scholarly journals ESTROGEN AFTER ISCHEMIC STROKE: Effect of estrogen replacement on risk of recurrent stroke and death in the Women’s Estrogen for Stroke Trial (WEST)

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 329-329
Author(s):  
Catherine M Viscoli ◽  
Lawrence M Brass ◽  
Walter N Kernan ◽  
Philip M Sarrel ◽  
Ralph Horwitz
Keyword(s):  
Adverse Events ◽  
Cerebrovascular Disease ◽  
Observational Research ◽  
Baseline Risk ◽  
Breast Cancers ◽  
Estrogen Replacement ◽  
Vascular Events ◽  
Fatal Stroke ◽  
Increased Risk

71 Introduction: Observational research has produced conflicting findings concerning the effect of estrogen replacement therapy (ERT) on reducing risk for vascular events or death in women. To test the effect of ERT in women with established cerebrovascular disease, we designed a randomized trial of estradiol-17β(1 mg/day) vs. placebo. Methods: Participants were identified from 20 hospitals in New England. Eligibility criteria included age over 44, at least 1 year since last menstrual period, and TIA or non-disabling stroke within 90 days of entry. Randomization was stratified by baseline risk group and hospital. Primary trial outcomes were non-fatal stroke and all-cause death. Results: From December 1993-May 1998, 652 women were randomized (332 estradiol, 320 placebo). Index event was TIA in 164 subjects and stroke in 488. Mean age of subjects was 71 years (range 46–91); 84% were white, 13% black, and 4% other. Mean follow-up was 2.7 years (range: 18 days-5.8 years). At 1 year, 76% of subjects assigned to estradiol were on study drug. In the estradiol group, adverse events were diagnosed during follow-up in 8 subjects (1 pulmonary embolus (PE), 1 deep venous thrombosis (DVT), 5 breast cancers, 1 endometrial cancer) compared with 7 events in placebo subjects (2 PE, 1 DVT, and 4 breast cancers). Non-fatal strokes were confirmed in 51 subjects in the estradiol group vs. 52 in placebo subjects (rates at 3 years[R]: 16.8% estradiol vs. 17.4% placebo; logrank p-value[p]=.83). Death occurred in 46 estradiol subjects vs. 38 placebo subjects (R=13.0% vs. 12.6%, p=.89). At 3 years, combined rate of non-fatal stroke or death was 27.6% in the estradiol group vs. 27.7% in placebo [p=.80]. Conclusion: During an average follow-up of 2.7 years, estradiol treatment did not protect against recurrent cerebral ischemia or reduce all-cause mortality in postmenopausal women with pre-existing cerebrovascular disease. No increased risk for adverse events associated with estrogen was observed. This trial adds to the growing body of evidence that fails to confirm a protective role for ERT in populations with known vascular disease.

scholarly journals Blood-Based Cardiac Biomarkers and the Risk of Cognitive Decline, Cerebrovascular Disease, and Clinical Events

Stroke ◽  
2021 ◽  
Author(s):  
Bibek Gyanwali ◽  
Mitchell K.P. Lai ◽  
Benedict Lui ◽  
Oi Wah Liew ◽  
Narayanaswamy Venketasubramanian ◽  
...  
Keyword(s):  
At Risk ◽  
Magnetic Resonance ◽  
Cerebrovascular Disease ◽  
Cognitive Decline ◽  
Cerebral Microbleeds ◽  
Cardiac Biomarkers ◽  
Vascular Events ◽  
Clinical Events ◽  
Increased Risk

