AHA: GLP-1 RA, SGLT-2i Use Can Lower Risk for MI, Recurrent Stroke in Stroke Survivors
For patients with ischemic stroke, sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with reduced mortality, myocardial infarction (MI), and recurrent stroke, according to a study presented at the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.
Mohammad Ali Sheffeh, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues examined the efficacy of GLP-1 RA or SGLT-2i initiation for reducing mortality or cardiovascular events among adults with ischemic stroke. Data were included for 7,044 individuals (mean age, 72 ± 14 years).
The researchers found that 6 percent of the participants had a second stroke, 6 percent had an incident MI, and 53 percent died during a median follow-up of three years. In the univariate analysis, those on an SGLT-2i/GLP-1 RA had a reduced risk for mortality, incident MI, and composite. After multivariable adjustment, these associations remained significant and were not affected by minimum time of exposure. In the multivariate analysis, SGLT-2i/GLP-1 RA use was also associated with recurrent ischemic stroke. In most sub-analyses of individual medications, all associations remained significant, except for the association between GLP-1 RA and recurrent stroke.
"The results of the study are consistent with other research about the preventive role of these medications against cardiovascular disease in people with obesity or heart failure," Sheffeh said in a statement.
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Get With The Guidelines-Stroke Participation Has Improved Stroke Care
For patients with stroke and transient ischemic attack, The Get With The Guidelines-Stroke participation is associated with sustained improvement in care and outcomes, according to a study published online Oct. 21 in Stroke.
Ying Xian, M.D., Ph.D., from UT Southwestern Medical Center in Dallas, and colleagues examined patient characteristics, adherence to performance measures, and in-hospital outcomes in patients hospitalized with stroke in The Get With The Guidelines-Stroke hospitals from 2003 to 2022. Temporal changes in performance measure adherence and clinical outcomes were quantified over time.
A total of 7,837,849 stroke cases were entered into the registry during the 20 years of the program: 69.2 percent ischemic strokes, 3.9 percent subarachnoid hemorrhages, 11.5 percent intracerebral hemorrhages, and 15.3 percent transient ischemic attacks. The researchers found significantly sustained improvements in all performance metrics except for antithrombotics at discharge (baseline performance >92 percent), regardless of type of cerebrovascular event. Independent of patient and hospital characteristics for each type of cerebrovascular event, there was a sustained increase in odds of receiving each performance measure over time in a multivariable analysis. There were temporal trends that patients were less likely to be discharged to a skilled nursing facility after risk adjustment; for ischemic stroke only, they were more likely to be discharged directly home.
"These findings provide compelling evidence to support continuous efforts in improving stroke care and outcomes in the United States and globally," the authors write.
Several authors disclosed ties to the pharmaceutical industry; The Get With The Guidelines-Stroke program is sponsored by pharmaceutical companies.
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Risk for Most Cardiovascular Events Reduced After COVID-19 Vaccination
COVID-19 vaccination is associated with a reduced risk for most cardiovascular events, but with slightly increased risks of extrasystoles and transient ischemic attack, as well as myocarditis and pericarditis after mRNA vaccination, according to a study published online Sept. 30 in the European Heart Journal.
Yiyi Xu, Ph.D., from the University of Gothenburg in Sweden, and colleagues examined the risks for several cardiovascular and cerebrovascular events in a nationwide register-based cohort (8,070,674 Swedish adults). The postvaccination risk for myocarditis/pericarditis, dysrhythmias, heart failure, myocardial infarction, and cerebrovascular events (transient ischemic attack and stroke) was examined in several risk windows after each vaccine dose.
The researchers found reduced risks for cardiovascular events postvaccination for most of the studied outcomes, especially after dose 3 (hazard ratios ranging from 0.69 to 0.81), while the risks for myocarditis and pericarditis were increased one to two weeks after COVID-19 mRNA vaccination. Across vaccines, similar slightly increased risks were seen for extrasystoles (hazard ratios, 1.17 and 1.22 for doses 1 and 2, respectively, which were stronger in the elderly and males), but not for arrhythmias, and for transient ischemic attack (hazard ratio, 1.13, mainly in elderly), but not for stroke.
"We found decreased risks of several serious cardiovascular outcomes after COVID-19 vaccination, likely related to the protection of vaccination against severe COVID-19," the authors write. "Overall, our results clearly underscore the protective benefits of complete vaccination, especially for elderlies."
