scholarly journals Association between ischemic stroke and seropositive rheumatoid arthritis in Korea: A nationwide longitudinal cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251851
Author(s):  
Dong Hyun Lee ◽  
Seung Hun Sheen ◽  
Dong-Geun Lee ◽  
Jae-Won Jang ◽  
Dong Chan Lee ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Ischemic Stroke ◽  
Hazard Ratio ◽  
Control Group ◽  
Medical Disorders ◽  
Seropositive Rheumatoid Arthritis ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Age And Sex

The purpose of this longitudinal follow-up study was to investigate the risk of ischemic stroke nationwide in patients with seropositive rheumatoid arthritis (RA) and controls who were matched in age and sex. Patient data were collected from the National Health Insurance Service (NHIS) Health Screening (HEALS) cohort. Using the International Classification of Diseases code M05 (seropositive RA), with a prescription of any disease-modifying anti-rheumatic drug (DMARD), RA was identified. A total of 2,765 patients and 13,825 control subjects were included in our study. The 12-year incidence of ischemic stroke in each group was calculated using the Kaplan–Meier method. The risk ratio of ischemic stroke was estimated using Cox proportional hazards regression. Sixty-four patients (2.31%) in the seropositive RA group and 512 (3.70%) in the control group experienced ischemic stroke (P < 0.001) during the follow-up period. The hazard ratio of ischemic stroke in the seropositive RA group was 1.32 (95% confidence interval (CI), 1.02–1.73) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in the seropositive RA group was 1.40 (95% CI, 1.07–1.82) after adjusting for demographics and comorbid medical disorders. According to the subgroup analysis, the hazard ratios of ischemic stroke risks in the female and hypertensive subgroups were 1.44 (95% CI, 1.05–1.97) and 1.66 (95% CI, 1.16–2.38), respectively. In the non-diabetes and non-dyslipidemia subgroups, the corresponding hazard ratios of ischemic stroke were 1.47 (95% CI, 1.11–1.95) and 1.43 (95% CI, 1.07–1.91). Seropositive RA patients have an increased risk of ischemic stroke. In female, hypertension, non-diabetes, and non-dyslipidemia RA subgroups, even without the traditional risk factors for stroke (except for hypertension), increased the risk, which could be potentially attributed to RA.

scholarly journals Increased Risk of Temporomandibular Joint Disorder in Patients with Rheumatoid Arthritis: A Longitudinal Follow-Up Study

2020 ◽  
Vol 9 (9) ◽  
pp. 3005
Author(s):  
Soo-Hwan Byun ◽  
Chanyang Min ◽  
Hyo-Geun Choi ◽  
Seok-Jin Hong
Keyword(s):  
Rheumatoid Arthritis ◽  
Temporomandibular Disorder ◽  
Population Data ◽  
Control Group ◽  
Chi Square ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Joint Disorder

We evaluated the incidence of temporomandibular disorder (TMD) in patients with rheumatoid arthritis (RA) and examined the association between TMD and RA, through longitudinal follow-up. Population data from the Korean National Health Insurance Service-Health Screening Cohort from 2002 to 2015 was used. From 514,866 subjects, 3122 with RA were matched with 12,488 controls in a 1:4 ratio. The crude and adjusted models (for obesity, smoking, alcohol consumption, blood pressure, blood glucose, total cholesterol, and Charlson Comorbidity Index scores) were calculated. Chi-square tests, Kaplan-Meier (KM) analysis, and two-tailed analyses were used for statistical analysis. Stratified Cox proportional hazard models were used to assess the hazard ratios (HR) and 95% confidence intervals (CI) for TMD in the RA group, compared to those in the control group. The adjusted HR for TMD in RA was 2.52 (95% CI = 1.70–3.74), compared to the control group. The results were consistent with the subgroup analyses, according to age and sex, except in men older than 60 years of age. KM analysis showed similar results. Hence, we found that patients with RA have a higher risk of TMD, and should be observed for symptoms of the initial stage of TMD to prevent the risk of aggravation.

scholarly journals Incidence of Ischemic Stroke in Individuals With and Without Aortic Valve Stenosis

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1364-1371
Author(s):  
Charlotte Andreasen ◽  
Gunnar H. Gislason ◽  
Lars Køber ◽  
Jawdat Abdulla ◽  
Andreas Martinsson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Aortic Valve ◽  
Valve Replacement ◽  
Aortic Valve Stenosis ◽  
Incidence Rates ◽  
Hazard Ratio ◽  
Relative Risks ◽  
Increased Risk ◽  
Age And Sex

