds ◽  
Major Adverse Cardiovascular Events

Background Which type of recurrent stroke is associated with pulse pressure (PP) remains uncertain in ischemic stroke with cerebral microbleeds or intracerebral hemorrhage. Methods and Results The (PICASSO) Prevention of Cardiovascular Events in Ischemic Stroke Patients With High Risk of Cerebral Hemorrhage database involving 1454 subjects was analyzed. Subjects were stratified into quartiles according to the distribution of mean PP (mm Hg) during follow‐up (mean, 1.9 years): <47 (first quartile), 48 to 53 (second quartile), 54 to 59 (third quartile), and ≥60 mm Hg (fourth quartile). The primary end point was hemorrhagic stroke, and the secondary end points were ischemic stroke, stroke of any type, and major adverse cardiovascular events. Adjusted time‐dependent area under the receiver operating characteristic curve analysis was performed to assess the prediction accuracy of mean PP. The mean frequency of visit for blood pressure checkup was 9.4±5.5 times. The stroke incidence rate per 100 person‐years was 3.14, 2.24, 5.52, and 6.22, respectively in increasing quartile of mean PP, and the rate of major adverse cardiovascular events was 3.82, 2.84, 6.37, and 7.14, respectively. In the presence of mean arterial pressure, hemorrhagic stroke risk was higher in the highest quartile (adjusted hazard ratio, 6.03; 95% CI, 1.04–34.99) versus the lowest quartile, which was evident at higher mean systolic blood pressure. Higher mean PP as a continuous variable was also a predictor of hemorrhagic stroke (1.09, 1.03−1.15). The time‐dependent area under the receiver operating characteristic curve for hemorrhagic stroke was 0.79. Conclusions Long‐term elevated PP with higher systolic blood pressure confers a greater risk of subsequent hemorrhagic stroke among stroke patients with cerebral microbleeds or intracerebral hemorrhage. Registration URL: https://www.clinicaltrials.gov ; Unique identifier, NCT01013532.

scholarly journals Genetically Predicted Blood Pressure Across the Lifespan

Hypertension ◽  
2020 ◽  
Vol 76 (3) ◽  
pp. 953-961
Author(s):  
Marios K. Georgakis ◽  
Dipender Gill ◽  
Rainer Malik ◽  
Athanase D. Protogerou ◽  
Alastair J.S. Webb ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Mendelian Randomization ◽  
Causal Effect ◽  
Later Life ◽  
Large Artery ◽  
Using Data

Hypertension is the leading risk factor for stroke. Yet, it remains unknown whether blood pressure pulsatility (pulse pressure [PP]) causally affects stroke risk independently of the steady pressure component (mean arterial pressure [MAP]). It is further unknown how the effects of MAP and PP on stroke risk vary with age and stroke cause. Using data from UK Biobank (N=408 228; 38–71 years), we selected genetic variants as instruments for MAP and PP at age ≤55 and >55 years and across age deciles. We applied multivariable Mendelian randomization analyses to explore associations with ischemic stroke, intracerebral hemorrhage, and their subtypes. Higher genetically predicted MAP was associated with higher risk of ischemic stroke and intracerebral hemorrhage across the examined age spectrum. Independent of MAP, higher genetically predicted PP only at age >55 years was further associated with higher risk of ischemic stroke (odds ratio per-SD-increment, 1.23 [95% CI, 1.13–1.34]). Among subtypes, the effect of genetically predicted MAP on large artery stroke was attenuated, whereas the effect of genetically predicted PP was augmented with increasing age. Genetically predicted MAP, but not PP, was associated with small vessel stroke and deep intracerebral hemorrhage homogeneously across age deciles. Neither genetically predicted MAP nor PP were associated with lobar intracerebral hemorrhage. Beyond an effect of high MAP at any age on ischemic and hemorrhagic stroke, our results support an independent causal effect of high PP at older ages on large artery stroke. This finding warrants further investigation for the development of stroke preventive strategies targeting pulsatility in later life.

scholarly journals Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis

2019 ◽  
Vol 12 ◽  
pp. 175628641986483 ◽  
Author(s):  
Ru Jian Jonathan Teoh ◽  
Chi-Jung Huang ◽  
Chi Peng Chan ◽  
Li-Yin Chien ◽  
Chih-Ping Chung ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Statin Therapy ◽  
Sequential Analysis ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Trial Sequential Analysis ◽  
Stroke Survivors ◽  
Composite Endpoints

