scholarly journals Analysis of the frequency of vascular comorbidity in patients with recurrent acute stroke

Author(s):  
O. N. Mikitey ◽  
N. K. Svyrydova ◽  
N. P. Pavliuk

Stroke is an important medical and social problem, which occupies the second place in the population figures for mortality and one of the first rate for disability. Given the magnitude of the incidence, severity, effects, high incidence of recurrence great importance becomes its primary and secondary prevention that provides impact on the risk factors: high blood pressure, diabetes, high cholesterol, atrial fibrillation, sickle-cell anemia, open oval window, alcoholism. Prognosis depends on many factors, primarily on the amount and location of lesions of the brain, the severity of comorbidity and the patient’s age.

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
O Greaves ◽  
S L Harrison ◽  
D A Lane ◽  
M Banach ◽  
M Mastej ◽  
...  

Abstract Background The National Health Service in England “Long Term Plan” aims to prevent 150,000 strokes and myocardial infarctions over the next 10 years. To achieve this, resources are being allocated to improve early detection of conditions strongly associated with cardiovascular disease. This includes working towards people routinely knowing their “ABC” risk factors (“A”: atrial fibrillation (AF), “B': hypertension and “C”: high cholesterol) (1). Purpose The aims of this study were to: 1) determine the proportion of participants with “A”, “B”, and “C” criteria; and 2) to identify risk factors for patients fulfilling any of these criteria. Methods LIPIDOGRAM2015 was a nationwide cross-sectional survey for adults in Poland. Adults were recruited in 2015 and 2016 by 438 family physicians. For the ABC criteria, “A” was defined as AF identified in the medical records of the participant, “B” was defined as either systolic blood pressure greater than 140mmHg or diastolic blood pressure greater than 90mmHg or both, and “C” was defined as total cholesterol greater than 200mg/dL (5.17mmol/L). The scaled and centred dataset underwent principal component analysis using singular value decomposition to achieve dimensionality reduction. K-means clustering was used to stratify patients with Hartigan's rule being used to identify optimal K number (2–4). The p-value for statistical significance used in this study was p<0.01 unless otherwise specified. Results 13,724 patients were included in the study. 71.0% (n=9,747) of participants fulfilled the criteria for one or more of the “A”, “B” or “C” components (Fig. 1). 26 variables were used in this analysis with Principal Component Analysis showing 7 principal components explaining over 50% of the variance with 20 components explaining over 90%. K-means clustering was also performed, finding 39 separate clusters. Correlations and statistical significance tests showed a high degree of variability between variables. Participants with AF were older (mean (SD) 67.7 (9.5) vs 55.7 (13.7), p<0.0001), with higher prevalence of concomitant coronary heart disease (CHD) (OR 6.73, 95% CL 5.75, 7.87) and ischaemic stroke (OR 13.45, 95% CL 7.66, 23.6). Participants with hypertension were older (mean (SD) 60.1 (SD 12.4) vs 53.8 (14.0), p<0.0001), with a higher BMI (mean (SD) 29.9 (5.1) vs 27.5 (4.8), p<0.0001) and resting heart rate (mean (SD) 75.7 (10.7) vs 72.7 (8.9), p<0.0001), more likely to be male (OR 1.42, 95% CL 1.32, 1.53) and have diabetes (OR 1.61, 95% CL 1.46, 1.78). Participants with high cholesterol showed an inverse correlation with prevalence of both concomitant diabetes (OR 0.85, 95% CL 0.77, 0.94) and CHD (OR 0.85, 95% CL 0.76, 0.94) (Fig. 2). Conclusion Simple demographic and clinical variables could be used to guide targeted screening to increase population awareness of “ABC” status, allowing for a greater proportion of the population to be appropriately managed with cardiovascular prevention strategies. FUNDunding Acknowledgement Type of funding sources: None. “ABC” Venn diagram Correlogram and significance plot


2020 ◽  
Author(s):  
Nebojša Mujović ◽  
Milan Marinković ◽  
Miroslav Mihajlović ◽  
Nataša Mujović ◽  
Tatjana S. Potpara

2020 ◽  
Author(s):  
Mujović Nebojša ◽  
Marinković Milan ◽  
Mihajlović Miroslav ◽  
Mujović Nataša ◽  
Potpara S. Tatjana

Author(s):  
Kristaps Jurjāns ◽  
Santa Sabeļnikova ◽  
Evija Miglāne ◽  
Baiba Luriņa ◽  
Oskars Kalējs ◽  
...  

Abstract Atrial fibrillation is one of major risk factors of cerebral infarction. The use of oral anticoagulants is the only evidence-based method of reducing the risk of cardioembolic accidents. The guidelines of oral anticoagulant admission and usage have been available since 2012. The results of this study show that of 550 stroke patients that were admitted to Pauls Stradiņš Clinical University Hospital, Rīga, Latvia, from 1 January 2014 until 1 July 2014, atrial fibrillation was diagnosed in 247 (45%) cases, and of these patients, only 8.5% used oral anticoagulants before the onset of stroke. Six months after discharge of 111 (44.9%) stroke survivors, five (4.5%) used no secondary prevention medication, 27 (24.3%) used antiplatelet agents, 54 (48.6%) warfarin, and 25 (22.5%) used target specific oral anticoagulants (TSOACs). The mortality rate was significantly higher in the patient group that used no secondary prevention medication or antiplatelet agents compared to the patient group that used oral anticoagulants. The use of oral anticoagulants for primary stroke prevention in Latvia is insufficient. The mortality of cardioembolic stroke in 180 days is very high - 40.4%. Secondary prevention is essential to prevent recurrent cardioembolic accidents.


Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Abdeslam Bouzeman ◽  
Maxime De Guillebon ◽  
Guillaume Duthoit ◽  
Magalie Ladouceur ◽  
Raphael Martins ◽  
...  

Background: Tetralogy of Fallot (TOF) is the most frequent form of congenital heart disease managed by EP physicians for potential ICD. However, few studies have reported long-term outcomes of TOF patients with ICD. Methods: Between 2005 and 2014, all TOF patients with ICD in 17 French centers were enrolled in a specific evaluation aiming to determine characteristics at implantation as well as outcomes (overall mortality, appropriate ICD therapies, and device-related complications). Results: Overall 78 patients (45±13 years, 64% males) were enrolled. A majority of patients were implanted in the setting of secondary prevention (73%), whereas the remaining (27%) in primary prevention. Among the latest group, known risk factors for sudden cardiac death were: severe pulmonary regurgitation (30%,) prior palliative shunt (50%), syncope with unknown origin (25%), inducible ventricular tachycardia (45%), QRS duration ≥180ms (18%), non-sustained ventricular tachycardia (25%), and documented sustained supra ventricular tachycardia (45%).Overall, patients implanted in the setting of primary prevention presented with a mean of 3.1±1.4 risk factors. After a mean follow-up of 4.9±3.8 years, 35 patients (45%) experienced at least one appropriate therapy (25% in the primary prevention group compared to 53% in the secondary prevention group), giving annual-incidences of 6.9% (95%CI 0.14-13.7) and 21.3% (12.4-30.3) respectively (P=0,01). The mean time between ICD implantation and the first appropriate therapy was 2.2±3.2 years, without significant differences between primary and secondary prevention. Overall, ≥one ICD-related complication occurred in 30 patients (38%), including inappropriate shock (n=9), major pocket hematoma (n=1), lead dysfunction (n=12), infection (n=4), shoulder algodystrophia (n=2), device failure or dislodgement needing reintervention (n=2). Eventually, four patients were transplanted (5%), and six patients (8%) died during the course of follow-up. Conclusions: Considering relatively long-term follow-up, patients with TOF and ICDs experience high rates of appropriate ICD therapies, in both primary and secondary prevention. Major ICD-related complications remain, however, high.


Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mari Matsumoto ◽  
Manabu Sakaguchi ◽  
Shuhei Okazaki ◽  
Shigetaka Furukado ◽  
Masafumi Tagaya ◽  
...  

Introduction and Hypothesis: The purpose of this study was to investigate the association between plasma D-dimer level at admission and infarct size in non-valvular atrial fibrillation (NVAF) patients. Methods: We identified 124 patients with consecutive ischemic stroke and NVAF who were admitted within 48 hours of symptom onset. We measured infarction volume from CT taken after 3±1 days from the onset. Relationships were analysed between infarction volume, risk factors, preadmission medications and admission conditions. We also assessed the functional outcome by tertile of D-dimer level (≦ 0.83, 0.83-2.16, ≧ 2.16 μg/mL) in patients with preadmission modified Rankin Scale (mRS) score of 0-1. Results: Infarction volume significantly correlated with D-dimer level (r=0.309, p < 0.001) (Figure 1), systolic blood pressure (r=0.201, p=0.026), diastolic blood pressure (r=0.283, p=0.002), National Institutes of Health Stroke Scale (NIHSS) score on admission (r=0.546, p < 0.001) and mRS score at discharge (r=0.557, p<0.001). Multivariate regression analyses showed that the D-dimer level was significantly associated with infarction volume (p=0.043) after adjustment with known risk factors. In patients with a preadmission mRS score of 0-1 patients (n=108), D-dimer level was significantly associated with NIHSS score at admission (r=0.318, p<0.001) and mRS score at discharge (r=0.310, p=0.001).Significant difference existed among tertiles (p = 0.003)(Figure 2). Conclusions: Plasma D-dimer level on admission is significantly related to infarction volume and functional outcome, following cardioembolic stroke in NVAF patients.


2020 ◽  
Vol 64 (6) ◽  
pp. 645-658
Author(s):  
Lucy A Barnes ◽  
Amanda Eng ◽  
Marine Corbin ◽  
Hayley J Denison ◽  
Andrea ‘t Mannetje ◽  
...  

Abstract Objectives Although cardiovascular disease (CVD) risk has been shown to differ between occupations, few studies have specifically evaluated the distribution of known CVD risk factors across occupational groups. This study assessed CVD risk factors in a range of occupational groups in New Zealand, stratified by sex and ethnicity. Methods Two probability-based sample surveys of the general New Zealand adult population (2004–2006; n = 3003) and of the indigenous people of New Zealand (Māori; 2009–2010; n = 2107), for which occupational histories and lifestyle factors were collected, were linked with routinely collected health data. Smoking, body mass index, deprivation, diabetes, high blood pressure, and high cholesterol were dichotomized and compared between occupational groups using age-adjusted logistic regression. Results The prevalence of all known CVD risk factors was greater in the Māori survey than the general population survey, and in males compared with females. In general for men and women in both surveys ‘Plant and machine operators and assemblers’ and ‘Elementary workers’ were more likely to experience traditional CVD risk factors, while ‘Professionals’ were less likely to experience these risk factors. ‘Clerks’ were more likely to have high blood pressure and male ‘Agricultural and fishery workers’ in the general survey were less likely to have high cholesterol, but this was not observed in the Māori survey. Male Māori ‘Trades workers’ were less likely to have high cholesterol and were less obese, while for the general population survey, this was not observed. Conclusions This study showed differences in the distribution of known CVD risk factors across occupational groups, as well as between ethnic groups and males and females.


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