Abstract W P155: Racial Differences in Ischemic Stroke Subtypes: The Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS)

Background: It is well known that blacks have higher stroke incidence rates than whites. It is commonly believed that whites have more cardioembolic (CE) and large vessel (LV) ischemic strokes (IS). However, using data from 1993-94, we showed that blacks have higher rates of every IS subtype. We sought to see if this pattern persisted in 2010 within a large, biracial population of 1.3 million representative of the US. Methods: The GCNKSS is a population-based stroke epidemiology study from five counties in the Greater Cincinnati region. During 2010, we captured all hospitalized strokes by screening ICD-9 codes 430-436. We also captured out-of-hospital strokes by sampling primary care offices and nursing homes. Study nurses abstracted all potential cases. Physicians adjudicated each possible event and then further subtyped IS based on available test results using established methods. Incidence rates per 100,000 and associated 95% confidence intervals (CI) were estimated for each subtype using first-ever IS, with weighting of out-of-hospital event sampling, then age- and sex- adjusted to the 2000 US population. Black/white risk ratios (RR) and 95% CI were also calculated. Results: In 2010 there were 2219 IS in 2116 patients, and 1693 first-ever IS. Of the 1693 incident IS, 944 (57%) were female, 346 (21%) black, with mean age 69 years. There were 285 (18%) small vessel, 465 (27%) CE, 218 (12%) LV, 107 (6%) other identified cause, and 617 (37%) undetermined. The table shows incident IS rates by subtype and the associated RR. For each subtype of IS, blacks had a higher point estimate than whites in 2010. In 2010, the RR CI’s cross 1.0 for CE and LV, thus the RR is not statistically significant. Conclusion: It is not clear if these data represent significant differences for CE and LV subtypes in 2010 or statistical variation between periods. Regardless, stroke prevention efforts for blacks should include strategies relevant to all IS subtypes, and not just those for small vessel disease.

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Total Cerebral Small Vessel Disease Score and Anthropometric Indices: A Population-Based Study in Older Adults of Amerindian Ancestry

European Neurology ◽

10.1159/000517915 ◽

2021 ◽

pp. 1-4

Author(s):

Oscar H. Del Brutto ◽

Robertino M. Mera

Keyword(s):

Older Adults ◽

Small Vessel Disease ◽

Brain Magnetic Resonance Imaging ◽

Population Based ◽

Cerebral Small Vessel Disease ◽

The Body ◽

Small Vessel ◽

Population Based Study ◽

Vessel Disease ◽

Ordinal Logistic Regression Model

A total of 590 older adults of Amerindian ancestry living in rural Ecuador received anthropometric measurements and a brain magnetic resonance imaging to estimate the total cerebral small vessel disease (cSVD) score. A fully adjusted ordinal logistic regression model, with categories of the total cSVD score as the dependent variable, disclosed significant associations between the waist circumference, the waist-to-hip, and the waist-to-height ratios – but not the body mass index (BMI) – and the cSVD burden. Indices of abdominal obesity may better correlate with severity of cSVD than the BMI in Amerindians. Phenotypic characteristics of this population may account for these results.

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Cerebral small vessel disease is related to disturbed 24-h activity rhythms: a population-based study

European Journal of Neurology ◽

10.1111/ene.12775 ◽

2015 ◽

Vol 22 (11) ◽

pp. 1482-1487 ◽

Cited By ~ 16

Author(s):

L. A. Zuurbier ◽

M. A. Ikram ◽

A. I. Luik ◽

A. Hofman ◽

E. J. W. Van Someren ◽

...

Keyword(s):

Small Vessel Disease ◽

Population Based ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Population Based Study ◽

Activity Rhythms ◽

Vessel Disease

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Abstract T MP66: Injury to the Head or Neck Increases Risk of Ischemic Stroke Three-fold After Trauma.