Several authors disclosed ties to pharmaceutical companies, including AstraZeneca and Pfizer.
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Risk for Stroke, TIA Increased in Adults With Sickle Cell Disease
Adults with sickle cell disease (SCD) have an increased risk for stroke and transient ischemic attack (TIA), according to a study published online Sept. 20 in Blood.
Olubusola Oluwole, M.D., from the University of Pittsburgh, and colleagues determined the cumulative incidence and rates for primary and recurrent strokes and TIAs in people with SCD before and after the STOP trial of 1998, which established chronic transfusions as the standard of care for children with SCD at high risk for stroke. The cohort included 7,636 patients with SCD.
The researchers found that the cumulative incidence was 2.1 and 13.5 percent for first ischemic stroke by age 20 years and by age 60 years, respectively. The corresponding cumulative incidence for first intracranial hemorrhage was 0.5 and 6.8 percent, respectively. Compared with the preceding decade, in 2010 to 2019, there was an increase in ischemic stroke rates in children (younger than 18 years: 234.9 versus 165.1 per 100,000 person-years) and adults (31 to 50 years: 431.1 versus 303.2 per 100,000 person-years). Compared with the previous decade, in 2010 to 2019 the rates of intracranial hemorrhage increased in those aged 18 to 30 years and TIA increased in children younger than 18 years. Older age, hypertension, and hyperlipidemia were risk factors for stroke and TIA.
"As people with SCD live longer, there remains an unmet need to develop guidelines for primary and secondary stroke prevention in adults at highest risk for neurological debility from adverse cerebrovascular events," the authors write.
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Balloon Angioplasty Lowers Risk for Composite Outcome in Intracranial Artery Stenosis
For patients with symptomatic intracranial atherosclerotic stenosis (sICAS), balloon angioplasty plus aggressive medical management is associated with a lower risk for a composite outcome of any stroke or death, according to a study published online Sept. 5 in the Journal of the American Medical Association.
Xuan Sun, M.D., from Capital Medical University in Beijing, and colleagues conducted a randomized clinical trial involving patients aged 35 to 80 years with sICAS, defined as recent transient ischemic attack (<90 days) or ischemic stroke (14 to 90 days). Participants were randomly allocated to submaximal balloon angioplasty plus aggressive medical management or aggressive medical management alone (249 and 252 individuals, respectively).
The researchers found that the incidence of the primary outcome, a composite of any stroke or death within 30 days after enrollment or any ischemic stroke after 30 days through 12 months after enrollment, occurred in 4.4 and 13.5 percent of patients in the balloon angioplasty and medical management groups, respectively (hazard ratio, 0.32). The corresponding rates of any stroke or all-cause death within 30 days were 3.2 and 1.6 percent. The rates of any ischemic stroke in the qualifying artery territory were 0.4 and 7.5 percent, respectively, and revascularization of the qualifying artery occurred in 1.2 and 8.3 percent, respectively, beyond 30 days and through 12 months after enrollment.
"Balloon angioplasty plus aggressive medical management may be an effective treatment for sICAS, although the risk of stroke or death within 30 days of balloon angioplasty should be considered in clinical practice," the authors write.
Several authors disclosed ties to the biopharmaceutical and medical device industries.
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American Stroke Association, Feb. 7-9
The annual International Stroke Conference of the American Heart Association/American Stroke Association was held from Feb. 7 to 9 in Phoenix and drew participants from around the world, including cerebrovascular research and practice experts. The conference featured presentations that emphasized basic, clinical, and translational medicine and provided insight into the prevention, management, and treatment of stroke.
In one study of patients who present with stroke-like symptoms in an acute care setting, Melinda Chang, of the Columbia University Irving Medical Center in New York City, and colleagues found that patients with a final diagnosis of stroke mimic have a three times greater risk for posttraumatic stress disorder (PTSD) at one-month follow-up compared with those with stroke.
