Abstract 54: Procalcitonin, Copeptin and Midregional Pro-atrial Natriuretic Peptide as Markers of Ischemic Stroke Risk: The Northern Manhattan Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Mira Katan ◽  
Yeseon P Moon ◽  
Janet DeRosa ◽  
Myunghee C Paik ◽  
Beat Mueller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Atrial Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Stroke Risk ◽  
Hemodynamic Stress ◽  
Increased Risk ◽  
Ischemic Stroke Risk ◽  
Atrial Natriuretic

Background: Chronic infections and neuroendocrine dysfunction may be risk factors for ischemic stroke. We hypothesized that selected blood biomarkers of infection (procalcitonin, or PCT), hypothalamic-pituitary-axis function (copeptin), and hemodynamic stress (midregional pro-atrial natriuretic peptide, or MRproANP) would be associated with incident ischemic stroke risk in the multi-ethnic, urban Northern Manhattan Study (NOMAS) cohort. Methods: A case-cohort study was performed among initially stroke-free participants from the prospective population-based NOMAS study. The mean follow up was 11 years. Cases were defined as first ischemic stroke (including fatal) with available baseline blood (n=172). We randomly selected controls among those who did not develop an event (n=344). Biomarkers were measured in a blinded batch analysis (Laboratory of the Medical University Clinic, Aarau, Switzerland, using B.R.A.H.M.S assays by Thermo Fisher Scientific). We calculated hazard ratios and 95% confidence intervals (HR, 95% CI) using Cox proportional hazards models, with inverse probability weighting to correct for the case-cohort study design, to estimate the association with risk of stroke after adjusting for demographic, behavioral, and medical risk factors. Results: Mean age of cases was 72 (IQR 65-78); 59% were female. After full adjustment, those with PCT in the top quartile, compared to the lowest quartile, were at increased risk of ischemic stroke (adjusted HR 1.98, 95% CI 1.02-3.83). Those with MRproANP levels in the top quartile, compared to the lowest quartile, were also at increased risk of stroke (adjusted HR 3.45, 95% CI 1.58-7.52), but not those with higher copeptin levels. The distribution of MRproANP differed by stroke etiology. Levels of MRproANP were greater for cardioembolic strokes (CE), and MRproANP levels were predictive of CE (adjusted HR 3.29 per SD, 95% CI 1.89-5.72). Conclusion: Higher levels of procalcitonin, a marker of infection, and MRproANP, a marker for hemodynamic stress, were independently associated with ischemic stroke risk in this multiethnic, urban cohort. MRproANP was specifically associated with cardioembolic stroke risk. Further study is needed to confirm these results.

scholarly journals Is migraine a risk factor for pediatric stroke?

Cephalalgia ◽  
2015 ◽  
Vol 35 (14) ◽  
pp. 1252-1260 ◽  
Author(s):  
Amy A Gelfand ◽  
Heather J Fullerton ◽  
Alice Jacobson ◽  
Stephen Sidney ◽  
Peter J Goadsby ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Incidence Rate ◽  
Stroke Risk ◽  
Stroke Incidence ◽  
Post Hoc Analysis ◽  
Ischemic Stroke Risk ◽  
Post Hoc

Importance Our understanding of risk factors for childhood stroke is incomplete. In adults, migraine with aura is associated with a two-fold increase in ischemic stroke risk. Objective In this cohort study we examine the association between migraine and stroke among children in Kaiser Permanente Northern California (KPNC). Design, setting, and participants Children ages 2–17 years who were members of KPNC for ≥6 months between 1997 and 2007 were included. Migraine cohort members had one or more of: an ICD-9 code for migraine, migraine listed as a significant health problem, or a prescription for a migraine-specific medication. The comparison group was children with no evidence of headache. Main outcome measures Main outcome measures included stroke incidence rates and incidence rate ratios (IR). Results Among the 1,566,952 children within KPNC during the study period, 88,164 had migraine, and 1,323,142 had no evidence of headache. Eight migraineurs had a stroke (three (38%) hemorrhagic; five (63%) ischemic). Eighty strokes occurred in children without headache (53 (66%) hemorrhagic; 27 (34%) ischemic). The ischemic stroke incidence rate was 0.9/100,000 person-years in migraineurs vs. 0.4/100,000 person-years in those without headache; IR 2.0 (95% CI 0.8–5.2). A post-hoc analysis of adolescents (12–17 years) showed an increased risk of ischemic stroke among those with migraine; IR 3.4 (95% CI 1.2–9.5). The hemorrhagic stroke incidence rate was 0.5/100,000 person-years in migraineurs and 0.9/100,000 person-years in those without headache; IR 0.6 (95% CI 0.2–2.0). Conclusions There was no statistically significant increase in hemorrhagic or ischemic stroke risk in pediatric migraineurs in this cohort study. A post-hoc analysis found that ischemic stroke risk was significantly elevated in adolescents with migraine. Future studies should focus on identifying risk factors for ischemic stroke among adolescent migraineurs. Based on adult data, we recommend that migraine aura status should be studied as a possible risk factor for ischemic stroke among adolescent migraineurs.

