Abstract 98: Midlife Vascular Risk Factors and Incident Dementia in the ARIC Cohort

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Rebecca F Gottesman ◽  
Marilyn Albert ◽  
Laura Coker ◽  
Josef Coresh ◽  
Sonia M Davis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Status ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Atherosclerosis Risk In Communities ◽  
Black And White ◽  
Apoe Ε4 ◽  
Phone Calls ◽  
Incident Dementia ◽  
Increased Risk

Background: Vascular risk factors have been associated with risk of cognitive decline, with increasing evidence that midlife exposure to these risk factors may be most important in conferring late-life risk of cognitive impairment. We explored associations between vascular risk factors measured in midlife and the development of dementia over 25 years in the biracial Atherosclerosis Risk in Communities (ARIC) cohort. Methods: Participants in the ARIC study were recruited from four U.S. communities in 1987-1989, at ages 45-64, with four additional in-person visits, surveillance for hospitalizations, annual phone calls, and repeated cognitive evaluations over a 25-year period. In 2011-2013, ARIC participants were seen for the ARIC Neurocognitive Study (ARIC-NCS), and underwent a detailed neurocognitive battery and informant interviews. Through adjudicated review, dementia cases were defined. Additional dementia cases were identified through the telephone interview for cognitive status (TICS) or informant interview for those participants not attending ARIC-NCS; or by a prior dementia ICD-9 code during a hospitalization. Results: Of 15,744 participants in the cohort, 1516 cases of dementia were identified, of whom over one third were among black participants. Risk of dementia was highest in individuals of black race, with less than a high school education, older age, APOE ε4 carriage, and who, at ARIC baseline, had hypertension, diabetes, or were current smokers (table). APOE ε4 and smoking were each stronger risk factors for dementia in whites than in blacks. Discussion: Vascular risk factors measured in midlife are associated with increased risk of dementia in this biracial cohort, in black and white participants. The risk associated with diabetes nears the increased risk associated with having an APOE ε4 allele. Further studies are needed to evaluate the mechanism of and opportunities for prevention of the cognitive sequelae of these risk factors in midlife.

Abstract 7: Association Between Incidence, Severity and Recurrence of Ischemic Stroke and Risk of Dementia: The Atherosclerosis Risk in Communities Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Silvia Koton ◽  
James R Pike ◽  
Michelle C Johansen ◽  
David Knopman ◽  
Kamakshi Lakshminarayan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Cox Proportional Hazards ◽  
Vascular Risk Factors ◽  
Stroke Severity ◽  
Vascular Risk ◽  
Atherosclerosis Risk In Communities ◽  
Expert Review ◽  
Increased Risk ◽  
Atherosclerosis Risk

Background: Ischemic Stroke (IS) is associated with an increased risk of dementia, but the relative contribution of IS severity or recurrence to cognition is not known. We aimed to determine the risk of dementia after incident IS and how it varies by stroke severity and recurrence in the Atherosclerosis Risk in Communities (ARIC) study. Methods: 15,405 ARIC participants free of stroke and dementia at baseline (1987-9) were followed for IS and dementia through 2019. Incident and recurrent IS were classified by expert review of hospital records, with stroke severity by the National Institutes of Health Stroke Scale (NIHSS) classified as NIHSS≤5, 6-10, 11-15, ≥16. Dementia cases were adjudicated through expert review of in-person evaluations, informant interviews, phone assessments, hospitalization code or death certificates. Poisson regression models with robust error variance were used to estimate dementia incidence in participants with and without IS, and associations between time-dependent IS incidence (excluding dementia in the first year after stroke), frequency and severity, and dementia were studied with Cox proportional hazards models, adjusting for demographics, APOE ε4 and vascular risk factors . Results: 1151 IS (970 incident) and 2807 dementia cases were identified. NIHSS was available for 877 IS (76%). Adjusted incidence rates (95% CI) of dementia per 100 person-years were 0.45 (0.42-0.49) in participants without IS vs. 1.33 (1.15-1.55) in those with IS. Compared to no IS, risk of dementia (adjusted HR, 95% CI) increased with IS number and severity from 1.71 (1.47-1.99) for participants with one IS to 6.68 (3.58-12.46) for those with ≥3 events, and from 1.64 (1.36-1.98) for NIHSS≤5 to 4.43 (1.84-10.68) for NIHSS≥16 ( Table ). Conclusion: Risk of dementia is significantly increased after stroke, independent of vascular risk factors. These data suggest a dose-response relationship between number of stroke events and stroke severity, and risk of dementia.

scholarly journals Associations Between Midlife Vascular Risk Factors and 25-Year Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort

2017 ◽  
Vol 74 (10) ◽  
pp. 1246 ◽  
Author(s):  
Rebecca F. Gottesman ◽  
Marilyn S. Albert ◽  
Alvaro Alonso ◽  
Laura H. Coker ◽  
Josef Coresh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Atherosclerosis Risk In Communities ◽  
Incident Dementia ◽  
Atherosclerosis Risk

