WorldWideScience

Sample records for stroke heart attack

  1. Outdoor Air Pollution, Heart Attack and Stroke

    Science.gov (United States)

    Elevated outdoor ambient air particle pollution triggers heart attacks, strokes, and abnormal heart rhythms and worsens heart failure in individuals at high risk due to underlying medical conditions. Emergency Medical Services in communities are the first responders to these eme...

  2. Diabetes - preventing heart attack and stroke

    Science.gov (United States)

    Diabetes complications - heart; Coronary artery disease - diabetes; CAD - diabetes; Cerebrovascular disease - diabetes ... People with diabetes have a higher chance of having heart attacks and strokes. Smoking and having high blood pressure and high ...

  3. Preventing Heart Attacks and Strokes: Increasing Awareness ...

    Science.gov (United States)

    Summary: Chronic cardiovascular disease imposes a significant health and economic burden on individuals and communities. Despite decades of improvement in cardiovascular mortality, cardiovascular disease and stroke remain the leading cause of death in the U.S. and disparities in health outcomes persist. Moreover, the continuous improvement in cardiovascular mortality typical of the last four decades has ended motivating new and innovative approaches to improve population health and wellbeing. Apart from continued focus on traditional risk factor modification such as identification and treatment of high blood pressure and cholesterol, cessation of smoking, and appropriate use of evidence-based pharmacological prevention measures and disease management, other factors should be considered such as increasing physical activity, dietary sodium reduction and modification of social and environmental determinants known to cause heart attacks and stroke and exacerbate vascular disease. Such an approach will require greater cooperation among public health, environmental health, the broader public and private healthcare delivery and payment systems, and federal agencies. To introduce this concept the U.S. EPA held a workshop in September 2016 bringing together representatives of local and state public health officials, the healthcare system, educators, data analytics, and federal partners (CMS, CDC, Dept. of State and EPA) for the purpose of exploring the idea of prom

  4. Can You Recognize a Heart Attack or Stroke? What To Do When Every Moment Counts

    Science.gov (United States)

    ... 2014 Print this issue Can You Recognize a Heart Attack or Stroke? What To Do When Every Moment ... When it comes to life-threatening conditions like heart attack or stroke, every minute counts. Get to know ...

  5. Knowledge of signs and symptoms of heart attack and stroke among Singapore residents.

    Science.gov (United States)

    Quah, Joy Li Juan; Yap, Susan; Cheah, Si Oon; Ng, Yih Yng; Goh, E Shaun; Doctor, Nausheen; Leong, Benjamin Sieu-Hon; Tiah, Ling; Chia, Michael Yih Chong; Ong, Marcus Eng Hock

    2014-01-01

    To determine the level of knowledge of signs and symptoms of heart attack and stroke in Singapore resident population, in comparison to the global community. A population based, random sample of 7,840 household addresses was selected from a validated national sampling frame. Each participant was asked eight questions on signs and symptoms of heart attack and 10 questions on stroke. The response rate was 65.2% with 4,192 respondents. The level of knowledge for preselected, common signs and symptoms of heart attack and stroke was 57.8% and 57.1%, respectively. The respondents scored a mean of 5.0 (SD 2.4) out of 8 for heart attack, while they scored a mean of 6.8 (SD 2.9) out of 10 for stroke. Respondents who were ≥ 50 years, with lower educational level, and unemployed/retired had the least knowledge about both conditions. The level of knowledge of signs and symptoms of heart attack and stroke in Singapore is comparable to USA and Canada. We found a comparable knowledge of stroke and heart attack signs and symptoms in the community to countries within the same economic, educational, and healthcare strata. However older persons, those with lower educational level and those who are unemployed/retired, require more public health education efforts.

  6. Knowledge of Signs and Symptoms of Heart Attack and Stroke among Singapore Residents

    Directory of Open Access Journals (Sweden)

    Joy Li Juan Quah

    2014-01-01

    Full Text Available Aim. To determine the level of knowledge of signs and symptoms of heart attack and stroke in Singapore resident population, in comparison to the global community. Methods. A population based, random sample of 7,840 household addresses was selected from a validated national sampling frame. Each participant was asked eight questions on signs and symptoms of heart attack and 10 questions on stroke. Results. The response rate was 65.2% with 4,192 respondents. The level of knowledge for preselected, common signs and symptoms of heart attack and stroke was 57.8% and 57.1%, respectively. The respondents scored a mean of 5.0 (SD 2.4 out of 8 for heart attack, while they scored a mean of 6.8 (SD 2.9 out of 10 for stroke. Respondents who were ≥50 years, with lower educational level, and unemployed/retired had the least knowledge about both conditions. The level of knowledge of signs and symptoms of heart attack and stroke in Singapore is comparable to USA and Canada. Conclusion. We found a comparable knowledge of stroke and heart attack signs and symptoms in the community to countries within the same economic, educational, and healthcare strata. However older persons, those with lower educational level and those who are unemployed/retired, require more public health education efforts.

  7. Heart Attack

    Science.gov (United States)

    Each year almost 800,000 Americans have a heart attack. A heart attack happens when blood flow to the heart suddenly ... it's important to know the symptoms of a heart attack and call 9-1-1 if you or ...

  8. Warning Signs of Heart Attack, Stroke and Cardiac Arrest

    Science.gov (United States)

    ... of High Cholesterol Cholesterol Tools & Resources Congenital Defects Children & Adults About Congenital Heart Defects The Impact of Congenital ... chest pain who arrive by ambulance usually receive faster treatment at the hospital, too. It is best to call EMS for rapid transport to the emergency room. Learn more about ... More about stroke Immediately ...

  9. Poor sleep linked to increased risk of heart attack and stroke.

    Science.gov (United States)

    2017-04-19

    Insomnia is associated with an increased risk of heart attack and stroke, according to a study in China. Researchers carried out a meta-analysis of 15 cohort studies to assess the association between insomnia symptoms and incidence or death from cardiovascular disease and stroke.

  10. Symptom recognition of heart attack and stroke in nine European countries: a representative survey.

    Science.gov (United States)

    Mata, Jutta; Frank, Ronald; Gigerenzer, Gerd

    2014-06-01

    Cardiovascular diseases are the number one cause of death and a source of chronic disability. To assess recognition of and reaction to symptoms of heart attack and stroke, and how recognition is related to the frequency of consulting physicians and other information sources. Face-to-face computer-assisted personal interviews. Representative sample of 10,228 persons in Austria, France, Germany, Italy, the Netherlands, Poland, Russia, Spain and UK, aged 14-98. Recognition of heart attack and stroke symptoms and proper reaction to symptoms. Chest pain was the only heart attack symptom recognized by more than 50% of participants. Eight percent knew no symptoms. Of 14 stroke symptoms, none was recognized by more than 50% of participants; 19% could not identify any symptom. For both heart attack and stroke, Germans and Austrians recognized the largest number of symptoms. Persons in Italy, Poland, Russia and Spain knew only about half as many symptoms as in Germany or Austria. Only 51% of Europeans would call an ambulance when someone suffers a stroke, the fewest (33 and 34%) in Germany and Austria. In most countries, people who consulted their physician more frequently had no better recognition of heart attack or stroke symptoms. The majority of persons in nine European countries recognize few heart attack and stroke symptoms; many do not know how to react. This low level of knowledge constitutes a major health risk and likely leads to delay in treatment, contributing to the high mortality and morbidity from these diseases. © 2012 John Wiley & Sons Ltd.