Background and Purpose: Cardiac biomarkers, NT-proBNP (N-terminal probrain natriuretic peptide), hs-cTnT (high-sensitivity-cardiac troponin T), and GDF-15 (growth differentiation factor-15) have been proposed as important biomarkers of early vascular pathology. However, little is known of the longitudinal associations of these cardiac biomarkers with cerebrovascular disease and clinical events. We examine the association of blood-based cardiac biomarkers (NT-proBNP, hs-cTnT, and GDF-15) with cognitive decline, incident cerebrovascular disease, vascular events, and mortality. Methods: Four hundred thirty-four memory-clinic patients provided blood samples at baseline, underwent 3 annual neuropsychological assessments and brain magnetic resonance imaging scans at baseline and follow-up. NT-proBNP and hs-cTnT concentrations were measured by electrochemiluminescence immunoassay and GDF-15 by quantitative sandwich immunoassay. Baseline and follow-up magnetic resonance imagings were graded for white matter hyperintensities, lacunes, cerebral microbleeds, cortical infarcts, and intracranial stenosis. Data on incident vascular events and mortality were obtained. Results: Patients with higher levels of NT-proBNP, hs-cTnT, and GDF-15 showed greater decline in memory domain. Additionally, hs-cTnT was associated with decline in global cognition, executive function, and visuomotor speed. Higher levels of NT-proBNP were associated with incident cerebral microbleeds and hs-cTnT with incident cortical infarcts. During a mean follow-up of 3 years, 26 (5.9%) patients died and 35 (8.1%) developed vascular events. Patients with higher levels of NTpro-BNP and hs-cTnT were at increased risk of vascular events whereas those with higher levels of NT-proBNP and GDF-15 were at risk of mortality. Conclusions: Higher levels of blood-based cardiac biomarkers were associated with decline in memory and risk of vascular events and mortality. Moreover, NT-proBNP and hs-cTnT were associated with incident cerebral microbleeds and cortical infarcts. Thus, these biomarkers are potentially useful in identifying patients at risk of adverse vascular events and death.

scholarly journals O06 Baseline predictors of methotrexate-related adverse events in methotrexate-naïve patients with RA

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Ahmad A Sherbini ◽  
James M Gwinnutt ◽  
Kimme L Hyrich ◽  
Suzanne M M Verstappen ◽  
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Events ◽  
Health Assessment ◽  
Prevalence Rates ◽  
Clinical Predictors ◽  
Research Support ◽  
Related Data ◽  
Increased Risk ◽  
One Year

Abstract Background/Aims  Methotrexate (MTX) is the most common treatment for rheumatoid arthritis (RA). The prevalence of adverse events (AEs) associated with MTX treatment for RA have been studied extensively, but there are limited data on the predictors of these AEs. This study aims to summarise the prevalence rates of MTX AEs, including gastrointestinal (GI), neurological, mucocutaneous, and elevated alanine transaminase (ALT) enzyme, and to identify baseline demographic and clinical predictors of these AEs. Methods  The Rheumatoid Arthritis Medication Study (RAMS) is a UK multi-centre prospective cohort study of patients with RA starting MTX for the first time. Relevant demographic, medication, clinical and disease related data were collected at baseline. AEs were reported at six and twelve months follow-ups. The prevalence rates of AEs were calculated based on the proportions of patients who reported having had an AE within one year of follow-up. The associations between candidate baseline predictors and AEs were assessed using multivariable logistic regression. Results  A total of 2,089 patients were included with a mean age of 58.4 (standard deviation: 13.5) years, 1390 (66.5%) were women. 1,814 and 1,579 patients completed the 6 and 12 months follow-up visits, respectively. The prevalence rates of the AEs within one year of follow-up were: GI = 777 (40.6%), mucocutaneous = 441 (23.1%), neurological = 487 (25.5%), elevated ALT (> upper limit of normal [ULN]) = 286 (15.5%). Younger age and being a woman were associated with increased risk of GI AEs, (age: OR 0.97 per year increase in age, 95% CI 0.98, 1.00; male sex: OR 0.58 vs female, 95% CI 0.46, 0.74) (Table 1). Higher baseline Health Assessment Questionnaire (HAQ) score was an independent predictor of GI, mucocutaneous, and neurological AEs. Furthermore, having ALT >1xULN at baseline or history of diabetes was associated with increased risk of subsequent ALT elevation during the study follow-up. Conclusion  In patients with RA starting MTX, GI AEs were the most commonly reported AEs during the first year of follow-up. The identified predictors of AEs may facilitate discussions between clinicians and patients prior to commencing MTX, and may lead to increased adherence and consequently improved effectiveness. Disclosure  A.A. Sherbini: None. J.M. Gwinnutt: Grants/research support; BMS. K.L. Hyrich: Member of speakers’ bureau; Abbvie. Grants/research support; Pfizer, UCB, BMS. S.M.M. Verstappen: Consultancies; Celltrion. Member of speakers’ bureau; Pfizer. Grants/research support; BMS.