The authors evaluated 1,000 patients, who were an average of 62 years of age (51 percent female and 52 percent Hispanic). The PTSD screening tool, the PCL-5, was used to assess preexisting PTSD during the month prior to presentation and again at one-month follow-up, with questions relating to the stroke-like event. The index events were categorized as stroke, transient ischemic attack (TIA), stroke mimic, or equivocal by a stroke neurologist blinded to PTSD status. The researchers found that approximately 15 percent of patients with stroke mimics had PSTD at one month compared with 6.3 percent of patients with stroke and 5.5 percent of patients with TIA. This was after the investigators controlled for age, gender, ethnicity, initial stroke severity, disability status at discharge, and preexisting PTSD. The only covariate that was significantly associated with PTSD at one month was having preexisting PTSD.
"Even when we removed patients with preexisting PSTD from our analysis, the finding still held: Those who did not have a stroke were more at risk for having PTSD one month later," Chang said. "It may be counterintuitive, but clinicians should be aware that those patients with stroke mimics may actually suffer more psychological distress after their stroke-like event compared to patients with stroke."
One author disclosed a financial relationship with Midmark; another author disclosed a relationship with Mighty Health.
In a population-wide study of 180,000 patients with stroke, Raed Joundi, M.D., of McMaster University in Hamilton, Ontario, Canada, and colleagues found that almost one-fifth developed dementia during an average follow-up of 5.5 years. The risk was much higher after stroke than for people in the general population or those who had had a heart attack, after matching for common vascular risk factors, age, and sex.
"Our results confirm the uniquely high risk of dementia after stroke. The study raises the importance of dementia as a common complication after stroke and that we need to find ways to lower the risk of dementia in this population," Joundi said. "The risk of dementia remained elevated even in long-term survivors of stroke (10+ years), suggesting that stroke somehow exerts a long-term effect on dementia risk. Over the entire follow-up, dementia diagnosis was also more common than having another stroke. This was surprising and means we need to pay attention to dementia as a complication of stroke in the short and long term."
Several authors disclosed ties to the pharmaceutical industry.
Kent Simmonds, D.O., Ph.D., of the University of Texas Southwestern Medical Center in Dallas, and colleagues found that antidepressant medications are generally safe for most ischemic stroke patients during the crucial early recovery period.
The authors evaluated the frequency of serious bleeding among stroke survivors who took different types of selective serotonin reuptake inhibitor (SSRI) and/or serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants. They also looked at serious bleeding among stroke survivors who took antidepressants combined with different blood thinners. For most stroke patients with ischemic stroke, the researchers found that antidepressant medications (SSRI and/or SNRI) are safe to use during the crucial early recovery periods. One exception was that an increased bleeding risk was seen among patients started on dual antiplatelet therapy (DAPT) for secondary prevention.
"Clinicians who care for stroke patients in the first few months after a stroke should screen for depression, as recovery after stroke is a time-dependent, nonlinear process which can be negatively affected by depression," Simmonds said. "Our study showed that treatment of depression with SSRIs or SNRIs during this early recovery period appears safe for most patients, including patients on oral anticoagulation medications. However, personalized risk-benefits should be considered among patients on DAPT, as we did see an increased bleed risk among these patients."
ASA: Endovascular Thrombectomy Beneficial for Large Ischemic Stroke
FRIDAY, Feb. 16, 2024 (HealthDay News) -- For patients with acute ischemic stroke and large cores, endovascular thrombectomy improves clinical outcomes compared with medical management, according to a study published online Feb. 7 in the Journal of the American Medical Association to coincide with the annual American Stroke Association International Stroke Conference, held from Feb. 7 to 9 in Phoenix.
ASA: No Drop in Recurrent Stroke Seen With Apixaban After Cryptogenic Stroke
FRIDAY, Feb. 16, 2024 (HealthDay News) -- For patients with recent cryptogenic stroke and evidence of atrial cardiopathy, the risk for recurrent stroke is not reduced with apixaban versus aspirin, according to a study published online Feb. 7 in the Journal of the American Medical Association to coincide with the annual American Stroke Association International Stroke Conference, held from Feb. 7 to 9 in Phoenix.
ASA: Door-to-Treatment Time Tied to Survival in Anticoagulation-Linked ICH
THURSDAY, Feb. 15, 2024 (HealthDay News) -- For patients with anticoagulation-associated intracerebral hemorrhage, earlier door-to-treatment time is associated with improved survival, according to a study published online Feb. 9 in JAMA Neurology to coincide with the annual American Stroke Association International Stroke Conference, held from Feb. 7 to 9 in Phoenix.
