scholarly journals Cognition, Statins, and Cholesterol in Elderly Ischemic Stroke Patients: A Neurologist’s Perspective

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 616
Author(s):  
Anamaria Jurcau ◽  
Aurel Simion
Keyword(s):  
Ischemic Stroke ◽  
Ldl Cholesterol ◽  
Neuropsychological Testing ◽  
Cognitively Impaired ◽  
Stroke Patients ◽  
Cognitive Differences ◽  
Reductase Inhibitors ◽  
Cholesterol Levels ◽  
Recall Memory ◽  
The Relationship

Background and Objectives: The efficacy of hydroxy methyl glutaryl-coenzyme A reductase inhibitors (statins) in reducing the incidence of cardiovascular events pushed the target LDL-cholesterol (LDL-C) levels lower and lower in successive guidelines despite signals regarding potential cognitive side effects. We evaluated the relationship between cognitive impairment and LDL-C levels in elderly ischemic stroke patients. Materials and Methods: 29 ischemic stroke patients aged 65 and above with LDL-C levels ≤70 mg/dL, classified according to the TOAST criteria, underwent detailed neuropsychological testing comprising the MMSE test, Montreal Cognitive Assessment (MoCA) and Addenbrooke’s Cognitive Evaluation (ACE-III) test. Their performances were compared to those of 29 age-matched ischemic stroke patients with LDL-Cl levels >71 mg/dL. Results: The MMSE test failed to detect significant cognitive differences between the two groups. The MoCA and ACE-III tests detected impairments in visuo-spatial/executive function, attention, and recall/memory in patients with low LDL-C. A stepwise linear regression model of the ACE-III total scores revealed that LDL-cholesterol levels could contribute to 13.8% of the detected cognitive dysfunction, second in importance only to age, which contributed to 38.8% of the detected impairment. Conclusions: Physicians should be cautious when prescribing statins to elderly people. Hydrophilic ones may be preferred in cognitively impaired patients.

Low-density lipoprotein cholesterol lowering for the prevention of cardiovascular outcomes in patients with ischemic stroke

2019 ◽  
Vol 14 (5) ◽  
pp. 476-482 ◽  
Author(s):  
George Ntaios ◽  
Haralampos Milionis
Keyword(s):  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Statin Treatment ◽  
Cardiovascular Outcomes ◽  
Stroke Patients ◽  
Pcsk9 Inhibitors ◽  
Cholesterol Levels

Background Low-density lipoprotein (LDL) cholesterol has been long associated with the risk for ischemic stroke, myocardial infarction, and cardiovascular death. For more than a decade, the main pharmacological option to prevent stroke and myocardial infarction through LDL-cholesterol lowering was the use of statins. During the recent years, two novel classes of drugs have proven their efficacy and safety to reduce LDL-cholesterol and prevent cardiovascular events in large, well-conducted randomized controlled trials: ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Aims The present review summarizes the evidence arising from the latest trials of lipid-lowering treatment for cardiovascular outcomes prevention and discusses their implications for secondary prevention strategies in patients with ischemic stroke. Summary of review There is strong evidence which confirms the hypothesis that the lower the LDL-cholesterol, the less frequent the cardiovascular events are and underlines the importance of treating our ischemic stroke patients with intensive statin treatment aiming at low LDL-cholesterol levels. The very low levels of LDL cholesterol seem to be safe, even in the mid/long term but longer follow-up data are needed. Currently there are no tools to reliably predict cardiovascular outcomes in the specific population of ischemic stroke patients. Conclusions Stroke physicians should aim for low LDL-cholesterol levels by intensive statin treatment in all ischemic stroke patients. For those patients who are at the highest risk for recurrent stroke or another cardiovascular event and have unacceptable LDL-cholesterol levels despite intensive statin treatment, PCSK9 inhibitors should be considered.

Pre-Admission CHADS2 and CHA2DS2-VASc Scores on Early Neurological Worsening

2021 ◽  
pp. 1-8
Author(s):  
Ki-Woong Nam ◽  
Chi Kyung Kim ◽  
Sungwook Yu ◽  
Jong-Won Chung ◽  
Oh Young Bang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Risk ◽  
Multivariable Analysis ◽  
National Institutes Of Health ◽  
Risk Scores ◽  
Stroke Patients ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Close Relationship ◽  
The Relationship

<b><i>Background:</i></b> Stroke risk scores (CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. <b><i>Objective:</i></b> The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. <b><i>Methods:</i></b> We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. <b><i>Results:</i></b> A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA<sub>2</sub>DS<sub>2</sub>-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04–1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA<sub>2</sub>DS<sub>2</sub>-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA<sub>2</sub>DS<sub>2</sub>-VASc (aOR = 1.20, 95% CI = 1.04–1.38) and CHADS<sub>2</sub> scores (aOR = 1.24, 95% CI = 1.01–1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. <b><i>Conclusions:</i></b> High CHA<sub>2</sub>DS<sub>2</sub>-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.