Abstract WP179: Rate of Pulmonary Embolism After Cerebral Venous Thrombosis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ava L Liberman ◽  
Alexander E Merkler ◽  
Gino Gialdini ◽  
Michael P Lerario ◽  
Steven R Messe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Vascular Risk Factors ◽  
Emergency Department Visits ◽  
Administrative Claims ◽  
Cerebral Vein ◽  
Vascular Risk ◽  
Index Hospitalization ◽  
Increased Risk

Introduction: Cerebral vein thrombosis (CVT) is associated with an increased risk of subsequent venous thromboembolism. It is unknown whether the risk of pulmonary embolism (PE) after CVT is similar to that of PE after deep venous thrombosis (DVT). Methods: We performed a retrospective cohort study using administrative claims data from all emergency department visits and hospitalizations in California from 2005-2011, New York from 2006-2013, and Florida from 2005-2013. We identified patients with CVT or DVT as well as the primary outcome of PE using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM ) codes. In order to minimize misclassification error, patients with both CVT and DVT during the same index hospitalization were excluded and patients with CVT were censored at the time of development of DVT and vice versa. Kaplan-Meier survival statistics and Cox proportional hazards models were used to compare the risk of PE after CVT versus after DVT while adjusting for demographics, vascular risk factors, and the Elixhauser comorbidity index. Results: We identified 4,450 patients with CVT and 217,589 patients with DVT. During a mean follow-up of 2.0 (±1.7) years, 124 patients with DVT developed a PE and 18,698 patients with DVT developed a PE. Patients with CVT were younger (mean age 45 vs 63), more often female (71% vs 52%), more often pregnant, and had fewer vascular risk factors than patients with DVT. During the index hospitalization, the rate of PE was 1.5% (95% confidence interval [CI], 1.1-1.8%) in patients with CVT and 6.2% (95% CI, 6.1-6.3%, p<0.001) in patients with DVT. By 5 years, the cumulative rate of PE after CVT was 3.7% (95% CI, 3.0-4.4%) compared to 10.5% (95% CI, 10.3-10.6%, p<0.001) after DVT. After adjustment for demographics and comorbidities, CVT was associated with a significantly lower hazard of PE when compared to DVT (hazard ratio, 0.31; 95% CI, 0.26-0.38). Conclusion: In a large, heterogeneous population, we found that the risk of PE after CVT was significantly lower than that of PE after DVT. Among patients with CVT, the greatest risk for PE was apparent during the index hospitalization.

NCMP-06. THE RISK AND BURDEN OF THROMBOEMBOLIC AND HEMORRHAGIC EVENTS IN PATIENTS WITH MALIGNANT GLIOMA RECEIVING BEVACIZUMAB

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi148-vi148
Author(s):  
Alexander Ou ◽  
Heather Lin ◽  
Ying Yuan ◽  
Charles Bornstein ◽  
Kristin Alfaro-Munoz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Performance Status ◽  
Univariate Analysis ◽  
Vascular Complications ◽  
Concurrent Chemotherapy ◽  
Vascular Risk Factors ◽  
Competing Risk ◽  
Vascular Risk ◽  
Acute Hemorrhage ◽  
Increased Risk

Abstract BACKGROUND Patients with high-grade gliomas (HGG) often receive anti-angiogenic therapy with bevacizumab to slow disease progression and/or palliate neurological symptoms. Bevacizumab has been associated with an increased risk of two major vascular complications: venous thromboembolism (VTE) and intracranial hemorrhage (ICH). We sought to identify clinical, pathologic, and radiographic variables correlated with risk of either event occurring in patients with HGG receiving bevacizumab. METHODS We retrospectively identified 94 patients with HGG who received bevacizumab at our center from 2015-2021. Variables included demographics, performance status, IDH, MGMT, vascular risk factors, baseline anti-coagulant/anti-platelet use, concurrent chemotherapy, and presence of macrobleeds on MRI (&gt;1 cm3 susceptibility) at the time of bevacizumab initiation. We conducted competing risk analysis using subdistribution hazard models with death as competing risk for ICH or VTE. The effects of covariates on the incidence of hemorrhage or VTE were evaluated in univariate and multivariate settings. RESULTS Of 94 patients, 36 (38.3%) and 27 (28.7%) developed VTE and ICH, respectively. 31 (33%) did not develop either. ICH and VTE events occurred after a mean of 4.46 and 5.94 cycles of bevacizumab, respectively. 20 had baseline anti-platelet/anticoagulant use, and 16 had prior VTEs. Patients with macrobleeds on MRI had a larger HR of developing acute hemorrhage [HR=2.368 (1.112, 5.043), p=0.0254]. Patients older than 50 trended toward larger HR of developing VTE in univariate analysis that approached significance [HR=1.799 (0.889, 3.637), p=0.1023]. Sex, performance status, IDH, MGMT, vascular risk factors, baseline anticoagulant/anti-platelet use and concurrent chemotherapy were not significantly associated with occurrence of VTE. CONCLUSIONS The presence of macrobleeds on MRI is associated with increased risk of developing acute ICH while on bevacizumab. Older age at diagnosis of HGG may be associated with an increased risk of VTE in patients receiving bevacizumab. Larger studies are needed to confirm these findings.

