Abstract TP200: Family History and Risk of Recurrent Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jun Yup Kim ◽  
Jong-Won Chung ◽  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
Kyusik Kang ◽  
...  
Keyword(s):  
Family History ◽  
Recurrent Stroke ◽  
Stroke Onset ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Stroke Registry ◽  
First Degree Relatives ◽  
Index Stroke ◽  
History Of ◽  
Cox Proportional Hazard Models

Background: Association between family history of stroke and stroke recurrence remains unclear. Methods: Using a web-based multicenter stroke registry database, information on history of stroke in first-degree relatives was collected prospectively in ischemic stroke patients hospitalized within 7 day of onset. Collected information was categorized as follows: type of affected relatives with stroke (paternal, maternal, sibling, or two or more) and age of relative’s stroke onset in relative (< 50, 50∼59, 60∼69, and ≥ 70). Stroke recurrence was captured prospectively using predetermined protocol. Subgroup analysis was performed using categories based on patient’s age at the index stroke. Results: Among 7,642 patients, 937 (12.3%) had history of stroke in their first-degree relatives, and 475(6.2%) experienced stroke recurrence (median follow-up, 365 days). In multivariate Cox proportional hazard models, overall family history was not associated with stroke recurrence (hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.80-1.41). However, the details of family history, including relative’s age at stroke onset < 50 (HR, 2.15; 95% CI, 1.01-4.57) and stroke history in sibling (HR, 1.67; 95% CI, 1.09-2.57) were independently associated with stroke recurrence after adjusting for possible confounders. The associations seemed to be stronger in stroke of young adults (age, <55) compared to older stroke patients. Conclusion: This study suggests that having relative with early onset stroke and sibling with history of stroke increase the risk of recurrent stroke and imply that additional precautions may be needed in such population.

Development of a questionnaire to identify persons with a family history of aneurysmal subarachnoid hemorrhage

2022 ◽  
pp. 174749302110690
Author(s):  
Charlotte CM Zuurbier ◽  
Jacoba P Greving ◽  
Gabriel JE Rinkel ◽  
Ynte M Ruigrok
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Family History ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Positive Family History ◽  
Stroke Patients ◽  
Degree Relative ◽  
First Degree Relatives ◽  
Family History Questionnaire ◽  
Affected Relative ◽  
History Of

Background: Preventive screening for intracranial aneurysms is effective in persons with a positive family history of aneurysmal subarachnoid hemorrhage (aSAH), but for many relatives of aSAH patients, it can be difficult to assess whether their relative had an aSAH or another type of stroke. Aim: We aimed to develop a family history questionnaire for people in the population who believe they have a first-degree relative who had a stroke and to assess its accuracy to identify relatives of aSAH patients. Methods: A questionnaire to distinguish between aSAH and other stroke types (ischemic stroke and intracerebral hemorrhage) was developed by a team of clinicians and consumers. The level of agreement between the questionnaire outcome and medical diagnosis was pilot tested in 30 previously admitted aSAH patients. Next, the sensitivity and specificity of the questionnaire were assessed in 91 first-degree relatives (siblings/children) of previously admitted stroke patients. Results: All 30 aSAH patients were identified by the questionnaire in the pilot study; 29 of 30 first-degree relatives of aSAH patients were correctly identified. The questionnaire had a sensitivity of 97% (95% confidence interval (CI) = 83–100%) and a specificity of 93% (95% CI = 84–98%) when tested in the first-degree relatives of stroke patients. Conclusion: Our questionnaire can help persons to discriminate an aSAH from other types of stroke in their affected relative. This family history questionnaire is developed in the Netherlands but could also be used in other countries after validation.