Background and Purpose— Aortic valve stenosis may lead to atrial and ventricular remodeling, predisposes to atrial fibrillation, and may also be an independent risk factor of ischemic stroke. However, information on stroke rates among persons with aortic valve stenosis are sparse. We aimed to determine the incidence rates and relative risks of ischemic stroke in individuals with diagnosed aortic valve stenosis compared with age- and sex-matched controls. Methods— All patients with incident aortic valve stenosis aged >18 years (n=79 310) and age- and sex-matched controls were identified using the Danish nationwide registries (1997–2017). Incidence rates per 1000 person-years (PY) and multivariable adjusted hazard ratios with 95% CIs were reported. Results— In total, 873 373 individuals (median age 77 years, 51.5% men, 9.1% with aortic valve stenosis) were included. Ischemic stroke occurred in 70 205 (8.0%) individuals during 4 880 862 PY of follow-up. Incidence rates of ischemic stroke were 13.3/1000 PY among the controls compared with 30.4/1000 PY in patients with aortic valve stenosis, corresponding to a hazard ratio of 1.31 (95% CI, 1.28–1.34). In all age-groups, the incidence rates and relative risks were significantly increased in patients with aortic valve stenosis compared with controls, but the relative risk was greater for younger individuals (eg, age group, 18–45 years: hazard ratio, 5.94 [95% CI, 4.10–8.36]). In patients with aortic valve stenosis above 65 years of age, the risk of ischemic stroke was markedly lower after aortic valve replacement (30.3 versus 19.6/1000 PY before and after valve replacement). Among people with atrial fibrillation the incidence rate of ischemic stroke was 1.5 times higher when aortic valve stenosis was present (33.0/1000 PY versus 49.9/1000 PY). Conclusions— People with aortic valve stenosis have a significantly increased risk of ischemic stroke compared with age- and sex-matched controls. Future studies are warranted to explore whether antithrombotic therapy may be beneficial in some individuals.

scholarly journals Peptic Ulcer Does Not Increase the Risk of Stroke: a Longitudinal Follow-up Study Using a National Sample Cohort

2021 ◽  
Author(s):  
Hyo Geun Choi ◽  
Jae Seung Soh ◽  
Jae Sung Lim ◽  
Song Yong Sim ◽  
Suk Woo Lee
Keyword(s):  
Peptic Ulcer ◽  
Ischemic Stroke ◽  
Subgroup Analysis ◽  
Gastrointestinal Diseases ◽  
National Sample ◽  
Control Group ◽  
Ulcer Disease ◽  
Hazard Ratios ◽  
Korean National Health Insurance ◽  
Age And Sex

Abstract Background: Studies have reported that several gastrointestinal diseases increase the risk of stroke. We aimed to evaluate the risk of stroke in patients with peptic ulcer disease (PUD) using a national sample cohort from South Korea. Methods: We extracted data entered into the Korean National Health Insurance Service for patients with PUD (n = 129,531) and for 1:1 matched control participants (n = 129,531) and analyzed the risk of stroke using Cox proportional hazard model. Subgroup analyses were performed based on age and sex.Results: The rates of hemorrhagic and ischemic stroke were lower in the PUD group than in the control group. In a subgroup analysis according to age, the adjusted hazard ratios (HRs) of PUD for hemorrhagic and ischemic stroke were 0.76 (95% CI = 0.63-0.90) and 0.85 (95% CI = 0.73-0.98) in the < 50-year-old group and 0.72 (95% CI = 0.65-0.80) and 0.84 (95% CI = 0.80-0.89) in the ≥ 50-year-old group, respectively (each p < 0.05). In a subgroup analysis according to sex, the adjusted HRs of PUD were 0.71 (95% CI = 0.63-0.81) and 0.81 (95% CI = 0.5-0.87) in men and 0.75 (95% CI = 0.66-0.86) and 0.88 (95% CI = 0.82-0.95) in women, respectively (each p < 0.05).Conclusions: Our study concluded that PUD does not increase the risk of ischemic or hemorrhagic stroke regardless of age and sex.

scholarly journals MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation

Neurology ◽  
2019 ◽  
Vol 92 (21) ◽  
pp. e2432-e2443 ◽  
Author(s):  
Joan Martí-Fàbregas ◽  
Santiago Medrano-Martorell ◽  
Elisa Merino ◽  
Luis Prats-Sánchez ◽  
Rebeca Marín ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Intracranial Hemorrhage ◽  
White Matter Hyperintensities ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Hazard Ratio ◽  
Superficial Siderosis ◽  
Increased Risk

