scholarly journals Carotid Atherosclerotic Disease and Risk Factors in Patients with Ischemic Stroke – Study Report –

2019 ◽  
Vol 24 (4) ◽  
pp. 34-36
Author(s):  
Cătălin Cosmin Mutu ◽  
Larisa Georgiana Cerei

Abstract Ischemic stroke (IS) is the second frequent vascular disease after myocardial infarction, with different clinical and etiological aspects and various risk factors. Large vessel atherosclerotic disease is the most frequent IS causing pathology, followed by cerebral microangiopathy and cardioembolic events. Cervical arteries Doppler ultrasonography helps identifying the subtype of IS, and by revealing the vascular status of the patient, guides the therapeutic decision and secondary IS prevention. The aim of this paper is to present the results of an observational, retrospective, analytical study on a number of 174 patients with acute IS evaluated by Doppler carotid ultrasound in CVASIC Research Centre of Academic Emergency Hospital of Sibiu from January to December 2018. Materials and methods: All patients with IS admitted in our centre received a Doppler carotid ultrasound evaluation. We observed the degree of carotid stenosis, presence of atherosclerotic risk factors and their influence. Results: The mean age of patients was 71.3 years (36 to 92 years range). 16 (9.19%) patients presented occlusion of internal carotid artery (ICA) on the same side as stroke, 37 (21.26%) had severe carotid stenosis (>70%), 31 (17.81%) presented moderate stenosis (50-70%), the remaining patients had mild or no stenosis. 129 (74,13%) patients presented arterial hypertension, 51 (29.31%) patients had diabetes mellitus, 14 (8.04%) were smokers, 81 (46.56%) had dyslipidemia. Conclusions: A large number of patients had severe carotid stenosis and occlusion. The most common risk factor was arterial hypertension, followed by dyslipidemia and diabetes mellitus. Continuous medical education of population at risk regarding good nutrition principles and healthy lifestyle are needed to reduce the social costs of ischemic stroke.

PRILOZI ◽  
2021 ◽  
Vol 42 (1) ◽  
pp. 53-66
Author(s):  
Savetka Paljoskovska Jordanova ◽  
Sasko Kedev ◽  
Danica Petkoska Spirova ◽  
Lily Stojanovska ◽  
Marijan Bosevski

AbstractAims: The aim of this paper is to indicate if carotid stenosis is predictive for the prognosis of coronary artery disease.Method and materials: Our study is a prospective cohort study. 1031 patients with proven coronary artery disease (CAD) were recruited consecutively. Carotid ultrasound was used to assess IMT, plaque, or stenosis. They were followed for 24 months for adverse cardiovascular events. Selected demographic date such as smoking history, dyslipidemia, hypertension, laboratory values, and clinical data (associated diseases and risk) were collected from each patient. Total cardiovascular events and mortality rate were followed up for the study population. The results were collected prospectively and retrospectively. The study was organized as a clinical, cross-sectional study and comparative study.From the data collected with the clinical research, a file was formed in the statistical program with the help of which the data were statistically analyzed.From the methods of descriptive statistics, absolute frequencies, percentages, arithmetic mean, median, measures of variability, minimum, maximum, standard deviation and logistic regression models were used.Result: Of the total number of patients 1026 had arterial hypertension (HTA). Data on hyperlipidemia (HLP) had been reported in 895 patients. 1.023 patients had peripheral artery disease (PAB). 1031 patients were presented with multivessel coronary artery disease (CAD). There were 1,029 patients with diabetes mellitus (DM), while 1,013 patients had coronary artery by-pass (CABG), and 1,012 had stroke (CVI). Elevated systolic blood pressure was reported in 966 patients. 184 patients had elevated triglycerides and 187 had elevated cholesterol. 1,008 patients have had a history of myocardial infarction. Carotid artery stenosis (CAS) has been found in 1,009 patients, increased body mass index (BMI) in 270 patients.1.031 patients were followed for 24 months. Cardiovascular events were reported in 54 patients (or 5.2%). Revascularization was performed in 28 (4.1%) patients, while 12 (1.8%) of patients died. Diabetes mellitus (OR 1.878 95% CI 0.491 7.184) and Carotid stenosis (OR 2.185 95% CI 0.731 6.53) were found to be predictive factors for future cardiovascular events.Conclusion: Due to our results carotid ultrasound may be a useful tool for risk stratification of coronary artery disease pts.