Abstract 2668: Lacunar Strokes In Patients With Symptomatic Intracranial Stenosis

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Amir Khan ◽  
Scott E Kasner ◽  
Michael J Lynn ◽  
Marc I Chimowitz ◽  
Keyword(s):  
Recurrent Stroke ◽  
Microvascular Disease ◽  
Intracranial Stenosis ◽  
Stroke Recurrence ◽  
Lacunar Stroke ◽  
Cox Proportional Hazard ◽  
Significant Difference ◽  
Index Stroke ◽  
Cox Proportional Hazard Models ◽  
Recurrent Strokes

Background and Purpose: Lacunar strokes are conventionally attributed to a distinct microvascular pathophysiology, but the “lacunar hypothesis” has been challenged since some small deep infarcts are identified in patients with sources of cardioembolism or large vessel atherosclerotic disease. We hypothesized that patients with intracranial stenosis with a lacunar stroke presentation would have a lower risk of recurrent stroke than those with an index non-lacunar stroke, and that their recurrent strokes would predominantly be lacunar. Methods: We analyzed subjects enrolled with an index stroke into the Warfarin Aspirin Symptomatic Intracranial Disease (WASID) trial. The index and endpoint strokes were classified as lacunar or non-lacunar by central adjudication. The primary endpoint was recurrent ischemic stroke. Cox proportional hazard models were generated with stratification for severity of stenosis. Results: 347 subjects were enrolled after an index stroke, 38 were lacunar and 309 were non-lacunar. Over a mean follow-up of 1.8 years there was no significant difference in stroke recurrence between patients whose index stroke was lacunar (7/38; 18%) vs. non-lacunar (69/309; 22%) (HR 0.79, 95%CI: 0.36-1.71). Further, no significant differences were found when groups were stratified by 50-69% stenosis (HR 0.50, 95%CI:0.12-2.1) and ≥70% stenosis (HR 0.87, 95%CI: 0.34-2.2) but power was limited. Of the 7 recurrent strokes in patients whose index stroke was lacunar, all 7 were non-lacunar and 3 were in the territory of the stenotic artery. Of the 69 recurrent strokes in patients whose index stroke was non-lacunar, 6 (9%) were lacunar of which 4 were in the territory of the stenotic artery. Conclusions: The risk of recurrent stroke due to intracranial stenosis was similar in patients who presented with lacunar vs. non-lacunar strokes, and all recurrent strokes in patients presenting with lacunar stroke were non-lacunar. These findings suggest that the pathophysiology of index and recurrent strokes in patients presenting with a lacunar stroke and intracranial stenosis is related to the stenosis and not microvascular disease. Therefore, patients with intracranial stenosis who present with lacunar strokes should be included in future trials investigating secondary stroke prevention for symptomatic intracranial stenosis.

Abstract TP205: Clinical Aspects Of First-ever Stroke In Patients With Permanent Pacemaker

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jiro Kitayama ◽  
Hiroshi Nakane ◽  
Hiromi Ishikawa ◽  
Masahiro Shijo ◽  
Masahiro Kamouchi ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Pacemaker Implantation ◽  
The United States ◽  
Permanent Pacemaker ◽  
Stroke Onset ◽  
Clinical Aspects ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Stroke Registry ◽  
History Of

OBJECTIVES: Recently, increasing numbers of patients take pacemaker implantation: almost sixty thousands in Japan, and no less than two hundreds of thousands in the United States per year. Previous reports have indicated that prevalence of atrial fibrillation (Af) is high, and several coagulation markers are elevated in those with pacemaker. However, the precise features of stroke with implanted device are not clear. We, thus, examined the clinical aspects of stroke in pacemaker patients. METHODS: For the present study, we analyzed data from the Fukuoka Stroke Registry that is a multicenter epidemiological study database on acute stroke. From June 1999 to May 2011, 11376 ischemic stroke patients (72±12 years of age, female/male=4613/6763) who admitted to the hospital within seven days after onset were enrolled in the registry. Stroke subtypes were classified according to the diagnostic criteria of TOAST (Trial of Org 10172 in Acute Stroke Treatment). RESULTS: A total of 207 patients (1.8% of registered stroke patients) were with pacemaker. Among them, 130 patients had no history of any stroke. They appeared to be a mean age of 81±9 (range 42 to 97) years, and female/male ratio of 77/53. Mean duration from pacemaker implantation to stroke onset was 8±7 (median 6, quartile 3-11) years. 32 patients (25%) were given oral anticoagulant prior to stroke onset; 60 (46%) were on antiplatelet. Prevalence of Af in pacemaker patients was 48% (n=63). In those with Af, 48 patients (76%) were diagnosed as cardioembolic stroke, but only 22 (35%) were on anticoagulation before onset. Even in those without Af, 33 cases (49%) were also diagnosed as cardioembolic. The percentage of subjects with increased plasma D-dimer (≥1.5 μg/ml) was significantly higher in pacemaker group than no-pacemaker group, regardless of the presence or absence of Af (75% vs. 45% with Af; p<0.0001, 74% vs. 25% without Af; p<0.0001). CONCLUSIONS: In our current study, stroke in pacemaker patients revealed to have higher incidence of cardiogenic embolism, with or without Af. In addition, the majority was elderly, and failed to receive anticoagulant prior to stroke. It is needed to re-consider therapeutic strategy, including anticoagulation, for prevention of stroke in those with permanent pacemaker.