Background: It remains debatable whether statin increases the risk of intracerebral hemorrhage (ICH) in poststroke patients. Methods: We systematically searched PubMed, EMBASE, and CENTRAL for randomized controlled trials. Trial sequential analysis (TSA) was conducted to assess the reliability and conclusiveness of the available evidence in the meta-analysis. To evaluate the overall effectiveness, the net composite endpoints were derived by totaling ischemic stroke, hemorrhagic stroke, transient ischemic attack (TIA), myocardial infarction, and cardiovascular mortality. Results: A total of 17 trials with 11,576 subjects with previous ischemic stroke, TIA, or ICH were included, in which statin therapy increased the risk of hemorrhagic stroke (risk ratio [RR], 1.42; 95% confidence interval [CI], 1.07–1.87), but reduced the risk of ischemic stroke (RR, 0.85; 95% CI, 0.75–0.95). For the net composite endpoints, statin therapy was associated with a 17% risk reduction (95% CI, 12–21%; number needed to treat = 6). With a control event rate 2% and RR increase 40%, the TSA suggested a conclusive signal of an increased risk of hemorrhagic stroke in stroke survivors taking statin. However, with the sensitivity analysis by changing assumptions, the conclusions about hemorrhagic stroke risk were less robust. Conclusions: Statin therapy in poststroke patients increased the risk of hemorrhagic stroke but effectively reduced ischemic stroke risk. Weighing the benefits and potential harms, statin has an overall beneficial effect in patients with previous stroke or TIA. However, more studies are required to investigate the conclusiveness of the increased hemorrhagic stroke risk revealed in our study.

Blood Pressure Changes in a Chinese Population Have a Greater Impact on Short-Term Outcomes Rather Than Long-Term Outcomes of Major Adverse Cardiovascular Events

2020 ◽  
pp. 101053952095508
Author(s):  
Qianyi Xu ◽  
Yali Wang ◽  
Yanxia Xie ◽  
Jia Zheng ◽  
Rongrong Guo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Stroke Risk ◽  
Rural China ◽  
Major Adverse Cardiovascular Events ◽  
Long Term Outcomes ◽  
Short Term ◽  
Initial Examination ◽  
The Difference

The purpose of our study was to explore the association of blood pressure (BP) changes on short-and long-term outcomes of major adverse cardiovascular events (MACEs) in rural China. This study was designed to learn the effects of BP changes (2004-2008) on short-term (2008-2010, within 2 years of the initial examination) and long-term (2008-2017) outcomes of MACE, including 24 285 and 27 290 participants, respectively. In this study, 423 (short-term) and 1952 (long-term) MACEs were identified. For prehypertension to hypertension, the risk of long-term stroke was increased (hazard ratio [HR] = 1.18 [1.00-1.39]). For hypertension to prehypertension, the short-term MACE risk (0.65 [0.47-0.90]), short-term stroke risk (0.45 [0.26-0.76]), and long-term stroke risk (0.83 [0.70-0.99]) all decreased. Short-term outcomes conferred a stronger impact than long-term outcomes (Fisher Z test, measured as the difference of β coefficients, all P < .05).

scholarly journals Prior intracerebral hemorrhage and white matter hyperintensity burden on recurrent stroke risk

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jong-Ho Park ◽  
Sun U. Kwon ◽  
Hyuk Sung Kwon ◽  
Sung Hyuk Heo
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Intracerebral Hemorrhage ◽  
Hemorrhagic Stroke ◽  
Small Vessel Disease ◽  
Recurrent Stroke ◽  
White Matter Hyperintensity ◽  
Major Adverse Cardiovascular Events ◽  
Stroke Incidence ◽  
Increased Risk

