Positive Association Between Serum Alkaline Phosphatase and First Stroke in Hypertensive Adults

The relation of alkaline phosphatase (ALP) with stroke risk remains uncertain. We aimed to examine the association between serum ALP and the risk of first stroke, and explore the possible effect modifiers in the association, among adults with hypertension. A total of 19,747 participants with baseline ALP measurements and without liver disease at baseline from the China Stroke Primary Prevention Trial (CSPPT) were included. The primary outcome was a first stroke. Over a median follow-up of 4.5 years, there was a positive association between serum ALP levels and the risk of first stroke (per SD increment, adjusted HR, 1.10; 95%CI: 1.01, 1.20). When serum ALP was evaluated as quartiles, a significantly higher risk of first stroke was observed in those in quartile 2–4 (ALP ≥79 IU/L; adjusted HR, 1.38; 95% CI: 1.11, 1.71), compared with participants in quartile 1 (ALP <79 IU/L). Similar results were found for first ischemic or hemorrhagic stroke. Similar findings were also found in those with a normal range of baseline ALP levels (20–140 IU/L) (per SD increment, adjusted HR, 1.15; 95%CI: 1.05, 1.27). None of the variables, including sex, age, body mass index, smoking, alcohol drinking, blood pressure, total cholesterol, fasting glucose levels at baseline, and blood pressure levels during the treatment period, significantly modified the association. In summary, our study suggests that higher serum ALP levels, even in normal range, were significantly related to higher risk of first stroke among Chinese hypertensive adults.

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Serum alkaline phosphatase levels and the risk of new-onset diabetes in hypertensive adults

Cardiovascular Diabetology ◽

10.1186/s12933-020-01161-x ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Yuanyuan Zhang ◽

Chun Zhou ◽

Jianping Li ◽

Yan Zhang ◽

Di Xie ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Fasting Glucose ◽

Serum Alkaline Phosphatase ◽

Positive Association ◽

Trial Registration ◽

Clinical Trial Registration ◽

Onset Diabetes ◽

Increased Risk ◽

New Onset

Abstract Background The association between alkaline phosphatase (ALP) and incident diabetes remains uncertain. Our study aimed to investigate the prospective relation of serum ALP with the risk of new-onset diabetes, and explore possible effect modifiers, in hypertensive adults. Methods A total 14,393 hypertensive patients with available ALP measurements and without diabetes and liver disease at baseline were included from the China Stroke Primary Prevention Trial (CSPPT). The primary outcome was new-onset diabetes, defined as physician-diagnosed diabetes or use of glucose-lowering drugs during follow-up, or fasting glucose ≥ 7.0 mmol/L at the exit visit. The secondary study outcome was new-onset impaired fasting glucose (IFG), defined as FG < 6.1 mmol/L at baseline and ≥ 6.1 but < 7.0 mmol/L at the exit visit. Results Over a median of 4.5 years follow-up, 1549 (10.8%) participants developed diabetes. Overall, there was a positive relation of serum ALP and the risk of new-onset diabetes (per SD increment, adjusted OR, 1.07; 95% CI: 1.01, 1.14) and new-onset IFG (per SD increment, adjusted OR, 1.07; 95% CI: 1.02, 1.14). Moreover, a stronger positive association between baseline ALP (per SD increment) with new-onset diabetes was found in participants with total homocysteine (tHcy) < 10 μmol/L (adjusted OR, 1.24; 95% CI: 1.10, 1.40 vs. ≥ 10 μmol/L: adjusted OR, 1.03; 95% CI: 0.96, 1.10; P-interaction = 0.007) or FG ≥ 5.9 mmol/L (adjusted OR, 1.16; 95% CI: 1.07, 1.27 vs. < 5.9 mmol/L: adjusted OR, 1.00; 95% CI: 0.93, 1.08; P-interaction = 0.009) Conclusions In this non-diabetic, hypertensive population, higher serum ALP was significantly associated with the increased risk of new-onset diabetes, especially in those with lower tHcy or higher FG levels. Clinical Trial Registration-URL Trial registration: NCT00794885 (clinicaltrials.gov). Retrospectively registered November 20, 2008.

