Abstract 121: Vascular Risk Factor Control in the Year After Ischemic Stroke Versus Myocardial Infarction

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Dawn M Bravata ◽  
Jared Brosch ◽  
Jason Sico ◽  
Fitsum Baye ◽  
Laura Myers ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Standard Deviation ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Hypertension Control ◽  
Stroke Patients ◽  
Risk Factor Control ◽  
Facility Level

Background: The Veterans Health Administration has multiple quality improvement activities directed at improving vascular risk factor control. We sought to examine facility quality of blood pressure (BP) control (<140/90 mm Hg), lipid control (LDL-cholesterol <100 mg/dL) and glycemic control (HbA1c <9%) in the one-year after hospitalization for ischemic stroke or acute myocardial infarction (AMI). Methods: We assembled a retrospective cohort of patients hospitalized with stroke or AMI (fiscal year 2011). Facilities were included if they admitted ≥25 stroke patients and ≥25 AMI patients. A facility-level consolidated measure of vascular risk factor control was calculated for the 3 processes of care (number of passes divided by number of opportunities). Results: A total of 2432 patients had a new stroke and 4873 had a new primary AMI (at 75 facilities). Stroke patients had worse vascular risk factor control than AMI patients (mean facility rate on consolidated measure: stroke, 70% [95%CI 0.68-0.72] vs AMI, 77% [0.75-0.78]). The greatest disparity between stroke and AMI patients was in hypertension control: at 87% of hospitals, fewer stroke patients achieved BP control than AMI patients (mean facility pass rate: stroke, 41% vs AMI, 52%; p<0.0001). Overall there were no statistical differences for stroke versus AMI patients in facility-level hyperlipidemia control (71% vs 73%, p=0.33) and glycemic control (79% versus 82%, p=0.24). AMI patients had more outpatient visits than stroke patients in the year after discharge [AMI: mean 7.9 visits (standard deviation 6.1)]; stroke: mean 6.0 visits (standard deviation 4.5; p<0.0001].); the primary difference in outpatient utilization was additional cardiology visits for AMI patients (2.5 visits with cardiology per AMI patient vs 0.4 visits per stroke patient; p<0.001). Conclusions: These results demonstrated clinically substantial disparities in hypertension control among patients with stroke vs patients with AMI. It may be that cardiologists provided risk factor management to AMI patients that stroke patients did not receive. The etiology of these observed differences merits additional investigation.

Abstract T P165: Women Had Worse Stroke Outcome

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Claudia Alonzo ◽  
Maria C Zurru ◽  
Laura Brescacin ◽  
Santiago Pigretti ◽  
Pedro Colla Machado ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Vascular Risk Factor ◽  
Stroke Outcome ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Stroke Outcomes ◽  
Post Stroke ◽  
Artery Disease

Background: women who have ischemic strokes are on average older than men.Several studies, however, show that stroke outcomes are worse in women even after adjusting for age, and the specific conditions that contribute to this outcome are poorly known. Our objective was to evaluate post-stroke disability and mortality after ischemic stroke in women. Methods: acute ischemic stroke patients were prospectively included in a multidisciplinary secondary stroke prevention program. Pre-stroke vascular risk factor profile and control were obtained from electronic records; disability (modified Rankin scale) were evaluated one month after stroke. Results: fifty seven percent of the 1194 ischemic stroke patients prospectively included between December 2006 and December 2013 were women. They were older, more probably hypertensive, dislipidemic and diabetic, and had higher incidence of atrial fibrillation, while men had higher prevalence of obesity, metabolic syndrome, smoking, and history of coronary heart disease and peripheral artery disease. Pre-stroke vascular risk factor control and management are shown in table 1. Women had worst outcome than men: mRankin >1 (66% women vs 52% men, p 0.0001), 30-day mortality (4% women vs 2% men, p 0.04), composite disability + mortality (52% women vs 36% men, p 0.0001). After adjusting by age women still had higher risk of disability and mortality: m-Rankin >1 (OR 1.40, 95%CI 1.05-1.87; p 0.02); mortality (OR 1.64, 95%CI 0,98-2,74), and composite disability + mortality (OR 1.59, 95%CI 1.22-2.07; p 0.004). Conclusion: in our cohort women have worst post-stroke outcome, even though they have higher burden of vascular risk factors they have lower prevalence of vascular disease in other vascular beds previous to stroke. This difference persists after adjusting by age, raising the possibility of specific gender risk factors influencing on ischemic stroke outcomes.