AbstractPrior intracerebral hemorrhage (ICH) is associated with increased risk of ischemic stroke. Since white matter hyperintensity (WMH) is associated with ischemic stroke and ICH, this study aimed to evaluate the relationship between ICH and the risk of recurrent stroke by WMH severity. From a prospective multicenter database comprising 1454 noncardioembolic stroke patients with cerebral small-vessel disease, patients were categorized by presence or absence of prior ICH and WMH severity: mild-moderate WMH (reference); advanced WMH; ICH with mild-moderate WMH; and ICH with advanced WMH. Among patients with ICH, the association with stroke outcomes by WMH burden was further assessed. The primary endpoint was ischemic stroke and hemorrhagic stroke. The secondary endpoint was major adverse cardiovascular events (MACE): stroke/coronary heart disease/vascular death. During the mean 1.9-year follow-up period, the ischemic stroke incidence rate per 100 person-years was 2.7, 4.0, 2.5, and 8.1 in increasing severity, and the rate of hemorrhagic stroke was 0.7, 1.3, 0.6, and 2.1, respectively. The risk of ischemic stroke was higher in ICH with advanced WMH (adjusted HR 2.62; 95% CI 1.22−5.60) than the reference group, while the risk of hemorrhagic stroke trended higher (3.75, 0.85–16.53). The risk of MACE showed a similar pattern in ICH with advanced WMH. Among ICH patients, compared with mild WMH, the risk of ischemic stroke trended to be higher in advanced WMH (HR 3.37; 95% CI 0.90‒12.61). Advanced WMH was independently associated with an increased risk of hemorrhagic stroke (HR 33.96; 95% CI 1.52−760.95). Given the fewer rate of hemorrhagic stroke, the risk of hemorrhagic stroke might not outweigh the benefits of antiplatelet therapy for secondary prevention.

Effect of blood pressure parameters on functional independence in patients with acute ischemic stroke in the first 6 hours after endovascular thrombectomy

2019 ◽  
Vol 12 (10) ◽  
pp. 937-941 ◽  
Author(s):  
Hai-Jui Chu ◽  
Chun-Hsien Lin ◽  
Chih-Hao Chen ◽  
Yi Ting Hwang ◽  
Meng Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Functional Independence ◽  
Time Intervals ◽  
Endovascular Thrombectomy ◽  
The Mean

Background and purposeStudies have suggested that blood pressure (BP) levels after endovascular thrombectomy (EVT) are correlated with clinical outcomes. The aim of our study was to investigate the effect of BP in different time intervals within the first 24 hours after EVT on functional outcomes.MethodsData of patients who received EVT for acute ischemic stroke at two institutions were reviewed. After EVT, hourly BP data were collected and divided into four time intervals: 1–6 hours, 7–12 hours, 13–18 hours, and 19–24 hours. The mean, maximum, and standard deviation (SD) of BP were calculated and compared with the outcome of interest in patients with successful recanalization. The outcome of interest was functional independence, which was defined as a 3-month modified Rankin Scale score of ≤2.ResultsOf 224 patients with stroke who received EVT, 166 (74.1%) (mean age 70.2±13.1 years; 49.4% men) achieved successful recanalization and 82 (49.4%) exhibited functional independence. After adjustment for possible confounders, lower mean, maximum, and SD values of systolic and diastolic BP observed in the first 6 hours after EVT were independently associated with functional independence. Furthermore, the area under the receiver operating characteristic curve values observed for BP parameters for outcome prediction in the first 6 hours were the highest across the 24-hour period following EVT.ConclusionIn patients with stroke who achieved successful recanalization, the first 6 hours after EVT was the key period influencing the correlation between BP and functional outcome.

scholarly journals Association between Migraine and the Risk of Stroke: A Bayesian Meta-Analysis

2021 ◽  
Vol 13 (7) ◽  
pp. 3759
Author(s):  
Kim-Ngan Ta-Thi ◽  
Kai-Jen Chuang ◽  
Chyi-Huey Bai
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Credible Interval ◽  
Fixed Effect Model ◽  
Bayesian Approaches ◽  
Effect Model ◽  
Newcastle Ottawa Scale ◽  
Form Quality