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Association of Blood Pressure With Stroke Risk in Chinese Population: A 6-Year Prospective Cohort Study

10.21203/rs.3.rs-583220/v1 ◽

2021 ◽

Author(s):

Qi Yu ◽

Qing-Dong Jin ◽

Yan-Qing Chen ◽

Xin-Ru Liu ◽

Qing-Ying Lin

Keyword(s):

Blood Pressure ◽

Hemorrhagic Stroke ◽

Stroke Risk ◽

Proportional Hazards ◽

Positive Association ◽

Cubic Spline ◽

Cox Proportional Hazards ◽

Nutrition Survey ◽

Cox Models ◽

Nonlinear Relationships

Abstract Objective: Previous results on the association between blood pressure(BP) and stroke risk were controversial. We investigated the association of BP with stroke risk in China. Method: We included a total of 5,700 adults aged 40-90 years from the China Health and Nutrition Survey (CHNS) cohort. Cox proportional hazards regression models were used to estimate hazard ratios and 95% CIs. Restricted cubic spline analyses were used to explore linear and nonlinear relationships of BP and stroke. Result: With a median follow-up of 6 years, a total of 5,700 individuals were enrolled in our study, of whom 178 developed stroke. Multivariable adjusted Cox models including systolic blood pressure(SBP) and diastolic blood pressure(DBP) showed a strong positive association between SBP and overall stroke. Compared with participants with SBP 0-130 mmHg, the multivariable adjusted HRs[95% CIs] in participants with SBP 130-140, 140-160, 160-180, and ≥180 mmHg were 1.08[0.62-1.89], 2.41[1.51-3.86], 2.21[1.16-4.20], and 3.90[1.78-8.55] for overall stroke; 0.65[0.21-2.04], 3.68[1.73-7.83], 2.51[0.84-7.47], and 5.91[1.69-20.60] for ischemic stroke; 1.26[0.50-3.20], 1.19[0.47-3.04], 2.06[0.66-6.41], and 5.10[1.36-19.20] for hemorrhagic stroke. Restricted cubic spline analyses including SBP and DBP showed linear relationships of SBP with overall, ischemic and hemorrhagic stroke. No linear or nonlinear relationships of DBP with overall, ischemic and hemorrhagic stroke were observed.Conclusion: SBP is independently and directly related to the risk of overall and its subtypes. Besides, the risk of ischemic and hemorrhagic stroke might be higher when SBP were more than 140 mmHg and 160 mmHg.

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Serum alkaline phosphatase levels and the risk of new-onset diabetes in hypertensive adults

10.21203/rs.3.rs-64854/v2 ◽

2020 ◽

Author(s):

Yuanyuan Zhang ◽

Chun Zhou ◽

Jianping Li ◽

Yan Zhang ◽

Di Xie ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Fasting Glucose ◽

Serum Alkaline Phosphatase ◽

Positive Association ◽

Trial Registration ◽

Clinical Trial Registration ◽

Onset Diabetes ◽

Increased Risk ◽

New Onset

Abstract Background: The association between alkaline phosphatase (ALP) and incident diabetes remains uncertain. Our study aimed to investigate the prospective relation of serum ALP with the risk of new-onset diabetes, and explore possible effect modifiers, in hypertensive adults.Methods: A total 14,393 hypertensive patients with available ALP measurements and without diabetes and liver disease at baseline were included from the China Stroke Primary Prevention Trial (CSPPT). The primary outcome was new-onset diabetes, defined as physician-diagnosed diabetes or use of glucose-lowering drugs during follow-up, or fasting glucose ≥7.0mmol/L at the exit visit. The secondary study outcome was new-onset impaired fasting glucose (IFG), defined as FG <6.1mmol/L at baseline and ≥6.1 but <7.0mmol/L at the exit visit.Results: Over a median of 4.5 years follow-up, 1,549 (10.8%) participants developed diabetes. Overall, there was a positive relation of serum ALP and the risk of new-onset diabetes (per SD increment, adjusted OR, 1.07; 95%CI: 1.01, 1.14) and new-onset IFG (per SD increment, adjusted OR, 1.07; 95%CI: 1.02, 1.14). Moreover, a stronger positive association between baseline ALP (per SD increment) with new-onset diabetes was found in participants with total homocysteine (tHcy) <10μmol/L (adjusted OR, 1.24; 95%CI: 1.10, 1.40 vs. ≥10μmol/L: adjusted OR, 1.03; 95%CI: 0.96, 1.10; P-interaction=0.007) or FG ≥5.9mmol/L (adjusted OR, 1.16; 95%CI: 1.07, 1.27 vs. <5.9mmol/L: adjusted OR, 1.00; 95%CI: 0.93, 1.08; P-interaction =0.009)Conclusions: In this non-diabetic, hypertensive population, higher serum ALP was significantly associated with the increased risk of new-onset diabetes, especially in those with lower tHcy or higher FG levels.Clinical Trial Registration-URL: Trial registration: NCT00794885 (clinicaltrials.gov). Retrospectively registered November 20, 2008.