ASA: Flat Head Position Before Thrombectomy Tied to Better Neurological Function
THURSDAY, Feb. 15, 2024 (HealthDay News) -- A flat position for a stroke patient's head before surgery may improve neurological function, according to a study presented at the annual American Stroke Association International Stroke Conference, held from Feb. 7 to 9 in Phoenix.
ASA: Embolization of MMA Cuts Risk for Subsequent Subdural Hematoma, Surgery
WEDNESDAY, Feb. 14, 2024 (HealthDay News) -- For patients with symptomatic subacute or chronic subdural hematoma, embolization of the middle meningeal artery as an adjunct to surgery reduces the risk for subsequent subdural hematoma and need for surgical drainage, according to a study presented at the annual American Stroke Association International Stroke Conference, held from Feb. 7 to 9 in Phoenix.
ASA: Adjuvant Methylprednisolone Role Examined in Acute Ischemic Stroke
WEDNESDAY, Feb. 14, 2024 (HealthDay News) -- For patients with acute ischemic stroke secondary to large-vessel occlusion undergoing endovascular thrombectomy, adjuvant low-dose methylprednisolone does not improve the degree of overall disability, according to a study published online Feb. 8 in the Journal of the American Medical Association to coincide with the annual American Stroke Association International Stroke Conference, held from Feb. 7 to 9 in Phoenix.
ASA: Stroke Survivors Face Twofold Higher Risk for MI One Year After Stroke
THURSDAY, Feb. 8, 2024 (HealthDay News) -- Stroke survivors are nearly twofold more likely to have subsequent myocardial infarction compared with patients experiencing cervical artery dissection, according to a study presented at the annual American Stroke Association International Stroke Conference 2024, held from Feb. 7 to 9 in Phoenix.
ASA: Nearly One in Five People Develop Dementia After Stroke
THURSDAY, Feb. 8, 2024 (HealthDay News) -- Almost one-fifth of people develop dementia after stroke, according to a study presented at the American Stroke Association International Stroke Conference 2024, held from Feb. 7 to 9 in Phoenix.
ASA: Vagus Nerve Stimulation + Rehab Boosts Arm, Hand Function in Stroke Survivors
WEDNESDAY, Feb. 7, 2024 (HealthDay News) -- Improvements in arm and hand function with vagus nerve stimulation in combination with rehabilitation are maintained at one-year follow-up in stroke survivors, according to a study presented at the annual American Stroke Association International Stroke Conference, held from Feb. 7 to 9 in Phoenix.
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ASA: Stroke Survivors Face Twofold Higher Risk for MI One Year After Stroke
THURSDAY, Feb. 8, 2024 (HealthDay News) -- Stroke survivors are nearly twofold more likely to have subsequent myocardial infarction (MI) compared with patients experiencing cervical artery dissection (CAD), according to a study presented at the annual American Stroke Association International Stroke Conference 2024, held from Feb. 7 to 9 in Phoenix.
Lukas Strelecky, from Brown University in Providence, Rhode Island, and colleagues utilized a multistate database to examine MI risk poststroke or post-CAD to estimate cardiovascular complication risk. The analysis included 827,761 patients identified from the State Inpatient Database from New York (2011 to 2017) and Florida (2011 to 2019).
The researchers found that 2.39 percent of all patients had MI within one year, including 1.4 percent of the reference group, 3.4 percent with acute ischemic stroke (AIS), 1.5 percent with CAD, and 1.8 percent of those with concurrent AIS and CAD. Patients with AIS alone and patients with concurrent CAD and AIS had a higher MI risk compared with the reference group (hazard ratio [HR], 4.91; 95 percent confidence interval [CI], 4.63 to 5.21 and HR, 1.67; 95 percent CI, 1.02 to 2.73, respectively). Patients with CAD alone had no elevated risk (HR, 1.17; 95 percent CI, 0.66 to 2.06). Patients with AIS alone still had the highest risk for MI (adjusted HR [aHR], 1.87; 95 percent CI, 1.75 to 1.99), followed by patients with concurrent CAD and AIS (aHR, 1.26; 95 percent CI, 1.05 to 1.5) after adjusting for age, diabetes, heart failure, coronary artery disease, and hyperlipidemia. Patients with CAD had a nonsignificant risk in an adjusted analysis (aHR, 1.142; 95 percent CI, 0.82 to 1.58).