There are still inconsistent results about association between migraine and stroke risk in studies. This paper was to review findings on the association between migraine (with or without aura) and stroke risk. We searched articles in the Embase and PubMed up to January 2021. Two independent reviewers extracted basic data from individual studies using a standardized form. Quality of studies was also assessed using the Newcastle–Ottawa Scale. We conducted a meta-analysis, both classical and Bayesian approaches. We identified 17 eligible studies with a sample size more than 2,788,000 participants. In the fixed effect model, the results demonstrated that migraine was positively associated with the risk of total stroke, hemorrhagic stroke, and ischemic stroke. Nevertheless, migraine was associated with only total stroke in the random effects model (risk ratio (RR) 1.31, 95%CI: 1.06–1.62). The probability that migraine increased total stroke risk was 0.978 (RR 1.31; 95% credible interval (CrI): 1.01–1.72). All types of migraine were not associated with ischemic stroke and hemorrhagic stroke. Under three prior distributions, there was no association between migraine and the risk of ischemic stroke or hemorrhagic stroke. Under the non-informative prior and enthusiastic prior, there was a high probability that migraine was associated with total stroke risk.

scholarly journals Clinical significance of cerebral microbleeds on MRI: A comprehensive meta-analysis of risk of intracerebral hemorrhage, ischemic stroke, mortality, and dementia in cohort studies (v1)

2018 ◽  
Vol 13 (5) ◽  
pp. 454-468 ◽  
Author(s):  
Andreas Charidimou ◽  
Sara Shams ◽  
Jose R Romero ◽  
Jie Ding ◽  
Roland Veltkamp ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Intracerebral Hemorrhage ◽  
Meta Analysis ◽  
Population Based ◽  
Cerebral Microbleeds ◽  
Clinical Settings ◽  
Memory Clinic ◽  
Increased Risk ◽  
Stroke Death

Background Cerebral microbleeds can confer a high risk of intracerebral hemorrhage, ischemic stroke, death and dementia, but estimated risks remain imprecise and often conflicting. We investigated the association between cerebral microbleeds presence and these outcomes in a large meta-analysis of all published cohorts including: ischemic stroke/TIA, memory clinic, “high risk” elderly populations, and healthy individuals in population-based studies. Methods Cohorts (with > 100 participants) that assessed cerebral microbleeds presence on MRI, with subsequent follow-up (≥3 months) were identified. The association between cerebral microbleeds and each of the outcomes (ischemic stroke, intracerebral hemorrhage, death, and dementia) was quantified using random effects models of (a) unadjusted crude odds ratios and (b) covariate-adjusted hazard rations. Results We identified 31 cohorts ( n = 20,368): 19 ischemic stroke/TIA ( n = 7672), 4 memory clinic ( n = 1957), 3 high risk elderly ( n = 1458) and 5 population-based cohorts ( n = 11,722). Cerebral microbleeds were associated with an increased risk of ischemic stroke (OR: 2.14; 95% CI: 1.58–2.89 and adj-HR: 2.09; 95% CI: 1.71–2.57), but the relative increase in future intracerebral hemorrhage risk was greater (OR: 4.65; 95% CI: 2.68–8.08 and adj-HR: 3.93; 95% CI: 2.71–5.69). Cerebral microbleeds were an independent predictor of all-cause mortality (adj-HR: 1.36; 95% CI: 1.24–1.48). In three population-based studies, cerebral microbleeds were independently associated with incident dementia (adj-HR: 1.35; 95% CI: 1.00–1.82). Results were overall consistent in analyses stratified by different populations, but with different degrees of heterogeneity. Conclusions Our meta-analysis shows that cerebral microbleeds predict an increased risk of stroke, death, and dementia and provides up-to-date effect sizes across different clinical settings. These pooled estimates can inform clinical decisions and trials, further supporting cerebral microbleeds role as biomarkers of underlying subclinical brain pathology in research and clinical settings.

Abstract MP052: Lifestyle Factors and Antihypertensive Treatment on the Risks of Ischemic and Haemorrhagic Stroke

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Gang Hu ◽  
Yurong Zhang ◽  
Pekka Jousilahti ◽  
Yujie Wang ◽  
Riitta Antikainen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Antihypertensive Treatment ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Healthy Lifestyle ◽  
Antihypertensive Drugs ◽  
Vegetable Consumption ◽  
Lifestyle Factors ◽  
Lifestyle Factor ◽  
Causal Pathway