Abstract WP222: Resistant Hypertension and Burden of Chronic Microvascular Brain Damage in Ischemic Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Maria C Zurru ◽  
Claudia Alonzo ◽  
Brescacín Laura ◽  
Luis Cámera ◽  
Santiago Pigretti ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Resistant Hypertension ◽  
Neurovascular Unit ◽  
Vascular Risk Factor ◽  
Cognitive Outcomes ◽  
Blood Pressure Target ◽  
Stroke Patients ◽  
Vascular Events ◽  
Multiple Drugs

Background and purpose: Hypertension is the most prevalent risk factor for acute and chronic cerebrovascular disease. As patients with resistant hypertension are a subgroup with even higher risk, we aimed to evaluate the burden of microangiopatic disease and functional outcome in subjects with stroke and difficult to treat hypertension. Design and method: acute ischemic stroke patients were prospectively included in a multidisciplinary secondary stroke prevention program. Pre-stroke vascular risk factor profile and control were obtained from electronic medical records and chronic vascular disease burden was assessed on admission MRI. Functional and cognitive evaluation were performed one-month after stroke. Results: 1327 patients (16% with resistant hypertension) were included from September 2009 and December 2015. Patients with resistant hypertension were older (80±8 vs 77±10, p 0.0004), with higher prevalence of obesity (62% vs 50%, p 0.001), metabolic syndrome (52% vs 38%, p 0.0001) and history of atrial fibrillation (27% vs 16%, p 0.0001). There was a direct relationship between resistant hypertension and the severity of chronic microvascular lesions, and also with functional and cognitive outcomes (table). Conclusion: Hypertension increases vascular events risk, even more in the setting of resistant hypertension. Requirement of a therapeutic strategy involving combination of multiple drugs generally indicates more severe underlying hypertensive disease. It is possible that mechanisms of endothelial dysfunction responsible of the neurovascular unit damage might remain active despite achieving blood pressure target.

Abstract TMP98: Could Mobile Health be an Effective Strategy for Enhancing Stroke Prevention?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shimeng Liu ◽  
Wuwei Feng ◽  
Pratik Y Chhatbar ◽  
Bruce I Ovbiagele
Keyword(s):  
Risk Factors ◽  
Smoking Cessation ◽  
Risk Factor ◽  
Glycemic Control ◽  
Mobile Health ◽  
Meta Analysis ◽  
Vascular Risk Factor ◽  
Smoking Abstinence ◽  
Vascular Risk ◽  
Risk Factor Control

Background: The overwhelming majority of strokes can be prevented via optimal vascular risk factor control. However, there remains an evidence practice gap with regard to treatment of vascular risk factors. With the rapid growth worldwide in cell-phone use, Internet connectivity, and digital health technology, mobile health (mHealth) technology may offer a promising approach to bridge these treatment gaps and reduce the global burden of stroke. Objective: To evaluate the effectiveness of mHealth in vascular risk factor control through a systemic review and meta-analysis. Methods: We searched PubMed from January 1, 2000 to May 17, 2016 using keywords: mobile health, mhealth, short message, cellular phone, mobile phone, stroke prevention and control, diabetes mellitus, hypertension, hyperlipidemia and smoking cessation. We performed a meta-analysis of all eligible randomized control clinical trials that assessed the long-term (at 6 months) effect of mHealth. Results: Of 79 articles identified, 13 of them met eligibility criteria (6 for glycemic control and 7 for smoking cessation) and were included for the final meta-analysis. There were no eligible studies for dyslipidemia or hypertension. mHealth resulted in greater HbA1c reduction at 6 months (6 studies; 663 subjects; SMD: -0.44; 95% CI: [-0.82, -0.06], P =0.02; Mean difference of decrease in HbA1c: -0.39%; 95% CI: [-0.74,-0.04], P =0.03). mHealth also led to relatively higher smoking abstinence rates at 6 months (7 studies; 9,514 subjects; OR: 1.54; 95% CI: [1.24, 1.90], P <0.0001). Conclusion: Use of mHealth improves glycemic control and smoking abstinence rates, two factors that may lead to better stroke outcomes. Future mHealth studies should focus on modifying premier vascular risk factors like hypertension, specifically in people with or at risk of stroke.