“Before, it was just a guess, but now we know that carotid or vertebral artery dissection not causing a stroke does not raise the risk of a heart attack, and it makes sense that clinicians should focus predominantly on stroke prevention in this subgroup of patients,” coauthor Liqi Shu, M.D., also from Brown University, said in a statement.
Several authors disclosed ties to industry.
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ASA: Nearly One in Five People Develop Dementia After Stroke
THURSDAY, Feb. 8, 2024 (HealthDay News) -- Almost one-fifth of people develop dementia after stroke, according to a study presented at the American Stroke Association International Stroke Conference 2024, held from Feb. 7 to 9 in Phoenix.
Raed A. Joundi, M.D., D.Phil., from McMaster University in Hamilton, Ontario, Canada, and colleagues used linked administrative databases to compare risk and time course of dementia among all 90-day survivors of first acute ischemic stroke or intracerebral hemorrhage (ICH) to controls in the general population and with acute myocardial infarction (AMI). The analysis included 180,940 people with acute stroke matched (1:1) on age, sex, rural residence, neighborhood marginalization, and vascular comorbidities and excluded people with prior dementia.
The researchers found that during a mean follow-up of 5.5 years, 33,765 individuals with acute stroke (18.7 percent) developed dementia. The rate of dementia was highest after acute stroke when compared with the general population (3.40 versus 1.88 per 100 person-years) and versus AMI (3.23 versus 1.81 per 100 person-years). Compared with the general population, the overall risk for dementia was higher in those with acute stroke (hazard ratio [HR], 1.79) and particularly after ICH (HR, 2.43). Results were similar compared with AMI (HR, 1.77). In the first year after stroke, there was an almost threefold higher risk for dementia, which decreased to 1.5-fold by five years but remained elevated even 20 years after.
“Our findings reinforce the importance of monitoring people with stroke for cognitive decline, instituting appropriate treatments to address vascular risk factors and prevent recurrent stroke, and encouraging lifestyle changes, such as smoking cessation and increased physical activity, which have many benefits and may reduce the risk of dementia,” Joundi said in a statement.
Several authors disclosed ties to industry.
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Ticagrelor-Acetylsalicylic Acid More Beneficial for Obese With Minor Stroke, TIA
MONDAY, July 10, 2023 (HealthDay News) -- For patients with minor stroke or transient ischemic attack (TIA) who carry the CYP2C19 loss-of-function allele, those with obesity receive more clinical benefit from ticagrelor-acetylsalicylic acid (ASA) than clopidogrel-ASA, according to a study published online July 10 in CMAJ, the journal of the Canadian Medical Association.
Jia Zhang, M.D., from The China National Clinical Research Center for Neurological Diseases in Beijing, and colleagues conducted a randomized, double-blind trial involving patients with minor stroke or TIA who carried the CYP2C19 loss-of-function allele. Participants were randomly assigned to receive ticagrelor-ASA or clopidogrel-ASA. Data were included for 6,412 patients: 876 were classified as obese and 5,536 were classified as nonobese.
The researchers found that among patients with obesity, ticagrelor-ASA was associated with a significantly lower rate of stroke within 90 days compared with clopidogrel-ASA (5.4 versus 11.3 percent; hazard ratio, 0.51; 95 percent confidence interval, 0.30 to 0.87), but not among those without obesity (6.0 versus 7.0 percent; hazard ratio, 0.84; 95 percent confidence interval, 0.69 to 1.04). No differences were seen in the rates of severe or moderate bleeding by body mass index group.
"Body mass index influences the efficacy of ticagrelor-ASA versus clopidogrel-ASA among patients with minor ischemic stroke or TIA who carry a CYP2C19 loss-of-function allele," the authors write. "Clopidogrel appears to lose its efficacy among patients with obesity."
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Incomplete ED Neurovascular Imaging Tied to Higher Odds of 90-Day Stroke
TUESDAY, June 13, 2023 (HealthDay News) -- Emergency department visits for transient ischemic attack (TIA) with incomplete neurovascular imaging are associated with higher odds of subsequent stroke within 90 days, according to a study published online May 31 in the American Journal of Roentgenology.