Author(s):  
A.A. Bykova ◽  
V.M. Alifirova ◽  
N.G. Brazovskaya

The problem of stroke is currently one of the most urgent both in our country and abroad. Every year more than 6 million people are down with stroke worldwide. In the United States stroke is the third leading cause of mortality, in Europe it is the second, and in Russia – the first. In Russia, 450 000 patients are diagnosed with stroke annually. The prevalence of this disease among able-bodied people under 65 increases the cost of the health care budget [1–3]. Currently, ischemic strokes (IS) prevail, their proportion is 80 %. In 2 % of patients, a recurrent stroke develops by the end of the first year after the previous one, in 30 % of patients it happens by the end of the fifth year. In case of a recurrent stroke, the mortality rate increases by 1.5 times. The main task is stroke prevention in order to reduce morbidity, mortality and disability [4]. The purpose of the paper is to study IS risk factors (RF), their frequency, contribution to the disease development and prediction of outcomes of acute cerebrovascular events. Materials and Methods. The authors studied the prevalence of risk factors in 696 patients. They used the hospital registry in the patient cohort in the Kabardino-Balkar Republic (KBR), the city of Nalchik, during 2016–2017. They analyzed the data from the current registration of IS over the period of two years in patients over 25 years of age, hospitalized to the primary vascular department of the City clinical hospital No. 1 and the Regional Vascular Center of the Republican Clinical Hospital. In general, the authors analyzed 696 cases of ischemic stroke in patients over 25 years of age, and created an electronic data bank. Results. By means of hospital registry method the most significant risk factors for ischemic stroke were identified in the studied patient cohort. Their effect on the lethal outcome was determined. Conclusions. The authors identified the risk factors that increased the mortality risk. These are chronic heart failure, atrial fibrillation, asequence, cardiac arrhythmias, diabetes mellitus, and dyslipidemia. Smoking, arterial hypertension, angina pectoris alone do not affect the mortality risk. Keywords: ischemic stroke, risk factors, atrial fibrillation, arterial hypertension, diabetes mellitus. Проблема инсульта в настоящее время является одной из приоритетных как у нас в стране, так и во всем мире. Ежегодно в мире инсультом заболевает более 6 млн чел. Церебральный инсульт в США является третьей по частоте причиной смерти, в Европе – второй, в России – первой. В России инсульт случается у 450 тыс. пациентов в год. Распространенность этого заболевания среди лиц трудоспособного возраста до 65 лет повышает затраты бюджета здравоохранения [1–3]. Преобладают ишемические инсульты (ИИ), доля которых составляет 80 %. У 2 % пациентов повторный инсульт развивается к концу первого года с момента инсульта, у 30 % – к концу пятого. При повторном инсульте отмечается повышение показателя смертности в 1,5 раза. Основополагающей задачей является профилактика инсульта в целях снижения заболеваемости, смертности и инвалидизации [4]. Цель исследования – изучить частоту встречаемости факторов риска (ФР) ИИ, их вклад в развитие заболевания и прогнозирование исходов острых нарушений мозгового кровообращения. Материалы и методы. Изучена распространенность факторов риска у 696 пациентов по данным госпитального регистра в когорте больных по Кабардино-Балкарской Республике (КБР) на примере г. Нальчик за период 2016–2017 гг. Использованы данные, полученные при текущей регистрации случаев ИИ на протяжении двух лет у лиц старше 25 лет, госпитализированных в первичное сосудистое отделение городской клинической больницы № 1 и Региональный сосудистый центр Республиканской клинической больницы. Проанализировано 696 случаев ИИ у лиц старше 25 лет, создан электронный банк данных. Результаты. В исследуемой когорте больных методом госпитального регистра определены наиболее значимые факторы риска ишемического инсульта. Определено их влияние на развитие смертельного исхода. Выводы. Были выявлены факторы риска, которые повышают риск развития смертельного исхода. Такими являются хроническая сердечная недостаточность, фибрилляция предсердий, нарушения проводимости и нарушения сердечного ритма, сахарный диабет, дислипидемия. Курение, артериальная гипертония, стенокардия изолированно не оказывают влияния на риск развития смертельного исхода. Ключевые слова: ишемический инсульт, факторы риска, фибрилляция предсердий, артериальная гипертония, сахарный диабет.