The Relationship Between Updated Sydney System Score and LDL Cholesterol Levels in Patients Infected with Helicobacter pylori

2008 ◽  
Vol 54 (3) ◽  
pp. 604-607 ◽  
Author(s):  
Metin Kucukazman ◽  
Bunyamin Yavuz ◽  
Muhammed Sacikara ◽  
Zeliha Asilturk ◽  
Naim Ata ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Ldl Cholesterol ◽  
Cholesterol Levels ◽  
Sydney System ◽  
Updated Sydney System ◽  
The Relationship

Abstract 90: Socioeconomic Status Is Associated With Disability Following Acute Ischemic Stroke: Findings From The Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) Registry

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Janet Prvu Bettger ◽  
Xin Zhao ◽  
Cheryl Bushnell ◽  
Louise Zimmer ◽  
Ying Xian ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Ischemic Stroke ◽  
Household Income ◽  
Work Status ◽  
Stroke Patients ◽  
Level Of Education ◽  
Post Stroke ◽  
Relationship Of ◽  
The Relationship ◽  
Education Work

Background: Socioeconomic status (SES) is widely recognized as an area of inequity that affects health outcomes. However, social determinants of health are less frequently measured in longitudinal studies of acute stroke patients. The relationship of SES on disability 3-months post-stroke is unknown. Methods: We analyzed ischemic stroke patients in the AVAIL registry who were enrolled at 98 hospitals participating in Get With The Guidelines-Stroke. Patients who died (n=64) or did not complete a modified Rankin Scale (mRS) at 3-months (n=154) were excluded. Multivariable logistic regression was used to examine the relationship of SES (defined by level of education, work status, and perceived adequacy of household income to meet needs) and disability (mRS scores 3-5). Results: Among the 2092 stroke patients who met eligibility criteria, the mean age was 65.5 ± 13.7, 44.2% were female, and 82.7% were White. Fifty seven percent had a high school or less education, 11.4% were not working post-stroke and were home not by choice, and 25.7% were without an adequate household income. A third of the sample had some level of disability at 3-months (34.6% mRS 3-5). Those with disability were more likely to be older, non-White, female, single, less educated, have inadequate income, and were home not by choice. In the multivariable analysis, lower education, inadequate income, and being home but not by choice (compared with those who returned to work) were independently associated with disability (p<0.01; Table ). Conclusion: In this national cohort of stroke survivors, socioeconomic status as measured by level of education, work status, and income were independently associated with post-stroke disability.

scholarly journals The relationship between aortic stiffness and changes in retinal microvessels among Asian ischemic stroke patients

2011 ◽  
Vol 26 (12) ◽  
pp. 716-722 ◽  
Author(s):  
D A De Silva ◽  
◽  
F-P Woon ◽  
J J F Manzano ◽  
E Y Liu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Aortic Stiffness ◽  
Stroke Patients ◽  
The Relationship

Abstract WP190: Excessive Daytime Sleepiness and Depression in Stroke Survivors

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Quynh Huong Pham ◽  
Anjail Sharrief ◽  
Sean Savitz ◽  
Amrou Sarraj ◽  
Lauren Fournier ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Severe Depression ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Patient Health ◽  
Post Stroke Depression ◽  
The Relationship ◽  
Concentration Table

Introduction: Excessive daytime sleepiness (EDS) and post-stroke depression (PSD) are risk factors for stroke morbidity and mortality. EDS is commonly seen after stroke, but is not routinely assessed after stroke. EDS may be related to sleep disordered breathing (SDB) including obstructive and central sleep apneas, but can also occur in the absence of SDB. The relationship between EDS and PSD is not well understood. Hypothesis: We sought to assess the association between EDS and PSD. We hypothesized that patients with EDS are more likely to demonstrate symptoms of moderate to severe depression compared to patients without EDS. Methods: We identified ischemic stroke patients from the outpatient clinic registry (06/2014 - 10/2015). We screened for depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9; range 0-27, higher worse), and for EDS using the Epworth Sleepiness Scale (ESS; range 0-24, higher worse). Univariate and multivariate analyses were used to evaluate association between EDS and PHQ-9 (moderate to severe depression = PHQ-9 > 9). Regression analysis was also used to evaluate association between EDS and symptoms included in the PHQ-9. Results: Among 200 ischemic stroke patients, 166 completed ESS and PHQ-9 within 90 days of stroke occurrence. Mean age was 61.5 and 54.8% were male. EDS (ESS>9) and moderate to severe depression were each present in 28.9% of patients. Patients with EDS had 3.5 times odds of moderate to severe depression compared to patients without EDS (table 1). Moreover, EDS was associated with higher odds of anhedonia, impaired mood, sleep disturbance, low energy, poor appetite, and impaired concentration (table 1). Conclusion: The presence of EDS is associated with moderate to severe depression in stroke survivors. This is not related solely to SDB symptoms. Patients with fatigue and EDS should be screened for depression. Future studies are also needed to explore the role that SDB plays in this relationship.

scholarly journals Life-Long Physical Activity Involvement and the Risk of Ischemic Stroke in Southern China

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Andy H. Lee ◽  
Wenbin Liang
Keyword(s):  
Physical Activity ◽  
Ischemic Stroke ◽  
Southern China ◽  
Stroke Patients ◽  
Activity Involvement ◽  
Major Chronic Disease ◽  
Ischemic Stroke Risk ◽  
The Life Course ◽  
The Relationship ◽  
Control Study

A case-control study was conducted in southern China to investigate the relationship between life-long physical activity involvement and the risk of ischemic stroke. Information on life-long physical activity exposure and other lifestyle characteristics was obtained from 374 incident stroke patients and 464 hospital-based controls using a validated and reliable questionnaire. Logistic regression analyses were performed to assess the association between life-long physical activity involvement and the ischemic stroke risk. The control subjects reported more involvement in physical activity over the life course than the stroke patients (). The risk of ischemic stroke was inversely associated with life-long physical activity exposure, with adjusted odds ratio 0.39 (95% confidence interval 0.25 to 0.59) for participants who had always been involved relative to those who have never been much involved. The dose-response relationship was also significant (). Therefore, being active life long should be encouraged to prevent this major chronic disease.

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