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Serum alkaline phosphatase levels and the risk of new-onset diabetes in hypertensive adults

10.21203/rs.3.rs-64854/v1 ◽

2020 ◽

Author(s):

Yuanyuan Zhang ◽

Chun Zhou ◽

Jianping Li ◽

Yan Zhang ◽

Di Xie ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Fasting Glucose ◽

Serum Alkaline Phosphatase ◽

Positive Association ◽

Trial Registration ◽

Clinical Trial Registration ◽

Onset Diabetes ◽

Increased Risk ◽

New Onset

Abstract Background: The association between alkaline phosphatase (ALP) and incident diabetes remains uncertain. Our study aimed to investigate the prospective relation of serum ALP with the risk of new-onset diabetes, and explore possible effect modifiers, in hypertensive adults. Methods: A total 14,393 hypertensive patients with available ALP measurements and without diabetes and liver disease at baseline were included from the China Stroke Primary Prevention Trial (CSPPT). The primary outcome was new-onset diabetes, defined as physician-diagnosed diabetes or use of glucose-lowering drugs during follow-up, or fasting glucose ≥7.0mmol/L at the exit visit. The secondary study outcome was new-onset impaired fasting glucose (IFG), defined as FG <6.1mmol/L at baseline and ≥6.1 but <7.0mmol/L at the exit visit.Results: Over a median of 4.5 years follow-up, 1,549 (10.8%) participants developed diabetes. Overall, there was a positive relation of serum ALP and the risk of new-onset diabetes (per SD increment, adjusted OR, 1.07; 95%CI: 1.01, 1.14) and new-onset IFG (per SD increment, adjusted OR, 1.07; 95%CI: 1.02, 1.14). Moreover, a stronger positive association between baseline ALP (per SD increment) with new-onset diabetes was found in participants with total homocysteine (tHcy) <10μmol/L (adjusted OR, 1.24; 95%CI: 1.10, 1.40 vs. ≥10μmol/L: adjusted OR, 1.03; 95%CI: 0.96, 1.10; P-interaction=0.007) or FG ≥5.9mmol/L (adjusted OR, 1.16; 95%CI: 1.07, 1.27 vs. <5.9mmol/L: adjusted OR, 1.00; 95%CI: 0.93, 1.08; P-interaction =0.009)Conclusions: In this non-diabetic, hypertensive population, higher serum ALP was significantly associated with the increased risk of new-onset diabetes, especially in those with lower tHcy or higher FG levels.Clinical Trial Registration-URL: Trial registration: NCT00794885 (clinicaltrials.gov). Retrospectively registered November 20, 2008.

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Using Ultrasound and Inflammation to Improve Prediction of Ischemic Stroke: A Secondary Analysis of the Multi-Ethnic Study of Atherosclerosis

Cerebrovascular Diseases Extra ◽

10.1159/000514373 ◽

2021 ◽

pp. 37-43

Author(s):

Hediyeh Baradaran ◽

Alen Delic ◽

Ka-Ho Wong ◽

Nazanin Sheibani ◽

Matthew Alexander ◽

...

Keyword(s):

Ischemic Stroke ◽

Goodness Of Fit ◽

Primary Outcome ◽

Stroke Risk ◽

Secondary Analysis ◽

Predictor Variables ◽

Baseline Model ◽

Fit Statistics ◽

Ischemic Stroke Risk

Introduction: Current ischemic stroke risk prediction is primarily based on clinical factors, rather than imaging or laboratory markers. We examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary ischemic stroke risk. Methods: In this secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), the primary outcome is the incident ischemic stroke during follow-up. The predictor variables are 9 carotid ultrasound-derived measurements and 6 serum inflammation measurements from the baseline study visit. We fit Cox regression models to the outcome of ischemic stroke. The baseline model included patient age, hypertension, diabetes, total cholesterol, smoking, and systolic blood pressure. Goodness-of-fit statistics were assessed to compare the baseline model to a model with ultrasound and inflammation predictor variables that remained significant when added to the baseline model. Results: We included 5,918 participants. The primary outcome of ischemic stroke was seen in 105 patients with a mean follow-up time of 7.7 years. In the Cox models, we found that carotid distensibility (CD), carotid stenosis (CS), and serum interleukin-6 (IL-6) were associated with incident stroke. Adding tertiles of CD, IL-6, and categories of CS to a baseline model that included traditional clinical vascular risk factors resulted in a better model fit than traditional risk factors alone as indicated by goodness-of-fit statistics. Conclusions: In a multiethnic cohort of patients without cerebrovascular disease at baseline, we found that CD, CS, and IL-6 helped predict the occurrence of primary ischemic stroke. Future research could evaluate if these basic ultrasound and serum measurements have implications for primary prevention efforts or clinical trial inclusion criteria.

