Abstract WP425: Predictive Value Of Daily Physical Activity And New Onset Of Vascular Events In Patients With Mild Ischemic Stroke.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Yuji Kono ◽  
Sumio Yamada ◽  
Kenta Kamisaka ◽  
Kotaro Iwatsu ◽  
Amane Araki ◽  
...  
Keyword(s):  
Physical Activity ◽  
Ischemic Stroke ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Daily Physical Activity ◽  
Stroke Recurrence ◽  
Daily Step ◽  
Vascular Events ◽  
Plaque Score ◽  
Step Counts

Introduction: Daily physical inactivity is associated with a substantially increased risk of cardiovascular events. However, the target level of daily physical activity is remained unclear. We aimed to evaluate the impact of physical activity on long-term vascular events in patients with mild ischemic stroke. Methods: We designed prospective observational study and enrolled 142 ischemic stroke patients with modified Rankin Scale 0-1 (mean age: 63.9±9.2). We measured daily step count as a variable of daily physical activity after 6-month from stroke onset. Other clinical characteristics including age, body mass index, blood pressure, blood labo test, carotid echo findings and medications were also assessed. The primary outcome was hospitalization due to stroke recurrence, myocardial infarction, angina pectoris, and peripheral artery disease. Survival curves were calculated by Kaplan-Meier survival analysis, and hazard ratios for recurrence were determined by univariate and multivariate Cox proportional hazards regression models. Results: After 1130.2±372.8 days of follow-up, 29 vascular events (19 stroke recurrence, 10 coronary heart disease) occurred, and the patients were divided into two groups: survival (n=113) and recurrenct (n=29). Daily step counts ( P =0.003) and plaque score ( P <0.001) were significantly lower in the recurrent group than survival group. Univariate and multivariate Cox proportional hazards analysis revealed daily step counts and plaque score to be independent predictors of new vascular events. A daily step counts cutoff value of 6000 steps per day was determined by the analysis of receiver-operating characteristics with sensitivity 69.4% and specificity 79.4%. Kaplan-Meier survival curves after log-rank test showed significantly lower event rate in over 6000 steps group as compared to less than 6000 steps group ( P =0.023). Conclusion: In conclusion, our data indicate that daily physical activity evaluated by step counts may be useful for forecasting prognosis in patients with mild ischemic stroke. Daily step counts of 6000 steps may be a first target level to reduce new vascular events.

scholarly journals Hemoglobin, Albumin, Lymphocyte, and Platelet Score is Associated With Adverse Clinical Outcomes of Acute Ischemic Stroke: A Prospective Cohort Study

2020 ◽  
Author(s):  
Mengke Tian ◽  
Youfeng Li ◽  
Xiao Wang ◽  
Xuan Tian ◽  
Lu-lu Pei ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Stroke Recurrence ◽  
Vascular Events ◽  
Risk Of Death ◽  
Clinical Events ◽  
Secondary Outcomes

Abstract Background The combined index of hemoglobin, albumin, lymphocyte and platelet (HALP) is considered as a novel score to reflect systemic inflammation and nutritional status. This study aimed to investigate the association between HALP score and adverse clinical events in patients with acute ischemic stroke (AIS). Methods This study prospectively included patients with AIS within 24 hours of admission to the First Affiliated Hospital of Zhengzhou University. The primary outcomes were all-cause death within 90 days and 1 year. The secondary outcomes included stroke recurrence and combined vascular events. The association between HALP score and adverse clinical outcomes was analyzed using Cox proportional hazards. Results A total of 1337 patients were included. Patients in the highest tertile of HALP score had a lower risk of death within 90 days and 1 year (Hazard ratio: 0.20 and 0.30; 95% confidence intervals: 0.06–0.66 and 0.13–0.69, P for trend < 0.01 for all) compared with the lowest tertile after adjusting relevant confounding factors. Similar results were found for secondary outcomes. Subgroup analyses further confirmed these association. Adding HALP score to the conventional risk factors improved prediction of death in patients with AIS within 90 days and 1 year (net reclassification index, 38.63% and 38.68%; integrated discrimination improvement, 2.43% and 2.57%; P < 0.02 for all). Conclusions High HALP score levels were associated with decreased risk of adverse clinical outcomes within 90 days and 1 year after stroke onset, suggesting that HALP score may serve as a powerful indicator for AIS.