  11. Attributing heart attack and stroke to "Old Age": Implications for subsequent health outcomes among older adults.

    Science.gov (United States)

    Stewart, Tara L; Chipperfield, Judith G; Perry, Raymond P; Hamm, Jeremy M

    2016-01-01

    This study assessed the extent to which older adults attribute a recent heart attack/stroke to "old age," and examined consequences for subsequent lifestyle behavior and health-care service utilization. Community-dwelling adults (N = 57, ages 73-98 years) were interviewed about their heart attack/stroke, and an objective health registry provided data on health-care utilization over a 3-year period. Endorsement of "old age" as a cause of heart attack/stroke negatively predicted lifestyle behavior change, and positively predicted frequency of physician visits and likelihood of hospitalization over the subsequent 3 years. Findings suggest the importance of considering "old age" attributions in the context of cardiovascular health events. © The Author(s) 2014.

  12. Awareness of heart attack and stroke symptoms among Hispanic male adults living in the United States.

    Science.gov (United States)

    Lutfiyya, May Nawal; Bardales, Ricardo; Bales, Robert; Aguero, Carlos; Brady, Shelly; Tobar, Adriana; McGrath, Cynthia; Zaiser, Julia; Lipsky, Martin S

    2010-10-01

    There is evidence that Hispanic men are a high risk group for treatment delay for both heart attack and stroke. More targeted research is needed to elucidate this specific population's knowledge of warning signs for these acute events. This study sought to describe within-group disparities in Hispanic men's knowledge of heart attack and stroke symptomology. Multivariate techniques were used to analyze a multi-year Behavioral Risk Factor Surveillance Heart and Stroke module database. The data were cross-sectional and focused on health risk factors and behaviors. The research participants were U.S. male Hispanic adults aged 18-99. The main outcome measure for the study was heart attack and stroke symptom knowledge score. Multivariate logistic regression analysis yielded that Hispanic men aged >or=18 years who earned low scores on the composite heart attack and stroke knowledge questions (range 0-8 points) were more likely to: have less than a high school education, have deferred medical care because of cost, not have an identified health care provider, and be uninsured. There were significant within-group differences. Targeting educational efforts toward older (>or=55 years) Hispanic men with less than high school education, those who do not have an identified health care provider or health insurance, and who defer health care because of cost could be ways to improve the outcome of acute vascular events among the U.S. Hispanic adult male population.

  13. Risks for Heart Disease & Stroke

    Science.gov (United States)

    ... Risks for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and strokes ... the Centers for Disease Control and Prevention: Heart Disease Stroke High Blood Pressure Cholesterol Salt Video: Know Your ...

  14. Heart attack

    Science.gov (United States)

    ... part in support groups for people with heart disease . Outlook (Prognosis) After a heart attack, you have a higher ... P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2014: ...

  15. Racial disparities in knowledge of stroke and heart attack risk factors and warning signs among Michigan adults.

    Science.gov (United States)

    Fussman, Chris; Rafferty, Ann P; Reeves, Mathew J; Zackery, Shannon; Lyon-Callo, Sarah; Anderson, Beth

    2009-01-01

    To describe the level of knowledge regarding risk factors and warning signs for stroke and heart attack among White and African American adults in Michigan and to quantify racial disparities. Knowledge of stroke and heart attack risk factors and warning signs was assessed by using data from the 2004 Michigan Behavioral Risk Factor Survey. Prevalence estimates of knowledge were generated, and statistical differences in knowledge between Whites and African Americans were assessed. Adequate knowledge was defined as knowing 3 correct warning signs or risk factors. Logistic regression models were used to quantify the racial disparity in knowledge while controlling for potential confounding. Whites had substantially higher levels of adequate knowledge of risk factors (stroke: 31.6% vs 13.8%; heart attack: 52.6% vs 24.3%) and warning signs (stroke: 30.0% vs 17.2%; heart attack: 29.3% vs 13.8%) compared with African Americans (all observed differences were significant at P heart attack: AOR 3.4) and warning signs (stroke: AOR 2.0; heart attack: AOR 2.4) were significantly higher for Whites than for African Americans. A strong racial disparity in the knowledge of stroke and heart attack risk factors and warning signs exists among Michigan adults. Communitywide public education programs in conjunction with targeted interventions for at-risk populations are necessary to produce meaningful improvements in the awareness of stroke and heart attack risk factors and warning signs among Michigan adults.

  16. Heart Attack

    Science.gov (United States)

    ... pain Fatigue Heart attack Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  17. About Heart Attacks

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More About Heart Attacks Updated:Jan 11,2018 A heart attack is ... coronary artery damage leads to a heart attack . Heart Attack Questions and Answers What is a heart attack? ...

  18. Heart Attack

    Science.gov (United States)

    ... Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back Nausea, indigestion, heartburn or abdominal pain Shortness of breath Cold sweat Fatigue Lightheadedness or sudden dizziness Heart attack ...

  19. Heart rate as a predictor of stroke in high-risk, hypertensive patients with previous stroke or transient ischemic attack.

    Science.gov (United States)

    Sandset, Else Charlotte; Berge, Eivind; Kjeldsen, Sverre E; Julius, Stevo; Holzhauer, Björn; Krarup, Lars-Henrik; Hua, Tsushung A

    2014-01-01

    Risk factors for first stroke are well established, but less is known about risk factors for recurrent stroke. In the present analysis, we aimed to assess the effect of heart rate and other possible predictors of stroke in a hypertensive population with previous stroke or transient ischemic attack (TIA). The Valsartan Antihypertensive Long-Term Use Evaluation trial was a multicentre, double-masked, randomized controlled, parallel group trial comparing the effects of an angiotensin receptor blocker (valsartan) and a calcium channel blocker (amlodipine) in patients with hypertension and high cardiovascular risk. We used Cox proportional hazard models to investigate the effect of baseline variables on the risk of stroke. Quadratic terms of the continuous variables were entered in the models to test for linearity. Of 15,245 patients included in the trial, 3014 had a previous stroke or TIA at baseline and were included in the present analysis. Stroke recurrence occurred in 239 patients (7.9%) during a median of 4.5 years of follow-up. Resting heart rate (per 10 beats per minute; hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.18-6.58) and diabetes mellitus at baseline (HR, 1.47; 95% CI, 1.03-2.10) were significantly associated with an increased risk of stroke recurrence in the multivariable analysis. In high-risk, hypertensive patients with previous stroke or TIA, resting heart rate was the strongest predictor of recurrent stroke. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. The relationship between knowledge and risk for heart attack and stroke.

