scholarly journals Risk for ischemic stroke and coronary heart disease associated with migraine and migraine medication among older adults

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Emily C. McKinley ◽  
Christine L. Lay ◽  
Robert S. Rosenson ◽  
Ligong Chen ◽  
Victoria Chia ◽  
...  
Keyword(s):  
Older Adults ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Lower Risk ◽  
Coronary Revascularization ◽  
Opioid Medication ◽  
Increased Risk ◽  
History Of ◽  
Migraine Medication

Abstract Background Migraine has been associated with cardiovascular disease (CVD) events among middle-aged adults. The objective of this study was to determine the risk for ischemic stroke and coronary heart disease (CHD) events among older adults with versus without migraine. Methods This retrospective cohort study was conducted using data from US adults ≥66 years of age with Medicare health insurance between 2008 and 2017. After stratification by history of CVD, patients with a history of migraine were matched 1:4 to those without a history of migraine, based on calendar year, age, and sex. Patients were followed through December 31, 2017 for ischemic stroke and CHD events including myocardial infarction or coronary revascularization. All analyses were done separately for patients with and without a history of CVD. Results Among patients without a history of CVD (n = 109,950 including n = 21,990 with migraine and n = 87,960 without migraine), 1789 had an ischemic stroke and 3552 had a CHD event. The adjusted hazard ratio (HR) among patients with versus without migraine was 1.20 (95% confidence interval [95%CI], 1.07–1.35) for ischemic stroke and 1.02 (95%CI, 0.93–1.11) for CHD events. Compared to patients without migraine, those with migraine who were taking an opioid medication had a higher risk for ischemic stroke (adjusted HR 1.43 [95%CI, 1.20–1.69]), while those taking a triptan had a lower risk for CHD events (adjusted HR 0.79 [95%CI, 0.67–0.93]). Among patients with a history of CVD (n = 79,515 including n = 15,903 with migraine and n = 63,612 without migraine), 2960 had an ischemic stroke and 7981 had a CHD event. The adjusted HRs (95%CI) for ischemic stroke and CHD events associated with migraine were 1.27 (1.17–1.39) and 0.99 (0.93–1.05), respectively. Patients with migraine taking an opioid medication had a higher risk for ischemic stroke (adjusted HR 1.21 [95%CI, 1.07–1.36]), while those taking a triptan had a lower risk for CHD events (adjusted HR 0.83 [95%CI, 0.72–0.95]), each versus those without migraine. Conclusions Older adults with migraine are at increased risk for ischemic stroke. The risk for ischemic stroke among older adults with migraine may differ by migraine medication classes.

Reader Response: First-Ever Ischemic Stroke and Increased Risk of Incident Heart Disease in Older Adults

Neurology ◽  
2021 ◽  
Vol 96 (15) ◽  
pp. 723.2-724
Author(s):  
Chrissa Sioka ◽  
Andreas Fotopoulos ◽  
Sotirios Giannopoulos
Keyword(s):  
Older Adults ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Reader Response ◽  
Increased Risk

scholarly journals Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 45 (5-6) ◽  
pp. 279-287 ◽  
Author(s):  
Frans Kauw ◽  
Richard A.P. Takx ◽  
Hugo W.A.M. de Jong ◽  
Birgitta K. Velthuis ◽  
L. Jaap Kappelle ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Lower Risk ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Large Artery ◽  
Cortical Lesions ◽  
Level Of Evidence ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
History Of

