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 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.

scholarly journals First-Ever Ischemic Stroke and Incident Major Adverse Cardiovascular Events in 93 627 Older Women and Men

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 387-394 ◽  
Author(s):  
Luciano A. Sposato ◽  
Melody Lam ◽  
Britney Allen ◽  
Salimah Z. Shariff ◽  
Gustavo Saposnik ◽  
...  
Keyword(s):  
Sex Differences ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Population Based ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Complications ◽  
Coronary Syndrome ◽  
Cardiovascular Comorbidities ◽  
Increased Risk

Background and Purpose— Stroke risk is sex-specific, but little is known about sex differences of poststroke major adverse cardiovascular events (MACEs). Stroke-related brain damage causes autonomic dysfunction and inflammation, sometimes resulting in cardiac complications. Sex-specific cardiovascular susceptibility to stroke without the confounding effect of preexisting heart disease constitutes an unexplored field because previous studies focusing on sex differences in poststroke MACE have not excluded patients with known cardiovascular comorbidities. We therefore investigated sex-specific risks of incident MACE in a heart disease-free population-based cohort of patients with first-ever ischemic stroke and propensity-matched individuals without stroke. Methods— We included Ontario residents ≥66 years, without known cardiovascular comorbidities, with first-ever ischemic stroke between 2002 and 2012 and propensity-matched individuals without stroke. We investigated the 1-year risk of incident MACE (acute coronary syndrome, myocardial infarction, incident coronary artery disease, coronary revascularization procedures, incident heart failure, or cardiovascular death) separately for females and males. For estimating cause-specific adjusted hazard ratios, we adjusted Cox models for variables with weighted standardized differences >0.10 or those known to influence MACE risk. Results— We included 93 627 subjects without known cardiovascular comorbidities; 21 931 with first-ever ischemic stroke and 71 696 propensity-matched subjects without stroke. Groups were well-balanced on propensity-matching variables. There were 53 476 women (12 421 with and 41 055 without ischemic stroke) and 40 151 men (9510 with and 30 641 without ischemic stroke). First-ever ischemic stroke was associated with increased risk of incident MACE in both sexes. The risk was time-dependent, highest within 30 days (women: adjusted hazard ratio, 25.1 [95% CI, 19.3–32.6]; men: aHR, 23.4 [95% CI, 17.2–31.9]) and decreasing but remaining significant between 31 and 90 days (women: aHR, 4.8 [95% CI, 3.8–6.0]; men: aHR, 4.2 [95% CI, 3.3–5.4]), and 91 to 365 days (aHR, 2.1 [95% CI, 1.8–2.3]; men: aHR, 2.0 [95% CI, 1.7–2.3]). Conclusions— In this large population-based study, ischemic stroke was independently associated with increased risk of incident MACE in both sexes.

First-ever ischemic stroke and increased risk of incident heart disease in older adults

Neurology ◽  
2020 ◽  
Vol 94 (15) ◽  
pp. e1559-e1570 ◽  
Author(s):  
Luciano A. Sposato ◽  
Melody Lam ◽  
Britney Allen ◽  
Lucie Richard ◽  
Salimah Z. Shariff ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Stroke ◽  
Coronary Artery ◽  
Cox Regression ◽  
Large Population ◽  
Population Based ◽  
Cardiac Complications ◽  
Comorbid Conditions ◽  
Increased Risk ◽  
Shared Risk

ObjectivePoststroke cardiac complications are common. It is unknown whether the reason is shared risk factors and preexisting heart disease or stroke-associated myocardial and coronary injury. We tested the hypothesis that first-ever ischemic stroke is associated with increased risk of incident cardiovascular complications in patients without known preexisting cardiac comorbid conditions.MethodsThis population-based cohort study included residents in Ontario between 2002 and 2012 who were ≥66 years of age without known cardiovascular disease. We compared the incident risk of major adverse cardiovascular events (MACE), defined as myocardial infarction, unstable angina, congestive heart failure, coronary artery disease, coronary artery revascularization, or cardiovascular death, at 1 year in patients with first-ever ischemic stroke vs propensity-matched individuals without stroke (4:1 matching using 31 variables). To estimate cause-specific hazard ratios (HRs), we used Cox regression models adjusted for variables with weighted standardized differences >0.10 or known to influence the risk of MACE.ResultsWe included 21,931 patients with first-ever ischemic stroke and 71,696 propensity-matched individuals, well balanced on all variables used for propensity matching. First-ever ischemic stroke was associated with increased unadjusted incident MACE risk (HR 4.5, 95% confidence interval [CI] 4.3–4.8). MACE adjusted risk was highest in the first 30 days (HR 25.0, 95% CI 20.5–30.5) and declined both at 31 to 90 days (HR 4.8, 95% CI 4.1–5.7) and at 91 to 365 days (HR 2.2, 95% CI 2.0–2.4).ConclusionsIn this large population-based study, ischemic stroke was independently associated with increased risk of incident MACE. Whether this association is explained by stroke-associated cardiac injury, preexisting subclinical cardiovascular comorbid conditions, or both remains unknown.

scholarly journals REHABILITATION OF STROKE IN CYANOTIC CONGENITAL SINGLE VENTRICLE HEART DEFECT PATIENT

2021 ◽  
Vol 10 (6) ◽  
pp. 3762-3765
Author(s):  
Ragini Dadgal
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Congenital Heart ◽  
Single Ventricle ◽  
Exercise Intolerance ◽  
Arterial Ischemic Stroke ◽  
Breathing Exercises ◽  
Increased Risk ◽  
Bed Mobility

Congenital heart disease consists of various conditions including tetralogy of Fallot, ventricular septal defect, Epstein’s anomaly, single ventricle, etc. Among these single ventricles is one of the gravest forms of cyanotic congenital heart disease. The cardiac diagnosis is associated with an increased risk of stroke among children. Pediatric arterial ischemic stroke (AIS) is an important cause of neurologic disease in children causing disability. The 14-year-old patient came to the hospital was presented with left side hemiplegia with severe exercise intolerance due to congenital heart disease. The patient has been advised to undergo Fontan procedure for single-ventricle condition 3 years back, but due to poor socioeconomic status, parents of patients refused to do so. The primary goal was to improve bed mobility and trunk balance without developing symptoms of exercise intolerance. The intervention was started with deep and segmental breathing exercises. Proprioceptive neuromuscular facilitation and constrained induced movement therapy were added in the program in addition to passive and active movements, bed mobility, functional reeducation, trunk control exercises, and balance exercises. Combinations of all of the above therapeutic approaches lead to increased functional independence in the patient. This case reports the effectiveness of a rehabilitation program for pediatric arterial ischemic stroke with preventive guidelines for exercise intolerance.

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.

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.

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