Evaluation of epidemiologic data, concomitant cardiovascular risk factors, treatment strategies and the current atrial fibrillation registry: RealiseAF

Author(s):  
Erdem Diker
Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Karen C Albright ◽  
Amelia K Boehme ◽  
Bisakha Sen ◽  
Monica Aswani ◽  
Michael T Mullen ◽  
...  

Background: Prior studies have shown that women present with more severe stroke. It has been suggested that sex differences in stroke severity are related to age, stroke subtype, or cardiovascular risk factors. We aimed to determine the proportion of sex disparity in stroke severity that can be explained by differences in these variables using Oaxaca decomposition, an econometric technique which quantifies the differences between groups. Methods: White and Black ischemic stroke patients who presented to two academic medical centers in the US (2004-2011) were identified using prospective stroke registries. In-hospital strokes were excluded. Patient demographics and medical history were collected. Stroke severity was measured by NIHSS. Linear regression was used to determine if female sex was associated with NIHSS score. This model was then adjusted for potential confounders including: age, race, stroke subtype, and cardiovascular risk factors. Oaxaca decomposition was then used to determine the proportion of the observed sex differences in stroke severity that can be explained by these variables. Results: 4925 patients met inclusion criteria. Nearly half (n=2346) were women and 39% (n=1942) were Black. Women presented with more severe strokes (median NIHSS 8 vs. 6). In addition, women were older on average (68 vs. 63 years) with more frequent atrial fibrillation (18% vs. 13%), diabetes (34% vs. 30%), and hypertension (78% vs. 72%). Oaxaca decomposition revealed that age, race, atrial fibrillation, large vessel etiology, diabetes, hypertension account for only 63% of the sex differences seen in NIHSS score on presentation. Conclusion: In our biracial sample, women presented with more severe strokes than men. This difference remained significant even after adjustment for age, stroke subtype, and cardiovascular risk factors. Further, over 1/3 of the observed gender difference in stroke severity was unexplained.. Additional study is warranted to investigate the etiology of the gender differences in stroke severity.


Heart & Lung ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 393-397 ◽  
Author(s):  
Jay Shah ◽  
Ashish Kumar ◽  
Monil Majmundar ◽  
Devina Adalja ◽  
Abhi Doshi ◽  
...  

2008 ◽  
Vol 66 (3a) ◽  
pp. 454-457 ◽  
Author(s):  
Alexandre Pieri ◽  
Mariana Spitz ◽  
Tania Oliveira Lopes ◽  
Claudia Garcia de Barros ◽  
Marcelo Wood Faulhaber ◽  
...  

INTRODUCTION: An ischemic stroke is usually a catastrophic event, mostly in the elderly. Cardiovascular involvement is the leading cause of ischemic stroke in this age population and hence the knowledge about its risk factors is important for the definition of specific policies of prevention. PURPOSE: To evaluate the prevalence of cardiovascular risk factors in patients with age equal to or above 80 in a hospital population with ischemic stroke. METHOD: Retrospective study of consecutive patients diagnosed with ischemic stroke admitted to a tertiary health facility. RESULTS: From September 2004 to March 2006, 215 patients were studied. There was a female preponderance (p<0.01). Among patients over eighty, 72% had hypertension and atrial fibrillation was more common among the oldest old (p<0.01). CONCLUSION: Hypertension and atrial fibrillation should be treated aggressively in the elderly. Anticoagulants should be considered more often in these patients.


BMJ ◽  
2012 ◽  
Vol 344 (mar27 2) ◽  
pp. e2259-e2259 ◽  
Author(s):  
J. Hippisley-Cox ◽  
C. Coupland ◽  
J. Robson ◽  
P. Brindle

CNS Spectrums ◽  
2003 ◽  
Vol 8 (11) ◽  
pp. 824-831 ◽  
Author(s):  
Ramit Ravona-Springer ◽  
Michael Davidson ◽  
Shlomo Noy

ABSTRACTThe distinction between Alzheimer's disease and vascular dementia, the two most common types of dementia, has been undermined by recent advances in epidemiologic, clinical, imaging, and neuropathological studies. Cardiovascular risk factors, traditionally regarded as distinguishing criteria between the two entities, have been shown to be associated with both AD and vascular dementia. In this article, we propose mechanisms of action of cardiovascular risk factors in AD, suggest possible explanations for the overlap with vascular dementia and discuss the implications this might have on future differential diagnosis, research, and treatment strategies.