scholarly journals Analisis Survival Kecepatan Kekambuhan Stroke

2018 ◽  
Vol 6 (1) ◽  
pp. 62
Author(s):  
Karina Pramudita ◽  
Hari Basuki Notobroto
Keyword(s):  
Diabetes Mellitus ◽  
Recurrence Rate ◽  
Cox Regression ◽  
Recurrent Stroke ◽  
Secondary Data ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Cox Regression Analysis ◽  
History Of ◽  
Heart Abnormalities

The objective of this study was to apply cox regression to factor analysis of stroke recurrence rate. This type of research was applied research on secondary data. The samples were 178 first stroke patients who are enrolled in inpatient period January to December 2011 and then made observations on the incidence of recurrent strokes up in February 2017 in medical record. Analysis techniques using Cox regression analysis on risk factors of stroke recurrence rate in RSAU dr. Esnawan Antariksa Halim Perdana Kusumah Jakarta. The analysis exhibited that the rate of recurrence of stroke has the same risk between categories of obesity. Stroke patients with a history of hypertension had a risk of a stroke recurrence rate of 5.594 times more likely than stroke patients with no history of hypertension, stroke patients with a history of diabetes mellitus had a risk of stroke recurrence rate of 1.912 times more likely than stroke patients with no history of diabetes mellitus, stroke patients with a history of dyslipidemia The risk of a recurrence rate of stroke was 2.153 times more likely than stroke patients without a history of dyslipidemia, and stroke patients with a history of heart abnormalities had a risk of recurrent stroke rates of 2.321 times more likely than stroke patients without a history of heart abnormalities. For stroke patients with a history of hypertension, diabetes mellitus, dyslipidemia and a history of cardiac abnormalities, need to do regular check-ups and controls every month to avoid recurrence of stroke.

Abstract 213: Cerebral Microbleeds in 1278 Lacunar Stroke Patients: The Secondary Prevention of Small Subcortical Strokes (SPS3) Trial

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ashkan Shoamanesh ◽  
Lesly A Pearce ◽  
Carlos Bazan ◽  
Luciana Catanese ◽  
Leslie A McClure ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Recurrent Stroke ◽  
Large Population ◽  
Cerebral Microbleeds ◽  
Stroke Recurrence ◽  
Blood Pressure Target ◽  
Lacunar Stroke ◽  
Stroke Patients ◽  
Increased Risk ◽  
History Of

