scholarly journals Outcomes of Ischemic Stroke and Associated Factors Among Elderly Patients With Large-Artery Atherosclerosis: A Hospital-Based Follow-Up Study in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Qianqian Wu ◽  
Jingjing Cui ◽  
Yuanli Xie ◽  
Min Wang ◽  
Huifang Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Protective Factor ◽  
Density Lipoprotein ◽  
The Elderly ◽  
Outcome Data ◽  
Stroke Onset ◽  
Stroke Recurrence ◽  
Large Artery

Large-artery atherosclerotic (LAA) stroke is the most common subtype of ischemic stroke. However, risk factors for long-term outcomes of LAA stroke in the elderly Chinese population have not been well-described. Therefore, we aimed to assess outcomes and risk factors at 3, 12, and 36 months after LAA stroke onset among stroke patients aged 60 years and older. All consecutive LAA patients aged ≥ 60 years were prospectively recruited from Dongying People's Hospital between January 2016 and December 2018. The clinical features and outcome data at 3, 12, and 36 months after stroke were collected. Differences in outcomes and relationship between outcomes and risk factors were assessed. A total of 1,772 patients were included in our study (61.7% male, 38.3% female). The rates of mortality, recurrence, and dependency were 6.6, 12.6, and 12.6%, respectively, at 3 months after stroke onset. The corresponding rate rose rapidly at 36 months (23.2, 78.7, and 79.7%, respectively). We found the positive predictors associated outcomes at 3, 12, and 36 months after stroke onset. The relative risk (RR) with 95% confidential interval (CI) is 1.06 (1.02–1.10, P = 0.006) at 3 months, 1.06 (1.02–1.10, P = 0.003) at12 months, and 1.10 (1.05–1.15, P < 0.001) at 36 months after stroke onset for age; 1.09 (1.01–1.19, P = 0.029) at 12 months for fasting plasma glucose (FPG) level; 4.25 (2.14–8.43, P < 0.001) at 3 months, 4.95 (2.70–9.10, P < 0.001) at 12 months, and 4.82 (2.25–10.32, P < 0.001) at 36 months for moderate stroke; 7.56 (3.42–16.72, P < 0.001) at 3 months, 11.08 (5.26–23.34, P < 0.001) at 12 months, and 14.30 (4.85–42.11, P < 0.001) at 36 months for severe stroke, compared to mild stroke. Hypersensitive C-reactive protein (hs-CRP) level was an independent risk factor for mortality at different follow-up times, with the RR (95%) of 1.02 (1.01–1.02, P < 0.001) at 3 months, 1.01 (1.00–1.02, P = 0.002) at 12 months. White blood cell count (WBC) level was associated with both stroke recurrence (RR = 1.09, 95%CI: 1.01–1.18, P = 0.023) and dependency (RR = 1.10, 95%CI: 1.02–1.19, P = 0.018) at 3 months. In contrast, a higher level of low-density lipoprotein cholesterol (LDL-C) within the normal range was a protective factor for recurrence and dependency at shorter follow-up times, with the RR (95%) of 0.67 (0.51–0.89, P = 0.005) and 0.67 (0.50–0.88, P = 0.005), respectively. These findings suggest that it is necessary to control the risk factors of LAA to reduce the burden of LAA stroke. Especially, this study provides a new challenge to explore the possibility of lowering LDL-C level for improved stroke prognosis.

scholarly journals Study on outcome of ischemic stroke patient with atrial fibrillation

KYAMC Journal ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. 8-12
Author(s):  
Achinta Kumar Mallick ◽  
Md Ahmed Ali ◽  
Md Kafiluddin ◽  
Md Parvez Amin ◽  
Pijus Kumar Kundu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Case Fatality ◽  
The Elderly ◽  
Clinical Deterioration ◽  
Stroke Recurrence ◽  
Stroke Severity ◽  
Ischemic Stroke Patient ◽  
Fold Excess