Background: Predictors of recurrent ischemic stroke are less well known in patients with a recent ischemic stroke than in patients with transient ischemic attack (TIA). We identified clinical and radiological factors for predicting recurrent ischemic stroke in patients with recent ischemic stroke. Methods: A systematic search in PubMed, Embase, Cochrane Library, and CINAHL was performed with the terms “ischemic stroke,” “predictors/determinants,” and “recurrence.” Quality assessment of the articles was performed and the level of evidence was graded for the articles included for the meta-analysis. Pooled risk ratios (RR) and heterogeneity (I2) were calculated using inverse variance random effects models. Results: Ten articles with high-quality results were identified for meta-analysis. Past medical history of stroke or TIA was a predictor of recurrent ischemic stroke (pooled RR 2.5, 95% CI 2.1–3.1). Small vessel strokes were associated with a lower risk of recurrence than large vessel strokes (pooled RR 0.3, 95% CI 0.1–0.7). Patients with stroke of an undetermined cause had a lower risk of recurrence than patients with large artery atherosclerosis (pooled RR 0.5, 95% CI 0.2–1.1). We found no studies using CT or ultrasound for the prediction of recurrent ischemic stroke. The following MRI findings were predictors of recurrent ischemic stroke: multiple lesions (pooled RR 1.7, 95% CI 1.5–2.0), multiple stage lesions (pooled RR 4.1, 95% CI 3.1–5.5), multiple territory lesions (pooled RR 2.9, 95% CI 2.0–4.2), chronic infarcts (pooled RR 1.5, 95% CI 1.2–1.9), and isolated cortical lesions (pooled RR 2.2, 95% CI 1.5–3.2). Conclusions: In patients with a recent ischemic stroke, a history of stroke or TIA and the subtype large artery atherosclerosis are associated with an increased risk of recurrent ischemic stroke. Predictors evaluated with MRI include multiple ischemic changes and isolated cortical lesions. Predictors of recurrent ischemic stroke concerning CT or ultrasound have not been published.

scholarly journals A multiethnic association analysis of hyperuricaemia with cardiovascular risk in rural and urban areas in Chinese adults

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Leilei Liu ◽  
Juan Lei ◽  
Linyuan Zhang ◽  
Nana Ma ◽  
Zixuan Xu ◽  
...  
Keyword(s):  
Older Adults ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ethnic Group ◽  
Rural Women ◽  
Urban Areas ◽  
Rural Residents ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Increased Risk

AbstractComprehensive research on rural–urban disparities in the association of hyperuricaemia (HUA) with cardiovascular disease (CVD) in China, especially among minority groups, is limited. We explored the HUA-CVD relationship between rural and urban areas within ethnic Chinese groups. We included Dong, Miao, and Bouyei adults in Southwest China from the China Multi-Ethnic Cohort Study. Multivariable logistic regression models were used to assess the relationship between HUA and CVD in both residences. We performed stratified analyses by sex and age. The study population included 16,618 people (37.48% Dong, 30.00% Miao, and 32.52% Bouyei) without a reduced estimated glomerular filtration rate. We identified 476 (188 Dong, 119 Miao, and 169 Bouyei) and 175 (62 Dong, 77 Miao, and 36 Bouyei) CVD cases in rural and urban areas. Compared to urban residents, an at least 49% increased CVD risk (adjusted OR 1.49, 95%CI 1.06–2.08 for the Dong ethnic group; 1.55, 1.07–2.25 for the Bouyei ethnic group) and a 1.65-fold elevated coronary heart disease risk (1.65, 1.03–2.64) related to HUA was present in rural residents. Moreover, HUA was positively associated with increased risk of CVD and coronary heart disease in rural women (2.05, 1.26–3.31; 2.11, 1.19–3.75) and rural older adults (1.83, 1.22–2.75; 2.32, 1.39–3.87) among the Bouyei ethnic group, respectively. We found rural elderly individuals with HUA among the Dong ethnic group had a 52% elevated risk of CVD (1.52, 1.05–2.21); furthermore, an at least 79% increased risk of stroke related to HUA was observed in women (2.24, 1.09–4.62) and elderly people (1.79, 1.02–3.13) in rural areas among the Dong ethnic group. But a positive association was not found among the Miao ethnic group. Screening early-onset HUA patients may be helpful for the control and prevention of CVD in rural residents, especially for women and older adults living in a rural community, among the Dong and Bouyei ethnic groups in China.

scholarly journals Levels and Change in Galectin‐3 and Association With Cardiovascular Events: The ARIC Study