Stroke ◽

10.1161/str.45.suppl_1.tmp66 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Christine K Fox ◽

Adam L Numis ◽

Steve Sidney ◽

Heather J Fullerton

Keyword(s):

Ischemic Stroke ◽

Traumatic Injury ◽

Young Patients ◽

Risk Groups ◽

Population Based ◽

Incidence Rates ◽

Neck Injury ◽

Diagnostic Code ◽

Stroke Incidence ◽

Diagnostic Codes

Background: Over 2 million people under age 50 are seen in a U.S. emergency room monthly for non-fatal injuries. Our objective was to measure ischemic stroke incidence after traumatic injury in young patients and identify stroke risk factors. Methods: We performed a population-based study of ischemic stroke after trauma among people <50 years old in a Northern Californian integrated health care system. We electronically identified a cohort of patients with diagnostic codes for trauma (ICD-9 800-959.9) in emergency and inpatient encounters from 1997-2011, then identified ischemic stroke outcomes within 4 weeks. To determine stroke, we required an ICD-9 stroke code (433-438) plus a radiology report of brain imaging containing a keyword: stroke, infarct#, thromb#, ischemi#, lacun#, or dissect#. A neurologist reviewed the reports to exclude those inconsistent with ischemic stroke. We obtained clinical data such as injury type from electronic databases to calculate stratified incidence rates and risk ratios. Results: From 1.5 million trauma encounters, we identified 197 ischemic strokes. The 4-week stroke incidence after any traumatic injury was 0.013% (95% CI 0.011, 0.015). Patients with stroke had a mean age of 37.7 years (SD 12.2) versus 24.0 years (SD 13.8) in those without stroke (P<0.0001). Patients with injury to the head or neck were more likely to have a stroke compared to those with other types of injuries (Table). The 4-week stroke incidence after head or neck injury was 0.07% (95% CI 0.05, 0.09) among adults and 0.005% (95% CI 0.001, 0.01) among children (P<0.0001). Of the 197 stroke cases, 16% (95% CI 11, 22) had a diagnostic code for cranio-cervical dissection. Conclusions: A 4-week stroke incidence of 0.013% suggests that 260 young people have an ischemic stroke after a traumatic injury every month in the U.S. Further research is needed to identify the highest risk groups, such as those with head or neck injury, and opportunities for stroke prevention.

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Abstract P287: Sex Differences in Stroke Incidence: The REGARDS Study

Circulation ◽

10.1161/circ.125.suppl_10.ap287 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Virginia J Howard ◽

Suzanne E Judd ◽

Abraham J Letter ◽

Dawn O Kleindorfer ◽

Leslie A McClure ◽

...

Keyword(s):

Sex Differences ◽

Stroke Risk ◽

Proportional Hazards ◽

Population Based ◽

Incidence Rates ◽

National Data ◽

Stroke Incidence ◽

The Difference ◽

Regards Study

Background: There are strikingly few national data available to describe sex differences in age-specific stroke incidence. Methods: REGARDS is a national, population-based, longitudinal study of black and white participants aged > 45 years old, with oversampling of blacks and residents of the stroke belt. Between 2003 and 2007, 30,239 participants were enrolled and examined; follow-up is every 6 months by telephone for self- or proxy-reported stroke, with retrieval and adjudication of medical records by physicians. This analysis included 27,756 participants with follow up data who had no physician-diagnosed stroke at baseline. Stroke incidence rates were calculated as the number of stroke events divided by the person-years at risk with 95% confidence limits. Proportional hazards models were used to assess the race-specific association of sex with stroke risk by age strata (<65, 65–74, and 75+) after adjustment for socioeconomic factors, and Framingham stroke risk factors. Results: There were 613 incident strokes events over 135,551 person-years of follow-up. Stroke incidence rates increased with age (from 237/100,000 to 1003/100,000), and were higher in men than women in both blacks and whites (left panel of figure). After multivariable adjustment, men had higher risk than women at younger ages (<75) but for the 65–75 age group, the difference is larger for blacks than whites (right panel of figure). Discussion: These national data confirm the patterns in male/female stroke risk observed in the Greater Cincinnati/Northern Kentucky Stroke Study, with smaller sex differences at older ages, and for men, larger excess risk in whites than blacks.

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Associations Between Plasma Ceramides and Cerebral Microbleeds or Lacunes

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvbaha.120.314796 ◽

2020 ◽

Vol 40 (11) ◽

pp. 2785-2793

Author(s):

Eseosa T. Ighodaro ◽

Jonathan Graff-Radford ◽

Jeremy A. Syrjanen ◽

Hai H. Bui ◽

Ronald C. Petersen ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Odds Ratio ◽

