Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke

BackgroundThe Queen Elizabeth Central Hospital (QECH) is preparing to set up the first stroke unit in Blantyre, Malawi. We conducted this audit to assess current stroke management practices and outcomes at QECH and identify priority areas for intervention.MethodsFrom April to June 2018, we prospectively enrolled patients with acute stroke and collected data on clinical presentation, cardiovascular risk factors, investigations and interventions, in-hospital outcomes, and follow-up plans after discharge. The American Heart Association/American Stroke Association (AHA/ASA) guidelines were used as the standard of care for comparison.ResultsFifty patients with acute stroke were enrolled (46% women, 54% men). The mean age was 63.1 years (95% CI: 59.7–66.6). The diagnosis of stroke was based on the World Health Organization criteria. The diagnosis was made within 24 hours of admission in 19 patients (38%). Acute revascularisation therapy was not available. Forty-eight patients (96%) had their vital signs checked at baseline and <10% had their vital signs checked more than three times within the first 24 hours. Essential blood tests including random blood sugar (RBS), full blood count (FBC), urea/creatinine, and lipid profiles were performed in 72%, 68%, 48%, and 4%, respectively. An electrocardiogram was performed on 34 patients (68%). Blood pressure on admission was >140/90 mmHg in 34 patients (68%), including 4 with values >220/120 mmHg. Nine patients had an RBS >10 mmol/L and four received insulin. Prophylaxis for deep venous thrombosis was offered to 12 patients (24%). Aspiration pneumonia was reported in 16 patients (32%) and was the most common hospital complication. The mean duration of hospitalisation was 10.4 days (95% CI: 5.6–15.2), and case fatality was 18%. The modified Rankin scale at discharge was ≤2 in 32% of patients. Only four patients (8%) were transferred to a rehabilitation centre. At the time of discharge, only 32% of patients received education on stroke.ConclusionAcute stroke care is less than optimal in this setting. Simple interventions such as reducing the delay in making a stroke diagnosis, early swallow assessments, and closer monitoring of vital signs could make a significant difference in stroke outcome. Furthermore, treating cardiovascular risk factors and setting up health education programmes to improve secondary prevention represent key priorities.

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Overlap in the Genetic Architecture of Stroke Risk, Early Neurological Changes, and Cardiovascular Risk Factors

Stroke ◽

10.1161/strokeaha.118.023097 ◽

2019 ◽

Vol 50 (6) ◽

pp. 1339-1345 ◽

Cited By ~ 6

Author(s):

Laura Ibanez ◽

Laura Heitsch ◽

Umber Dube ◽

Fabiana H.G. Farias ◽

John Budde ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Genetic Architecture ◽

Stroke Risk

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Lacune and Large Perivascular Space: Two Kinds of Cavities Are of Different Risk Factors and Stroke Risk

Cerebrovascular Diseases ◽

10.1159/000508732 ◽

2020 ◽

Vol 49 (5) ◽

pp. 522-530

Author(s):

Jiangtao Zhang ◽

Fei Han ◽

Xinyu Liang ◽

Mingli Li ◽

Dingding Zhang ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Stroke Risk ◽