Background Although hypertension is a potential intermediate factor on the causal pathway of lifestyle factor with stroke risk, the joint relationship between healthy lifestyle and antihypertensive treatment with stroke risk is unclear. Methods We prospectively investigated the individual and joint effects of healthy lifestyle factors and antihypertensive treatment on total and type-specific stroke risk among 36,686 Finnish participants who were 25 to 74 years old and free of coronary heart disease and stroke at baseline. The Cox proportional hazards model was used to evaluate the associations between healthy lifestyle factors and hypertension subgroups with stroke risk. Results During a mean follow-up of 13.7 years, 1,478 people developed an incident stroke event (1,167 ischemic and 311 hemorrhagic). The risk of stroke was significantly decreased in people adhered to ≥3 healthy lifestyle factors (never smoking, normal weight, moderate/high level of physical activity, vegetable consumption ≥3 times/week, and light/moderate alcohol drinking) compared with those adhered to <3 healthy lifestyle factors and this association was present among participants with different hypertensive status. The risk of stroke was significantly increased in all hypertensive subgroups compared with the normotensive group. Compared with hypertensive subjects who did not use antihypertensive drugs and were adhered to ≥3 healthy lifestyle factors, the multivariable-adjusted hazard ratios in hypertensive subjects who used antihypertensive drugs and were adhered to <3 healthy lifestyle factors were 1.39 (95% CI 1.04-1.86) for total stroke, 1.42 (1.03-1.97) for ischemic stroke, 1.37 (0.72-2.58) for hemorrhagic stroke in men, and 2.27 (1.71-3.01) for total stroke, 2.31 (1.69-3.16) for ischemic stroke, 2.21 (1.16-4.23) for hemorrhagic stroke in women, respectively. Only hypertensive men but not women who used antihypertensive drugs and were adhered to ≥3 healthy lifestyle factors had decreased risks of total and ischemic stroke compared with those who did not use antihypertensive drugs and were adhered to <3 healthy lifestyle factors. Conclusions The present study demonstrates our study demonstrates that a healthy lifestyle significantly decreases the risks of total, ischemic and hemorrhagic stroke in different hypertensive status in both men and women. A healthy lifestyle may be more effective in preventing stroke than antihypertensive treatment in hypertensive subjects.

Homocysteine as a potential predictive factor for high major adverse cardiovascular events risk in female patients with premature acute coronary syndrome

2019 ◽  
Author(s):  
Mei Wei ◽  
Le Wang ◽  
Yongsheng Liu ◽  
Mingqi Zheng ◽  
Fangfang Ma ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Predictive Factor ◽  
Cardiovascular Events ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Major Adverse Cardiovascular Events ◽  
Free Survival ◽  
Female Patients ◽  
Coronary Syndrome ◽  
Kaplan Meier

Abstract Background We aimed to investigate correlation of homocysteine (Hcy) level with clinical characteristics, and explore its predictive value for major adverse cardiovascular events (MACE) risk in female patients with premature acute coronary syndrome (ACS).Methods Serum Hcy level was detected from 1,299 female patients with premature ACS. According to the tertile of Hcy level, patients were divided into three groups: lowest tertile group (≤9.1 µmol/L), middle tertile group (9.2~11.6 µmol/L) and highest tertile group (>11.6 µmol/L). MACE incidence was recorded and MACE-free survival was caculated with the median follow-up duration of 28.3 months.Results Increased Hcy correlated with older age ( P <0.001), higher creatinine level ( P <0.001) and enhanced uric acid level ( P =0.001), while reduced fasting glucose concentration ( P <0.001). MACE incidence was 10.7% and it was highest in highest tertile group (22.1%), followed by middle tertile group (7.7%) and lowest tertile group (2.4%) ( P <0.001). Receiver operating characteristic curve showed that Hcy distinguished MACE patients from non-MACE patients with the area under the curve of 0.789 (95% CI: 0.742-0.835). Kaplan-Meier curves revealed that MACE-free survival was shortest in Hcy highest tertile group, followed by middle tertile group and lowest tertile group ( P <0.001). Multivariate Cox’s analyses further showed that higher Hcy level was an independently predictive factor for poor MACE-free survival (middle tertile vs. lowest tertile ( P =0.001, HR: 3.615, 95% CI: 1.661-7.864); highest tertile vs. lowest tertile ( P <0.001, HR: 11.023, 95% CI: 5.356-22.684)).Conclusion Hcy serves as a potential predictive factor for increased MACE risk in female patients with premature ACS.

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