Abstract P418: Increased Pro-neurotensin/neuromedin N is Associated With Incident Ischemic Stroke

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Charles D Nicoli ◽  
Nicholas Wettersten ◽  
George Howard ◽  
Virginia J Howard ◽  
Suzanne E Judd ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Racial Differences ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Disease Risk ◽  
Stroke Risk Factors ◽  
Increased Risk ◽  
Ischemic Stroke Risk ◽  
Neuromedin N

Introduction: The neuropeptide neurotensin (NT) has been linked to cardiovascular and metabolic disease risk. Through measurement of its stable equimolar precursor, pro-neurotensin/neuromedin N (pro-NT/NMN), hyperactivity of NT has been associated with aggregate cardiovascular outcomes that include stroke. However, the exclusive association of pro-NT/NMN with incident ischemic or hemorrhagic stroke has not been studied. Hypothesis: Higher serum pro-NT/NMN is associated with incident ischemic and hemorrhagic stroke. Methods: Prospective case-cohort study in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. From 2003-2007, REGARDS enrolled 30,239 White or Black adults aged ≥45. Pro-NT/NMN was measured by immunoassay in 464 ischemic stroke cases, 49 hemorrhagic stroke cases, and 800 non-cases from a random cohort. Cox proportional-hazards models were used to calculate hazard ratios (HR) of stroke by pro-NT/NMN quartiles and per standard deviation (SD) of log pro-NT/NMN. Model 1 (both stroke types) included demographic factors as covariates, Model 2A (ischemic only) added ischemic stroke risk factors, and Model 2B (hemorrhagic only) added hemorrhagic stroke risk factors. Results: The table shows an increased HR of ischemic stroke for those in the 4th vs 1st-quartile pro-NT/NMN in Model 1 with a trend of increased risk across quartiles; this was attenuated in Model 2A. Prebaseline diabetes and coronary artery disease were the largest confounders of ischemic stroke risk, with each accounting for 19% of the association observed in Model 1. There was no association of pro-NT/NMN with hemorrhagic stroke in either model. There were no interactions of race or sex with log pro-NT/NMN. Conclusions: Higher pro-NT/NMN is associated with increased risk of ischemic stroke after adjusting for demographics, but this was not independent of stroke risk factors. No significant association with hemorrhagic stroke was observed; this analysis was limited by a small number of events.

scholarly journals Low ADAMTS13 activity is associated with an increased risk of ischemic stroke

Blood ◽  
2015 ◽  
Vol 126 (25) ◽  
pp. 2739-2746 ◽  
Author(s):  
Michelle A. H. Sonneveld ◽  
Moniek P. M. de Maat ◽  
Marileen L. P. Portegies ◽  
Maryam Kavousi ◽  
Albert Hofman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Adamts13 Activity ◽  
Increased Risk ◽  
Key Points ◽  
Ischemic Stroke Risk ◽  
Traditional Risk Factors

Key Points Low ADAMTS13 activity is associated with ischemic stroke. ADAMTS13 activity improved the accuracy of ischemic stroke risk predictions beyond the traditional risk factors.

scholarly journals A snapshot of Ischemic stroke risk factors, sub-types, and its epidemiology: Cohort study

2020 ◽  
Vol 59 ◽  
pp. 101-105
Author(s):  
Khaled Z. Alawneh ◽  
Majdi Al Qawasmeh ◽  
Liqaa A. Raffee ◽  
Bashar Abuzayed ◽  
Diab A. Bani Hani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Stroke Risk Factors ◽  
Ischemic Stroke Risk

FC 069CHRONIC KIDNEY DISEASE AND ATRIAL FIBRILLATION: A DANGEROUS COMBINATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Gurbey Ocak ◽  
Meriem Khairoun ◽  
Othman Khairoun ◽  
Willem Jan Bos ◽  
Edouard Fu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Stroke Risk ◽  
Bleeding Event ◽  
Arterial Disease ◽  
Positive Interaction ◽  
Increased Risk ◽  
Ischemic Stroke Risk