ObjectiveWe tested the hypothesis that the risk of intracranial hemorrhage (ICH) in patients with cardioembolic ischemic stroke who are treated with oral anticoagulants (OAs) can be predicted by evaluating surrogate markers of hemorrhagic-prone cerebral angiopathies using a baseline MRI.MethodsPatients were participants in a multicenter and prospective observational study. They were older than 64 years, had a recent cardioembolic ischemic stroke, and were new users of OAs. They underwent a baseline MRI analysis to evaluate microbleeds, white matter hyperintensities, and cortical superficial siderosis. We collected demographic variables, clinical characteristics, risk scores, and therapeutic data. The primary endpoint was ICH that occurred during follow-up. We performed bivariate and multivariate Cox regression analyses.ResultsWe recruited 937 patients (aged 77.6 ± 6.5 years; 47.9% were men). Microbleeds were detected in 207 patients (22.5%), moderate/severe white matter hyperintensities in 419 (45.1%), and superficial siderosis in 28 patients (3%). After a mean follow-up of 23.1 ± 6.8 months, 18 patients (1.9%) experienced an ICH. In multivariable analysis, microbleeds (hazard ratio 2.7, 95% confidence interval [CI] 1.1–7, p = 0.034) and moderate/severe white matter hyperintensities (hazard ratio 5.7, 95% CI 1.6–20, p = 0.006) were associated with ICH (C index 0.76, 95% CI 0.66–0.85). Rate of ICH was highest in patients with both microbleed and moderate/severe WMH (3.76 per 100 patient-years, 95% CI 1.62–7.4).ConclusionPatients taking OAs who have advanced cerebral small vessel disease, evidenced by microbleeds and moderate to severe white matter hyperintensities, had an increased risk of ICH. Our results should help to determine the risk of prescribing OA for a patient with cardioembolic stroke.ClinicalTrials.gov identifierNCT02238470.

scholarly journals Evaluation of the increased risk of spine fracture in patients with mood disorder compared with matched controls: a longitudinal follow-up study using a national sample cohort in Korea

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e027581
Author(s):  
So Young Kim ◽  
Chanyang Min ◽  
Bumjung Park ◽  
Miyoung Kim ◽  
Hyo Geun Choi
Keyword(s):  
Mood Disorder ◽  
National Sample ◽  
Spine Fracture ◽  
Secondary Outcome ◽  
Control Group ◽  
Follow Up Study ◽  
Increased Risk ◽  
History Of ◽  
Age And Sex

ObjectiveTo evaluate the risk of spine fracture in patients with mood disorder using a nationwide cohort.DesignA longitudinal follow-up study.SettingClaims data for the population ≥20 years of age were collected from 2002 to 2013 for the Korean National Health Insurance Service-National Sample Cohort.ParticipantsA total of 60 140 individuals with mood disorder were matched with 240 560 individuals (control group) for age, sex, income, region of residence and osteoporosis.InterventionsIn both the mood disorder and control groups, the history of spine fracture was evaluated. The International Classification of Diseases 10th Revision codes for mood disorder (F31–F39) and spine fracture (S220 and S320) were included.Primary and secondary outcome measuresThe univariable and multivariable HRs and 95% CIs of spine fracture for patients with mood disorder were analysed using a stratified Cox proportional hazards model. Subgroup analyses were conducted according to the history of osteoporosis, age and sex.ResultsApproximately 3.3% (2011/60 140) of patients in the mood disorder group and 2.8% (6795/240 560) of individuals in the control group had spine fracture (p<0.001). The mood disorder group demonstrated a higher adjusted HR for spine fracture than the control group (multivariable HR=1.10, 95% CI 1.04 to 1.15, p<0.001). The participants without osteoporosis showed a higher HR of mood disorder for spine fracture than the control participants (multivariable HR=1.25, 95% CI 1.14 to 1.37, p<0.001). According to age and sex, this result was consistent in subgroups of women aged 20–39 and 40–59 years and men aged ≥60 years.ConclusionThe risk of spine fracture was increased in patients with mood disorder. The potential risk of spine fracture needs to be evaluated when managing patients with mood disorder.

scholarly journals Subjective motoric complaints and new onset slow gait

2020 ◽  
Author(s):  
Joe Verghese ◽  
Emmeline Ayers
Keyword(s):  
Primary Outcome ◽  
Walking Speed ◽  
Risk Assessments ◽  
Recall Bias ◽  
Normal Range ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Age And Sex ◽  
New Onset