Background: Cerebral microbleeds (CMBs) are radiographic markers of cerebral small vessel disease (CSVD) reported to independently predict recurrent stroke and mortality. However, characterization of CMBs in a large population of pure CSVD is lacking. We aimed to characterize CMBs in a well-defined population of lacunar stroke patients, and assess the relationship between CMBs and recurrent stroke and death. Methods: SPS3 was a randomized trial investigating optimal blood pressure target and antiplatelet regimen in 3020 patients with recent, symptomatic, MRI-confirmed lacunar stroke. CMBs were rated as per the Brain Observer MicroBleed Scale in all participants who had an interpretable axial T2*- GRE sequence available as part of their baseline MRI (n=1278, intra-rater reliability for + CMB 91% agreement, Kappa = 0.82). Results: CMBs were present in 30% of 1278 patients (mean age 63 y, 65% male, 75% history of hypertension). CMBs were lobar in 21%, deep in 44%, and mixed in 35% of cases. Of patients with CMBs, most (57%) had 1-2 CMBs, 31% had 3-10, and 12% >10. Male gender (OR 1.7, 95% CI 1.3-2.3), history of hypertension (1.6, 1.2-2.3), increased systolic blood pressure (1.2 per 20 mmHg, 1.1-1.4), non-diabetic (1.4, 1.1-1.9), multiple lacunar infarcts (1.9, 1.5-2.5) and moderate (1.7, 1.2-2.3) or severe (4.2, 3.0-5.9) white matter hyperintensities on MRI were independently associated with the odds of having CMBs in multivariable logistic regression. During a mean follow-up of 3.3 y, overall stroke recurrence was 2.5% per patient-y. In comparison to patients without CMBs, those with CMBs had a two-fold increased risk of stroke (HR 2.1, 1.4-3.1), after adjusting for assigned treatments and risk factors, whereas those with >10 CMBs had a four-fold increased risk (HR 4.0, 1.8-8.7). CMBs were not a risk factor for death (HR 1.2, 0.8-2.0). There were no interactions between CMBs and treatment assignments. Conclusions: In this largest reported cohort of lacunar stroke investigating CMBs, CMBs were highly prevalent and an independent predictor of stroke recurrence. Accordingly, patients with lacunar stroke and CMBs likely represent a more aggressive form of CSVD in need of efficacious therapeutic strategies. Further research is warranted in this field.

scholarly journals Family history of cancer in first degree relatives and risk of cancer of unknown primary

2021 ◽  
Author(s):  
Alexander L. R. Grewcock ◽  
Karlijn E. P. E. Hermans ◽  
Matty P. Weijenberg ◽  
Piet A. Brandt ◽  
Caroline Loef ◽  
...  
Keyword(s):  
Family History ◽  
Cancer Of Unknown Primary ◽  
Unknown Primary ◽  
Family History Of Cancer ◽  
First Degree Relatives ◽  
History Of ◽  
Risk Of Cancer ◽  
History Of Cancer

Abstract MP86: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Acute Ischemic Stroke Patients by History of Hypertension and Use of Antihypertensive Medications

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Tan Xu ◽  
Yonghong Zhang ◽  
Yingxian Sun ◽  
Chung-Shiuan Chen ◽  
Jing Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Acute Ischemic Stroke ◽  
Hospital Discharge ◽  
Odds Ratio ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Antihypertensive Medications ◽  
History Of

Introduction: The effects of blood pressure (BP) reduction on clinical outcomes among acute stroke patient remain uncertain. Hypothesis: We tested the effects of immediate BP reduction on death and major disability at 14 days or hospital discharge and 3-month follow-up in acute ischemic stroke patients with and without a previous history of hypertension or use of antihypertensive medications. Methods: The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomly assigned patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP) to receive antihypertensive treatment (N=2,038) or to discontinue all antihypertensive medications (N=2,033) during hospitalization. Randomization was stratified by participating hospitals and use of antihypertensive medications. Study outcomes were assessed at 14 days or hospital discharge and 3-month post-treatment follow-up. The primary outcome was death and major disability (modified Rankin Scale score≥3), and secondary outcomes included recurrent stroke and vascular events. Results: Mean SBP was reduced 12.7% in the treatment group and 7.2% in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mmHg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At 14 days or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups by subgroups. At the 3-month follow-up, recurrent stroke was significantly reduced in the antihypertensive treatment group among patients with a history of hypertension (odds ratio 0.43, 95% CI 0.24-0.75, P=0.003) and among patients with a history of use of antihypertensive medications (odds ratio 0.41, 95% CI 0.20-0.84, P=0.01). All-cause mortality (odds ratio 2.84, 95% CI 1.11-7.27, P=0.03) was increased among patients without a history of hypertension. Conclusion: Immediate BP reduction lowers recurrent stroke among acute ischemic stroke patients with a previous history of hypertension or use of antihypertensive medications at 3 months. On the other hand, BP reduction increases all-cause mortality among patients without a history of hypertension.