Different vascular risk factor profiles in ischemic stroke subtypes: a study fromthe "Sagrat Cor Hospital of Barcelona Stroke Registry"

2000 ◽  
Vol 102 (4) ◽  
pp. 264-270 ◽  
Author(s):  
A. Arboix ◽  
C. Morcillo ◽  
L. Garcia-Eroles ◽  
M. Oliveres ◽  
J. Massons ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Stroke Registry ◽  
Stroke Subtypes

scholarly journals Relationship Between Homocysteine and Carotid Artery Stenosis in Ischemic Stroke

2013 ◽  
Vol 28 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Aminur Rahman ◽  
Firoz Ahmed Quraishi ◽  
Md Nurul Amin Miah ◽  
Maliha Hakim ◽  
Uttam Kumar Saha ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Homocysteine Level ◽  
Density Lipoprotein ◽  
Case Group ◽  
Healthy Controls ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Artery Disease

Background: Epidemiologic studies have identified hyper-homocysteinemia as a possible risk factor for atherosclerosis. The aim of my study was based on evaluation of relationship between homocysteinemia with carotid artery stenosis in ischemic stroke patients.Methods and materials: It was a prospective observational study conducted in the Department of Neurology, Sir Salimullah Medical College & Mitford hospital, Dhaka. Thirty six consecutive patients with ischemic stroke were analyzed by serum total homocysteine, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride and extracranial Doppler ultrasonography and vascular risk factors were recorded. Equal number of controls of same ages were compared with the case group.Result: Mean fasting blood sugar, serum fasting total cholesterol (TC), serum fasting Low density lipoprotein (LDL) were significantly higher in case group (p=0.001). Serum TC and LDL had a positive correlation with serum homocystine (p=0.001). Serum High density lipoprotein (HDL) had a negative correlation (p=0.718) and serum triglyceride (TG) had a negative correlation (p = 0.182). Total plasma fasting homocysteine level in case group was 21.89 ± 9.38 ìmol/l and control group was 12.31 ± 3.27 ìmol/l, (p=0.001). Elevated fasting homocysteine level was found in 75.0% of the ischemic stroke patients and in 16.67% of healthy controls (p=0.001).On the basis of clinical evaluation and results of imaging studies, etiological classification of the ischemic stroke patients were made, where 36.1% cases were small artery disease, 38.9% large artery disease, 8.3% cases cardioembolic and in 16.7 % other causes. Among the cases, carotid duplex study was found normal in seven cases (19.4%), Group 1 findings in seven cases (19.4%), group 2 findings in eight cases (22.2%), group 3 findings in thirteen cases (36.1%) and group 4 findings in one case (2.8%). All abnormal carotid duplex findings were significantly higher among cases with elevated level of homocysteine (p=0.001, 0.001, 0.001).Conclusion: The incidence of hyperhomo-cysteinemia is higher in ischaemic stroke cases than that in age-sex matched healthy controls. Hyperhomocysteinemia in ischaemic stroke patients has been determined as vascular risk factor in our study. Significant correlation has been found between homocysteine concentration and intraluminal thickness and carotid artery stenosis.Bangladesh Journal of Neuroscience 2012; Vol. 28 (1): 1-9

Abstract T MP107: Ischemic Strokes While on Aspirin: Initiation of Clopidogrel Is Better than Re-initiation of Aspirin for Prevention of Future Vascular Events

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Meng Lee ◽  
Yi-Ling Wu ◽  
Jeffrey L Saver ◽  
Hsuei-Chen Lee ◽  
Jiann-Der Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Treatment Failure ◽  
Risk Reduction ◽  
Recurrent Stroke ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Vascular Events ◽  
Index Stroke

Background: It is currently unclear about what to do for the patient who has a breakthrough ischemic stroke while receiving aspirin, the so-called ‘aspirin treatment failure’. Objective: To compare the effectiveness of clopidogrel vs. aspirin for vascular risk reduction among ischemic stroke patients who were on aspirin treatment at the time of the index stroke. Methods: We analyzed the Taiwan National Health Insurance registry which comprises beneficiaries aged ≥ 18 years. Code ICD-9 was used to identify a primary hospitalization diagnosis of ischemic stroke among subjects encountered between 2003 and 2009, and continuously treated with aspirin ≥ 30 days before the index stroke. Follow-up was from time of the index stroke to admission for recurrent stroke or myocardial infarction; withdrawal from the registry; and last medical claim before 1/1/2011. Patients were categorized into 2 groups based on whether clopidogrel or aspirin was prescribed during follow-up period. Patients were excluded if their Medication Possession Ratio was < 80% or they not taking clopidogrel or aspirin within 30 days before an endpoint. Primary endpoints were a major adverse cardiovascular event (MACE: composite of stroke and myocardial infarction) and a recurrent stroke alone. Multivariate-adjusted hazard ratio (HR) and 95% CI for the development of events were estimated using Cox models. Results: Among 2281 eligible patients, mean age was 72 years, 41% were female, and mean follow-up duration was 2.2 years. Compared to aspirin, clopidogrel was associated with a significantly lower occurrence of MACE (adjusted HR 0.67, 95% CI 0.55 to 0.81) and recurrent stroke (adjusted HR 0.67, 0.54 to 0.82). The pattern of benefit for clopidogrel users was consistent across several endpoints (Table). Conclusion: Among ischemic stroke patients with so called ‘aspirin treatment failure’, clopidogrel may a better choice than aspirin for future vascular risk reduction.