2020 ◽  
Vol 7 (05) ◽  
pp. 4788-4794
Author(s):  
Dr. Arun Tyagi ◽  
Dr. A.K Shrivastava ◽  
Dr Marcia Waran

INTRODUCTION Currently, ischemic heart diseases and stroke are the leading causes of morbidity and mortality worldwide and more than 80% of deaths occurring in the low and the middle-income countries. There are a number of risk factors associated with ischemic stroke; the important ones being hypertension, diabetes mellitus, tobacco use and hyperlipidemia. All the risk factors also contribute towards atherogenesis. Change in the carotid artery intima–media thickness (CIMT) is an indicator of generalized atherosclerosis. This study was conducted to find out correlation between risk factors and CIMT in the stroke patients of western Maharashtra. AIMS AND OBJECTIVES This observational study was conducted in department of medicine from February 2013 to June 2014 to study the risk factors and their association with CIMT if any, in patients of stroke. Fifty stroke patients admitted in the medical ICU were studied. RESULTS Thirty-five patients out of 50 studied had ischemic stroke. Tobacco use (82%) and hypertension (80%) were the commonest risk factors for stroke followed by, dyslipidemia, obesity, metabolic syndrome and diabetes mellitus. Twenty-four (68.5%) out of 35 ischemic stroke patients had CIMT value more than 1.00 mm. Out of 35 ischemic stroke patients 15 had carotid stenosis; four severe (>70%), five moderate (50% - 70%) and six patients had mild (<50%) stenosis. Out of the patients with carotid stenosis, 13 patients had hypertension, 12 were tobacco user, 8 dyslipidemia and 6 had diabetes mellitus. CONCLUSION Increased CIMT is a marker of generalized atherosclerosis and it correlates directly with other risk factors like age, tobacco use, hypertension, diabetes and dyslipidemia.


2008 ◽  
Vol 65 (11) ◽  
pp. 803-809 ◽  
Author(s):  
Dejana Jovanovic ◽  
Ljiljana Beslac-Bumbasirevic ◽  
Ranko Raicevic ◽  
Jasna Zidverc-Trajkovic ◽  
Marko Ercegovac

Background/Aim. Etiology of ischemic stroke (IS) among young adults varies among countries. The aim of the study was to investigate the causes and risk factors of IS in the young adults of Serbia. Methods. A total of 865 patients with IS, aged 15 to 45 years, were treated throughout the period 1989-2005. Etiologic diagnostic tests were performed on the patient by the patient basis and according to their availability at the time of investigation. The most likely cause of stroke was categorized according to the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. Results. There were 486 men and 379 women, with 19% of the patients ? 30 years old. Large artery arteriosclerosis and small artery disease were confirmed in 14% of the patients, and embolism and other determined causes in 20%. Undetermined causes made up 32% of the patients, mostly those (26%) with incomplete investigations. Smoking (37%), hypertension (35%) and hyperlipidemia (35%) were the most common risk factors. Rheumatic heart diseases and prosthetic valves were the most common causes of IS. Arterial dissections and coagulation inhibitors deficiency were detected in a small number of patients. Conclusion. Etiology of IS among Serbian young adults shares characteristics of those in both western and less developed countries.