Vincent M. Timpone, M.D., from the University of Colorado Hospital in Aurora, and colleagues evaluated the association between incomplete neurovascular imaging workup during emergency department encounters for TIA and odds of subsequent stroke. Analysis included 111,417 patients with a TIA diagnosis who underwent brain computed tomography or brain magnetic resonance imaging during or within two days of the encounter identified through the Medicare Standard Analytical Files for calendar years 2016 and 2017.
The researchers found that 37.3 percent of patients had an incomplete neurovascular imaging workup. Within 90 days of the TIA encounter, a new stroke diagnosis occurred in 4.4 percent of patients with complete neurovascular imaging versus 7.0 percent of patients with incomplete neurovascular imaging. When adjusting for patient (age, sex, race and ethnicity, high-risk comorbidities, median county household income) and hospital (region, rurality, number of beds, major teaching hospital designation) characteristics, incomplete neurovascular imaging was associated with increased likelihood of stroke within 90 days (odds ratio, 1.3).
"Increased access to urgent neurovascular imaging in patients with TIA may represent a target that could facilitate detection and treatment of modifiable stroke risk factors," the authors write.
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Adverse Pregnancy Outcomes Increase Stroke Risk at an Earlier Age
TUESDAY, May 30, 2023 (HealthDay News) -- Women who experience an adverse pregnancy outcome (APO) have a higher risk of having a stroke in their lifetime, and at a younger age, according to a study published online May 22 in Stroke.
Eliza C. Miller, M.D., from Columbia University in New York City, and colleagues assessed whether APOs are associated with younger age at first stroke. Analysis included 144,306 Finnish women (316,789 births) who gave birth after 1969, with 17.9 percent having at least one pregnancy with an APO.
The researchers found that women with APOs had more comorbidities, including obesity, hypertension, heart disease, and migraine. APO was associated with lower age at first stroke, with median age at first stroke of 58.3 years for patients with no APO, versus 54.8 years in those with one APO and 51.6 years in those with recurrent APOs. Risk of stroke was greater in women with one APO (adjusted hazard ratio, 1.3) and recurrent APOs (adjusted hazard ratio, 1.4) versus those with no APO when adjusting for sociodemographic characteristics and stroke risk factors. Compared to those without APO, women with recurrent APOs had doubled the stroke risk before age 45 (adjusted odds ratio, 2.1).
"This emphasizes the need for women to share their pregnancy history with their doctors, especially if they experience neurologic symptoms concerning for stroke or transient ischemic attack that tends to resolve within minutes to hours," a author said in a statement.
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Statin Use Cuts Five-Year Stroke Risk for Patients With Atrial Fibrillation
MONDAY, May 15, 2023 (HealthDay News) -- Statin use is associated with a lower risk for incident stroke and transient ischemic attack (TIA) in a duration-dependent manner among patients with atrial fibrillation (AF), according to a study presented at the annual meeting of the European Heart Rhythm Association, held from April 16 to 18 in Barcelona, Spain.
Jiayi Huang, from the University of Hong Kong, and colleagues assessed the association between statin use and AF-related outcomes among patients with AF. The analysis included 51,472 patients with newly diagnosed AF (2010 to 2018) categorized by statin therapy use (11,866 individuals) and statin nonuse (39,606 individuals).
The researchers found that during a median follow-up of 5.1 years, previous statin use was significantly associated with a lower risk for ischemic stroke (IS)/systemic embolism (SE), versus statin nonuse (subdistribution hazard ratio [SHR], 0.83). Similar patterns were seen for the associations between previous statin use and hemorrhagic stroke (HS; SHR, 0.93) and TIA (SHR, 0.85). Statin use of six or more years predicted a lower risk for IS/SE, HS, and TIA (SHRs, 0.57, 0.56, 0.58, respectively) versus short-term statin use (three months to less than two years). In stratified analyses, a lower risk for IS was found to be associated with statin use consistently.
"These data support the use of statins to prevent stroke and transient ischemic attack in patients with new-onset atrial fibrillation," Huang said in a statement. "The findings have important clinical implications particularly given that in atrial fibrillation patients, ischemic strokes are often fatal or disabling, and have a high risk of recurrence."
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Smog Tied to More Cardiovascular Disease-Related Mortality
TUESDAY, April 25, 2023 (HealthDay News) -- "Polish smog" has a significant impact on cardiovascular disease (CVD)-related mortality, according to a study presented at the annual congress of the European Association of Preventive Cardiology, held from April 13 to 15 in Malaga, Spain.
