APOEϵ2 allele is an independent risk factor for vulnerable carotid plaque in ischemic stroke patients

Background: Ischemic stroke is the most common and severe arterial thrombotic event in Antiphospholipid syndrome (APS). APS is an autoimmune disease characterized by the presence of thrombosis and antiphospholipid antibodies (aPL), which provide a pro-coagulant state. The aPL included in the classification criteria are lupus anticoagulant, anti-cardiolipin (aCL) and anti-β2-glycoprotein-I antibodies (aB2GPI) of IgG and IgM isotypes. Extra-criteria aPL, especially IgA aB2GPI and IgG/IgM anti-phosphatidylserine/prothrombin antibodies (aPS/PT), have been strongly associated with thrombosis. However, their role in the general population suffering from stroke is unknown. We aim (1) to evaluate the aPL prevalence in ischemic stroke patients, (2) to determine the role of aPL as a risk factor for stroke, and (3) to create an easy-to-use tool to stratify the risk of ischemic stroke occurrence considering the presence of aPL and other risk factors.Materials and Methods: A cohort of 245 consecutive ischemic stroke patients was evaluated in the first 24 h after the acute event for the presence of classic aPL, extra-criteria aPL (IgA aB2GPI, IgG, and IgM aPS/PT) and conventional cardiovascular risk factors. These patients were followed-up for 2-years. A group of 121 healthy volunteers of the same age range and representative of the general population was used as reference population. The study was approved by the Ethics Committee for Clinical Research (Reference numbers CEIC-14/354 and CEIC-18/182).Results: The overall aPL prevalence in stroke patients was 28% and IgA aB2GPI were the most prevalent (20%). In the multivariant analysis, the presence of IgA aB2GPI (OR 2.40, 95% CI: 1.03–5.53), dyslipidemia (OR 1.70, 95% CI: 1.01–2.84), arterial hypertension (OR 1.82, 95% CI: 1.03–3.22), atrial fibrillation (OR 4.31, 95% CI: 1.90–9.78), and active smoking (OR 3.47, 95% CI: 1.72–6.99) were identified as independent risk factors for ischemic stroke. A risk stratification tool for stroke was created based on these factors (AUC: 0.75).Conclusions: IgA aB2GPI are an important independent risk factor for ischemic stroke. Evaluation of aPL (including extra-criteria) in cardiovascular risk factor assessment for stroke can potentially increase the identification of patients at risk of thrombotic event, facilitating a decision on preventive treatments.

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Stroke History is an Independent Risk Factor for Poor Prognosis in Ischemic Stroke Patients: Results from a Large Nationwide Stroke Registry

Current Neurovascular Research ◽

10.2174/1567202617666200817141837 ◽

2020 ◽

Vol 17 (4) ◽

pp. 487-494

Author(s):

Haiqiang Qin ◽

Penglian Wang ◽

Runhua Zhang ◽

Miaoxin Yu ◽

Guitao Zhang ◽

...

Keyword(s):