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Abstract WP328: A Nurse-Led Initiative Improves Adherence Rates for Stroke Follow-up and Blood Pressure Management

Stroke ◽

10.1161/str.44.suppl_1.awp328 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Darren T Larsen ◽

Helmi L Lutsep

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Stroke Prevention ◽

Stroke Risk ◽

Retention Rates ◽

Matched Cohort ◽

Stroke Patients ◽

Stroke Risk Factor ◽

Chi Square Analysis

Background and Issues Aggressive management of vascular risk factors reduces stroke rates. It is unknown whether structured nurse-led follow up increases adherence rates for stroke patients after hospital discharge. Purpose The purpose of this program is to improve secondary stroke risk factor management by instituting a nurse-led initiative called Stroke Therapy, Education, Prevention (STEP). Methods The pilot STEP program was based on protocols used for other stroke prevention trials. This nurse-led program includes inpatient initiation and outpatient maintenance of pharmacologic and lifestyle goals for stroke patients. Eligible patients have a non-disabling ischemic stroke or TIA and are without insurance restrictions and live within a distance allowing return to clinic for follow up. Prior to discharge, the STEP nurse completes patient education, and reviews outpatient goals. The STEP nurse makes phone contact with the patient 7-10 days after discharge to review medication compliance and reinforce education. At 30 days post discharge patients are seen in clinic by the STEP nurse where a resting blood pressure (BP) is measured. If the patient does not meet targets (<140 SBP or <130 SBP for DM) medications are adjusted by a stroke neurologist. We undertook a retrospective chart review of a consecutive cohort of patients matched to STEP eligibility criteria to determine whether the program improved retention rates and BP management. Chi-Square analysis was used to compare visit adherence and percentage achieving goal BPs at 30 days. Results In the STEP group 25/32(78%) patients completed the 30 day follow up compared to 14/32 (44%) patients in the historical matched cohort (p=0.0048). Target BP was achieved in 13/25(52%) STEP patients and 5/14 (36%) matched cohort patients (p=0.32) returning to clinic. Overall, target BP was achieved in 13/32 (41%) and 5/32 (16%) respectively (p=0.026). Conclusions In conclusion, follow up adherence and BP management in the group as a whole was better in the nurse-led model and is recommended for secondary stroke prevention. Long term follow up with this model may further increase in-target rates of BP control and other stroke risk factors.

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Abstract 81: Translesional Pressure Gradient Alters the Relationship Between Blood Pressure and Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Disease

Stroke ◽

10.1161/str.51.suppl_1.81 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Xueyan Feng ◽

Ka Lung Chan ◽

Jill Abrigo ◽

Linda Lan ◽

Yannie Soo ◽

...

Keyword(s):

Blood Pressure ◽

Pressure Gradient ◽

Stroke Prevention ◽

Primary Outcome ◽

Stroke Recurrence ◽

Secondary Stroke Prevention ◽

Cfd Models ◽

Intracranial Atherosclerotic Disease ◽

The Relationship

Objective: Patients with symptomatic intracranial atherosclerotic stenosis (sICAS) have a high risk of stroke recurrence. There is debate over an optimal blood pressure (BP) lowering target in secondary stroke prevention in such patients, when some factors (e.g., impaired cerebral perfusion) may alter the relationship between BP and risk of stroke recurrence. In this study, we investigated whether translesional pressure gradient across sICAS lesions would also alter such relationship. Methods: We recruited patients with sICAS (50-99% stenosis) confirmed in CT angiography (CTA). Computational fluid dynamics (CFD) models were built based on CTA to simulate blood flow across sICAS and calculate the translesional pressure ratio (PR, the ratio of pressures distal and proximal to a lesion). PR ≤ median was defined as low PR, indicating larger translesional pressure gradient and hence restricted downstream perfusion. The primary outcome was recurrent ischemic stroke in the same territory in 1 year. We investigated the interaction of PR and mean systolic BP (SBP) during follow-up in determining the risk of the primary outcome. Results: Among 157 patients, the median PR was 0.93. Multivariate Cox regression revealed significant PR-SBP interaction on the primary outcome (p=0.025): in patients with normal PR, the risk of primary outcome significantly decreased with lower SBP during follow-up (for 10 mmHg decrement: HR 0.46; p=0.018); however, in those with low PR, mean SBP ≤130 mmHg was associated with significantly increased risk of primary outcome, compared with 130<SBP<150mmHg (HR 5.08; p=0.043) (Figure). Conclusion: Intensive BP lowering may increase the risk of stroke recurrence in sICAS patients with a large translesional pressure gradient, warranting further investigation. PR by CFD models may yield a promising indicator to differentiate sICAS patients for different BP management strategies for better secondary stroke prevention.