Background: Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for ischemic stroke, especially in the elderly patients. Patients with non-valvular AF have a 5-fold excess risk of stroke recurrence and case-fatality rate.Objectives: This study was to evaluate the prevalence of AF and its influence on prognosis in patients with ischemic stroke.Materials & Methods: Total 125 patients with ischaemic stroke were enrolled in this study. Initially they were divided into two groups by ECG - those with AF and those without AF. They were followed up after one month, three months and six months. Comparison was done between the two groups in term of recurrence, mortality and clinical improvement which were assessed by Modified Rankin Score (MRS).Results: Among 125 patients, 22 patients had AF. Those with AF were more frequently male, aged more than 45 years. Recurrence was significantly higher in AF group during one month follow up (p<0.05). The presence of AF was associated with higher mortality in 3 months (p<0.05) and 6 months (p<0.05) follow up. At 3 months follow up clinical deterioration was noted in 9.1% patient with AF compared to 2.9% patients without AF (p<0.01) and at 6 months follow up clinical deterioration was noted in 18.2% patient with AF compared to 4.9% patients without AF (p<0.01).Conclusion: Patients who had an ischemic stroke with accompanying AF had higher mortality, graver stroke severity, more recurrences and poorer functional status than those without AF.KYAMC Journal Vol. 8, No.-2, Jan 2018, Page 8-12

Abstract TP200: Independent Contribution of HbA1c, Systolic Blood Pressure, and LDL Cholesterol Control to Risk of Ischemic Stroke Hospitalizations in Type 2 Diabetes

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Gregory A Nichols ◽  
Shreekant Parasuraman ◽  
Sandra Joshua-Gotlib
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Density Lipoprotein ◽  
Increased Risk ◽  
Hba1c Control

Risk of ischemic stroke is approximately doubled in patients with diabetes. To reduce risk, managing diabetes includes optimizing glycemic, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) control. We studied which risk factors alone or in combination were most strongly associated with stroke hospitalizations. We identified 26,924 Kaiser Permanente Northwest members with type 2 diabetes and no known prior cardiovascular disease hospitalization. Beginning in 2002, we identified the earliest point patients had glycosolated hemoglobin (HbA1c), systolic BP (SBP), and LDL-C measurements within 6 months of each other and followed them until they died, disenrolled, or 31 December 2011. Outcome was hospitalization with primary diagnosis of ischemic stroke. Using mean HbA1c, SBP, and LDL-C between baseline and end of follow-up, we identified dichotomous categories of control of HbA1c (<7%), SBP (<130 mm Hg) and LDL-C (<100 mg/dL) and estimated the relative risk of stroke hospitalization independently associated with all combinations of risk factors controlling for age, sex, diabetes duration, comorbidities, body mass index, smoking, and pharmacotherapy. Mean (SD) age of patients was 59 (12) years; 50% were men. Over mean (SD) follow-up of 6.2 (2.8) years, 606 (2.3%) patients were hospitalized for ischemic stroke. Compared with patients with all 3 risk factors in control, patients who had no risk factors controlled or only HbA1c controlled had >2-fold increased risk of ischemic stroke. Patients who controlled both SBP and LDL-C had significantly lower risk relative to control of all 3 risk factors. In this observational study, maintaining control of SBP over 6.2 years was essential to reduction of ischemic stroke risk. Simultaneous control of LDL-C further reduced risk, but HbA1c control <7% did not mitigate stroke risk beyond SBP and LDL-C control. Further research is needed to evaluate the relationship between HbA1c control and stroke risk.

scholarly journals The Association among Hyperuricemia, Aspirin Resistance, and Ischemic Events Recurrence in Stroke Patients

2020 ◽  
Author(s):  
Yongkang Zhang ◽  
Huihui Lv ◽  
Zhuqing Shi ◽  
Xu Liu ◽  
Wei Liu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Protective Factor ◽  
Univariate Analysis ◽  
Aspirin Resistance ◽  
Major Adverse Cardiovascular Events ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Ischemic Attack ◽  
Ischemic Events