Abstract Background While reports of mobility problems are common with aging, their relationship to new onset of slow gait is unknown. Our objective was to examine the validity of subjective motoric complaints for predicting the incidence of slow gait. Methods Ambulatory community-residing participants (mean age 76.6, 55% women) with gait speeds in the normal range enrolled in an aging cohort. Five subjective motoric complaints were assessed. Incident slow gait (walking speed 1 standard deviation below age and sex means) was the primary outcome. Results Of the 548 participants at baseline, 90 had prevalent slow gait and 253 participants (73.7%) reported one or more subjective motoric complaints. Subjective motoric complaints were more common in women than men (1.78 vs. 1.23). Over a median follow-up of 3.34 years, 68 participants developed new onset slow gait. All five questions predicted incident slow gait (adjusted hazard ratios varying from 2.26 to 4.44). More subjective motoric complaints were associated with increased risk of developing incident slow gait (hazard ratio per complaint 1.81). Predictive validity of subjective motoric complaints for incident slow gait was unchanged when using alternate outcome definitions, accounting for diagnostic misclassification, recall bias or adjusting for multiple confounders. Conclusions Subjective motoric complaints are a harbinger of mobility disability, and can help improve clinical risk assessments and identify high risk individuals for interventions to prevent onset of slow gait.

scholarly journals Association of Parkinson’s disease with ischemic stroke in Korea: A nationwide longitudinal cohort study in Korea

2021 ◽  
Vol 23 (3) ◽  
pp. 233-239
Author(s):  
Woo Yup Kim ◽  
Hakyung Kim ◽  
Je Beom Hong ◽  
Seung Hun Sheen ◽  
In-bo Han ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
National Health ◽  
Incidence Rates ◽  
Hazard Ratio ◽  
Stroke Incidence ◽  
Increased Risk ◽  
Age And Sex

Objective: The aim of this nationwide age- and sex- matched longitudinal follow up study is to determine the risk of Parkinson’s disease (PD) associated with ischemic stroke in Korea.Methods: Patient data were collected from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS). PD was identified using the International Classification of Diseases (ICD) 10-CM code G 20. In total, 6,475 patients were enrolled in the PD group from the NHISS. After subtracting 1,039 patients who underwent hospitalization less than once or those who visited an outpatient clinic less than two times, 5,259 patients who were diagnosed after January 1, 2004 ultimately participated in this study. After case-control match was done through 1:5 age- and sex- stratified matching, 26,295 individuals were chosen as control. Kaplan-Meier method and Cox proportional hazard regression analysis were performed to evaluate the risk of ischemic stroke in PD.Results: The hazard ratio of ischemic stroke in the PD group was 3.848 (95% confidence interval (confidence interval [CI]): 3.14-4.70) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in PD group was 3.885 (95% CI: 3.17-4.75) after adjusting for comorbidities. According to subgroup analysis, in male and female and non-diabetes and diabetes and non-hypertension and hypertension and dyslipidemia and non-dyslipidemia subgroups, ischemic stroke incidence rates were significantly higher in the PD group than those in the control group.Conclusions: This nationwide longitudinal study suggests an increased risk of ischemic stroke in PD patients.

scholarly journals Risk of ischemic stroke in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Fauchier ◽  
A Bisson ◽  
A Bodin ◽  
J Herbert ◽  
T Genet ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of

Abstract Background In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with a similar risk of stroke and should be similarly managed is a matter of debate. Methods Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2019 in France. The adverse outcomes were investigated during follow-up. Results Among 797,212 patients with STEMI or NSTEMI, 146,922 (18.4%) had history of AF, and 11,824 (1.5%) had new AF diagnosed between day 1 and day 30 after AMI. Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. Both groups with history of AF or new AF had less frequent STEMI and anterior MI, less frequent use of percutaneous coronary intervention but more frequent HF at the acute phase than patients with no AF. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1–3.1] years), 163,845 deaths and 20,168 ischemic strokes were recorded. Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.06 95% CI 1.05–1.08) while this was not the case for patients with new AF (adjusted HR 0.98 95% CI 0.95–1.02). By contrast, both history of AF and new AF were associated with a higher risk of ischemic stroke during follow-up compared to patients with no AF: adjusted hazard ratio HR 1.29 95% CI 1.25–1.34 for history of AF, adjusted HR 1.72 95% CI 1.59–1.85 for new AF. New AF was associated with a higher risk of ischemic stroke than history of AF (adjusted HR 1.38 95% CI 1.27–1.49). Conclusion In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was associated with an increased risk of ischemic stroke. Specific management should be considered in order to improve outcomes in these patients after AMI. Funding Acknowledgement Type of funding source: None