Abstract 2646: Aortic Arch Plaques and Risk of Vascular Events in Subjects Without Prior Stroke

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Cesare Russo ◽  
Zhezhen Jin ◽  
Ralph L Sacco ◽  
Shunichi Homma ◽  
Tatjana Rundek ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Aortic Arch ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Study Cohort ◽  
Vascular Events ◽  
Increased Risk ◽  
Prior Stroke

BACKGROUND: Aortic arch plaques (AAP) are a risk factor for cardiovascular embolic events. However, the risk of vascular events associated with AAP in the general population is unclear. AIM: To assess whether AAP detected by transesophageal echocardiography (TEE) are associated with an increased risk of vascular events in a stroke-free cohort. METHODS: The study cohort consisted of stroke-free subjects over age 50 from the Aortic Plaques and Risk of Ischemic Stroke (APRIS) study. AAP were assessed by multiplane TEE, and considered large if ≥ 4 mm in thickness. Vascular events including myocardial infarction, ischemic stroke and vascular death were recorded during the follow-up. The association between AAP and outcomes was assessed by univariate and multivariate Cox proportional hazards models. RESULTS: A group of 209 subjects was studied (mean age 67±9 years; 45% women; 14% whites, 30% blacks, 56% Hispanics). AAP of any size were present in 130 subjects (62%); large AAP in 50 (24%). Subjects with AAP were older (69±8 vs. 63±7 years), had higher systolic BP (146±21 vs.139±20 mmHg), were more often white (19% vs. 8%), smokers (20% vs. 9%) and more frequently had a history of coronary artery disease (26% vs. 14%) than those without AAP (all p<0.05). Lipid parameters, prevalence of atrial fibrillation and diabetes mellitus were not significantly different between the two groups. During the follow up (94±29 months) 30 events occurred (13 myocardial infarctions, 11 ischemic strokes, 6 vascular deaths). After adjustment for other risk factors, AAP of any size were not associated with an increased risk of combined vascular events (HR 1.07, 95% CI 0.44 to 2.56). The same result was observed for large AAP (HR 0.94, CI 0.34 to 2.64). Age (HR 1.05, CI 1.01 to 1.10), body mass index (HR 1.08, CI 1.01 to 1.15) and atrial fibrillation (HR 3.52, CI 1.07 to 11.61) showed independent association with vascular events. In a sub-analysis with ischemic stroke as outcome, neither AAP of any size nor large AAP were associated with an increased risk. CONCLUSIONS: In this cohort without prior stroke, the incidental detection of AAP was not associated with an increased risk of future vascular events. Associated co-factors may affect the AAP-related risk of vascular events reported in previous studies.

scholarly journals Use of aspirin in Chinese after recovery from primary intracranial haemorrhage

2012 ◽  
Vol 107 (02) ◽  
pp. 241-247 ◽  
Author(s):  
Boon-Hor Chong ◽  
Koon-Ho Chan ◽  
Vincent Pong ◽  
Kui-Kai Lau ◽  
Yap-Hang Chan ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Ischaemic Stroke ◽  
Intracranial Haemorrhage ◽  
Chinese Patients ◽  
Vascular Events ◽  
Coronary Syndrome ◽  
Anti Platelet Therapy ◽  
Anti Platelet Agent ◽  
Increased Risk