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 Traffic-borne pollution as a risk factor for acute vascular events: a population study in Milan

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P Magnoni ◽  
R Murtas ◽  
A G Russo
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Proportional Hazards ◽  
Traffic Noise ◽  
Cox Proportional Hazards ◽  
Positive Trend ◽  
Traffic Intensity ◽  
Vascular Events ◽  
Remarkable Effect

Abstract Background Traffic-borne noise and air pollution have both been associated with cardiovascular and cerebrovascular diseases, albeit with inconsistent findings and issues of collinearity/mutual confounding. The present study aims at evaluating the role of long-term exposure to traffic-borne pollution as a risk factor for acute vascular events in a highly urbanized setting. Methods This is a population-based retrospective dynamic cohort study including all residents aged &gt;35 years in the municipality of Milan over the years 2011-2018 (N = 1087110). A noise predictive model and a NO2 land-use regression model were used to assign mean values of traffic noise at the day-evening-night level (Lden, dB) and NO2 concentration (µg/m3) to the residential address of each subject. Cox proportional hazards models were performed to assess the incidence of acute vascular events, with adjustment for potential confounders (age, sex, nationality, a socio-economic deprivation index) and sub-analyses for different outcomes (acute myocardial infarction, ischemic stroke, hemorrhagic stroke). Results A total of 27282 subjects (2.5%) had an acute vascular event. Models using NO2 yielded inconsistent results. When using Lden as a proxy of traffic intensity, there was a positive trend in risk with increasing levels of exposure, with an optimal cut-off for dichotomization set at 70 dB (HR 1.025, 95% C.I. 1.000-1.050). The association was observed specifically for ischemic stroke (HR 1.043, 95% C.I. 1.003-1.085) and hemorrhagic stroke (HR 1.036, 95% C.I. 0.969-1.107). When stratifying by age group and sex, a remarkable effect was found for hemorrhagic stroke in men aged &lt;60 (HR 1.439, 95% C.I. 1.156-1.792). Conclusions Living close to high-traffic roads was found to exert a small but tangible effect on the risk of stroke. The varying effects observed for specific outcomes and in different age and sex groups are likely due to different pathogenetic mechanisms at play, which warrant further investigation. Key messages Residential proximity to roads with high traffic intensity (mean traffic noise level over 70 dB) is a risk factor for stroke, especially for hemorrhagic stroke in middle-aged men. Further interventions aimed at reducing traffic intensity in highly urbanized cities may be justified in order to reduce morbidity and mortality from stroke.

Within-Person Dynamics of Older Adults’ Physical Activity, Sedentary Behavior, and Sit-to-Stand Transitions

2018 ◽  
Vol 1 (4) ◽  
pp. 159-164 ◽  
Author(s):  
Jaclyn P. Maher ◽  
David E. Conroy
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Sedentary Behavior ◽  
Multilevel Modeling ◽  
Daily Physical Activity ◽  
Daily Step ◽  
Step Counts ◽  
Sit To Stand ◽  
Naturally Occurring ◽  
Standing Up

This study evaluated how older adults’ daily physical activity covaries with naturally occurring variation in both the duration and patterning of daily sedentary behavior. Older adults (n = 95) wore activPAL3 monitors for 15 consecutive days. Multilevel modeling regressed daily step counts on the frequency of sit-to-stand transitions and the duration of sedentary behavior. At the person-level, older adults who sat less (b = −14.31, p < .001) and stood up more frequently (b = 41.08, p = .01) took more steps on average. At the within-person level, older adults took more steps on days when they sat less than usual (b = −8.29, p < .001) and stood up more frequently than usual (b = 52.75, p < .001). Older adults’ daily physical activity may be influenced by interrupting sedentary behavior more frequently as well as reducing total sedentary behavior. It may be easier to monitor the frequency of discrete behaviors, like standing up, than it is to monitor the duration of continuous behaviors (e.g., walking, sitting).