    Science.gov (United States)

    Lambert, Cameron; Vinson, Seth; Shofer, Frances; Brice, Jane

    2013-10-01

    Stroke and myocardial infarction (MI) represent 2 of the leading causes of death in the United States. The early recognition of risk factors and event symptoms allows for the mitigation of disability or death. We sought to compare subject knowledge of stroke and MI, assess subject risk for cardiovascular disease, and determine if an association exists between knowledge and risk. In this cross-sectional survey, adult, non-health care professionals were presented with a written knowledge test and risk assessment tool. Subjects were classified into 3 categories of cardiovascular risk. Associations were then calculated between knowledge, risk, and population demographics. Of 500 subjects approached, 364 were enrolled. The subjects were mostly white, middle-aged, and high school educated. Gender and income were evenly distributed. Forty-eight (14%) subjects were identified as ideal risk, 130 (38%) as low risk, and 168 (49%) as moderate/high risk. MI and stroke knowledge scores decreased as cardiovascular risk increased (85%, 79%, and 73% for ideal, low, and moderate/high risk groups, respectively; P heart attack knowledge scores. Knowledge about stroke and MI was modest, with knowledge of MI exceeding that of stroke at every level of risk. Subjects with higher risk were less knowledgeable about the stroke signs, symptoms, and risk factors than those of MI. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Knowledge of heart attack and stroke symptomology: a cross-sectional comparison of rural and non-rural US adults.

    Science.gov (United States)

    Swanoski, Michael T; Lutfiyya, May Nawal; Amaro, Maria L; Akers, Michael F; Huot, Krista L

    2012-06-01

    Understanding the signs and symptoms of heart attacks and strokes are important not only in saving lives, but also in preserving quality of life. Findings from recent research have yielded that the prevalence of cardiovascular disease risk factors are higher in rural populations, suggesting that adults living in rural locales may be at higher risk for heart attack and/or stroke. Knowledge of heart attack and stroke symptomology as well as calling 911 for a suspected heart attack or stroke are essential first steps in seeking care. This study sought to examine the knowledge of heart attack and stroke symptoms among rural adults in comparison to non-rural adults living in the U.S. Using multivariate techniques, a cross-sectional analysis of an amalgamated multi-year Behavioral Risk Factor Surveillance Survey (BRFSS) database was performed. The dependent variable for this analysis was low heart attack and stroke knowledge score. The covariates for the analysis were: age, sex, race/ethnicity, annual household income, attained education, health insurance status, having a health care provider (HCP), timing of last routine medical check-up, medical care deferment because of cost, self-defined health status and geographic locale. The weighted n for this study overall was 103,262,115 U.S. adults  > =18 years of age. Approximately 22.0% of these respondents were U.S. adults living in rural locales. Logistic regression analysis revealed that those U.S. adults who had low composite heart attack and stroke knowledge scores were more likely to be rural (OR=1.218 95%CI 1.216-1.219) rather than non-rural residents. Furthermore, those with low scores were more likely to be: male (OR=1.353 95%CI 1.352-1.354), >65 years of age (OR=1.369 95%CI 1.368-1.371), African American (OR=1.892 95%CI 1.889-1.894), not educated beyond high school (OR=1.400 955CI 1.399-1.402), uninsured (OR=1.308 95%CI 1.3-6-1.310), without a HCP (OR=1.216 95%CI 1.215-1.218), and living in a household with an

  2. Knowledge of heart attack and stroke symptomology: a cross-sectional comparison of rural and non-rural US adults

    Directory of Open Access Journals (Sweden)

    Swanoski Michael T

    2012-06-01

    Full Text Available Abstract Background Understanding the signs and symptoms of heart attacks and strokes are important not only in saving lives, but also in preserving quality of life. Findings from recent research have yielded that the prevalence of cardiovascular disease risk factors are higher in rural populations, suggesting that adults living in rural locales may be at higher risk for heart attack and/or stroke. Knowledge of heart attack and stroke symptomology as well as calling 911 for a suspected heart attack or stroke are essential first steps in seeking care. This study sought to examine the knowledge of heart attack and stroke symptoms among rural adults in comparison to non-rural adults living in the U.S. Methods Using multivariate techniques, a cross-sectional analysis of an amalgamated multi-year Behavioral Risk Factor Surveillance Survey (BRFSS database was performed. The dependent variable for this analysis was low heart attack and stroke knowledge score. The covariates for the analysis were: age, sex, race/ethnicity, annual household income, attained education, health insurance status, having a health care provider (HCP, timing of last routine medical check-up, medical care deferment because of cost, self-defined health status and geographic locale. Results The weighted n for this study overall was 103,262,115 U.S. adults > =18 years of age. Approximately 22.0% of these respondents were U.S. adults living in rural locales. Logistic regression analysis revealed that those U.S. adults who had low composite heart attack and stroke knowledge scores were more likely to be rural (OR = 1.218 95%CI 1.216-1.219 rather than non-rural residents. Furthermore, those with low scores were more likely to be: male (OR = 1.353 95%CI 1.352-1.354, >65 years of age (OR = 1.369 95%CI 1.368-1.371, African American (OR = 1.892 95%CI 1.889-1.894, not educated beyond high school (OR = 1.400 955CI 1.399-1.402, uninsured (OR = 1.308 95%CI 1

  3. Cooperative Strategies to Develop Effective Stroke and Heart Attack Awareness Messages in Rural American Indian Communities, 2009–2010

    Science.gov (United States)

    Gohdes, Dorothy; Fogle, Crystelle C.; Tadios, Fawn; Doore, Velva; Bell, Doreen S.; Harwell, Todd S.; Helgerson, Steven D.

    2013-01-01

    Introduction National initiatives to improve the recognition of heart attack and stroke warning signs have encouraged symptomatic people to seek early treatment, but few have shown significant effects in rural American Indian (AI) communities. Methods During 2009 and 2010, the Montana Cardiovascular Health Program, in collaboration with 2 tribal health departments, developed and conducted culturally specific public awareness campaigns for signs and symptoms of heart attack and stroke via local media. Telephone surveys were conducted before and after each campaign to evaluate the effectiveness of the campaigns. Results Knowledge of 3 or more heart attack warning signs and symptoms increased significantly on 1 reservation from 35% at baseline to 47% postcampaign. On the second reservation, recognition of 2 or more stroke signs and symptoms increased from 62% at baseline to 75% postcampaign, and the level of awareness remained at 73% approximately 4 months after the high-intensity campaign advertisements ended. Intent to call 9-1-1 did not increase in the heart attack campaign but did improve in the stroke campaign for specific symptoms. Recall of media campaigns on both reservations increased significantly from baseline to postcampaign for both media outlets (ie, radio and newspaper). Conclusion Carefully designed, culturally specific campaigns may help eliminate disparities in the recognition of heart attack and stroke warning signs in AI communities. PMID:23680509

  4. Cooperative strategies to develop effective stroke and heart attack awareness messages in rural american Indian communities, 2009-2010.