Increased risk of stroke after trigeminal neuralgia – a population-based follow-up study

Cephalalgia ◽  
2011 ◽  
Vol 31 (8) ◽  
pp. 937-942 ◽  
Author(s):  
Shin-Liang Pan ◽  
Li-Sheng Chen ◽  
Ming-Fang Yen ◽  
Yueh-Hsia Chiu ◽  
Hsiu-Hsi Chen
Keyword(s):  
Trigeminal Neuralgia ◽  
Proportional Hazards ◽  
Underlying Mechanism ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Follow Up Study ◽  
Medical Disorders ◽  
Increased Risk

Background: There are no reports on the risk of stroke after trigeminal neuralgia (TN). The aim of this population-based follow-up study was to investigate whether the occurrence of TN is associated with a higher risk of developing stroke. Methods: A total of 1453 people with at least three ambulatory visits in 2001 with the principal diagnosis of TN were enrolled in the TN cohort. The non-TN cohort consisted of 5812 age- and sex-matched, randomly sampled subjects without TN. The 2-year stroke-free survival rate between the two groups was compared using the Kaplan-Meier method. The Cox proportional hazards regression model was used to estimate the hazard ratio of stroke after adjustment for demographic and clinical covariates. Results: In the TN cohort, 73 patients developed stroke during follow-up, while in the non-TN cohort, 157 subjects suffered a stroke. The crude hazard ratio of stroke for the subjects with TN was 1.86 (95% CI, 1.41–2.45; p < 0.0001). The adjusted hazard ratio was 1.76 (95% CI, 1.33–2.33; p < 0.0001) after adjusting for demographic characteristics and comorbid medical disorders. Conclusion: This study showed a significantly increased risk of developing stroke after TN. Further studies are needed to investigate the underlying mechanism of this association.

Abstract MP78: Progression of Valvular Calcification and Risk of Incident Stroke: The Multi-ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Oluwaseun Fashanu ◽  
Anas Bizanti ◽  
Ahmad Al-Abdouh ◽  
Di Zhao ◽  
Matthew J Budoff ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Risk ◽  
Cox Regression ◽  
The United States ◽  
Cvd Risk ◽  
Valvular Calcification ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Annular Calcification

Introduction: Stroke is a leading cause of morbidity and mortality in the United States. Identification of individuals at risk for stroke is important for implementation of preventive therapies. Prevalent valvular calcification (VC) has been shown to be associated with stroke but less is known about associations of VC progression with stroke. Methods: Progression (interval increase >0 Agatston units/year) of aortic valvular calcification (AVC) and mitral annular calcification (MAC) was assessed by two cardiac CTs over a median of 2.4 years. We determined the risk of adjudicated total and ischemic stroke using Cox regression adjusted for cardiovascular disease (CVD) risk factors. Results: We studied 5,606 multiethnic participants (39.6% White, 26.9% Black, 21.4% Hispanic, 12.2% Chinese) free of baseline CVD enrolled in MESA. Baseline mean ± SD age was 62 ± 10 years; 53% were women; 12% had prevalent AVC and 9% prevalent MAC at the baseline visit; 83% had no progression of VC, 14%, progression at one site (AVC or MAC), and 3% progression at both sites (AVC and MAC) at follow-up. Over a median of 12 years, 214 total and 170 ischemic strokes occurred. The number of sites with VC progression (range 0-2) was not associated with total and ischemic stroke (all p>0.05). We found MAC progression to be associated with increased risk of total stroke [adjusted hazard ratios (95% CI) 1.59 (1.11 - 2.27)] and ischemic stroke [1.64 (1.10 - 2.43)] in the whole cohort (model 3) and after further adjustment for baseline coronary artery calcification (model 4) ( Table ). Results remained significant for total stroke risk after excluding participants with interim atrial fibrillation or coronary heart disease [1.60 (1.01 - 2.54)]. In women, AVC progression was associated with ischemic stroke [1.87 (1.04 - 3.36)] (p-for-interaction=0.03). Conclusion: Progression of MAC over 2.4 years is associated with increased risk of total and ischemic stroke, and in women, AVC progression with higher ischemic stroke risk.

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