Abstract 140: Association Between Epilepsy and the Risk of Ischemic Stroke or Myocardial Infarction

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Matthew A Mercuri ◽  
Alexander E Merkler ◽  
Neal S Parikh ◽  
Michael E Reznik ◽  
Hooman Kamel
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Elderly Patients ◽  
Proportional Hazards ◽  
Predictor Variable ◽  
Cox Proportional Hazards ◽  
Vascular Events ◽  
Increased Risk ◽  
Acute Mi

Background: Vascular brain injury can result in epilepsy. It is posited that seizures in elderly patients might reflect subclinical vascular disease and thus herald future clinical vascular events. Hypothesis: Seizures in elderly patients are associated with an increased risk of ischemic stroke or myocardial infarction (MI). Methods: We obtained inpatient and outpatient claims data from 2008-2014 on a 5% sample of Medicare beneficiaries ≥66 years of age. The predictor variable was epilepsy, defined as two or more inpatient or outpatient claims with a diagnosis of seizure. The primary outcome was a composite of ischemic stroke or acute MI. The predictors and outcomes were all ascertained with previously validated ICD-9-CM code algorithms. Survival statistics and Cox proportional hazards models were used to assess the relationship between epilepsy and incident ischemic stroke or MI while adjusting for demographic characteristics and vascular risk factors. Patients were censored at the first occurrence of a stroke or MI, at the time of death, or on December 31, 2014. Results: Among 1,548,556 beneficiaries with a mean follow-up of 4.4 (±1.8) years, 15,055 (1.0%) developed epilepsy and 121,866 (7.9%) experienced an ischemic stroke or acute MI. Patients with seizures were older (76.1 versus 73.7 years) and had a significantly higher burden of vascular comorbidities than the remainder of the cohort. The annual incidence of stroke or acute MI was 3.28% (95% confidence interval [CI], 3.10-3.47%) in those with seizures versus 1.79% (95% CI, 1.78-1.80%) in those without (unadjusted hazard ratio [HR], 1.89; 95% CI, 1.78-2.00). After adjustment for demographics and risk factors, epilepsy had a weak association with the composite outcome (adjusted HR, 1.36; 95% CI, 1.29-1.44), a stronger association with ischemic stroke (adjusted HR, 1.77; 95% CI, 1.65-1.90), and no association with acute MI (adjusted HR, 0.95; 95% CI, 0.86-1.04). Conclusions: We found an association between epilepsy in elderly patients and future ischemic stroke but not acute MI. Therefore, seizures might signify occult cerebrovascular disease but not necessarily occult disease in other vascular beds.

Abstract W P143: Ankle-brachial Index Predicts Extracranial Vascular Events After Transient Ischemic Attacks. Data From The Promapa Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Francisco Purroy ◽  
Sara Porta ◽  
Pedro E Jiménez-Caballero ◽  
Juan María Jirón ◽  
Arantxa Gorospe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Proportional Hazards ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Cox Proportional Hazards ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Vascular Events ◽  
Ankle Pressure ◽  
Peripheral Arterial