    Science.gov (United States)

    Oser, Carrie S; Gohdes, Dorothy; Fogle, Crystelle C; Tadios, Fawn; Doore, Velva; Bell, Doreen S; Harwell, Todd S; Helgerson, Steven D

    2013-05-16

    National initiatives to improve the recognition of heart attack and stroke warning signs have encouraged symptomatic people to seek early treatment, but few have shown significant effects in rural American Indian (AI) communities. During 2009 and 2010, the Montana Cardiovascular Health Program, in collaboration with 2 tribal health departments, developed and conducted culturally specific public awareness campaigns for signs and symptoms of heart attack and stroke via local media. Telephone surveys were conducted before and after each campaign to evaluate the effectiveness of the campaigns. Knowledge of 3 or more heart attack warning signs and symptoms increased significantly on 1 reservation from 35% at baseline to 47% postcampaign. On the second reservation, recognition of 2 or more stroke signs and symptoms increased from 62% at baseline to 75% postcampaign, and the level of awareness remained at 73% approximately 4 months after the high-intensity campaign advertisements ended. Intent to call 9-1-1 did not increase in the heart attack campaign but did improve in the stroke campaign for specific symptoms. Recall of media campaigns on both reservations increased significantly from baseline to postcampaign for both media outlets (ie, radio and newspaper). Carefully designed, culturally specific campaigns may help eliminate disparities in the recognition of heart attack and stroke warning signs in AI communities.

  5. Heart attack first aid

    Science.gov (United States)

    First aid - heart attack; First aid - cardiopulmonary arrest; First aid - cardiac arrest ... A heart attack occurs when the blood flow that carries oxygen to the heart is blocked. The heart muscle becomes ...

  6. Disparities in adult African American women's knowledge of heart attack and stroke symptomatology: an analysis of 2003-2005 Behavioral Risk Factor Surveillance Survey data.

    Science.gov (United States)

    Lutfiyya, May Nawal; Cumba, Marites T; McCullough, Joel Emery; Barlow, Erika Laverne; Lipsky, Martin S

    2008-06-01

    Heart disease and stroke are the first and third leading causes of death of American women, respectively. African American women experience a disproportionate burden of these diseases compared with Caucasian women and are also more likely to delay seeking treatment for acute symptoms. As knowledge is a first step in seeking care, this study examined the knowledge of heart attack and stroke symptoms among African American women. This was a cross-sectional study analyzing 2003-2005 Behavioral Risk Factor Surveillance Survey (BRFSS) data. A composite heart attack and stroke knowledge score was computed for each respondent from the 13 heart attack and stroke symptom knowledge questions. Multivariate logistic regression was performed using low scores on the heart attack and stroke knowledge questions as the dependent variable. Twenty percent of the respondents were low scorers, and 23.8% were high scorers. Logistic regression analysis showed that adult African American women who earned low scores on the composite heart attack and stroke knowledge questions (range 0-8 points) were more likely to be aged 18-34 (OR = 1.36, CI 1.35, 1.37), be uninsured (OR = 1.32, CI 1.31, 1.33), have an annual household income heart attack and stroke symptoms varied significantly among African American women, depending on socioeconomic variables. Targeting interventions to African American women, particularly those in lower socioeconomic groups, may increase knowledge of heart attack and stroke symptoms, subsequently improving preventive action taken in response to these conditions.

  7. Aspirin for Reducing Your Risk of Heart Attack and Stroke: Know the Facts

    Science.gov (United States)

    ... the-Counter Medicines Safe Daily Use of Aspirin Aspirin for Reducing Your Risk of Heart Attack and ... any pharmacy, grocery or convenience store and buy aspirin without a prescription. The Drug Facts label on ...

  8. Pericarditis - after heart attack

    Science.gov (United States)

    ... medlineplus.gov/ency/article/000166.htm Pericarditis - after heart attack To use the sharing features on this page, ... occur in the days or weeks following a heart attack . Causes Two types of pericarditis can occur after ...

  9. What Is a Heart Attack?

    Science.gov (United States)

    ... Research Home / Heart Attack Heart Attack Also known as Myocardial infarction Leer en español ... or years after the procedure. Other Treatments for Heart Attack Other treatments for heart attack include: Medicines Medical ...

  10. Elevated troponin in patients with acute stroke - Is it a true heart attack?

    Science.gov (United States)

    Dous, George V; Grigos, Angela C; Grodman, Richard

    2017-09-01

    Although the prognostic value of a positive troponin in an acute stroke patient is still uncertain, it is a commonly encountered clinical situation given that Ischemic Heart Disease (IHD) and cerebrovascular disease (CVD) frequently co-exist in the same patient and share similar risk factors. Our objectives in this review are to (1) identify the biologic relationship between acute cerebrovascular stroke and elevated troponin levels, (2) determine the pathophysiologic differences between positive troponin in the setting of acute stroke versus acute myocardial infarction (AMI), and (3) examine whether positive troponin in the setting of acute stroke has prognostic significance. We also will provide an insight analysis of some of the available studies and will provide guidance for a management approach based on the available data according to the current guidelines.

  11. Heart attack - discharge

    Science.gov (United States)

    ... and lifestyle Cholesterol - drug treatment Controlling your high blood pressure Deep vein thrombosis - discharge Dietary fats explained Fast food tips Heart attack - discharge Heart attack - what to ask your doctor Heart bypass ... pacemaker - discharge High blood pressure - what to ask your doctor How to read ...

  12. Coronary heart disease risk in patients with stroke or transient ischemic attack and no known coronary heart disease: findings from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

    DEFF Research Database (Denmark)

    Amarenco, Pierre; Goldstein, Larry B; Sillesen, Henrik

    2010-01-01

    Noncoronary forms of atherosclerosis (including transient ischemic attacks or stroke of carotid origin or >50% stenosis of the carotid artery) are associated with a 10-year vascular risk of >20% and are considered as a coronary heart disease (CHD) -risk equivalent from the standpoint of lipid...... management. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial included patients with stroke or transient ischemic attack and no known CHD regardless of the presence of carotid atherosclerosis. We evaluated the risk of developing clinically recognized CHD in SPARCL patients....

  13. What Is a Heart Attack?

    Science.gov (United States)

    ... to help prevent your first heart attack. Heart-Healthy Lifestyle Changes A heart-healthy lifestyle can help prevent ... blood to flow to the heart muscle. Heart-Healthy Lifestyle Changes Treatment for a heart attack usually includes ...

  14. Before Using Aspirin to Lower Your Risk of Heart Attack or Stroke, Here Is What You Should Know

    Science.gov (United States)

    ... Medicines Safe Daily Use of Aspirin Before Using Aspirin to Lower Your Risk of Heart Attack or ... care provider can determine whether regular use of aspirin will help to prevent a heart attack or ...

  15. Heart Attack Payment - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – state data. This data set includes state-level data for payments associated with a 30-day episode of care for heart...

  16. Heart Attack Payment - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – provider data. This data set includes provider data for payments associated with a 30-day episode of care for heart...

  17. Heart Attack Payment - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – national data. This data set includes national-level data for payments associated with a 30-day episode of care for heart...

  18. The polypill and the prevention of heart attacks and strokes by Caroline Telfer.

    Science.gov (United States)

    Wald, David S

    2013-07-01

    David S Wald speaks to Caroline Telfer, Assistant Commissioning Editor. David S Wald is a Consultant Cardiologist and Reader in Preventive Cardiology. He trained at Oxford University (UK) and Imperial College of Science and Technology, London (UK). His work combines interventional and preventive approaches to cardiovascular disease. He is currently leading a multicenter randomized trial assessing the value of preventive angioplasty in patients with acute myocardial infarction and a UK trial of a polypill for people over the age of 50 years for the prevention of ischemic heart disease and stroke.