SummaryIntracranial haemorrhage (ICH) accounts for ~35% of all strokes in Chinese. Anti-platelet agent is often avoided after an index event due to the possibility of recurrent ICH. This single-centered observational study included 440 consecutive Chinese patients with a first spontaneous ICH surviving the first month performed during 1996–2010. The subjects were identified, and their clinical characteristics, anti-platelet therapy after ICH, and outcomes including recurrent ICH, ischaemic stroke, and acute coronary syndrome were checked from hospital records. Of these 440 patients, 56 patients (12.7%) were prescribed aspirin (312 patient-aspirin years). After a follow-up of 62.2 ± 1.8 months, 47 patients had recurrent ICH (10.7%, 20.6 per 1,000 patient years). Patients prescribed aspirin did not have a higher risk of recurrent ICH compared with those not prescribed aspirin (22.7 per 1,000 patient-aspirin years vs. 22.4 per 1,000 patient years, p=0.70). Multivariate analysis identified age > 60 years (hazard ratio [HR]: 2.0, 95% confidence interval [CI]: 1.07–3.85, p=0.03) and hypertension (HR: 2.0, 95% CI: 1.06–3.75, p=0.03) as independent predictors for recurrent ICH. In a subgroup analysis including 127 patients with standard indications for aspirin of whom 56 were prescribed aspirin, the incidence of combined vascular events including recurrent ICH, ischaemic stroke, and acute coronary syndrome was statistically lower in patients prescribed aspirin than those not prescribed aspirin (52.4 per 1,000 patient-aspirin years, vs. 112.8 per 1,000 patient-years, p=0.04). In conclusion, we observed in a cohort of Chinese post-ICH patients that aspirin use was not associated with an increased risk for a recurrent ICH.

Relative Risk of Cardiovascular Disease after Treatment for Aggressive Non-Hodgkin’s Lymphoma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2831-2831
Author(s):  
E. C. Moser ◽  
E. M. Noordijk ◽  
F. E. van Leeuwen ◽  
S. le Cessie ◽  
J. W. Baars ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Chronic Heart Failure ◽  
Hodgkin Lymphoma ◽  
Risk Model ◽  
Salvage Treatment ◽  
Excess Risk ◽  
Vascular Events ◽  
Increased Risk

Abstract Cardiovascular complications after therapy for Hodgkin lymphoma have been related to radiotherapy on the mediastinum, but have only incidentally been studied in NHL. As cardiovascular disease occurs commonly in the normal population, it is important to realize that risk factors as age, hypertension and life-style (diet and smoking) may be more outspoken in patients with NHL, who are generally older than patients with Hodgkin lymphoma. Moreover, although most patients with aggressive NHL will initially receive only chemotherapy, many will be treated with more than one therapy modality, incorporating stem cell transplantation or radiotherapy, because of early failure or relapses. Therefore, risk estimation of cardiovascular disease in NHL patients requires comparison to population-based rates. Here, we evaluated whether patients with aggressive NHL treated in 4 EORTC trials between 1980–1999 have an increased excess cardiovascular risk, compared to Dutch population rates. Relative risks (RR) and absolute excessive risks (AER per 1000 person-years) of cardiovascular disease were determined in 476 (Dutch and Belgian) patients and compared to incidence rates from the Continuous Morbidity Registry Nijmegen. Analyses were restricted to those patients treated with at least 6 cycles of doxorubicin-based chemotherapy and with a minimal follow-up time of 0.5 years. Only serious late events requiring daily medication and/or clinical interventions were recorded. Cumulative incidences of cardiovascular disease were estimated in the competing risk model by Gray with death by any cause as competing event. The overall cumulative incidence of cardiovascular disease was 12% at 5 and 22% at 10 years. At a median follow-up of 8.4 years, 66 cases of chronic heart failure (RR 5.4, 95% CI 4.1–6.9, AER 20.8), 17 myocardial infarctions (RR 1.2; 0.8–1.8, AER 0.8), 12 strokes (RR 1.8; 1.1–2.4, AER 1.5) and 9 other large vessel occlusions were registered. The large vascular events including strokes occurred in 16/21 patients after radiotherapy given in the same area. Pre-existent hypertension, NHL at young age (&lt;55 years) and (any) salvage treatment increased risk of cardiovascular disease. Excess risk for myocardial infarction or stroke after radiotherapy on respectively the mediastinum or neck depended on cumulative radiation dose and was only seen after more than 40 Gy. Excess risk for chronic heart failure was registerd in both non-irradiated (RR 4.4) and irradiated patients, with an extremely high RR of 32 (13.7–57.0) if &gt;40 Gy had been given. In conclusion, NHL patients treated with doxorubicin-based chemotherapy, especially those who are young, have hypertension, or received salvage treatment or radiotherapy above 40 Gy, are at high risk of cardiovascular disease and need lifelong monitoring in this regard.