Risk Factor ◽

Ischemic Stroke ◽

Poor Prognosis ◽

Independent Risk Factor ◽

Multivariable Analysis ◽

Stroke Patients ◽

Stroke Registry ◽

Risk Of Death ◽

History Of ◽

The Difference

Background: There is some controversy whether stroke history is an independent risk factor for poor prognosis of stroke or not. This study aimed to investigate the difference of mortality, disability and recurrent rate of ischemic stroke patients without and with stroke history, as well as to explore the effect of stroke history on stroke prognosis. Methods: We analyzed patients with ischemic stroke enrolled in the China National Stroke Registry which was a nationwide, multicenter, and prospective registry of consecutive patients with acute cerebrovascular events from 2007 to 2008. Multivariable logistic regression was performed to assess the risk of worse prognosis of stroke history in patients with ischemic stroke. Results: A total of 8181(65.9%) patients without stroke history and 4234(34.1%) patients with stroke history were enrolled in the study. The mortality, recurrence, modified Rankin Scale (mRS) 3-6 rate was 11.4%, 14.7% and 28.5% respectively at 1 year for patients without stroke history, which was significantly lower than that of 17.3%, 23.6%, 42.1% in patients with stroke history, respectively. Multivariable analysis showed that patients with stroke history had higher risk of death [odds ratio (OR) 1.34,95% confidence interval (CI) 1.17-1.54], recurrence (OR 1.47, 95 % CI 1.31-1.65) and mRS 3-6 (OR 1.49,95% CI 1.34-1.66) at 1 year. Conclusion: After adjusting for the potential confounders, stroke history was still an independent risk factor for poor prognosis of ischemic stroke, which further emphasizes the importance of secondary prevention of ischemic stroke. The specific causes of poor prognosis in patients with history of stroke need to be furtherly investigated.

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

Stroke ◽

10.1161/str.46.suppl_1.121 ◽

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.

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Plasma Retinol Binding Protein 4 as a Biomarker for Detecting Progressive Stroke and Prediction of Early Prognosis in Patients with Acute Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202618666211122150730 ◽

2021 ◽

Vol 18 ◽

Author(s):

Shuqiong Liu ◽

Jiande Li ◽

Xiaoming Rong ◽

Yingmei Wei ◽

Ying Peng ◽

...

Keyword(s):

Risk Factor ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Independent Risk Factor ◽

Binding Protein ◽

Multivariate Logistic Regression Analysis ◽

Retinol Binding Protein ◽

Retinol Binding Protein 4 ◽

Treatment Measures ◽

Plasma Retinol

Aim and purpose: Progressive stroke (PS) lacks effective treatment measures and leads to serious disability or death. Retinol binding protein 4 (RBP4) could be closely associated with acute ischemic stroke(AIS). We aimed to explore plasma RBP4 as a biomarker for detecting the progression in patients with AIS. Methods: Participants of this retrospective study were 234 patients with AIS within the 48 h onset of disease. The primary endpoint was to ascertain if there was PS through the National Institute of Health stroke scale (NIHSS), early prognosis was confirmed through the modified Rankin scale score (mRS) at discharge or 14 days after the onset of stroke, and determine the significance of demographic characteristics and clinical data . Results: In this study, 43 of 234 patients demonstrated PS. . The level of plasma RBP4 in patients with progressive stroke was significantly lower (29 mg/L, 22.60－40.38 mg/L) than that without progression (38.70 mg/L, 27.28－46.40 mg/L, P = 0.003). In patients with lower plasma RBP4, he proportion of patients with progression (c2 = 9.63, P = 0.008) and with mRS scores ≥2 (c2 = 6.73, P = 0.035) were significantly higher Multivariate logistic regression analysis showed that a lower RBP4 level on admission was an independent risk factor for progressive stroke during hospitalization with an OR value of 2.70 (P = 0.03, 95% CI: 1.12－6.52). Conclusion: A low plasma RBP4 level on admission could be an independent risk factor of PS during hospitalization.

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

Stroke ◽

10.1161/str.48.suppl_1.wp222 ◽

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.

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Complex Left Atrial Appendage Morphology Is an Independent Risk Factor for Cryptogenic Ischemic Stroke

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2018.00131 ◽

2018 ◽

Vol 5 ◽

Cited By ~ 1

Author(s):

Indranill Basu-Ray ◽

Deepthi Sudhakar ◽

Gregory Schwing ◽

Dominique Monlezun ◽

Lucy Zhang ◽

...