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
David Aguilar ◽  
Caroline Sun ◽  
Ron C. Hoogeveen ◽  
Vijay Nambi ◽  
Elizabeth Selvin ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Total Mortality ◽  
Cox Proportional Hazards ◽  
Prognostic Information ◽  
Incident Coronary Heart Disease ◽  
Increased Risk ◽  
Galectin 3

Background Circulating galectin‐3 levels provide prognostic information in patients with established heart failure (HF), but the associations between galectin‐3 levels and other incident cardiovascular events in asymptomatic individuals at midlife and when remeasured ≈15 years later are largely uncharacterized. Methods and Results Using multivariable Cox proportional hazards models, we identified associations between plasma galectin‐3 levels (hazard ratio [HR] per 1 SD increase in natural log galectin‐3) and incident coronary heart disease, ischemic stroke, HF hospitalization, and total mortality in ARIC (Atherosclerosis Risk in Communities) participants free of cardiovascular disease at ARIC visit 4 (1996–1998; n=9247) and at ARIC visit 5 (2011–2013; n=4829). Higher galectin‐3 level at visit 4 (median age 62) was independently associated with incident coronary heart disease (adjusted HR, 1.30; 95% CI, 1.06–1.60), ischemic stroke (HR, 1.42; 95% CI, 1.01–2.00), HF (HR, 1.44; 95% CI, 1.17–1.76), and mortality (HR, 1.56; 95% CI, 1.35–1.80). At visit 5 (median age, 74), higher galectin‐3 level was associated with incident HF (HR, 1.93; 95% CI, 1.15–3.24) and total mortality (HR, 1.70; 95% CI, 1.15–2.52), but not coronary heart disease or stoke. Individuals with the greatest increase in galectin‐3 levels from visit 4 to visit 5 were also at increased risk of incident HF and total mortality. Conclusions In a large, biracial community‐based cohort, galectin‐3 measured at midlife and older age was associated with increased risk of cardiovascular events. An increase in galectin‐3 levels over this period was also associated with increased risk.

Cardiovascular toxicity follwing sunitinib therapy in metastatic renal cell cancer: A multicenter analysis

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16051-e16051
Author(s):  
G. Di Lorenzo ◽  
S. De Placido ◽  
G. Cartenì ◽  
R. Autorino ◽  
A. Gonnella ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Renal Cell ◽  
Cell Cancer ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Increased Risk ◽  
History Of ◽  
Grade 3

e16051 Background: Recent data have shown that cardiotoxicity represents a potentially important side-effect in patients treated with sunitinib. We reviewed cardiac adverse events in patients with metastatic renal cell carcinoma (RCC) who underwent treatment with this agent. Methods: The medical records of 175 patients with metastatic RCC treated with sunitinib at eight Italian Institutions were retrospectively reviewed. Alterations in left ventricular ejection fraction (LVEF) and blood pressure were evaluated. Patients with pre-existing cardiac risk factors were specifically scrutinized for increased expression of cardiac changes. Results: Grade 3 hypertension was seen in 17 patients (9.7%); in twelve of these 17, hypertension developed after receiving the third sunitinib cycle. Among these 17 patients, 12 (70.6%) also experienced left-ventricular systolic (LVEF) dysfunction; in all, 33 of the 175 patients (18.9%) developed some degree of cardiac abnormality, of which 12 were of classified as grade 3 LVEF dysfunction and/or congestive heart failure (CHF) (6.9%). A significant univariate association for predictors of CHF were history of hypertension (p=0.008), history of coronary heart disease (p=0.0005) and prior treatment with an angiotensin converting enzyme inhibitor (ACE) (p= 0.04). Multivariate analysis suggested that a history of coronary artery disease (OR 18, 95% CI, 4–160 p 0.005) and hypertension (OR 3, 95% CI, 1.5–80 p 0.04) were the only significant independent predictors of CHF. Conclusions: Patients undergoing sunitinib, especially those with a previous history of hypertension and coronary heart disease, are at increased risk for cardiovascular events and should be monitored for exacerbations of their hypertension and for evidence of LVEF dysfunction during treatment. [Table: see text]