Risk of Thromboembolic Events in ET and Early/Prefibrotic PMF: The Relevance of an Accurate Histological Diagnosis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1735-1735
Author(s):  
Serena Rupoli ◽  
Gaia Goteri ◽  
Picardi Picardi ◽  
Lucia Canafoglia ◽  
Giorgia Micucci ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conflicts Of Interest ◽  
Myeloproliferative Neoplasm ◽  
Primary Myelofibrosis ◽  
Vascular Events ◽  
Bone Marrow Trephine Biopsy ◽  
Increased Risk ◽  
Risk Patients ◽  
Early Primary

Abstract Abstract 1735 Background: Essential Thrombocytemia (ET) is a myeloproliferative neoplasm characterized by increased risk of vascular events. Established thrombosis risk factors are age and previous vascular events. The clinical and prognostic relevance of WHO histologic criteria for ET and prefibrotic/early Primary Myelofibrosis (PMF) has been well recognized. Our aim was to evaluate the correlation between histologic interpretation and vascular events in our series of thrombocytemias. Material and methods: From our files, we retrieved all patients consecutively diagnosed as having ET with complete clinical data (N = 283) who had undergone to a bone marrow trephine biopsy before any treatment at or within 1 year of diagnosis (N= 133). The histologic slides were reviewed in order to separate true ET cases from early/prefibrotic PMF; vaso-occlusive events at diagnosis and in the follow-up were than compared in the two groups. Results: Histologic review reclassified 61 cases as ET and 72 cases as prefibrotic/early PMF. Prefibrotic/early PMF showed a significant higher prevalence of thrombosis history and thrombotic events at diagnosis, and an increased leukocyte count than ET (22% vs 8%, 15.2% vs 1.6%, 8389/mmc vs 7500/mmc, respectively); furthermore, venous thromboses (mainly atypical) were relatively common in PMF, as opposed to WHO-defined ET. During follow-up, patients with prefibrotic PMF, although younger, showed a significant higher risk of developing thrombosis: the 15-year risk of thrombosis was 48% in prefibrotic PMF (grade 0), 16% in early PMF (grade 1, 2) and 17% in ET. Multivariate analysis confirmed that age and histopathology are independent risk factors for thrombosis during follow-up. Patients older than 60 or with prefibrotic PMF are high risk patients whereas those younger and with non prefibrotic PMF or ET should be considered at low risk (20-year risk of thrombosis 47% vs 4%, p=0.005). Conclusion: The results of present study indicate prefibrotic PMF as a myloproliferative neoplasm with the highest tendency to develop vascular events compared to early PMF and ET. Therefore we suggest to include histopathology interpretation in the risk stratification of so-called ET patients. Disclosures: No relevant conflicts of interest to declare.

Long-term comparative toxicity of LDR versus HDR prostate brachytherapy ± EBRT and evaluation of risk hazard over time: A SEER-Medicare analysis.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 108-108 ◽  
Author(s):  
Jonathan D. Tward ◽  
Stephanie Jarosek ◽  
Haitao Chu ◽  
Dennis C. Shrieve ◽  
Sean Elliott
Keyword(s):  
Adverse Events ◽  
Dose Rate ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Baseline Risk ◽  
High Dose ◽  
Radiation Toxicity ◽  
Prostate Brachytherapy ◽  
Increased Risk ◽  
Over Time