Population Based ◽

Carrier Status ◽

Perivascular Spaces ◽

Increased Risk ◽

Ordinal Logistic Regression Analysis ◽

Study Participants

Background and Purpose: To compare the risk factors and risk of stroke between lacune and large perivascular spaces (PVSs) in a community-based sample. Methods: Large PVSs were assessed using 3.0T MRI in a population-based cohort consisting of 1,204 participants. The relationship between cardiovascular risk factors, neuroimaging changes, and incidental stroke risk and the presence of lacune or large PVSs was assessed with univariate and multivariable ordinal logistic regression analysis. Results: Of the 1,204 study participants (55.7 ± 9.3 years, 37.0% men), a total of 347 large PVSs were detected in 235 (19.5%) subjects, while a total of 219 lacunes were detected in 183 subjects (15.2%). The presence of lacunes was found to be significantly associated with age, male gender, hypertension, and diabetes, whereas only age (p < 0.01) and ApoEε4 carrier status (p < 0.01) were related to the presence of large PVSs. Those who had lacunes detected on MRI at baseline had a significant increased risk of stroke (hazard ratio [HR] 4.68; 95% confidence interval [CI], 1.15–19.07) during the 3-year follow-up independent of age, gender, and other vascular risk factors. However, there was no significant relationship between the presence of large PVSs and incident stroke (HR 3.84; 95% CI, 0.82–18.04). Conclusions: The lack of association between large PVSs and cardiovascular risk factors or risk of stroke indicated a nonvascular pathogenic mechanism underlying large PVSs, suggesting the importance of distinguishing large PVSs from lacunes in clinical practice.

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Prevalence of cardiovascular risk factors among elderly Brazilians over eighty with ischemic stroke

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000400002 ◽

2008 ◽

Vol 66 (3a) ◽

pp. 454-457 ◽

Cited By ~ 4

Author(s):

Alexandre Pieri ◽

Mariana Spitz ◽

Tania Oliveira Lopes ◽

Claudia Garcia de Barros ◽

Marcelo Wood Faulhaber ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Oldest Old ◽

The Elderly ◽

Catastrophic Event ◽

Cardiovascular Involvement ◽

Definition Of

INTRODUCTION: An ischemic stroke is usually a catastrophic event, mostly in the elderly. Cardiovascular involvement is the leading cause of ischemic stroke in this age population and hence the knowledge about its risk factors is important for the definition of specific policies of prevention. PURPOSE: To evaluate the prevalence of cardiovascular risk factors in patients with age equal to or above 80 in a hospital population with ischemic stroke. METHOD: Retrospective study of consecutive patients diagnosed with ischemic stroke admitted to a tertiary health facility. RESULTS: From September 2004 to March 2006, 215 patients were studied. There was a female preponderance (p<0.01). Among patients over eighty, 72% had hypertension and atrial fibrillation was more common among the oldest old (p<0.01). CONCLUSION: Hypertension and atrial fibrillation should be treated aggressively in the elderly. Anticoagulants should be considered more often in these patients.

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Prevalence of major cardiovascular risk factors and adverse risk profiles among three ethnic groups in the Xinjiang Uygur Autonomous Region, China

Lipids in Health and Disease ◽

10.1186/1476-511x-12-185 ◽

2013 ◽

Vol 12 (1) ◽

pp. 185 ◽

Cited By ~ 17

Author(s):

Jing Tao ◽

Yi-tong Ma ◽

Yang Xiang ◽

Xiang Xie ◽

Yi-ning Yang ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Ethnic Groups ◽

Risk Profiles ◽

Autonomous Region ◽

Xinjiang Uygur Autonomous Region

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Stress hyperglycemia is associated with in-hospital mortality in patients with diabetes and acute ischemic stroke

10.21203/rs.3.rs-54844/v1 ◽

2020 ◽

Author(s):

Donghua Mi ◽

Zixiao Li ◽

Hongqiu Gu ◽

Yin Yang ◽

Chunjuan Wang ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Cardiovascular Risk ◽