Abstract W MP99: Race/Ethnic and Sex Differences in EMS Transport among Hospitalized U.S. Stroke Patients: Analysis of the National Get With The Guidelines-Stroke Registry

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Heidi Mochari-Greenberger ◽  
Ying Xian ◽  
Anne S Hellkamp ◽  
Phillip J Schulte ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Ethnic Group ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
National Sample ◽  
Stroke Patients ◽  
Hispanic Males ◽  
Stroke Registry ◽  
Black Females ◽  
History Of ◽  
Get With The Guidelines

Background: Calling 911 is the recommended first step when stroke symptoms occur. Differences in activation of emergency medical services (EMS) may contribute to race/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS utilization varies among a contemporary, diverse national sample of hospitalized acute stroke patients. Methods: We analyzed data from 398,798 stroke patients admitted to 1,613 Get With The Guidelines-Stroke participating hospitals from 10/1/11-3/31/14. Multivariable logistic regression was utilized to evaluate the associations between race/ethnic group and sex, with EMS use, adjusting for potential confounders. Results: Patients were 50.4% female, 69% white, 19% black, 8% Hispanic, 3% Asian, 1% other; 85.9% ischemic stroke. Overall 58.6% of stroke patients were transported to the hospital by EMS. EMS utilization differed by sex and race/ethnic group (interaction p<0.001). White females were most likely to use EMS (62.0%) and Hispanic males were least likely to (52.2%). Age, health insurance coverage, and history of prior stroke or TIA varied significantly among race/ethnic groups (p<0.0001). After adjustment for both patient and hospital characteristics, Hispanic and Asian men and women were less likely than their white counterparts to utilize EMS; black females were less likely than white females to utilize EMS (Table). Conclusion: EMS use was low overall and differential by race/ethnicity and sex. These contemporary data support a need for targeted initiatives to increase EMS transport among U.S. stroke patients.

Abstract P132: Clinical Outcomes In Ischemic Stroke Patients With Uncontrolled Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Zahra Abuzaid ◽  
Sara Almuslem ◽  
Farah Aleisa
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Recurrent Stroke ◽  
Uncontrolled Hypertension ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Stroke Event ◽  
Uncontrolled Blood Pressure

Background: Hypertension is considered major risk factor for incidence of ischemic stroke, controlling blood pressure reduces this risk, the relationship of uncontrolled blood pressure and stroke outcomes is complex, post stroke uncontrolled blood pressure remains one of the major contributing factors for stroke recurrence and mortality, in our study we studied the long term effects of uncontrolled hypertension in modern health care setting. Methodology: Patients in the study were admitted to the neurology department at KFSH-D between March 2015- August 2019, we included 102 acute ischemic stroke patients whom had hypertension, all patients had follow up appointments at stroke clinic a minimum of 2 visits over 4 years. We retrospectively compared blood pressure data from stroke patients with recurrent ischemic stroke events vs. patients with initial stroke event, and recurrent stroke, also we studied blood pressure readings for different stroke severity groups, patients who had severe stroke with mRS>4, compared to milder stroke group of mRS<4. Results: We found 48 patients identified with recurrent stroke event, those with uncontrolled hypertension had significantly higher stroke recurrence events (P=0.002), despite acute stroke treatment, patients who had history of uncontrolled hypertension were found to have more severe stroke deficits than those who had controlled blood pressure (P=0.029). We found significant difference in the long term stroke clinical outcomes between patients who had uncontrolled blood pressure and patients who had controlled blood pressure recordings within the same hospital setting (P=0.064). Conclusion: Based on our findings, uncontrolled hypertension was associated with higher risk of stroke recurrence, it also increased susceptibility to worse stroke clinical outcomes up to 1 year after initial stroke event, which deserved further close attention and better blood pressure control.

Sign in / Sign up

Export Citation Format

Share Document