108 Background: Severe urinary adverse events (UAEs) include surgical treatment of urethral stricture, urinary incontinence and radiation cystitis. Our objective is to compare the incidence of late UAEs after low dose rate BT (LDR) and high dose rate BT (HDR) as well as LDR+EBRT and HDR+EBRT. Methods: We identified men treated with LDR (n=12,801), HDR (n=685), LDR+EBRT (8,518) and HDR+EBRT (n=2,392) from the SEER-Medicare Database. The populations were balanced by propensity weighting and the Kaplan-Meier incidence of severe UAEs was compared. Propensity-weighted Cox proportional hazards models were used to compare the adjusted hazard of UAEs. These UAEs were compared to a cohort of men not treated for prostate cancer. Results: Median follow-up was 4.3 years. At 8 years, the propensity weighted cumulative UAE incidence was highest after HDR+EBRT (28%) and lowest after LDR (17%; see Figure). The absolute excess risk over non-treated controls of a UAE at 8 years was 1.9%, 3.8%, 8.4% and 12.9% for the LDR, HDR, LDR + EBRT, and HDR + EBRT respectively. This translates into a number needed to harm of 53, 26, 12, and 8 persons. There is no statistical difference in severe UAE risk between HDR vs. LDR or between HDR+EBRT vs. LDR+EBRT. The additional risk for developing a UAE related to treatment for LDR, LDR+EBRT, and HDR+EBRT, was greatest within the 2 years following treatment, and continued to decline over time. For HDR monotherapy, the risk was greatest within the first 4 years, and then declined. The risk of developing a severe UAE matched the baseline risk of the control population for all treatments at 4 years following therapy. Conclusions: LDR and HDR brachytherapy are statistically indistinguishable for late severe urinary adverse events. However, combination radiotherapy (either HDR+EBRT or LDR+EBRT) increases the risk of severe UAEs compared to HDR alone or LDR alone. In the 8 years following brachytherapy treatment, the increased risk of urinary toxicity occurs almost exclusively within the 2 years following therapy, and then declines to a baseline hazard. The hypothesis that late urinary radiation toxicity accelerates over time is not supported by this study.

scholarly journals Association of BMI, comorbidities and all-cause mortality by using a baseline mortality risk model

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253696
Author(s):  
Jia Li ◽  
Gyorgy Simon ◽  
M. Regina Castro ◽  
Vipin Kumar ◽  
Michael S. Steinbach ◽  
...  
Keyword(s):  
Body Mass ◽  
Mortality Risk ◽  
Risk Model ◽  
Risk Groups ◽  
Baseline Risk ◽  
Increased Risk ◽  
Wide Range ◽  
Baseline Mortality ◽  
All Cause Mortality

Objective The association of body mass index (BMI) and all-cause mortality is controversial, frequently referred to as a paradox. Whether the cause is metabolic factors or statistical biases is still controversial. We assessed the association of BMI and all-cause mortality considering a wide range of comorbidities and baseline mortality risk. Methods Retrospective cohort study of Olmsted County residents with at least one BMI measurement between 2000–2005, clinical data in the electronic health record and minimum 8 year follow-up or death within this time. The cohort was categorized based on baseline mortality risk: Low, Medium, Medium-high, High and Very-high. All-cause mortality was assessed for BMI intervals of 5 and 0.5 Kg/m2. Results Of 39,739 subjects (average age 52.6, range 18–89; 38.1% male) 11.86% died during 8-year follow-up. The 8-year all-cause mortality risk had a “U” shape with a flat nadir in all the risk groups. Extreme BMI showed higher risk (BMI <15 = 36.4%, 15 to <20 = 15.4% and ≥45 = 13.7%), while intermediate BMI categories showed a plateau between 10.6 and 12.5%. The increased risk attributed to baseline risk and comorbidities was more obvious than the risk based on BMI increase within the same risk groups. Conclusions There is a complex association between BMI and all-cause mortality when evaluated including comorbidities and baseline mortality risk. In general, comorbidities are better predictors of mortality risk except at extreme BMIs. In patients with no or few comorbidities, BMI seems to better define mortality risk. Aggressive management of comorbidities may provide better survival outcome for patients with body mass between normal and moderate obesity.