2006 ◽  
Vol 134 (Suppl. 2) ◽  
pp. 122-127 ◽  
Author(s):  
Miroslav Ilic

INTRODUCTION. Present knowledge of population on basic characteristics of tuberculosis is a significant issue of prevention of tuberculosis. OBJECTIVE. The objective of our study was to determine the level of knowledge on risk factors of tuberculosis among tubercular patients. METHOD. A total of 115 new patients with the active pulmonary tuberculosis were interviewed by means of anonymous questionnaire, who has been treated at the Institute of Pulmonary Diseases, Sremska Kamenica during six-month period (October 2003-March 2004). RESULTS. The patients fulfilled the questionnaire; 37.6 % had no or finished only elementary school, and 58.6 % considered genetics the main risk factor of tuberculosis. Every second patient believed that he could not catch tuberculosis if he suffered from diabetes mellitus or any kind of tumor. 8.7 % of patients who suffered from diabetes mellitus had been informed by their physicians that could catch tuberculosis one day. Every third patient did not possess sewage system and nearly 20% lived in moist flats. Around 85% had no regular salaries or these were significantly under the average Serbian income per capita in this period (12820 dinars-CSD). Leading risk factors that can contribute to development of tuberculosis were as follows: irregular nutrition (91.4 %), smoking (74.2 %), alcohol consumption (65.5%) and associated diseases (diabetes mellitus, tumors). Only 15% of them believed that all these risk factors (smoking, alcohol, irregular diet) could participate together in development of tuberculosis, and not as individual factors. Analyzing the patients? knowledge on risk factors of tuberculosis, in relation to their educational level and alcohol and cigarettes consumption, there was no significant difference (p<0.05). Nevertheless, analyzing the quality of life in patients? houses, in relation to salary and bad habits (alcohol, cigarettes) as risk factors of tuberculosis, significant statistical difference was found (p>0.05). CONCLUSION. Intensive and permanent education of population is necessary primarily considering the knowledge on tuberculosis that would be the basis of reducing the number of patients and leading to possible eradication of this disease.


Author(s):  
Susanti Dwi Ariani ◽  
Dodik Tugasworo ◽  
Maria Imakulata Widiastuti Samekto

RISK FACTORS OF STROKE IN STAGE V CHRONIC KIDNEY DISEASE WHO UNDERWENT HEMODIALYSISABSTRACTIntroduction: Chronic kidney disease (CKD) and end-stage renal disease are associated with a significantly in- creased risk of stroke. Incidence and mortality of stroke in CKD patients is higher rather than among the general popula- tion. Stroke in hemodialysis patients is also associated with high mortality.Aims: To analyze risk factors that have a relationship with the occurrence of stroke in patients with stage V CKD who underwent hemodialysis in Dr. Kariadi Hospital, Semarang.Method: A case control with retrospective cohort study of patients diagnosed with stage V CKD undergoing hemo- dialysis in Dr. Kariadi Hospital, Semarang, from March 2016 to August 2017. Subject was divided into case group, who experienced stroke, and control group, who did not experience stroke. Bivariate analysis was performed with Chi-square test, multivariate analysis with logistic regression test and rasio Odds.Results: There were 140 subjects with stage V CKD, 70 subjects in each groups. In case group, 85.7% experienced ischemic stroke while the rest hemorrhagic stroke. The duration of hemodialysis was related to the incidence of stroke. In multivariate analysis, patients with diabetes mellitus were more likely to have a stroke by 0.14 times compared to patients who did not have diabetes mellitus, and patients who underwent hemodialysis >12 months, were more likely to have a stroke 4.05 times greater than patients who underwent hemodialysis <12 months.Discussion: There is a relationship between diabetes mellitus and duration of hemodialysis with the occurrence of ischemic stroke, in stage V CKD patients who underwent hemodialysis.Keywords: Chronic kidney disease, hemodialysis, strokeABSTRAKPendahuluan: Penyakit ginjal kronik (PGK) dan penyakit ginjal stadium akhir terkait dengan peningkatan risiko yang signifikan dari stroke. Insiden dan mortalitas stroke pada pasien PGK lebih tinggi dibandingkan populasi umum. Stroke pada pasien dialisis juga dihubungkan dengan mortalitas yang tinggi.Tujuan: Untuk menganalisis faktor-faktor risiko yang memengaruhi terjadinya stroke pada pasien dengan PGK stadium V yang menjalani hemodialisis (HD) di RSUP Dr. Kariadi, Semarang.Metode: Penelitian kasus kontrol dengan pendekatan kohort retrospektif terhadap pasien penyakit ginjal kronik stadium V yang menjalani HD di RSUP Dr. Kariadi, Semarang dari bulan Maret 2016 hingga Agustus 2017. Subjek dibagi ke dalam kelompok kasus, yaitu yang mengalami stroke dan kelompok kontrol yang tidak mengalami stroke. Dilakukan analisis bivariat dengan uji Chi-square dan analisis multivariat dengan uji regresi logistik serta rasio Odds.Hasil: Didapatkan 140 subjek dengan PGK stadium V yang masing-masing kelompok terdiri dari 70 orang. Pada kelompok kasus, sebanyak 85,7% adalah stroke iskemik dan sisanya stroke hemoragik. Lama HD berhubungan dengan kejadian stroke. Pada uji multivariat, subjek yang menderita diabetes melitus (DM) berisiko mengalami stroke sebesar 0,14 kali dibandingkan yang tidak DM dan subjek yang menjalani HD >12 bulan berisiko mengalami stroke 4,05 kali lebih besar dibandingkan yang menjalani HD <12 bulan.Diskusi: Terdapat pengaruh faktor risiko DM dan lama hemodialisis terhadap kejadian stroke iskemik pada pasien PGK stadium V yang menjalani HD.Kata kunci: Hemodialisis, penyakit ginjal kronik, stroke