Michal Swieczkowski, M.D., from the Medical University of Bialystok in Poland, and colleagues assessed whether "Polish smog" has an impact on mortality due to CVD. The analysis included 87,990 all-cause deaths (2016 to 2020) from five main cities in Eastern Poland, including 34,907 from CVD, 9,688 from acute coronary syndromes (ACS), and 3,776 from ischemic stroke (IS). Air pollution concentrations were obtained from Voivodeship Inspectorate for Environmental Protection.
The researchers found that a 10-μg/m3 increase in all analyzed air pollutants was associated with an increase in mortality due to CVD on the day of exposure (particulate matter [PM2.5]: odds ratio [OR], 1.034; PM10: OR, 1.033; nitrogen dioxide [NO2]: OR, 1.083). Similar findings were seen with a time lag of one and two days after the polluted day. On the day of pollution, the increased mortality due to higher PM level was due to ACS (PM2.5: OR, 1.029; PM10: OR, 1.015). On day 1 after pollution, increased mortality was due to an increase in both IS (PM2.5: OR, 1.03) and ACS (PM2.5: OR, 1.028; PM10: OR, 1.026; NO2: OR, 1.036). These effects were found to be greater in women and in older adults.
"Our study suggests that to preserve heart health, it is advisable to plan time outdoors around air quality forecasts," Swieczkowski said in a statement. "When staying home is not an option, wearing a mask during peak pollution hours and avoiding areas with heavy traffic should be considered."
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American Stroke Association, Feb. 8-10
The annual International Stroke Conference of the American Heart Association/American Stroke Association was held from Feb. 8 to 10 in Dallas and attracted participants from around the world, including cerebrovascular research and practice experts. The conference featured presentations that emphasized basic, clinical, and translational medicine and provided insight into the prevention, management, and treatment of stroke.
In one study, Naruchorn Kijpaisalratana, M.D., of Massachusetts General Hospital in Boston, and colleagues found that gluconic acid is associated with prevalent hypertension and incident ischemic stroke in Black, but not White, individuals.
Using data from the biracial observational, population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study, the authors measured plasma metabolites at baseline by targeted metabolomics and studied the differential association with hypertension and future risk for ischemic stroke in Black and White individuals. Among 162 metabolites, the researchers found that gluconic acid was associated with prevalent hypertension and incident ischemic stroke in Black, but not White, participants. Gluconic acid mediated 25 percent of the relationship between hypertension and ischemic stroke in Black individuals. Furthermore, the investigators found that socioeconomic and lifestyle factors, including a Southern Diet, lower educational attainment, and lack of exercise, were associated with higher gluconic acid level.
"Gluconic acid may serve as a biomarker for socioeconomic and lifestyle factors," Kijpaisalratana said. "The findings in our study have a potential for future personalized medicine. We envisioned that a metabolite biomarker like gluconic acid could potentially be used as an objective measure to inform health care professionals about how well their patients are doing reducing hypertension and stroke risk and may also be helpful to motivate Black patients to modify their lifestyles as appropriate to prevent stroke."
One author disclosed financial ties to several pharmaceutical companies.
In another study, Lynda D. Lisabeth, Ph.D., of the University of Michigan in Ann Arbor, and colleagues found that a high proportion of stroke survivors report receiving no rehabilitation in the first 90 days following stroke.
The authors evaluated 554 stroke survivors who were identified from a population-based stroke study in South Texas during a two-year period, including 66 percent who were Mexican American and 49 percent who were women. The researchers found that one-third of the stroke survivors did not report any rehabilitation in the first 90 days following stroke. After adjustment for sociodemographic and clinical factors, Mexican Americans were roughly two times more likely to use any rehabilitation than their non-Hispanic White counterparts. This was primarily due to an increase in the use of outpatient and home health rehabilitation services. Use of inpatient rehabilitation and rehabilitation in skilled nursing facilities did not differ by ethnicity.
"While Mexican Americans were more likely to receive rehabilitation, they reported greater use of less intense forms of rehabilitation than non-Hispanic Whites, despite worse outcomes," Lisabeth said. "The study is ongoing so we need to wait for the final results, but we are aiming to identify facilitators and barriers to the use of more intense rehabilitation care, mainly inpatient rehabilitation, particularly among Mexican Americans. This work may identify strategies that could be used in discharge planning to support patients who are able to go to more intense rehabilitation settings with the goal of maximizing recovery and reducing ethnic disparities."