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Long-term benefit of renal denervation on blood pressure control in a patient with hemorrhagic stroke

SAGE Open Medical Case Reports ◽

10.1177/2050313x19870972 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1987097

Author(s):

Francesco Versaci ◽

Giuseppe Andò ◽

Marcello Chiocchi ◽

Francesco Romeo

Keyword(s):

Blood Pressure ◽

Renal Denervation ◽

Hemorrhagic Stroke ◽

Blood Pressure Reduction ◽

Pressure Control ◽

Refractory Hypertension ◽

Sustained Efficacy ◽

Term Benefit

A 49-year-old man with malignant hypertension had been admitted with hemorrhagic stroke. Refractory hypertension had been observed during hospitalization and the decision had been made to perform renal denervation. A significant blood pressure reduction was obtained immediately after renal denervation and persists at 2-year follow-up. This case demonstrates the long-term sustained efficacy of renal denervation performed in the acute phase of hemorrhagic stroke. In addition, it supports the notion that renal denervation–induced normalization of blood pressure may contribute to better outcomes in a challenging setting such as intracranial bleeding.

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Diabetic Retinopathy and Risk of Stroke

Stroke ◽

10.1161/strokeaha.120.030350 ◽

2020 ◽

Vol 51 (12) ◽

pp. 3733-3736

Author(s):

Ka-Ho Wong ◽

Katherine Hu ◽

Cecilia Peterson ◽

Nazanin Sheibani ◽

Georgios Tsivgoulis ◽

...

Keyword(s):

Blood Pressure ◽

Diabetic Retinopathy ◽

Primary Outcome ◽

Vision Loss ◽

Proportional Hazards ◽

Cox Regression ◽

Secondary Analysis ◽

Cox Proportional Hazards ◽

Increased Risk

Background and Purpose: Diabetic retinopathy (DR) is a common microvascular complication of diabetes, which causes damage to the retina and may lead to rapid vision loss. Previous research has shown that the macrovascular complications of diabetes, including stroke, are often comorbid with DR. We sought to explore the association between DR and subsequent stroke events. Methods: This is a secondary analysis of patients enrolled in the ACCORD Eye study (Action to Control Cardiovascular Risk in Diabetes). The primary outcome was stroke during follow-up. The exposure was presence of DR at study baseline. We fit adjusted Cox proportional hazards models to provide hazard ratios for stroke and included interaction terms with the ACCORD randomization arms. Results: We included 2828 patients, in whom the primary outcome of stroke was met by 117 (4.1%) patients during a mean (SD) of 5.4 (1.8) years of follow-up. DR was present in 874 of 2828 (30.9%) patients at baseline and was more common in patients with than without incident stroke (41.0% versus 30.5%; P =0.016). In an adjusted Cox regression model, DR was independently associated with incident stroke (hazard ratio, 1.52 [95% CI, 1.05–2.20]; P =0.026). This association was not affected by randomization arm in the ACCORD glucose ( P =0.300), lipid ( P =0.660), or blood pressure interventions ( P =0.469). Conclusions: DR is associated with an increased risk of stroke, which suggests that the microvascular pathology inherent to DR has larger cerebrovascular implications. This association appears not to be mediated by serum glucose, lipid, and blood pressure interventions.

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Serum alkaline phosphatase: normal values by sex and age.

Clinical Chemistry ◽

10.1093/clinchem/23.9.1769 ◽

1977 ◽

Vol 23 (9) ◽

pp. 1769-1770 ◽

Cited By ~ 23

Author(s):

J R Eastman ◽

D Bixler

Keyword(s):

Alkaline Phosphatase ◽

Enzyme Activity ◽

Statistical Analysis ◽

Normal Values ◽

Serum Alkaline Phosphatase ◽

Blood Type ◽

Sample Population ◽

Normal Range ◽

Larger Sample ◽

Alkaline Phophatase

Abstract We report here the normal range of serum alkaline phophatase activity as measured by the method proposed by Hausamen et al. [Clin. Chim. Acta 15, 241 (1967)] with a much larger sample size than used in previous investigations. In the statistical analysis the sample population is subdivided by sex and age, two variables which are known to influence enzyme activity. No statistically significant influence of blood type on enzyme activity was observed. The normal range of enzyme activity is reported in percentiles.

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