Small Vessel Disease ◽

High Plasma ◽

Population Based ◽

Cerebral Microbleeds ◽

Small Vessel ◽

Resonance Imaging ◽

Logistic Regression Models

Objective: High plasma ceramide levels and ratios are associated with poor outcomes in individuals with cardiovascular disease; less is known about their relation to cerebral small vessel disease. We examined whether high plasma ceramide levels or ratios were associated with cerebral microbleeds (CMBs) and lacunes and whether associations differ by sex. Approach and Results: We included 548 participants enrolled in the MCSA (Mayo Clinic Study of Aging) with concurrent plasma ceramide assays and magnetic resonance imaging. CMBs were quantified on T2* magnetic resonance imaging and lacunes on T2 fluid-attenuated inversion recovery magnetic resonance imaging. Fasting plasma ceramides were assayed using liquid chromatography-electrospray ionization tandem mass spectrometry. We used logistic regression models adjusting for age, sex, hypertension, and diabetes mellitus to examine the relationship between ceramides and presence of a lacune; hurdle models were used for presence and number of CMBs. Each SD increase in the log ceramide C16:0/24:0 ratio was associated with greater odds of a CMB (odds ratio, 1.28 [95% CI, 1.01–1.64]). There was an interaction between sex and the ceramide C16:0/24:0 ratio ( P =0.049). The association between this ratio and presence of a CMB was stronger for women (odds ratio, 1.87 [95% CI, 1.20–3.00]) than men (odds ratio, 1.09 [95% CI, 0.80–1.46]). Several ceramides and all ceramide ratios were associated with number of CMBs. We did not find associations between plasma ceramides and lacunes. Conclusions: In a population-based sample, the plasma ceramide C16:0/24:0 ratio was associated with CMBs and was stronger for women. Plasma ceramides are differentially associated with cerebral small vessel pathologies.

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Rationale and design of a longitudinal study of cerebral small vessel diseases, clinical and imaging outcomes in patients presenting with mild ischaemic stroke: Mild Stroke Study 3

European Stroke Journal ◽

10.1177/2396987320929617 ◽

2020 ◽

pp. 239698732092961

Author(s):

Una Clancy ◽

Daniela Jaime Garcia ◽

Michael S Stringer ◽

Michael J Thrippleton ◽

Maria C Valdés-Hernández ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Risk Factors ◽

Magnetic Resonance ◽

Small Vessel Disease ◽

Brain Magnetic Resonance Imaging ◽

Small Vessel ◽

Resonance Imaging ◽

Vessel Disease ◽

Stroke Study ◽

Mild Stroke

Background Cerebral small vessel disease is a major cause of dementia and stroke, visible on brain magnetic resonance imaging. Recent data suggest that small vessel disease lesions may be dynamic, damage extends into normal-appearing brain and microvascular dysfunctions include abnormal blood–brain barrier leakage, vasoreactivity and pulsatility, but much remains unknown regarding underlying pathophysiology, symptoms, clinical features and risk factors of small vessel disease. Patients and Methods: The Mild Stroke Study 3 is a prospective observational cohort study to identify risk factors for and clinical implications of small vessel disease progression and regression among up to 300 adults with non-disabling stroke. We perform detailed serial clinical, cognitive, lifestyle, physiological, retinal and brain magnetic resonance imaging assessments over one year; we assess cerebrovascular reactivity, blood flow, pulsatility and blood–brain barrier leakage on magnetic resonance imaging at baseline; we follow up to four years by post and phone. The study is registered ISRCTN 12113543. Summary Factors which influence direction and rate of change of small vessel disease lesions are poorly understood. We investigate the role of small vessel dysfunction using advanced serial neuroimaging in a deeply phenotyped cohort to increase understanding of the natural history of small vessel disease, identify those at highest risk of early disease progression or regression and uncover novel targets for small vessel disease prevention and therapy.

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Secular Trends of Stroke Epidemiology in Örebro, Sweden, 2017 Compared to the Trends in 1999: A Population-Based Study

Cerebrovascular Diseases ◽

10.1159/000504082 ◽

2019 ◽

Vol 48 (3-6) ◽

pp. 149-156 ◽

Cited By ~ 1

Author(s):

Peter Appelros

Keyword(s):