  19. Coronary heart disease risk in patients with stroke or transient ischemic attack and no known coronary heart disease: findings from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial.

    Science.gov (United States)

    Amarenco, Pierre; Goldstein, Larry B; Sillesen, Henrik; Benavente, Oscar; Zweifler, Richard M; Callahan, Alfred; Hennerici, Michael G; Zivin, Justin A; Welch, K Michael A

    2010-03-01

    Noncoronary forms of atherosclerosis (including transient ischemic attacks or stroke of carotid origin or >50% stenosis of the carotid artery) are associated with a 10-year vascular risk of >20% and are considered as a coronary heart disease (CHD) -risk equivalent from the standpoint of lipid management. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial included patients with stroke or transient ischemic attack and no known CHD regardless of the presence of carotid atherosclerosis. We evaluated the risk of developing clinically recognized CHD in SPARCL patients. A total of 4731 patients (mean age, 63 years) was randomized to 80 mg/day atorvastatin placebo. The rates of major coronary event, any CHD event, and any revascularization procedure were evaluated. After 4.9 years of follow-up, the risks of a major coronary event and of any CHD end point in the placebo group were 5.1% and 8.6%, respectively. The rate of outcome of stroke decreased over time, whereas the major coronary event rate was stable. Relative to those having a large vessel-related stroke at baseline, those having a transient ischemic attack, hemorrhagic stroke, small vessel stroke, or a stroke of unknown cause had similar absolute rates for a first major coronary event and for any CHD event; transient ischemic attack, small vessel, and unknown cause groups had lower absolute revascularization procedure rates. Major coronary event, any CHD event, and any revascularization procedure rates were similarly reduced in all baseline stroke subtypes in the atorvastatin arm compared with placebo with no heterogeneity between groups. CHD risk can be substantially reduced by atorvastatin therapy in patients with recent stroke or transient ischemic attack regardless of stroke subtype.

  20. 'BeAWARE': supporting non-clinical staff within general practice to promptly identify patients presenting with warning signs of heart attack or stroke.

    Science.gov (United States)

    Poulter, Christopher; Stewart, Michelle; Fitzpatrick, Cliona; Keech, Wendy; Stavreski, Bill; Grenfell, Robert

    2014-06-01

    General practice requires systems to deal with patients presenting with urgent needs. BeAWARE was developed to support non-clinical staff to promptly identify patients with symptoms of heart attack or stroke. Data were collected from May 2012 to December 2012 on participants completing the BeAWARE learning module, including pre- and post-assessments on knowledge, confidence and intended action. From May 2012 to December 2012, 1865 participants completed the module. There were significant increases in recall of heart attack and stroke symptoms among non-clinical participants, including chest tightness (23.4-48.7%, P DISCUSSION: BeAWARE fulfils a practice gap in patient safety by improving non-clinical staff's knowledge, confidence and intended action in response to patients presenting with heart attack or stroke warning signs.

  1. Thrombolytic drugs for heart attack

    Science.gov (United States)

    ... gov/ency/article/007488.htm Thrombolytic drugs for heart attack To use the sharing features on this page, ... supply blood and oxygen to the heart. A heart attack can occur if a blood clot stops the ...

  2. Depression After Heart Attack

    Science.gov (United States)

    ... Heart Attack? Redford B. Williams Download PDF https://doi.org/10.1161/CIRCULATIONAHA.110.017285 Circulation. 2011; 123: ... e639-e640 , originally published June 27, 2011 https://doi.org/10.1161/CIRCULATIONAHA.110.017285 Citation Manager Formats ...

  3. Panic Attack or Heart Attack?

    Science.gov (United States)

    ... MPI") that uses a nucleotide tracer (e.g. Thallium) that is injected into your veins to view blood flow to your heart muscle. MPI is used in combination with the stress test to improve accuracy in diagnosing heart disease. Women of child-bearing age may wish to opt for ultrasound ...

  4. Heart Attack Coronary Artery Disease

    Science.gov (United States)

    ... our e-newsletter! Aging & Health A to Z Heart Attack Coronary Artery Disease, Angina Basic Facts & Information What ... and oxygen supply; this is what causes a heart attack. If the damaged area is small, however, your ...

  5. Socioeconomic and air pollution correlates of adult asthma, heart attack, and stroke risks in the United States, 2010-2013.

    Science.gov (United States)

    Cox, Louis Anthony Tony

    2017-05-01

    Asthma in the United States has become an important public health issue, with many physicians, regulators, and scientists elsewhere expressing concern that criterion air pollutants have contributed to a rising tide of asthma cases and symptoms. This paper studies recent associations (from 2008 to 2012) between self-reported asthma experiences and potential predictors, including age, sex, income, education, smoking, and county-level average annual ambient concentrations of ozone (O3) and fine particulate matter (PM2.5) levels recorded by the U.S. Environmental Protection Agency, for adults 50 years old or older for whom survey data are available from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS). We also examine associations between these variables and self-reported heart attack and stroke experience; all three health outcomes are positively associated with each other. Young divorced women with low incomes are at greatest risk of asthma, especially if they are ever-smokers. Income is an important confounder of other relations. For example, in logistic regression modeling, PM2.5 is positively associated (pheart attack risk when these are regressed only against PM2.5, sex, age, and ever-smoking status, but not when they are regressed against these variables and income. In this data set, PM2.5 is significantly negatively associated with asthma risk in regression models, with a 10μg/m 3 decrease in PM2.5 corresponding to about a 6% increase in the probability of asthma, possibly because of confounding by smoking, which is negatively associated with PM2.5 and positively associated with asthma risk. A variety of non-parametric methods are used to quantify these associations and to explore potential causal interpretations. Copyright © 2017. Published by Elsevier Inc.

  6. Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability.

    Science.gov (United States)

    Guan, Ling; Collet, Jean-Paul; Mazowita, Garey; Claydon, Victoria E

    2018-01-01

    Transient ischemic attack (TIA) and minor stroke have high risks of recurrence and deterioration into severe ischemic strokes. Risk stratification of TIA and minor stroke is essential for early effective treatment. Traditional tools have only moderate predictive value, likely due to their inclusion of the limited number of stroke risk factors. Our review follows Hans Selye's fundamental work on stress theory and the progressive shift of the autonomic nervous system (ANS) from adaptation to disease when stress becomes chronic. We will first show that traditional risk factors and acute triggers of ischemic stroke are chronic and acute stress factors or "stressors," respectively. Our first review shows solid evidence of the relationship between chronic stress and stroke occurrence. The stress response is tightly regulated by the ANS whose function can be assessed with heart rate variability (HRV). Our second review demonstrates that stress-related risk factors of ischemic stroke are correlated with ANS dysfunction and impaired HRV. Our conclusions support the idea that HRV parameters may represent the combined effects of all body stressors that are risk factors for ischemic stroke and, thus, may be of important predictive value for the risk of subsequent ischemic events after TIA or minor stroke.

  7. Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability

    Science.gov (United States)

    Guan, Ling; Collet, Jean-Paul; Mazowita, Garey; Claydon, Victoria E.