The ankle brachial index (ABI) is a known measure of lower-limb peripheral artery disease (PAD), as well as an independent predictor of vascular events. Various methods of ABI calculation have been described. The traditional method (ABI-TM) uses the higher ankle pressure as a numerator and it results in higher specificity. The alternative method (ABI-AM) takes the lower ankle pressure as numerator. It is associated with better sensitivity. Our goal was to compare the prognostic value of abnormal ABI (ABI <=0.9), determined by the two methods, in order to predict subsequent stroke and extracranial vascular events (EVE) in transient ischemic attack (TIA) patients from a multicenter study. Methods: We analyzed data from consecutive 1137 patients with TIA from the multicenter PROMAPA study in which ABI was determined. We determined risk of stroke recurrence (SR) and EVE (ischemic cardiopathy or peripheral arterial disease) at one year of follow up. Results: A total of 616 (54.2%) subjects fulfilled all inclusion criteria. The risk of SR and EVE was 4.7% and 2.1%, respectively. The proportion of abnormal ABI differed according to the method used: 11.5% ABI-TM versus 38.0 ABI-AM (p=0.001). In both situations, abnormal ABI was related to the association of >1 risk factors and large artery atherosclerosis. SR was not predicted by abnormal ABI. However, only abnormal ABI-AM was significantly associated with EVE (p=0.003). Cox proportional-hazards multivariate analyses identify the association of > 1 risk factors (Hazard Ratio [HR] 4.7, 95% CI 1.1-21.2. p=0.045) and abnormal ABI-AM (HR 4.0, 95% CI 1.1-14.6, p=0.035) as independent predictors of EVE. Conclusion: ABI using the lower ankle pressure as numerator is associated with EVE after TIA. The measurement of ABI using the lower ankle pressure as numerator among TIA patients appeared to be useful to identify patients with risk of EVE and to plan adequate prevention therapies or specific diagnostic protocols.

Carotid Intraplaque Neovascularization Predicts Ischemic Stroke Recurrence in Patients with Carotid Atherosclerosis

Gerontology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Yan Song ◽  
Ying Dang ◽  
Jichang Wang ◽  
Hui Cai ◽  
Jun Feng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Stenosis ◽  
Carotid Atherosclerosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Stroke Recurrence ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
A Prospective Study

<b><i>Introduction:</i></b> This study aimed to examine whether intraplaque neovascularization (IPN) of carotid plaques, as characterized by contrast-enhanced ultrasound (CEUS), is associated with ischemic stroke recurrence in patients with carotid atherosclerosis. <b><i>Methods:</i></b> We conducted a prospective study of consecutive patients with a recent stroke and at least one atherosclerotic plaque in the carotid artery on the side consistent with symptoms. All patients underwent CEUS after their first admission. IPN was graded on the basis of the presence and location of microbubbles within each plaque. <b><i>Results:</i></b> We eventually included 155 patients, all of whom underwent IPN analysis. After a follow-up of 24 months, we recorded 25 (16.1%) stroke recurrences in the whole population. All the recurrences occurred in patients presenting IPN. There was significant difference in the IPN between the 2 groups (<i>p</i> = 0.002). In the final Cox proportional-hazards multivariable models, IPN of grade 2 was independently associated with the risk of stroke recurrence (HR = 4.535; 95% CI: 1.892–10.870; <i>p</i> = 0.001). This association remained after adjusting for the degree of carotid stenosis (HR = 3.491; 95% CI: 1.410–8.646; <i>p</i> = 0.007). <b><i>Conclusions:</i></b> IPN was an independent predictor of stroke recurrence in patients with a recent ischemic stroke and carotid atherosclerosis. In predicting stroke recurrence, IPN may be an earlier indicator than carotid stenosis and may help stratify the risk of stroke recurrence.

Abstract TP201: Diabetes and the Risk of Death and Stroke Recurrence Following Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Erin L MacDougal ◽  
Jeffrey J Wing ◽  
William H Herman ◽  
Lewis B Morgenstern ◽  
Lynda D Lisabeth
Keyword(s):  
Ischemic Stroke ◽  
Mexican Americans ◽  
Proportional Hazards ◽  
Recurrence Risk ◽  
Effect Modification ◽  
Cox Proportional Hazards ◽  
Stroke Recurrence ◽  
Risk Of Death ◽  
Established Risk Factor ◽  
Cox Proportional Hazards Models