Abstract Background: It is unclear about the relationship among hyperuricemia, aspirin resistance (AR) and recurrence of ischemic events in ischemic stroke patients. This study focuses on this topic. Methods: In this prospective, observational, and single-center study, acute ischemic stroke (AIS) patients within 14 days of onset were recruited. Every patient took aspirin 100mg/d during the follow-up period, the aspirin reaction unit (ARU) was detected by the VerifyNow System on the 5-7th day, and serum uric acid (SUA) level was also tested. ARU≥550 is defined as AR. Patients were followed up for 3 years and record ischemic events recurrence in the clinical database we built (including transient ischemic attack, ischemic stroke recurrence, major adverse cardiovascular events, and vascular composite death). Results: A total of 138 patients with newly ischemic stroke were recruited in this study, of which 27 were AR and 14 were hyperuricemia. A total of 119 patients completed 3-year follow up, among which 32 patients experienced at least one endpoint, 23 patients had aspirin resistance, and 12 patients had hyperuricemia. Among these 32 patients, no one had hyperuricemia. In the univariate analysis, hyperuricemia was significantly associated with no ischemic events (p=0.035); the incidence of AR was significantly associated with recurrent ischemic events (p=0.012); hyperuricemia has no association with AR (p=0.457). Conclusions: Hyperuricemia might be a protective factor in patients with AIS, and AR has a significant association with ischemic events recurrence which is not associated with hyperuricemia.

Differences in physical function and metabolic syndrome risk factors according to the level of physical activity in elderly Korean men: a pilot study

2020 ◽  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Metabolic Syndrome ◽  
Physical Function ◽  
Vigorous Physical Activity ◽  
Density Lipoprotein ◽  
The Elderly ◽  
Berg Balance Scale ◽  
Lower Percentage ◽  
Mineral Density

Background and objective: Managing the decrease in physical function in the elderly is a major task in aging societies globally. Here, we aimed to compare the physical function and metabolic syndrome (MetS) risk factors according to levels of physical activity (PA). Material and methods: We measured PA in 77 elderly Korean men (74.21 ± 6.26 years old) with an accelerometer and recorded body composition, physical function, and MetS-related risk factors. Participants were divided into three groups based on daily moderate-vigorous physical activity (MVPA): low (under 60 min), middle (60-120 min), and high (over 120 min). The groups were compared using a one-way analysis of variance and the Scheffe post hoc test. Odds ratios (OR) were calculated by logistic regression analysis. Results: Significant differences were found between the groups for sedentary behavior time (P < 0.001), light PA (P < 0.05), moderate PA (P < 0.001), vigorous PA (P < 0.05), and total energy expenditure (P < 0.001). The high PA group showed a significantly lower percentage of body fat and fat mass and higher muscle mass than did the low and middle PA groups (P < 0.05). The 6-min walk test was significantly better in the high PA group than in the low and middle PA groups (P < 0.05). Grip strength and the Berg balance scale were also significantly better in the high PA group (P < 0.05). Bone mineral density (BMD) and high-density lipoprotein cholesterol (HDL-C) were significantly higher in the high PA group than in the low PA group (P < 0.05). Systolic blood pressure (SBP) was significantly higher in the middle PA group than in the low PA group (P < 0.05). Participants with more than three MetS criteria showed an OR of 0.09 (95% confidence interval 0.01-0.82) in the high PA group as compared with the low PA group (P < 0.05). Conclusions: Moderate-vigorous physical activity of more than 120 min daily showed better physical function and lower OR of MetS than did lower MVPA levels in elderly Korean men.

scholarly journals In-hospital recurrence in a Chinese large cohort with acute ischemic stroke

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Fan Yu ◽  
Xiaolu Liu ◽  
Qiong Yang ◽  
Yu Fu ◽  
Dongsheng Fan
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Recurrent Events ◽  
Early Stage ◽  
High Rate ◽  
Large Artery ◽  
Stroke Event

Abstract Acute ischemic stroke (AIS) has a high risk of recurrence, particularly in the early stage. The purpose of this study was to assess the frequency and risk factors of in-hospital recurrence in patients with AIS in China. A retrospective analysis was performed of all of the patients with new-onset AIS who were hospitalized in the past three years. Recurrence was defined as a new stroke event, with an interval between the primary and recurrent events greater than 24 hours; other potential causes of neurological deterioration were excluded. The risk factors for recurrence were analyzed using univariate and logistic regression analyses. A total of 1,021 patients were included in this study with a median length of stay of 14 days (interquartile range,11–18). In-hospital recurrence occurred in 58 cases (5.68%), primarily during the first five days of hospitalization. In-hospital recurrence significantly prolonged the hospital stay (P < 0.001), and the in-hospital mortality was also significantly increased (P = 0.006). The independent risk factors for in-hospital recurrence included large artery atherosclerosis, urinary or respiratory infection and abnormal blood glucose, whereas recurrence was less likely to occur in the patients with aphasia. Our study showed that the patients with AIS had a high rate of in-hospital recurrence, and the recurrence mainly occurred in the first five days of the hospital stay. In-hospital recurrence resulted in a prolonged hospital stay and a higher in-hospital mortality rate.