    2018-01-01

    Transient ischemic attack (TIA) and minor stroke have high risks of recurrence and deterioration into severe ischemic strokes. Risk stratification of TIA and minor stroke is essential for early effective treatment. Traditional tools have only moderate predictive value, likely due to their inclusion of the limited number of stroke risk factors. Our review follows Hans Selye’s fundamental work on stress theory and the progressive shift of the autonomic nervous system (ANS) from adaptation to disease when stress becomes chronic. We will first show that traditional risk factors and acute triggers of ischemic stroke are chronic and acute stress factors or “stressors,” respectively. Our first review shows solid evidence of the relationship between chronic stress and stroke occurrence. The stress response is tightly regulated by the ANS whose function can be assessed with heart rate variability (HRV). Our second review demonstrates that stress-related risk factors of ischemic stroke are correlated with ANS dysfunction and impaired HRV. Our conclusions support the idea that HRV parameters may represent the combined effects of all body stressors that are risk factors for ischemic stroke and, thus, may be of important predictive value for the risk of subsequent ischemic events after TIA or minor stroke. PMID:29556209

  8. Heart and Stroke Encyclopedia

    Science.gov (United States)

    ... Thromboembolism Aortic Aneurysm More The Heart and Stroke Encyclopedia Click a letter below to get a brief ... of cardiovascular terms from our Heart and Stroke Encyclopedia and get links to in-depth information. A ...

  9. The association of a heart attack or stroke with depressive symptoms stratified by the presence of a close social contact: findings from the National Health and Aging Trends Study Cohort.

    Science.gov (United States)

    Simning, Adam; Seplaki, Christopher L; Conwell, Yeates

    2018-01-01

    The objective of the study is to examine whether the risk of having clinically significant depressive symptoms following a heart attack or stroke varies by the presence of a close social contact. The National Health and Aging Trends Study is a nationally representative longitudinal survey of US Medicare beneficiaries aged 65 and older initiated in 2011. A total of 5643 older adults had information on social contacts at baseline and depressive symptoms at the 1-year follow-up interview. The two-item Patient Health Questionnaire identified clinically significant depressive symptoms. Interview questions examined social contacts and the presence of self-reported heart attack or stroke during the year of follow-up. A total of 297 older adults reported experiencing a heart attack and/or stroke between their baseline and follow-up interviews. In regression analyses accounting for sociodemographics, baseline depressive symptoms, medical comorbidity, and activities of daily living impairment, older adults with no close social contacts had increased odds of depressive symptoms at follow-up after experiencing a heart attack or stroke, while those with close social contacts had increased odds of depressive symptoms at follow-up after experiencing a stroke, but not a heart attack. Older adults have increased odds of having depressive symptoms following a self-reported stroke, but only those with no close social contacts had increased odds of depressive symptoms following a heart attack. Social networks may play a role in the mechanisms underlying depression among older adults experiencing certain acute health events. Future work exploring the potential causal relationships suggested here, if confirmed, could inform interventions to alleviate or prevent depression among at risk older adults. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  10. Understand Your Risk of Heart Attack

    Science.gov (United States)

    ... Heart-Health Basics Reducing your risk starts with smart choices. If you smoke, stop. The American Heart ... a Second Heart Attack | Spanish Cardiac Rehab Referral Card | Spanish Heart Attack Warning Signs: Patient sheet | Infographic | ...

  11. Can Vitamins Help Prevent a Heart Attack?

    Science.gov (United States)

    ... vitamins help prevent a heart attack? Can taking vitamins help prevent heart disease or a heart attack? Answers ... M.D. It's not yet clear if taking vitamins can reduce your risk of developing heart disease ...

  12. [Heart-attack in pregnancy].

    Science.gov (United States)

    Výtisková, T; Suchá, D; Fučíková, Z

    To describe hear-attack on crystal meth addicted pregnant woman. Case report. Acute heart-attack during pregnancy means unexpected obstetric complication. The consequences could be fatal for the mother and the fetus. Although good delivery management and treatment could reduce morbidity and mortality to a minimum.

  13. Baseline Quality of Life and Risk of Stroke in the ALLHAT Study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).

    Science.gov (United States)

    Shams, Tanzila; Auchus, Alexander P; Oparil, Suzanne; Wright, Clinton B; Wright, Jackson; Furlan, Anthony J; Sila, Cathy A; Davis, Barry R; Pressel, Sara; Yamal, Jose-Miguel; Einhorn, Paula T; Lerner, Alan J

    2017-11-01

    The visual analogue scale is a self-reported, validated tool to measure quality of life (QoL). Our purpose was to determine whether baseline QoL predicted strokes in the ALLHAT study (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) and evaluate determinants of poststroke change in QoL. In the ALLHAT study, among the 33 357 patients randomized to treatment arms, 1525 experienced strokes; 1202 (79%) strokes were nonfatal. This study cohort includes 32 318 (97%) subjects who completed the baseline visual analogue scale QoL estimate. QoL was measured on a visual analogue scale and adjusted using a Torrance transformation (transformed QoL [TQoL]). Kaplan-Meier curves and adjusted proportional hazards analyses were used to estimate the effect of TQoL on the risk of stroke, on a continuous scale (0-1) and by quartiles (≤0.81, >0.81≤0.89, >0.89≤0.95, >0.95). We analyzed the change from baseline to first poststroke TQoL using adjusted linear regression. After adjusting for multiple stroke risk factors, the hazard ratio for stroke events for baseline TQoL was 0.93 (95% confidence interval, 0.89-0.98) per 0.1 U increase. The lowest baseline TQoL quartile had a 20% increased stroke risk (hazard ratio=1.20 [95% confidence interval, 1.00-1.44]) compared with the reference highest quartile TQoL. Poststroke TQoL change was significant within all treatment groups ( P ≤0.001). Multivariate regression analysis revealed that baseline TQoL was the strongest predictor of poststroke TQoL with similar results for the untransformed QoL. The lowest baseline TQoL quartile had a 20% higher stroke risk than the highest quartile. Baseline TQoL was the only factor that predicted poststroke change in TQoL. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542. © 2017 American Heart Association, Inc.

  14. Heart Attack Recovery FAQs

    Science.gov (United States)

    ... some cases, surgical procedures. Your doctor may also run some diagnostic tests to determine how much your heart was damaged and what degree ... some cases, surgical procedures. Your doctor may also run some diagnostic tests to determine how much your heart was damaged and what degree ...

  15. Efficacy of a Community-Based Physical Activity Program KM2H2 for Stroke and Heart Attack Prevention among Senior Hypertensive Patients: A Cluster Randomized Controlled Phase-II Trial.