scholarly journals Alternative Splicing of Putative Stroke/Vascular Risk Factor Genes Expressed in Blood Following Ischemic Stroke Is Sexually Dimorphic and Cause-Specific

2020 ◽  
Vol 11 ◽  
Author(s):  
Cheryl Dykstra-Aiello ◽  
Frank R. Sharp ◽  
Glen C. Jickling ◽  
Heather Hull ◽  
Farah Hamade ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Alternative Splicing ◽  
Vascular Risk Factor ◽  
Sexually Dimorphic ◽  
Vascular Risk

scholarly journals Opportunities and Limitations of Vascular Risk Factor Models in Studying Plasticity-Promoting and Restorative Ischemic Stroke Therapies

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Dirk M. Hermann ◽  
Thorsten R. Doeppner ◽  
Aurel Popa-Wagner
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Brain Plasticity ◽  
Experimental Studies ◽  
Vascular Risk Factor ◽  
Factor Models ◽  
Vascular Risk ◽  
Short Lifespan ◽  
Risk Factor Models

Major efforts are currently made promoting neuronal plasticity and brain remodeling in the postacute stroke phase. Experimental studies evaluating new stroke therapies are mostly performed in rodents, which compared to humans exhibit a short lifespan. These studies widely employ young, otherwise healthy, rodents that lack the vascular risk factors and comorbidities of stroke patients. These risk factors compromise postischemic neurological recovery and brain plasticity and in several contexts reduce the brain responsiveness to recovery-inducing plasticity-promoting treatments. By examining risk factor models, which have hitherto been used for studying experimentally induced ischemic stroke, this review outlines the possibilities and limitations of risk factor models in the evaluation of plasticity-promoting and restorative stroke treatments.

scholarly journals Vascular risk factor control and adherence to secondary preventive medication after ischaemic stroke

2020 ◽  
Author(s):  
M. N. Gynnild ◽  
R. Aakerøy ◽  
O. Spigset ◽  
T. Askim ◽  
M. K. Beyer ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischaemic Stroke ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Risk Factor Control ◽  
Preventive Medication

scholarly journals White matter hyperintensity burden in acute stroke patients differs by ischemic stroke subtype

Neurology ◽  
2020 ◽  
Vol 95 (1) ◽  
pp. e79-e88 ◽  
Author(s):  
Anne-Katrin Giese ◽  
Markus D. Schirmer ◽  
Adrian V. Dalca ◽  
Ramesh Sridharan ◽  
Kathleen L. Donahue ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
White Matter ◽  
Brain Mri ◽  
Vascular Risk Factor ◽  
White Matter Hyperintensity ◽  
Large Artery ◽  
Vascular Risk ◽  
Stroke Subtypes ◽  
Small Artery Occlusion

ObjectiveTo examine etiologic stroke subtypes and vascular risk factor profiles and their association with white matter hyperintensity (WMH) burden in patients hospitalized for acute ischemic stroke (AIS).MethodsFor the MRI Genetics Interface Exploration (MRI-GENIE) study, we systematically assembled brain imaging and phenotypic data for 3,301 patients with AIS. All cases underwent standardized web tool–based stroke subtyping with the Causative Classification of Ischemic Stroke (CCS). WMH volume (WMHv) was measured on T2 brain MRI scans of 2,529 patients with a fully automated deep-learning trained algorithm. Univariable and multivariable linear mixed-effects modeling was carried out to investigate the relationship of vascular risk factors with WMHv and CCS subtypes.ResultsPatients with AIS with large artery atherosclerosis, major cardioembolic stroke, small artery occlusion (SAO), other, and undetermined causes of AIS differed significantly in their vascular risk factor profile (all p < 0.001). Median WMHv in all patients with AIS was 5.86 cm3 (interquartile range 2.18–14.61 cm3) and differed significantly across CCS subtypes (p < 0.0001). In multivariable analysis, age, hypertension, prior stroke, smoking (all p < 0.001), and diabetes mellitus (p = 0.041) were independent predictors of WMHv. When adjusted for confounders, patients with SAO had significantly higher WMHv compared to those with all other stroke subtypes (p < 0.001).ConclusionIn this international multicenter, hospital-based cohort of patients with AIS, we demonstrate that vascular risk factor profiles and extent of WMH burden differ by CCS subtype, with the highest lesion burden detected in patients with SAO. These findings further support the small vessel hypothesis of WMH lesions detected on brain MRI of patients with ischemic stroke.

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