Fifteen-year risk of major coronary events predicted by Holter ST-monitoring in asymptomatic middle-aged men

2005 ◽  
Vol 12 (5) ◽  
pp. 478-483 ◽  
Author(s):  
Martin Stagmo ◽  
Steen Juul-Möller ◽  
Bo Israelsson
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Revascularization ◽  
Holter Monitoring ◽  
Middle Aged ◽  
Major Coronary Event ◽  
St Segment ◽  
Increased Risk ◽  
Coronary Events

Background Ambulatory electrocardiogram monitoring (Holter) with ST-analysis as a measure of myocardial ichemia has in populations with coronary heart disease been shown to predict major coronary events: death, myocardial infarction or coronary revascularization. There has, however, been conflicting evidence regarding the usefulness of this technique in identification of healthy subjects with increased risk for coronary heart disease. The aim of this study was to assess if Holter monitoring with ST-analysis could be used to predict future major coronary events in asymptomatic middle-aged men with a defined aggregation of traditional risk factors for coronary heart disease. Methods One hundred and fifty-five asymptomatic participants from the city of Malmö, Sweden, with known levels of conventional cardiovascular risk factors underwent Holter monitoring for analysis of transient ST-segment depression at the age of 55 years. Fifteen years after the Holter monitoring, hospital records, diagnosis and death registries were revisited for major coronary events. Results An ST-segment depression of 1 mm or greater (0.1 mV) was considered significant for myocardial ischemia and was found in 54 of the 155 men. There were no significant differences in risk factors in the two groups at baseline. The 15-year incidence of a first major coronary event was significantly higher in men with ST-segment depression (39%) than in men without ST-segment depression (20%) ( P < 0.015). A Holter electrocardiogram could predict future major coronary events with a positive and negative predictive value of 35 and 80%, respectively. Conclusions Holter monitoring can be used as a complement to conventional risk factor evaluation in deciding whether or not to treat risk factors for CHD in asymptomatic subjects.

scholarly journals Association between the TIMD4-HAVCR1 variants and serum lipid levels, coronary heart disease and ischemic stroke risk and atorvastatin lipid-lowering efficacy

2018 ◽  
Vol 38 (1) ◽  
Author(s):  
Qing-Hui Zhang ◽  
Rui-Xing Yin ◽  
Wu-Xian Chen ◽  
Xiao-Li Cao ◽  
Yu-Ming Chen
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Serum Lipid ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Lipid Levels ◽  
Serum Lipid Levels ◽  
Increased Risk

Little is known about the association of the TIMD4 (T-cell immunoglobulin and mucin domain 4 gene)-HAVCR1 (hepatitis A virus cellular receptor 1) variants and lipid metabolism, the risk of coronary heart disease (CHD) and ischemic stroke (IS). The present study aimed to determine the TIMD4-HAVCR1 variants, their haplotypes and gene–environment interactions on serum lipid levels, the risk of CHD and IS, and the lipid-lowering efficacy of atorvastatin in a southern Chinese Han population. Genotypes of three variants in 622 controls, 579 CHD, and 546 IS patients were determined by the Snapshot technology. Atorvastatin calcium tablet (20 mg/day) was given in 724 hyperlipidemic patients for 8 weeks after genotyping. The rs12522248 genotypic and allelic frequencies were different between controls and patients, and were associated with the risk of CHD and IS. The rs1501908G-rs12522248T-rs2036402T haplotype was associated with an increased risk of CHD; the G-C-T haplotype was associated with lower risk of CHD; and the C-C-C haplotype was associated with an increased risk of IS. Variants and their haplotypes in controls were associated with triglyceride (rs1501908), low-density lipoprotein cholesterol (LDL-C, rs1501908, G-T-T), high-density lipoprotein cholesterol (HDL-C, rs12522248, C-C-C) and the ratio of total cholesterol (TC) to HDL-C (C-C-C). Interactions of rs1501908- and rs2036402-alcohol (HDL-C); rs1501908- and rs12522248-high body mass index (hBMI, ≥24 kg/m2; TC); and TIMD4-HAVCR1 variants-atorvastatin on several lipid parameters were detected. Interactions of rs12522248TC/CC-hBMI, G-T-T-, and C-C-C-smoking on the risk of CHD; and C-C-C-smoking, C-C-C-, and G-C-T-hBMI on the risk of IS were also observed. These findings suggest that the TIMD4-HAVCR1 variants may be the genetic risk factors for CHD and IS.