scholarly journals Vascular risk factors and incident late-life depression in a Korean population

2006 ◽  
Vol 189 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Jae-Min Kim ◽  
Robert Stewart ◽  
Sung-Wan Kim ◽  
Su-Jin Yang ◽  
Il-Seon Shin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Function ◽  
Density Lipoprotein ◽  
Late Life ◽  
Diagnostic Interview ◽  
Affective States ◽  
Late Life Depression ◽  
Lower Baseline ◽  
Vascular Status

BackgroundCausal relationships between vascular factors and late-life depression are controversial.AimsTo investigate prospective associations between risk factors for vascular disease and incidence of late-life depression.MethodOf 661 community participants aged 65 years or over, without depression at baseline, 521 (79%) were re-evaluated 2 years later. At baseline and follow-up, a diagnostic interview for depression was carried out and information on vascular status, disability and cognitive function was gathered.ResultsPre-existing heart disease, incident stroke and lower baseline high-density lipoprotein cholesterol level were significantly associated with incidence of late-life depression, independently of disability and cognitive function.ConclusionsThese results provide some support for a vascular aetiology of late-life depression. However, important risk factors for cerebrovascular disease such as hypertension and diabetes were not implicated, and the associations with lipid levels might still be explained by affective states earlier in life.

scholarly journals A Mendelian randomization analysis of the relationship between cardioembolic risk factors and ischemic stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Danyang Tian ◽  
Linjing Zhang ◽  
Zhenhuang Zhuang ◽  
Tao Huang ◽  
Dongsheng Fan
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Mendelian Randomization ◽  
P Wave ◽  
Cardioembolic Stroke ◽  
Large Artery ◽  
Weighted Analysis ◽  
Inverse Variance ◽  
Weighted Median ◽  
Genetically Determined

AbstractObservational studies have shown that several risk factors are associated with cardioembolic stroke. However, whether such associations reflect causality remains unknown. We aimed to determine whether established and provisional cardioembolic risk factors are causally associated with cardioembolic stroke. Genetic instruments for atrial fibrillation (AF), myocardial infarction (MI), electrocardiogram (ECG) indices and N-terminal pro-brain natriuretic peptide (NT-pro BNP) were obtained from large genetic consortiums. Summarized data of ischemic stroke and its subtypes were extracted from the MEGASTROKE consortium. Causal estimates were calculated by applying inverse-variance weighted analysis, weighted median analysis, simple median analysis and Mendelian randomization (MR)-Egger regression. Genetically predicted AF was significantly associated with higher odds of ischemic stroke (odds ratio (OR): 1.20, 95% confidence intervals (CI): 1.16–1.24, P = 6.53 × 10–30) and cardioembolic stroke (OR: 1.95, 95% CI: 1.85–2.06, P = 8.81 × 10–125). Suggestive associations were found between genetically determined resting heart rate and higher odds of ischemic stroke (OR: 1.01, 95% CI: 1.00–1.02, P = 0.005), large-artery atherosclerotic stroke (OR: 1.02, 95% CI: 1.00–1.04, P = 0.026) and cardioembolic stroke (OR: 1.02, 95% CI: 1.00–1.04, P = 0.028). There was no causal association of P‐wave terminal force in the precordial lead V1 (PTFVI), P-wave duration (PWD), NT-pro BNP or PR interval with ischemic stroke or any subtype.