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Anne-Katrin Giese ◽  
Markus D Schirmer ◽  
Adrian V Dalca ◽  
Ramesh Sridharan ◽  
Lisa Cloonan ◽  
...  

Introduction: White matter hyperintensity (WMH) is a highly heritable trait and a significant contributor to stroke risk and severity. Vascular risk factors contribute to WMH severity; however, knowledge of the determinants of WMH in acute ischemic stroke (AIS) is still limited. Hypothesis: WMH volume (WMHv) varies across AIS subtypes and is modified by vascular risk factors. Methods: We extracted WMHv from the clinical MRI scans of 2683 AIS subjects from the MRI-Genetics Interface Exploration (MRI-GENIE) study using a novel fully-automated, volumetric analysis pipeline. Demographic data, stroke risk factors and stroke subtyping for the Causative Classification of Stroke (CCS) were performed at each of the 12 international study sites. WMHv was natural log-transformed for linear regression analyses. Results: Median WMHv was 5.7cm 3 (interquartile range (IQR): 2.2-12.8cm 3 ). In univariable analysis, age (63.1 ± 14.7 years, β=0.04, SE=0.002), prior stroke (10.2%, β=0.66, SE=0.08), hypertension (65.4%, β=0.75, SE=0.05), diabetes mellitus (23.1%, β=0.35, SE=0.06), coronary artery disease (17.6%, β=0.04, SE=0.002), and atrial fibrillation (14.6%, β=0.48, SE=0.07) were significant predictors of WMHv (all p<0.0001), as well as smoking status (52.2%, β=0.15, SE=0.05, p=0.005), race (16.5% Non-Caucasian, β=0.25, SE=0.07) and ethnicity (8.2% Hispanic, β=0.30, SE=0.11) (all p<0.01). In multivariable analysis, age (β=0.04, SE=0.002), prior stroke (β=0.56, SE=0.08), hypertension (β=0.33, SE=0.05), smoking status (β=0.16, SE=0.05), race (β=0.42, SE=0.06), and ethnicity (β=0.34, SE=0.09) were independent predictors of WMHv (all p<0.0001), as well as diabetes mellitus (β=0.13, SE=0.06, p=0.02). WMHv differed significantly (p<0.0001, unadjusted) across CCS stroke subtypes: cardioembolic stroke (8.0cm 3 , IQR: 4.2-15.4cm 3 ), large-artery stroke (6.9cm 3 , IQR: 3.1-14.7cm 3 ), small-vessel stroke (5.8cm 3 , IQR: 2.5-13.5cm 3 ), stroke of undetermined (4.7cm 3 , IQR: 1.6-11.0cm 3 ) or other (2.55cm 3 , IQR: 0.9-8.8cm 3 ) causes. Conclusion: In this largest-to-date, multicenter hospital-based cohort of AIS patients with automated WMHv analysis, common vascular risk factors contribute significantly to WMH burden and WMHv varies by CCS subtype.