Elective Bilateral Oophorectomy Versus Ovarian Conservation at the Time of Benign Hysterectomy

2021 ◽  
pp. 185-190
Author(s):  
Johnny Yi ◽  
Megan Wasson
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Gynecologic Cancer ◽  
Premenopausal Women ◽  
Health Study ◽  
Bilateral Oophorectomy ◽  
Increased Risk ◽  
All Cause Mortality ◽  
History Of ◽  
Ovarian Conservation

The Nurses’ Health Study prospectively evaluated long-term mortality associated with oophorectomy versus ovarian conservation at the time of benign hysterectomy in women with no history of gynecologic cancer, other cancers, coronary heart disease, stroke, or pulmonary embolus. The study showed that performing a bilateral oophorectomy at the time of a benign hysterectomy is associated with an increased risk of all-cause mortality as well as mortality from coronary heart disease, lung cancer, and colorectal cancer. Concurrent oophorectomy is associated with a decreased risk of ovarian cancer. It was also found to reduce the risk of breast cancer when performed in women younger than 47.5 years of age. This study has been supported by further research showing that bilateral oophorectomy is not associated with improved all-cause mortality and is associated with greater mortality particularly in younger, premenopausal women.

scholarly journals XKR6 rs7014968 SNP Increases Serum Total Cholesterol Levels and the Risk of Coronary Heart Disease and Ischemic Stroke

2020 ◽  
Vol 26 ◽  
pp. 107602962090284
Author(s):  
Kai-Guang Li ◽  
Rui-Xing Yin ◽  
Feng Huang ◽  
Wu-Xian Chen ◽  
Jin-Zhen Wu ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Total Cholesterol ◽  
Serum Lipid ◽  
Serum Total Cholesterol ◽  
Control Group ◽  
Nucleotide Polymorphisms ◽  
Related Family ◽  
Increased Risk

The X Kell blood group complex subunit-related family member 6 ( XKR6) gene single-nucleotide polymorphisms (SNPs) have been associated with serum lipid profiles and the risk of coronary heart disease (CHD) and ischemic stroke (IS) in several previous studies, but the association between the XKR6 rs7014968 SNP and serum lipid levels and the risk of CHD and IS has not been detected previously. This study aims to explore the association between the XKR6 rs7014968 SNP and serum lipid traits and the susceptibility to CHD and IS in the Guangxi Han Chinese population. Snapshot technology was used to determine the genotypes of the XKR6 rs7014968 SNP in 624 controls, 588 patients with CHD, and 544 patients with IS. The XKR6 rs7014968C allele carriers in the control group had higher serum total cholesterol (TC) levels than the C allele noncarriers ( P = .025). The XKR6 rs7014968C allele carriers also had an increased risk of CHD and IS ( P < .05-.01). Stratified analysis showed that the patients with the rs7014968C allele in the female, age >60 years, body mass index (BMI) >24 kg/m2, and hypertension subgroups had a higher risk of CHD than those in the subgroup counterparts. The patients with the rs7014968C allele in the male, BMI > 24 kg/m2, smoker, and hypertension subgroups also had a higher risk of IS than those in the subgroup counterparts. These results suggest that the XKR6 rs7014968 SNP is likely to increase the risk of CHD and IS by increasing serum TC levels in our study populations.

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