scholarly journals Vascular Events, Vascular Disease and Vascular Risk Factors—Strongly Intertwined with COVID-19

2020 ◽  
Vol 22 (11) ◽  
Author(s):  
Adrian Scutelnic ◽  
Mirjam R. Heldner
Keyword(s):  
Risk Factors ◽  
Vascular Disease ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Vascular Events ◽  
Increased Risk ◽  
Clinical Benefits ◽  
Infection And Inflammation ◽  
Unhealthy Diet ◽  
New Perspective

Abstract Purpose of review To elucidate the intertwining of vascular events, vascular disease and vascular risk factors and COVID-19. Recent findings Strokes are a leading cause of disability and death worldwide. Vascular risk factors are important drivers of strokes. There are unmodifiable vascular risk factors such as age and ethnicity and modifiable vascular risk factors. According to the INTERSTROKE study, the 10 most frequent modifiable vascular risk factors are arterial hypertension, physical inactivity, overweight, dyslipidaemia, smoking, unhealthy diet, cardiac pathologies, diabetes mellitus, stress/depression and overconsumption of alcohol. Also, infection and inflammation have been shown to increase the risk of stroke. There is high-quality evidence for the clinical benefits of optimal primary and secondary stroke prevention. The COVID-19 pandemic brought a new perspective to this field. Vascular events, vascular disease and vascular risk factors—and COVID-19—are strongly intertwined. An increased risk of vascular events—by multifactorial mechanisms—has been observed in COVID-19 patients. Also, a higher rate of infection with COVID-19, severe COVID-19 and bad outcome has been demonstrated in patients with pre-existing vascular disease and vascular risk factors. Summary At present, we suggest that regular interactions between healthcare professionals and patients should include education on COVID-19 and on primary and secondary vascular prevention in order to reduce the burden of disease in our ageing populations.

Association between carotid stenosis or lacunar infarction and incident dementia in patients with vascular risk factors

2014 ◽  
Vol 22 (1) ◽  
pp. 187-192 ◽  
Author(s):  
K. Kitagawa ◽  
K. Miwa ◽  
Y. Yagita ◽  
S. Okazaki ◽  
M. Sakaguchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Stenosis ◽  
Vascular Risk Factors ◽  
Lacunar Infarction ◽  
Vascular Risk ◽  
Incident Dementia

Abstract 3431: A High Vascular Risk Factors Profile Predicts Lacunar Stroke Progression

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Stefania Nannoni ◽  
Vanessa Palumbo ◽  
Alessandra Del Bene ◽  
Giovanni Pracucci ◽  
Domenico Inzitari
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Vascular Risk Factors ◽  
Stroke Onset ◽  
Independent Effect ◽  
Parent Artery ◽  
Vascular Risk ◽  
Lacunar Stroke ◽  
Increased Risk ◽  
Risk Of Progression

Background. Lacunar stroke (LS) accounts for a quarter of all ischemic strokes and is considered to have a benign prognosis. However, 20-30% of patients experience worsening of neurological deficit in hours or days after stroke onset. Mechanisms of progression are not known and no reliable clinical predictor has been identified. Aim of this study was to explore vascular risk factors and baseline clinical or laboratory features potentially associated with progression in LS. Methods. We performed a retrospective analysis of consecutive patients with LS admitted to the Stroke Unit of Careggi University Hospital (Florence, Italy) between January 2002 and December 2010. Patients were included in the study if they presented with a lacunar syndrome according to OCSP classification and/or small vessel disease according to TOAST classification and/or a lacunar infarct on neuroimaging consistent with the clinical deficit. Patients were divided into “progressive” and “non progressive”. Progression was defined as an increase of at least one point on one of the motor items of the NIHSS during the first 72 hours after stroke onset. Factors associated with progression after univariate analysis were entered into a multiple logistic regression model in order to select independent determinants of progression. Results. Out of 1502 patients with ischemic stroke admitted during the study period, 156 met the inclusion criteria. Thirty-nine (25%) patients showed neurological worsening. Latency of progression was 25.7 hours. Patients who progressed were younger than those who did not (mean age: 67.9±10.7 vs 70.6±13.0). There were no significant differences for single vascular risk factors distribution, laboratory parameters and baseline stroke severity comparing the two groups. When considering the presence of one versus more than one factor among hypertension, diabetes, smoking and hypercholesterolemia, the risk of progression increased with increasing number of risk factors: neurological worsening was observed in 0% (0/17) of patients with no risk factor, 24% (15/62) of those with one risk factor and 31% (24/77) of those with more than one risk factor (p=0.025). After adjustment for univariate predictors (age, sex, diastolic hypertension and lesion location in pons or internal capsule), the presence of multiple vascular risk factors maintained an independent effect on progression: risk of progression increased with an OR=1.7 (95%IC=1.1-2.8) for any additional risk factor. Conclusion. Our results suggest that a high risk factors profile is associated with an increased risk of progression. Translating this observation into a hypothetical pathological setting, it could support the hypothesis of mural atheroma involving the parent artery and proximal portion of the perforating arteries, eventually leading to the progressive enlargement of the ischemic area as a putative mechanism of progressive LS.

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