2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
M. L. Furlanetto ◽  
E. F. B. Chagas ◽  
Payão SLM

Introduction. Atherosclerotic disease is a diffuse disease that is strongly associated with age, risk factors, and variable progression. The anatomical prevalence of atheromas does not always follow, a sequence by sectors, and in many cases are concomitant. Objectives. This study is aimed at studying atherosclerosis in the arterial territories of the carotid and lower limbs, in order to correlate their extension as a form of primary prevention. Methods. Participating patients with the main risk factors for atherosclerotic disease were composed of two groups: one with chronic peripheral obstructive arterial disease (PAD) and another without PAD. After performing carotid ultrasound Doppler (USD) of all patients, the occasional prevalence of the disease was evaluated. We performed by statistical tests the correlation between the findings in these patients and the risk factors. Obtaining n from 226 patients, in which 116 patients are from the PAD group and 110 patients are from the group without PAD. Results. Our findings add up to 8.8% for lesions over 50% in patients with PAD, with 6.2% over 70% meeting the few published scientific findings. In this study, the correlation was evaluated between carotid stenosis and PAD, in which we observed a positive association. We observed in the studies that the prevalence of moderate and severe carotid stenosis was similar to patients with coronary artery disease (CAD). There are a number of nonclassical risk factors that we do not evaluate, but even studying the traditional ones, we find that they are less than 27% dependent. Conclusion. Therefore, our study proposes an improvement in the clinical approach of patients with PAD for both the carotid and coronary territory, not using only 2 factors traditional risk factors, for the extension study and to consider the PAD that has 10% dependence alone, as effect and projection of the carotid atherosclerotic plaque.


2021 ◽  
Vol 17 (1) ◽  
pp. 19-24
Author(s):  
Paweł Wańkowicz ◽  
Przemysław Nowacki ◽  
Monika Gołąb-Janowska

IntroductionAtrial fibrillation (AF) is the most common heart arrhythmia. The condition is known to increase the risk of ischemic stroke (IS). Classical risk factors for the development of AF include advanced age, hypertension, diabetes mellitus, coronary heart disease and lipid metabolism disorders. Importantly, these are also recognized risk factors for ischemic stroke. Therefore, the purpose of this study was to investigate AF risk factors in patients with IS.Material and methodsThis is single-centre retrospective study which included 696 patients with acute ischemic stroke and nonvalvular atrial fibrillation and 1678 patients with acute ischemic stroke without atrial fibrillation.ResultsIn this study we found – based on a univariable and multivariable logistic regression model – that compared to the patients with IS without AF, the group of patients which suffered from IS with nonvalvular atrial fibrillation (NVAF) had a higher proportion of patients who smoked cigarettes (OR = 15.742, p < 0.01; OR = 41.1, p < 0.01), had hypertension (OR = 5.161, p < 0.01; OR = 5.666, p < 0.01), history of previous stroke (OR = 3.951, p < 0.01; OR = 4.792, p < 0.01), dyslipidemia (OR = 2.312, p < 0.01; OR = 1.592, p < 0.01), coronary heart disease (OR = 2.306, p < 0.01; OR = 1.988, p < 0.01), a greater proportion of female patients (OR = 1.717, p < 0.01; OR = 2.095, p < 0.01), higher incidence of diabetes mellitus (OR = 1.341, p < 0.01; OR = 1.261, p = 0.106) and more patients in old age (OR = 1.084, p < 0.01; OR = 1.101, p < 0.01).ConclusionsOur study demonstrates a need for thorough and systematic monitoring of post-ischemic stroke patients in whom AF has not been detected and who display other important risk factors. Regardless of the stroke, these factors may be responsible for development of AF.


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