    Science.gov (United States)

    Gong, Jie; Chen, Xinguang; Li, Sijian

    2015-01-01

    To evaluate the efficacy of the program Keep Moving toward Healthy Heart and Healthy Brain (KM2H2) in encouraging physical activities for the prevention of heart attack and stroke among hypertensive patients enrolled in the Community-Based Hypertension Control Program (CBHCP). Cluster randomized controlled trial with three waves of longitudinal assessments at baseline, 3 and 6 months post intervention. Community-based and patient-centered self-care for behavioral intervention in urban settings of China. A total of 450 participants diagnosed with hypertension from 12 community health centers in Wuhan, China were recruited, and were randomly assigned by center to receive either KM2H2 plus standard CBHCP care (6 centers and 232 patients) or the standard care only (6 centers and 218 patients). KM2H2 is a behavioral intervention guided by the Transtheoretical Model, the Model of Personalized Medicine and Social Capital Theory. It consists of six intervention sessions and two booster sessions engineered in a progressive manner. The purpose is to motivate and maintain physical activities for the prevention of heart attack and stroke. Heart attack and stroke (clinically diagnosed, primary outcome), blood pressure (measured, secondary outcome), and physical activity (self-report, tertiary outcome) were assessed at the individual level during the baseline, 3- and 6-month post-intervention. Relative to the standard care, receiving KM2H2 was associated with significant reductions in the incidence of heart attack (3.60% vs. 7.03%, p heart attack and stroke among senior patients who are on anti-hypertensive medication. Findings of this study provide solid data supporting a formal phase-III trial to establish the effectiveness of KM2H2 for use in community settings for prevention. ISRCTN Register ISRCTN12608966.

  16. Being active after a heart attack (image)

    Science.gov (United States)

    ... best activity when you start exercising after a heart attack. Start slowly, and increase the amount of time ... best activity when you start exercising after a heart attack. Start slowly, and increase the amount of time ...

  17. Diabetes, Heart Disease, and Stroke

    Science.gov (United States)

    ... Disease, & Other Dental Problems Diabetes & Sexual & Urologic Problems Diabetes, Heart Disease, and Stroke Having diabetes means that ... help to stop. What is the link between diabetes, heart disease, and stroke? Over time, high blood ...

  18. Coronary Artery Dissection: Not Just a Heart Attack

    Science.gov (United States)

    ... Aneurysm More Coronary Artery Dissection: Not Just a Heart Attack Updated:Mar 15,2018 Sometimes a heart attack ... Disease Go Red For Women Types of aneurysms Heart Attack • Home • About Heart Attacks Acute Coronary Syndrome (ACS) ...

  19. Identifying Unique Neighborhood Characteristics to Guide Health Planning for Stroke and Heart Attack: Fuzzy Cluster and Discriminant Analyses Approaches

    Science.gov (United States)

    Pedigo, Ashley; Seaver, William; Odoi, Agricola

    2011-01-01

    Background Socioeconomic, demographic, and geographic factors are known determinants of stroke and myocardial infarction (MI) risk. Clustering of these factors in neighborhoods needs to be taken into consideration during planning, prioritization and implementation of health programs intended to reduce disparities. Given the complex and multidimensional nature of these factors, multivariate methods are needed to identify neighborhood clusters of these determinants so as to better understand the unique neighborhood profiles. This information is critical for evidence-based health planning and service provision. Therefore, this study used a robust multivariate approach to classify neighborhoods and identify their socio-demographic characteristics so as to provide information for evidence-based neighborhood health planning for stroke and MI. Methods and Findings The study was performed in East Tennessee Appalachia, an area with one of the highest stroke and MI risks in USA. Robust principal component analysis was performed on neighborhood (census tract) socioeconomic and demographic characteristics, obtained from the US Census, to reduce the dimensionality and influence of outliers in the data. Fuzzy cluster analysis was used to classify neighborhoods into Peer Neighborhoods (PNs) based on their socioeconomic and demographic characteristics. Nearest neighbor discriminant analysis and decision trees were used to validate PNs and determine the characteristics important for discrimination. Stroke and MI mortality risks were compared across PNs. Four distinct PNs were identified and their unique characteristics and potential health needs described. The highest risk of stroke and MI mortality tended to occur in less affluent PNs located in urban areas, while the suburban most affluent PNs had the lowest risk. Conclusions Implementation of this multivariate strategy provides health planners useful information to better understand and effectively plan for the unique

  20. Efficacy of a Community-Based Physical Activity Program KM2H2 for Stroke and Heart Attack Prevention among Senior Hypertensive Patients: A Cluster Randomized Controlled Phase-II Trial.

    Directory of Open Access Journals (Sweden)

    Jie Gong

    Full Text Available To evaluate the efficacy of the program Keep Moving toward Healthy Heart and Healthy Brain (KM2H2 in encouraging physical activities for the prevention of heart attack and stroke among hypertensive patients enrolled in the Community-Based Hypertension Control Program (CBHCP.Cluster randomized controlled trial with three waves of longitudinal assessments at baseline, 3 and 6 months post intervention.Community-based and patient-centered self-care for behavioral intervention in urban settings of China.A total of 450 participants diagnosed with hypertension from 12 community health centers in Wuhan, China were recruited, and were randomly assigned by center to receive either KM2H2 plus standard CBHCP care (6 centers and 232 patients or the standard care only (6 centers and 218 patients.KM2H2 is a behavioral intervention guided by the Transtheoretical Model, the Model of Personalized Medicine and Social Capital Theory. It consists of six intervention sessions and two booster sessions engineered in a progressive manner. The purpose is to motivate and maintain physical activities for the prevention of heart attack and stroke.Heart attack and stroke (clinically diagnosed, primary outcome, blood pressure (measured, secondary outcome, and physical activity (self-report, tertiary outcome were assessed at the individual level during the baseline, 3- and 6-month post-intervention.Relative to the standard care, receiving KM2H2 was associated with significant reductions in the incidence of heart attack (3.60% vs. 7.03%, p < .05 and stroke (5.11% vs. 9.90%, p<0.05, and moderate reduction in blood pressure (-3.72 mmHg in DBP and -2.92 mmHg in DBP at 6-month post-intervention; and significant increases in physical activity at 3- (d = 0.53, 95% CI: 0.21, 0.85 and 6-month (d = 0.45, 95% CI: 0.04, 0.85 post-intervention, respectively.The program KM2H2 is efficacious to reduce the risk of heart attack and stroke among senior patients who are on anti

  1. Predictors of Stroke After Transient Ischemic Attack in Children.

    Science.gov (United States)

    Lehman, Laura L; Watson, Christopher G; Kapur, Kush; Danehy, Amy R; Rivkin, Michael J

    2016-01-01

    Transient ischemic attack (TIA) in children has received far less attention compared with TIA in adults. The risk factors of stroke after TIA in children are relatively unknown. We aimed to determine the percentage of children who have stroke after TIA and the risk factors associated with stroke after TIA. We searched the medical records at Boston Children's Hospital for the year 2010 to find children who were evaluated for TIA to determine associated risk factors of stroke after TIA. We included children who were evaluated in 2009 through 2010 for TIA and had magnetic resonance imaging. We examined follow-up imaging through August 2014 for subsequent stroke. Logistic regression was used to calculate odds ratios for factors in our cohort who are associated with stroke after presentation with TIA. We identified 63 children who experienced a TIA. The mean time of imaging follow-up was 4.5 years after TIA presentation. Of the 63 children, 10 (16%) developed radiological evidence of ischemic cerebral injury within the follow-up period. Four of the 10 (6%) demonstrated diffusion abnormalities on magnetic resonance imaging at TIA presentation, whereas 8 (13%) had a stroke after their TIA. Arteriopathy, female sex, and autoimmune disorders were significantly associated with stroke after TIA. In our cohort of children, stroke occurred after TIA at a rate similar to that seen in adults, but the risk factors for stroke after TIA in children are different. © 2015 American Heart Association, Inc.