Author(s):  
Wendy Wang ◽  
Faye L. Norby ◽  
Michael J. Zhang ◽  
Jorge L. Reyes ◽  
Amil M. Shah ◽  
...  

Background Black Americans have more atrial fibrillation risk factors but lower atrial fibrillation risk than White Americans. Left atrial (LA) enlargement and/or dysfunction, frequent atrial tachycardia (AT), and premature atrial contractions (PAC) are associated with increased atrial fibrillation risk. Racial differences in these factors may exist that could explain the difference in atrial fibrillation risk. Methods and Results We included 2133 ARIC (Atherosclerosis Risk in Communities) study participants (aged 74±4.5 years[mean±SD], 59% women, 27% Black participants) who had echocardiograms in 2011 to 2013 and wore the Zio XT Patch (a 2‐week continuous heart monitor) in 2016 to 2017. Linear regression was used to analyze (1) differences in AT/day or PAC/hour between Black and White participants, (2) differences in LA measures between Black and White participants, and (3) racial differences in the association of LA measures with AT or PAC frequency. Compared with White participants, Black participants had a higher prevalence of cardiovascular risk factors and disease, lower AT frequency, greater LA size, and lower LA function. After multivariable adjustments, Black participants had 37% (95% CI, 24%–47%) fewer AT runs/day than White participants. No difference in PAC between races was noted. Greater LA size and reduced LA function are associated with more AT and PAC runs; however, no race interaction was present. Conclusions Differences in LA measures are unlikely to explain the difference in atrial fibrillation risk between Black and White individuals. Despite more cardiovascular risk factors and greater atrial remodeling, Black participants have lower AT frequency than White participants. Future research is needed to elucidate the protective mechanisms that confer resilience to atrial arrhythmias in Black individuals.


2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
B Igual Munoz ◽  
E S L C Elena Sanchez Lacuesta ◽  
J L D G Jose Luis Diez Gil ◽  
M F V Maria Ferre Valverdu ◽  
F T M Francisco Ten Morro ◽  
...  

Abstract Intramyocardial hemorrhage (IMH) is considered a marker of tissue damage severity in patients with reperfused ST-segment elevation myocardial infarction (STEMI) and has been associated with a poor prognosis despite successful revascularization of the culprit artery . We aim to study the impact of cardiovascular risk factors and treatment strategies on the presence of IMH studied with T2* -w cardiovascular magnetic resonance (CMR) in this clinical setting METHODS A prospective observational study including patients with repefused STEMI who underwent an MRI during the first week post-revascularization were conducted . The presence of IMH was analyzed in ECG triggered T2 * w sequences as presence of hipointensity area . Clinical data including cardiovascular risk factors and treatment strategies at cath lab were studied. RESULTS 94 patients with reperfused STEMI were included. Demographic data are shown at the the table. No significant association was observed between the presence of IMH and the different treatment strategies used. All data were introduced in a multivariate model including presence of thrombus, total ischemia time and culprit coronary artery. The analysis showed previous infarction as an independent risk factor (OR: 6 p = 0.03, CI: 1.1-29) while history of hypertension (OR: 0.9, p = 0.04, CI: 0.1- 0.9) and systolic blood pressure showed independent protective effect (OR: 0.3 p = 0.02 IC: 0.9-0.99.) CONCLUSIONS. 1. Previous infarction was shown to be an independent risk factor for IMH . 2. Arterial hypertension and systolic blood pressure showed a protective effect. Age (years) 62 ±13 Male sex 72 (77) Diabetes mellitus 32 (34) Hypertension 53 (56) Hyperlipidaemia 52 (55) Current or prior smoking 55 (58) Time to reperfusion 203 (142-300) Infarct-related artery LAD 38 (41) RCA 49 (52) Cx 7 (7) Infarct size (% LV mass) 18 ± 11 MO (% LV mass) 3.15 (1.44-5.48) Abstract P824 Figure. Intramyocardial hemorraghe T2* sequences


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