Background and Purpose: Diabetes mellitus (DM) is a well-established risk factor for ischemic stroke (IS), but the literature is inconsistent on the effect of DM on outcomes after IS. We sought to determine if DM increases the risk of mortality and recurrence after IS, and if these associations are greater in Mexican Americans (MA) than non-Hispanic whites (NHW). Methods: IS cases, all-cause mortality, and recurrent strokes were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project (2006-2012). Sociodemographics and clinical data were obtained from medical records and interviews. Cumulative mortality and stroke recurrence risk were estimated at 30 days and 1 year using Kaplan-Meier analysis and Cox proportional hazards models. Effect modification by ethnicity was examined. Results: There were 1,301 IS cases, 46% with a history of DM, median age 70 (IQR: 58-81), and 61% MA. Patients with DM were younger and more likely to be MA compared to patients without DM. Risk of 30-day and 1-year mortality was 8.4% and 20.5% for those with DM and 9.5% and 20.8% for those without DM, respectively. Risk of 30-day and 1-year stroke recurrence was 1.2% and 7.5% for those with DM and 1.5% and 5.8% for those without DM, respectively. Unadjusted, DM was not a significant predictor of mortality or recurrence (see table). After adjustment, DM predicted mortality (30-day HR=1.58, 95% CI: 0.98-2.53; 1-year HR=1.48, 95% CI: 1.10-2.00) but not stroke recurrence (1-year HR=1.28, 95% CI: 0.78-2.08). Effect modification by ethnicity was not significant (p>0.2 for all models). Conclusions: Given that patients with DM were significantly younger than patients without DM, the crude association between DM and mortality revealed no difference. However, after accounting for age and other factors, patients with DM were 50% more likely to die at 1 year after IS compared to patients without DM.

scholarly journals Serum dickkopf-3 is associated with death and vascular events after ischemic stroke: an observational study from CATIS

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Zhengbao Zhu ◽  
Daoxia Guo ◽  
Chongke Zhong ◽  
Aili Wang ◽  
Tan Xu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Primary Outcome ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Stroke Patients ◽  
Special Effect ◽  
Vascular Events ◽  
Cox Proportional Hazards Regression ◽  
Net Reclassification Improvement ◽  
Proportional Hazards Regression

Abstract Background Dickkopf-3 (Dkk-3) is implicated in the progression of atherosclerosis. This study aimed to investigate the association between serum Dkk-3 and the prognosis of ischemic stroke. Methods We measured serum Dkk-3 levels in 3344 ischemic stroke patients from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). The primary outcome was a combination of death and vascular events within 3 months after ischemic stroke. Results During 3 months of follow-up, the cumulative incidence rates of primary outcome among ischemic stroke patients in five quintiles of serum Dkk-3 (from low to high) were 4.49%, 3.74%, 2.54%, 5.23%, and 6.73%, respectively (log-rank p = 0.004). Multivariable Cox proportional hazards regression analyses showed that compared with the third quintile of serum Dkk-3, the adjusted hazard ratios (95% confidence intervals) associated with the first and fifth quintile were 3.49 (1.46–8.34) and 4.23 (1.86–9.64) for primary outcome, 3.47 (1.06–11.36) and 5.30 (1.81–15.51) for death, and 2.66 (1.01–7.01) and 3.35 (1.33–8.40) for vascular events, respectively. Multivariable-adjusted Cox proportional hazards regression model with restricted cubic splines showed a U-shaped association between serum Dkk-3 and the risk of primary outcome (p for nonlinearity = 0.030). Moreover, adding serum Dkk-3 to conventional risk factors could improve the predictive power for primary outcome (net reclassification improvement 28.44%, p < 0.001; integrated discrimination improvement 0.48%, p = 0.001). Conclusions Both low and high serum Dkk-3 levels are associated with increased risks of death and vascular events within 3 months after ischemic stroke, indicating that serum Dkk-3 may have a special effect on the prognosis of ischemic stroke. We also found that serum Dkk-3 might be a prognostic biomarker for ischemic stroke. Further studies are needed to replicate our findings and to determine the optimal levels of serum Dkk-3.

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