Keyword(s):

Risk Factor ◽

Ischemic Stroke ◽

Left Atrial ◽

Independent Risk Factor ◽

Left Atrial Appendage ◽

Atrial Appendage

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Association between serum lipid and ischaemic stroke in a tertiary hospital in Northern Andhra Pradesh, India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20202553 ◽

2020 ◽

Vol 7 (7) ◽

pp. 1078

Author(s):

Tamminana Venugopala Rao ◽

Budumuru Annaji Rao ◽

Sreedevi Panchadi ◽

K. Sudheer

Keyword(s):

Risk Factor ◽

Ischaemic Stroke ◽

Serum Lipid ◽

Serum Lipids ◽

Independent Risk Factor ◽

Ldl Cholesterol ◽

Control Group ◽

Case Group ◽

Stroke Patients ◽

The Brain

Background: The incidence of cerebrovascular disease increases with age and the number of strokes is projected to increase as the elderly population grows. A stroke occurs when blood vessels that carry blood to the brain suddenly blocked or burst, preventing blood flow to the brain. The most common cause of blood vessel blockages is thrombosis (a blood clot) or an embolism (floating clot). Blood clots may form in the arteries that are damaged by atherosclerosis. Atherosclerosis is an aging process but some factors (risk factor) precipitate it to occur earlier. To find out the risk factors properly are of tremendous importance as risk factor change could directly influence or indirectly affect case fatality by altering the natural history of the disease. Serum lipids are thought to interact with the pathogenesis of stroke through the atherosclerotic mechanism. Objective was to identify the high serum lipid as an independent risk factor of stroke.Methods: This is a hospital-based case-control study. Seventy cases of stroke patients and age, sex-matched 70 healthy control subjects were enrolled by non-random sampling. 12 hours of fasting plasma lipids were estimated in both cases and control subjects. Then it was compared between cases and controls.Results: Hypercholesterolemia was higher in the case group than control but not statistically significant. Mean LDL- cholesterol, and triglycerides were significantly higher in the case group than the control group. The mean value of serum HDL-cholesterol was not significantly lower in the case group than the control group.Conclusions: Serum lipids are significantly higher in ischaemic stroke patients than the control group (LDL cholesterol and triglyceride). So, it may be an independent risk factor of ischemic stroke.

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Abstract WP236: The Urban-Rural Divide: Risk Factor Prevalence in Ischemic Stroke Patients Across Two Decades

Stroke ◽

10.1161/str.51.suppl_1.wp236 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Dinesh V Jillella ◽

Sara Crawford ◽

Anne S Tang ◽

Rocio Lopez ◽

Ken Uchino

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Regression Models ◽

Stroke Risk ◽

Stroke Patients ◽

Stroke Risk Factor ◽

Risk Factor Prevalence ◽

Urban Rural ◽

Artery Disease

Introduction: Regional disparities exist in stroke incidence and stroke related mortality in the United States. We aimed to elucidate the stroke risk factor prevalence trends based on urban versus rural location. Methods: From the National Inpatient Sample database the comorbid stroke risk factors were collected among hospitalized ischemic stroke patients during 2000-2016. Crude and age-and sex-standardized prevalence estimates were calculated for each risk factor during the time periods 2000-2008 and 2009-2016. We compared risk factor prevalence over the defined time periods using regression models, and differences in risk factor trends based on patient location categorized as urban (metropolitan with population of ≥ 1 million) and rural (neither micropolitan or metropolitan) using interaction terms in the regression models. Results: Stroke risk factor prevalence significantly increased from 2000-2008 to 2009-2016. When stratified based on patient location, most risk factors increased in both urban and rural groups. In the crude model, the urban to rural trend difference across 2000-08 and 2009-16 was significant in hypertension (p<0.0001), hyperlipidemia (p=0.0008), diabetes mellitus (p<0.0001), coronary artery disease (p<0.0001), smoking (p<0.0001) and alcohol (p=0.02). With age and sex standardization, the urban to rural trend difference was significant in hypertension (p<0.0001), hyperlipidemia (p=0.0007), coronary artery disease (p=0.01) and smoking (p<0.0001). Conclusion: The prevalence of vascular risk factors among ischemic stroke patients has increased over the last two decades. There exists an urban-rural divide, with rural patients showing larger increases in prevalence of several risk factors compared to urban patients.

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