scholarly journals Increased risk of ischemic heart disease after kidney donation

2021 ◽  
Author(s):  
Anders J Haugen ◽  
Stein Hallan ◽  
Nina E Langberg ◽  
Dag Olav Dahle ◽  
Hege Pihlstrøm ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Cerebrovascular Disease ◽  
Ischemic Heart ◽  
Kidney Donation ◽  
Baseline Body Mass Index ◽  
Healthy Controls ◽  
Kidney Donors ◽  
Increased Risk

Abstract Background Previous reports suggest increased risk of hypertension and cardiovascular mortality after kidney donation. In this study we investigate occurrence of ischemic heart disease and cerebrovascular disease, diabetes and cancer in live kidney donors compared with healthy controls eligible for donation. Methods Different diagnoses were assessed in 1029 kidney donors and 16084 controls. The diagnoses at follow-up were self-reported for the controls and registered by a physician for the donors. Stratified logistic regression was used to estimate associations with various disease outcomes, adjusted for gender, age at follow up, smoking at baseline, body mass index at baseline, systolic blood pressure at baseline and time since donation. Results The mean (standard deviation) observation time was 11.3 (8.1) years for donors versus 16.4 (5.7) years for controls. Age at follow-up was 56.1 (12.4) years in donors vs 53.5 (11.1) years in controls and 44% of donors were males vs 39.3% in the controls. At follow up 35 (3.5%) of the donors had been diagnosed with ischemic heart disease versus 267 (1.7%) of the controls. Adjusted odds ratio for ischemic heart disease was 1.64 (confidence interval 1.10-2.43, P = 0.01) in donors compared with controls. There were no significant differences for the risks of cerebrovascular disease, diabetes or cancer. Conclusions During long-term follow-up of kidney donors we find an increased risk of ischemic heart disease compared to healthy controls. This information may be important in the follow-up and selection process of living kidney donors.

scholarly journals 134 Does a Purely Occipital Lobe Stroke Lead to Significant Long Term Disability and Handicap?

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Naomi Davey ◽  
Sarah McNally ◽  
Kerri Donnelly ◽  
Mary Kate Meagher ◽  
Imelda Noone ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Occipital Lobe ◽  
Cognitive Testing ◽  
Phone Call ◽  
Motor Deficit ◽  
Post Discharge ◽  
Vascular Events ◽  
Increased Risk

Abstract Background Occipital lobe strokes are characterised by a visual field deficit (VFD) and the absence of a motor deficit. A persistent VFD may have significant long-term implications for a patient and their lifestyle. Our aim was to assess the overall impact of these events particularly patients’ ability to return to driving. Methods All patients admitted with an acute occipital lobe stroke to a Dublin teaching hospital in 2017 were identified. Case notes were retrospectively reviewed to identify patients’ pre-stroke function, stroke pathology, neurological losses and further vascular events. A follow up phone call was made 18 months after the event to assess if previous drivers had returned to driving and required the installation of formalised home supports after discharge. Results In 2017, 37 of 311 stroke patients admitted had a confirmed occipital lobe stroke. 33 of these patients (89.1%) had ischemic events. The median age was 76 (50-93) years old. Twenty-nine patients were able to undergo formal cognitive testing; the median Montreal Cognitive Assessment (MOCA) was 18 (2-29). 15 patients (40.5%) had underlying Atrial Fibrillation with one (6.7%) of this cohort being identified post discharge; 14 (85.7%) of those patients with ischemic strokes were anticoagulated for atrial fibrillation. The median length of stay was 33.9 days, with a range of 2-391 days. Further vascular events occurred in 2 (5.8%) of the patients. A follow up phone call was made to the 15 patients who drove prior to their event. 12 patients (80%) could not resume driving due to persistent VFD. One (7%) of the previous drivers had a home care package installed since discharge. Conclusion A persistent VFD results in long term problems including an increased risk of further vascular events, a reduction in overall independence and quality of life following an occipital lobe stroke. This study has led to a business plan for a dedicated hemianopia clinic.

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