Length Of Stay ◽

Incidence Study ◽

Large Population ◽

Case Fatality ◽

Population Based ◽

Incidence Rates ◽

European Population ◽

Stroke Severity ◽

Stroke Incidence ◽

Preventive Medication

Background and Purpose: A stroke incidence study in Örebro, situated in Southern Sweden, that was carried out in 1999 showed high incidence rates. Since then, in many Western countries, declining incidence rates have been observed. The main purpose of this study is to examine whether there have been any changes in stroke incidence in the city of Örebro between 1999 and 2017. Secondary purposes are to show trends in stroke severity, length of stay and case fatality (CF). Methods: The criterion of an “ideal” stroke incidence study was used in both the 1999 and the present investigation. These criteria include uniform diagnostics, case ascertainment including strokes managed outside the hospital, and the use of several overlapping sources, prospective design, well-defined denominator, and a large population. Results: The overall stroke incidence rate of first ever stroke (adjusted to the 2013 European population) dropped from 346/100,000 (95% CI 314–380) to 168/100,000 (95% CI 148–190). Stroke severity declined from a median of 6 to 4 points on the National Institute of Health Stroke scale. CF within 28 days also declined from 19 to 16% (n.s.). Median length-of-stay in hospital was 16 days in 1999, and 10 days in 2017. Twenty-one per cent of all kinds of stroke were recurrent (not included in the above results). Conclusions: During the years between 1999 and 2017, there have been reductions in stroke incidence, severity and mortality. The explanation is most likely to be found in the prevalence of risk factors and how they are treated. The use of antihypertensives and statins has increased, corresponding to lower levels of blood pressure and cholesterol in the population. The use of anticoagulants in patients with atrial fibrillation has increased. Cigarette smoking has decreased. These are encouraging results that show that preventive medication and public health measures work in practice.

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Markedly Reduced Risk of Internal Malignancies in Patients With Vitiligo: A Nationwide Population-Based Cohort Study

Journal of Clinical Oncology ◽

10.1200/jco.18.01223 ◽

2019 ◽

Vol 37 (11) ◽

pp. 903-911 ◽

Cited By ~ 10

Author(s):

Jung Min Bae ◽

Kee Yang Chung ◽

Sook Jung Yun ◽

Heesu Kim ◽

Byung Cheol Park ◽

...

Keyword(s):

Cohort Study ◽

Immune Surveillance ◽

Population Based ◽

Incidence Rates ◽

Control Group ◽

Frequency Matching ◽

Organ Specific ◽

Using Data ◽

Risk Of Cancer ◽

Reduced Risk

PURPOSE Recent studies indicated that the autoimmunity of vitiligo exerts effects on cells other than melanocytes, which confer reduced risks of both melanoma and nonmelanoma skin cancers in patients with vitiligo. However, the risk of internal malignancy in patients with vitiligo has not been elucidated. PATIENTS AND METHODS We conducted a population-based retrospective cohort study using data from the Korean National Health Insurance claims database obtained from January 2007 to December 2016. All patients age 20 years or older with vitiligo who had at least two contacts with a physician from 2009 to 2016, during which a principal diagnosis was made, were identified (vitiligo group). Controls were randomly selected (two per patient with vitiligo) after frequency matching with the vitiligo group for age and sex during the same period (control group). RESULTS A total of 101,078 patients with vitiligo and 202,156 controls without vitiligo were included. The incidence rates of internal malignancies were 612.9 and 708.9 per 100,000 person-years in the vitiligo and control groups, respectively. Patients with vitiligo showed a significantly reduced risk of overall internal malignancies (hazard ratio [HR], 0.86; 95% CI, 0.82 to 0.89; P < .001) compared with controls without vitiligo after adjustments for age, sex, and comorbidities. With regard to organ-specific malignancies, patients with vitiligo showed a remarkably decreased risk of cancer in the colon and rectum (HR, 0.62; 95% CI, 0.55 to 0.69; P < .001), ovary (HR, 0.62; 95% CI, 0.46 to 0.83; P < .001), and lung (HR, 0.75; 95% CI, 0.65 to 0.86; P < .001). CONCLUSION Vitiligo was associated with a reduced risk of overall internal malignancies. These findings suggest that autoimmune diseases, including vitiligo, may provide immune surveillance for the development of cancer beyond the targeted organ.

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Changes in stroke incidence, outcome, and associated factors in Porto between 1998 and 2011

International Journal of Stroke ◽

10.1177/1747493016669846 ◽

2016 ◽

Vol 12 (2) ◽

pp. 169-179 ◽

Cited By ~ 11

Author(s):

Manuel Correia ◽

Rui Magalhães ◽

Rui Felgueiras ◽

Cláudia Quintas ◽

Laura Guimarães ◽

...