scholarly journals Association between physical exercise and stroke recurrence among first-ever ischemic stroke survivors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lisha Hou ◽  
Mier Li ◽  
Ju Wang ◽  
Yawen Li ◽  
Qianwen Zheng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Exercise Duration ◽  
Stroke Recurrence ◽  
Stroke Survivors ◽  
Face To Face ◽  
Baseline Information ◽  
Exercise Type ◽  
The Relationship

AbstractThe relationship between exercise and stroke recurrence is controversial. This study was designed to test whether an association exists between exercise and ischemic stroke recurrence in first-ever ischemic stroke survivors. Data were collected from January 2010 to June 2016. Baseline information was obtained during face-to-face interviews, and follow-up phone interviews were conducted every 3 months. Exercise type, frequency, intensity, and duration were recorded. Discrete-time survival analysis was used to determine the relationship between exercise and stroke recurrence. 760 first-ever ischemic stroke survivors who were able to exercise were enrolled. After adjusting for covariates, patients who exercised 3.5–7 h per week and more than 7 h per week had a lower relapse risk than patients who did not exercise (3.5–7: OR 0.415; > 7: OR 0.356). Moreover, if the fluctuation of exercise duration was over 4 h, the patients had a higher risk of stroke recurrence than those with variability of less than 2 h (OR 2.153, P = 0.013). Stroke survivors who engage in long-term regular mild exercise (more than 5 sessions per week and lasting on average 40 min per session) have a lower recurrence rate. Irregular exercise increases the risk of stroke recurrence.

Patient Demographics, Characteristics, and Intrahospital Mortality of Different Ischemic Stroke Subtypes in a Tertiary Hospital during Five-Year Period

2021 ◽  
Vol 6 (1) ◽  
pp. 6
Author(s):  
Sintija Strautmane ◽  
Kristaps Jurjāns ◽  
Estere Zeltiņa ◽  
Evija Miglāne ◽  
Andrejs Millers
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Reperfusion Therapy ◽  
Cardioembolic Stroke ◽  
Study Group ◽  
Large Artery ◽  
Patient Demographics ◽  
Stroke Subtypes ◽  
Female Predominance ◽  
Study Population

Background and Objectives. Ischemic stroke (IS) is one of the leading causes of disability, morbidity, and mortality worldwide. The goal of the study was to evaluate patient demographics, characteristics, and intrahospital mortality among different ischemic stroke subtypes. Materials and Methods. A retrospective observational non-randomized study was conducted, including only ischemic stroke patients, admitted to Pauls Stradins Clinical university hospital, Riga, Latvia, from January of 2016 until December 2020. Ischemic stroke subtypes were determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria as a stroke due to (1) large-artery atherosclerosis (atherothrombotic stroke (AS)), (2) cardioembolism (cardioembolic stroke (CS)), (3) small-vessel occlusion (lacunar stroke (LS)), (4) stroke of other determined etiology (other specified stroke (OSS)), and (5) stroke of undetermined etiology (undetermined stroke (US)). The data between different stroke subtypes were compared. Results. There was a slight female predominance among our study population, as 2673 (56.2%) patients were females. In our study group, the most common IS subtypes were cardioembolic stroke (CS), 2252 (47.4%), and atherothrombotic stroke (AS), 1304 (27.4%). CS patients were significantly more severely disabled on admission, 1828 (81.4%), and on discharge, 378 (16.8%), p < 0.05. Moreover, patients with CS demonstrated the highest rate of comorbidities and risk factors. This was also statistically significant, p < 0.05. Differences between the total patient count with no atrial fibrillation (AF), paroxysmal AF, permanent AF, and different IS subtypes among our study population demonstrated not only statistical significance but also a strong association, Cramer’s V = 0.53. The majority of patients in our study group were treated conservatively, 3389 (71.3%). Reperfusion therapy was significantly more often performed among CS patients, 770 (34.2%), p < 0.05. The overall intrahospital mortality among our study population was 570 (12.0%), with the highest intrahospital mortality rate noted among CS patients, 378 (66.3%), p < 0.05. No statistically significant difference was observed between acute myocardial infarction and adiposity, p > 0.05. Conclusions. In our study, CS and AS were the most common IS subtypes. CS patients were significantly older with slight female predominance. CS patients demonstrated the greatest disability, risk factors, comorbidities, reperfusion therapy, and intrahospital mortality.

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