Acute Ischemic Stroke ◽

Cardiovascular Risk Factors ◽

Fasting Blood Glucose ◽

Hospital Death ◽

Diabetic Patients ◽

Stress Hyperglycemia ◽

Patients With Diabetes

Abstract Background and Objective: Stress hyperglycemia may occur in diabetic patients with acute severe cerebrovascular disease, but the results regarding its association with stroke outcomes are conflicting.Our study aimed to examine the association between stress-induced hyperglycemia and the occurrence of in-hospital death in patients with diabetes and acute ischemic stroke. Research Design and Methods: All data were from the Chinese Stroke Center Alliance (CSCA) database and were collected between 2016 and 2018 from > 300 centers across China. Patients’ demographics, clinical presentation, and laboratory data were extracted from the database. The primary endpoint was in-hospital death. The ratio of fasting blood glucose (FBG) to HbA1c was calculated, i.e., the stress-induced hyperglycemia ratio (SHR), to determine stress hyperglycemia following acute ischemic stroke. Results A total of 168,381 patients were included. The mean age was 66.2 ± 10.7, and 77,688 (43.0%) patients were female. The patients were divided into two groups: survivors (n = 167,499) and non-survivors (n = 882), as well as into four groups according to their SHR quartiles (n = 42,090 − 42,099/quartile). The frequencies of traditional cardiovascular risk factors increased with the SHR quartiles. There were 109 (0.26%), 142 (0.34%), 196 (0.47%), and 435 (1.03%) patients who died in the Q1, Q2, Q3, and Q4 quartiles, respectively. Compared with Q1 patients, the death risk was higher in Q4 patients (odds ratio (OR) = 4.02) (adjusted OR = 1.89, 95% confidence interval [CI] = 1.14–3.12, P = 0.026 after adjustment for traditional cardiovascular risk factors). Conclusions The SHR may serve as an accessory parameter for the prognosis of patients with diabetes after acute ischemic stroke.Hyperglycemia in stroke patients with diabetes mellitus is associated with a higher risk of in-hospital death.

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Prevalence of the Antiphospholipid Antibodies in Young Adults with Ischemic Stroke

Blood ◽

10.1182/blood-2019-123727 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4952-4952

Author(s):

Antonella Vaccarino ◽

Maria Pagliaro ◽

Clara Rollone ◽

Fabio Melis ◽

Federica De Marco ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Ischemic Stroke ◽

Cardiovascular Risk ◽

Ct Scan ◽

Cardiovascular Risk Factors ◽

Antiphospholipid Antibodies ◽

Thrombotic Event ◽

Ischemic Lesion ◽

Number Of Patients

Background: Ischemic stroke is rare in young adults, with an incidence of about 10-15% of all the ischemic strokes. In about one third of these patients a cause is missing. Among patients with antiphospholipid antibodies syndrome (APS), stroke is the first thrombotic event in about 13% of cases. Aims of our project were: to evaluate the prevalence of antiphosfolipid antibodies (aPL),to investigate on the prevalence of conventional risk factors and to define the radiological characteristics of the ischemic lesion. Materials and methods: this is a no profit, observational multicenter prospective study. Inclusion criteria were: age older than 18 and younger than 55 years, informed written consent, a clinical and radiological diagnosis of stroke. Patient's data were collected at diagnosis and after 30 days from stroke. If any aPL positivity was found the patient was referred to our service to further/eventually confirm the diagnosis of APS. For each patient these data were collected: age, sex, body mass index, personal and familial history, concomitant co morbidities and therapies, cardiovascular risk factors, drug abuse. CT scan or angioCT or MRI was always performed at diagnosis, aPL profile was determined at diagnosis and eventually confirmed after 12 weeks according to the Sapporo criteria. None of the patients had a previous diagnosis of APS. Results: enrolled patients from January 2017 to December2018 were 46 out of 425 ischemic stroke (10.8%). We found 11/46 aPL positivity patients. Among these patients, 7 were confirmed at 12 weeks (15%). Baselines characteristics of the study population are detailed in table 1. We found a high prevalence of associated conventional cardiovascular risk factors: hypertension (56%), dyslipidemia ( 50%), obesity (55%), smoke ( 52%). We didn't find any correlation between APS and a clear radiological pattern on MRI and CT scan. Conclusions: Prevalence of APS was 15% in our cohort of young patients with stroke, 85% of which had an high risk aPL profile. The detection frequency is similar to the recent APS-ACTION and literature findings. In our cohort stroke was a relapse of a previous ischemic event in 24% of the patients, while in 15% there was a stroke's relapse. Even if these data should be confirmed with a wider number of patients, it seems to be useful to evaluate the presence of aPL in a young patient with ischemic stroke . Disclosures No relevant conflicts of interest to declare.

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