Abstract Background and Aims Chronic kidney disease (CKD) and atrial fibrillation (AF) are both risk factors for bleeding, stroke and mortality. Whether the combination of CKD and AF leads to higher risks of bleeding, stroke and mortality than CKD or AF alone is not known. The aim of our study was to investigate the interaction between CKD and AF and outcomes. Method We included 12,394 subjects referred to the University Medical Center Utrecht (the Netherlands) from September 1996 to February 2018f for an out-patient visit with classical risk factors for arterial disease or with symptomatic arterial disease (Utrecht Cardiovascular Cohort Second Manifestation of Arterial disease (UCC-SMART) cohort). Hazard ratios (HRs) with 95% confidence intervals (CIs) for bleeding, ischemic stroke or mortality were calculated with Cox proportional hazards analyses. Presence of additive interaction between AF and CKD was examined by calculating the relative excess risk due to interaction (RERI), the attributable proportion (AP) due to interaction and the synergy index (S). Results Of the 12,394 patients, 699 patients had AF, 2,752 patients had CKD and 325 patients had both AF and CKD. Overall, 382 patients developed a first bleeding event, 421 patients had a first ischemic stroke and 2203 patients died. Patients with both CKD and AF had a 3.0-fold (95% CI 2.0-4.4) increased risk for bleeding, a 4.2-fold (95% CI 3.0-6.0) increased ischemic stroke risk and a 2.2-fold (95% CI 1.9-2.6) increased mortality risk after adjustment as compared with subjects without AF and CKD (Table 1). Although bleeding and mortality risks were highest for the combination of AF and CKD, we did not find interaction between AF and CKD. However, we found an interaction between AF and CKD for ischemic stroke risk (RERI 1.88 (95% CI 0.31-3.46), AP 0.45 (95% CI 0.17-0.72) and S 2.40 (95% CI 1.08-5.32)) (Table 1). Conclusion The combination of CKD and AF is associated with high risks for bleeding, ischemic stroke and mortality. There is a positive interaction between AF and CKD for ischemic stroke risk, but not for bleeding or mortality.

Abstract T P153: Women and Men with Ischemic Stroke in SiGN Have Different Subtype Distributions and Risk Factors

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kathryn M Rexrode ◽  
Braxton D Mitchell ◽  
Kathleen A Ryan ◽  
Steven J Kittner ◽  
Hakan Ay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Cardioembolic Stroke ◽  
Relative Distribution ◽  
Large Artery ◽  
Stroke Risk Factors ◽  
Stroke Subtypes ◽  
Small Artery Occlusion ◽  
Ischemic Stroke Risk

Introduction: The relative distribution of stroke risk factors, as well as ischemic stroke subtypes, in women compared with men is not well described. Hypothesis: We hypothesized that the distribution of ischemic stroke risk factors and subtypes would differ by sex, with a later onset in women and greater proportion of comorbidities. Methods: The NINDS Stroke Genetics Network (SiGN) consortium was established to evaluate genetic risk factors for ischemic stroke. A total of 23 separate studies performed Causative Classification of Stroke (CCS) typing using standardized criteria on ischemic stroke cases and contributed data on risk factors. We compared the distribution of ischemic stroke risk factors and CCS phenotypes between men and women with ischemic stroke. Results: Of the 16,228 ischemic strokes in SiGN, 8005 (49.3%) occurred in women. Median age at stroke was older in female than male stroke cases (73 vs. 66 years) (p=<0.0001). Among stroke cases, women were more likely than men cases to have hypertension or atrial fibrillation and less likely to have diabetes or coronary artery disease, or to smoke (p <0.003 for all). The distribution of stroke subtypes also differed by sex, with women less likely than men to have large artery infarction and small artery occlusion, and more likely to have cardioembolic stroke and undetermined stroke due to incomplete work-up (p values all <0.0001; see Table). Results were similar when the distribution of stroke subtypes was examined for those <70 years and ≥70 years, except for cardioembolic stroke remaining more common only among women ≥70. Conclusions: In this large group of carefully phenotyped ischemic strokes, the distribution of ischemic stroke subtypes and risk factor profiles differ significantly by sex. Evaluation of the causes of these differences may highlight areas for improved prevention and risk reduction in both genders.

scholarly journals Premature Atrial Contractions on the Screening Electrocardiogram and Risk of Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke Study

2016 ◽  
Vol 47 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Wesley T. O'Neal ◽  
Hooman Kamel ◽  
Dawn Kleindorfer ◽  
Suzanne E. Judd ◽  
George Howard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Racial Differences ◽  
Stroke Risk ◽  
Cox Regression ◽  
Stroke Risk Factors ◽  
Stroke Study ◽  
Increased Risk ◽  
Study Participants ◽  
The Relationship

Background: It is currently unknown if premature atrial contractions (PACs) detected on the routine screening electrocardiogram are associated with an increased risk of ischemic stroke. Methods: We examined the association between PACs and ischemic stroke in 22,975 (mean age 64 ± 9.2; 56% women; 40% black) participants from the Reasons for Geographic and Racial Differences in Stroke study. Participants who were free of stroke at baseline were included. PACs were detected from centrally read electrocardiograms at baseline. Cox regression was used to examine the association between PACs and ischemic stroke events through March 31, 2014. Results: PACs were present in 1,687 (7.3%) participants at baseline. In a Cox regression model adjusted for stroke risk factors and potential confounders, PACs were associated with an increased risk of ischemic stroke (hazards ratio (HR) 1.34, 95% CI 1.04-1.74). The relationship was limited to non-lacunar infarcts (HR 1.42, 95% CI 1.08-1.87), and not lacunar strokes (HR 1.01, 95% CI 0.51-2.03). An interaction by sex was detected, with the association between PACs and ischemic stroke being stronger among women (HR 1.82, 95% CI 1.29-2.56) than men (HR 1.03, 95% CI 0.69-1.52; p-interaction = 0.0095). Conclusion: PACs detected on the routine electrocardiogram are associated with an increased risk for non-lacunar ischemic strokes, especially in women.

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