Kent Simmonds, D.O., Ph.D., of the University of Texas Southwestern Medical Center in Dallas, and colleagues identified race/ethnic disparities in the medical treatment of many poststroke complications.
The authors evaluated electronic health records from 65 large health care centers across the United States between August 2002 and July 2022. The investigators found that significant race/ethnic differences emerged very early after the stroke (within two weeks) and remained significant for the year during which patients were followed. The magnitude of treatment differences depended on the complication. Differences in the treatment of complications such as seizure (which can have clear physiologic manifestations) were much lower compared with differences in the treatment of issues such as fatigue or depression (which may not be as obvious).
"This study reinforces the need for health care providers to engage with their patients and more actively attempt to identify the signs and symptoms associated with poststroke complications to ensure that appropriate medications can be given to reduce the negative impact that these treatments have on quality of life," Simmonds said. "Our results reinforce the need for health care providers to continue to improve on cultural competence and continue to build trust with their patients."
One author disclosed financial ties to the medical technology industry.
ASA: Endovascular Therapy Beneficial for Large Ischemic Strokes
WEDNESDAY, Feb. 15, 2023 (HealthDay News) -- For patients with large ischemic strokes, endovascular therapy is associated with improved outcomes, according to two studies published online Feb. 10 in the New England Journal of Medicine to coincide with the annual American Stroke Association International Stroke Conference, held from Feb. 8 to 10 in Dallas.
ASA: Sex Differences Seen in Use of Dual Antiplatelet Therapy After Minor Stroke
THURSDAY, Feb. 9, 2023 (HealthDay News) -- Dual antiplatelet therapy is underused following transient ischemic attack and minor acute ischemic stroke, particularly in women, according to a study presented at the annual American Stroke Association International Stroke Conference, held from Feb. 8 to 10 in Dallas.
ASA: Stem Cell Transplant Improves Vasculopathy in Sickle Cell Patients
THURSDAY, Feb. 9, 2023 (HealthDay News) -- For adults with sickle cell disease, hematopoietic stem cell transplantation seems to improve or prevent development of vasculopathies, according to a study presented at the American Stroke Association International Stroke Conference, held from Feb. 8 to 10 in Dallas.
ASA: Racial Differences Seen in Treatment of Common Magazine Poststroke Sequelae
MONDAY, Feb. 6, 2023 (HealthDay News) -- Considerable racial differences are seen in the treatment of common poststroke sequelae, according to a study presented at the American Stroke Association International Stroke Conference, held from Feb. 8 to 10 in Dallas.
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Premature Cardiovascular Disease Linked to Lower Cognition
WEDNESDAY, Jan. 25, 2023 (HealthDay News) -- Premature cardiovascular disease (CVD; age 60 years or younger) is associated with lower cognition, according to a study published online Jan. 25 in Neurology.
Xiaqing Jiang, M.D., Ph.D., M.P.H., from the University of California in San Francisco, and colleagues examined the association of premature CVD with midlife cognition and white matter health among 3,146 participants in the Coronary Artery Risk Development in Young Adults study, who were aged 18 to 30 years at baseline in 1985 to 1986 and were followed for up to 30 years. Five cognitive tests measuring different domains were administered at follow-up. In a subset of 656 participants, brain magnetic resonance imaging measures of white matter hyperintensity and white matter integrity were available.
The researchers found that 147 participants (5 percent) had premature CVD. Premature CVD was associated with lower cognition in four of five domains after adjustment for multiple variables: global cognition (−0.22), verbal memory (−0.28), processing speed (−0.46), and executive function (−0.38). After adjustment for covariates, premature CVD was associated with greater white matter hyperintensity (total, temporal, and parietal lobes) and higher white matter mean diffusivity (total and temporal lobes). After adjustment for cardiovascular risk factors and excluding those with stroke/transient ischemic attack, these associations remained significant. There was also an association seen for premature CVD with accelerated cognitive decline over five years (adjusted odds ratio, 3.07).
"Our research suggests that a person's 20s and 30s are a crucial time to begin protecting brain health through cardiovascular disease prevention and intervention," Jiang said in a statement.
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