Keyword(s):

Poisson Model ◽

Incidence Rates ◽

Short Term ◽

Term Outcome ◽

Stroke Incidence ◽

Awareness Campaigns ◽

Short Term Outcome ◽

Health Authorities ◽

Using Data ◽

Year 2000

Objective Year 2000 marked a turning point in stroke prevention and treatment in Portugal. In face of high incidence rates stroke awareness campaigns, close surveillance of vascular risk factors and implementation of hospital stroke units were advanced by the National Health Authorities. To understand the effect of such measures, we assessed changes in stroke incidence and short-term outcome using data from two community-based registers undertaken in Porto in 1998–2000 and 2009–2011. Methods We used standard diagnostic criteria and multiple overlapping sources of case-ascertainment for first-ever strokes. Short-term outcome was measured by the modified Rankin Scale; disabling stroke was defined whenever post-stroke mRS score>pre-stroke mRS and >1. Results Globally, 462 and 405 first-ever stroke cases were registered in 1998–2000 and 2009–2011, respectively. Stroke incidence decreased by 23%, from 261 to 203/100,000 after adjustment for the Portuguese population. Significant reduction was found in those aged <75 years (31%) and in women (32%). Incidence of disabling strokes was reduced by 29%. Fatal strokes decreased by 46%, while intracerebral hemorrhage decreased by 51%. Risk of disability from stroke decreased by 11% (RR = 0.89; 95%CI, 0.81–0.98) in 2009–2011, as found after adjusting for patient/stroke characteristics in a Poisson model. Moreover, when patients arrived hospital within 3 h from stroke onset, the risk of disabling stroke was 0.76 (95%CI, 0.67–0.87) in 2009–2011 vs. 1998–2000, compared to 1.03 (95%CI, 0.89–1.12) for late arrival. Conclusion Risk of stroke, mainly of hemorrhagic stroke, was substantially reduced over time. Timely action in acute phase was responsible for the decline in disability across periods.

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Traditional Chinese Medicine Reduces the Incidence of Chemotherapy-Induced Stroke: A Five-Year Nationwide Population-Based Cohort Study From Taiwan

Frontiers in Pharmacology ◽

10.3389/fphar.2021.614606 ◽

2021 ◽

Vol 12 ◽

Author(s):

Chien-Chen Huang ◽

Yu-Cih Yang ◽

Iona MacDonald ◽

Ching-Yuan Lai ◽

Cheng-Hao Tu ◽

...

Keyword(s):

Risk Factor ◽

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Large Scale ◽

Population Based ◽

Incidence Rates ◽

First Year ◽

Subdistribution Hazard ◽

Stroke Incidence ◽

Kaplan Meier

Background: Chemotherapy is suspected to be a risk factor for stroke in patients with cancer, athough the results from large-scale studies are controversial. Few strategies are available for reducing the stroke-related risks.Methods: We analyzed stroke incidence rates in Taiwan’s Longitudinal Health Insurance database 2000 (LHID2000) for patients aged ≥20 years with newly-diagnosed cancer between Jan 1, 2000 and Dec 31, 2006, who did or did not receive chemotherapy. Moreover, we compared stroke incidence rates among chemotherapy users who did or did not use traditional Chinese medicine. All study participants were followed-up for 5 years or until they had a stroke.Results: In adjusted Kaplan-Meier analysis, the incidence of stroke was higher within the first year of cancer diagnosis among chemotherapy recipients compared with those who did not receive chemotherapy (31.1 vs. 9.75; adjusted subdistribution hazard ratio [sHR] 2.21; 95% confidence interval [CI], 1.52–3.20; p < 0.001). This between-group difference persisted at 4 years of follow-up (13.6 vs. 5.42; adjusted sHR 1.94; 95% CI, 1.53–2.46; p < 0.001). Similarly, the 5-year incidence rate of stroke was significantly lower among chemotherapy recipients using TCM vs. non-TCM users (0.19 vs. 0.46; adjusted sHR 0.45; 95% CI, 0.26–0.79; p < 0.001), as was the mortality rate (adjusted sHR 0.55; 95% CI, 0.44–0.68; p < 0.001).Conclusion: These Taiwanese data suggest that chemotherapy is a risk factor for stroke and that the use of TCM can significantly mitigate this risk. TCM also appears to reduce the mortality risk associated with chemotherapy.

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