  2. In-hospital stroke recurrence and stroke after transient ischemic attack: frequency and risk factors.

    Science.gov (United States)

    Erdur, Hebun; Scheitz, Jan F; Ebinger, Martin; Rocco, Andrea; Grittner, Ulrike; Meisel, Andreas; Rothwell, Peter M; Endres, Matthias; Nolte, Christian H

    2015-04-01

    We aimed to assess the risk of recurrent ischemic events during hospitalization for stroke or transient ischemic attack (TIA) with optimal current management and to identify associated risk factors. We performed a retrospective analysis of all patients treated for acute ischemic stroke or TIA in 3 stroke units between 2010 and 2013. Recurrent stroke was defined as new persisting (≥24 hours) neurological deficit occurring >24 hours after the index event and not attributable to other causes of neurological deterioration. Cox proportional hazard regression identified risk factors associated with recurrent stroke. The study included 5106 patients. During a median length of stay of 5 days (interquartile range, 4-8), stroke recurrence (or stroke after TIA) occurred in 40 patients (0.8%) and was independently associated with history of TIA, symptomatic carotid stenosis (≥70%), or other determined etiology. Patients with recurrent stroke and other determined etiology had cervical arterial dissection (n=2), primary angiitis of the central nervous system (n=1), giant cell arteritis (n=1), and lung cancer with nonbacterial thrombotic endocarditis (n=1). In patients with initial TIA or minor stroke (National Institutes of Health Stroke Scale ≤5) recurrence was associated additionally with pneumonia after the inciting ischemic event but before stroke recurrence. Patients with initial stroke and aphasia had a lower stroke recurrence rate and there were no recurrences in patients with lacunar stroke. Recurrence was associated with significantly higher in-hospital mortality (17.5% versus 3.1%; Pstroke recurrence was low with optimal current management. Patients with a history of TIA, severe symptomatic carotid stenosis, or uncommon causes of stroke were at higher risk. Pneumonia was associated with a higher risk of stroke recurrence in patients with initial TIA or minor stroke but not in the overall population studied. Aphasia may bias the detection rate by concealing new

  3. Calcium Supplements: A Risk Factor for Heart Attack?

    Science.gov (United States)

    ... for heart attack? I've read that calcium supplements may increase the risk of heart attack. Is ... Some doctors think it's possible that taking calcium supplements may increase your risk of a heart attack. ...

  4. Heart Disease and Stroke Statistics

    Science.gov (United States)

    ... mortality statistics found in the Heart Disease & Stroke Statistics Update . Because mortality is considered "hard" data, it's possible to do time-trend analysis and compute percent changes over time. What are ...

  5. Know the Warning Signs of a Heart Attack

    Science.gov (United States)

    ... No. 22 Know the Warning Signs of a Heart Attack What is a heart attack? Aheart attack happens when the blood vessels that ... hurting your heart muscle. Another name for a heart attack is myocardial infarction, or MI. If you have ...

  6. Persistent effect at 30-month post intervention of a community-based randomized trial of KM2H2 in reducing stroke and heart attack among senior hypertensive patients.

    Science.gov (United States)

    Gong, Jie; Xu, Yunan; Chen, Xinguang; Yang, Niannian; Li, Fang; Yan, Yaqiong

    2018-01-02

    The effect of the Keep Moving toward Healthy Heart and Healthy Brain (KM2H2) program at 6-month post intervention has been assessed.  The purpose of this study is to evaluate the KM2H 2 program at 30-month post intervention. A total of 450 senior hypertensive patients from 12 community health centers were randomized by center to either receive KM2H 2 plus standard care (6 centers, n = 232) or standard care only (6 centers, n = 218). Data for outcome measures at 30-month post intervention were analyzed. New cases of stroke and heart attack were verified with medical records; levels of physical activity were assessed using self-reported questionnaire. In addition to comparative analysis, adjusted incidence rate and program effects were determined using mixed effects modeling method. At the 30-month follow-up, the adjusted incidence rate [95% CI] of stroke was 11.81% [5.90, 17.72] for patients in the intervention group and 19.78% [14.07, 25.50] (p = 0.03) for the control group. The adjusted incidence rate of heart attack was 3.34% [1.91, 8.58] and 6.68% [1.64, 11.73] for the intervention and control groups (p = 0.16), respectively; the proportion and the duration of engaging in regular physical activity were significantly greater for the intervention group than the control group. The reductions in blood pressure between the intervention and the control was not statistically significant. The KM2H 2 program showed a persistent effect up to 30 months post intervention in enhancing physical activity and reducing the risk of cardio-cerebrovascular events, particularly stroke. These findings demonstrate the persistent effect of the KM2H 2 and suggest the need for a full-scale evaluation of the intervention program for practical use. ISRCTN Register ISRCTN12608966 . Registered 03 March 2015. Retrospectively registered.

  7. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... stroke symptoms. Popular Topics TIA Cardiac Catheter Cholesterol Heart Attack Stent © 2018, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. ...

  8. CHA2DS2-VASc Score (Congestive Heart Failure, Hypertension, Age ≥75 [Doubled], Diabetes Mellitus, Prior Stroke or Transient Ischemic Attack [Doubled], Vascular Disease, Age 65-74, Female) for Stroke in Asian Patients With Atrial Fibrillation: A Korean Nationwide Sample Cohort Study.

    Science.gov (United States)

    Kim, Tae-Hoon; Yang, Pil-Sung; Uhm, Jae-Sun; Kim, Jong-Youn; Pak, Hui-Nam; Lee, Moon-Hyoung; Joung, Boyoung; Lip, Gregory Y H

    2017-06-01

    The CHA 2 DS 2 -VASc stroke score (congestive heart failure, hypertension, age ≥75 (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65-74, female) is used in most guidelines for risk stratification in atrial fibrillation (AF), but most data for this score have been derived in Western populations. Ethnic differences in stroke risk may be present. Our objective was to investigate risk factors for stroke in AF and application of the CHA 2 DS 2 -VASc score in an Asian AF population from Korea. A total of 5855 oral anticoagulant-naive nonvalvular AF patients aged ≥20 years were enrolled from Korea National Health Insurance Service Sample cohort from 2002 to 2008 and were followed up until December 2013. The incidence rates (per 100 person-years) of ischemic stroke were 3.32 in the total population, being 0.23 in low-risk (CHA 2 DS 2 -VASc score 0 [male] or 1 [female]) and 4.59 in high-risk patients (CHA 2 DS 2 -VASc ≥2). Incidence rates of ischemic stroke or the composite thromboembolism end point showed a clear increase with increasing CHA 2 DS 2 -VASc score. On multivariable analysis, significant associations between CHA 2 DS 2 -VASc risk factors and ischemic stroke were observed; however, the significance of vascular disease or diabetes mellitus was attenuated after multivariate adjustment, and female sex (hazard ratio, 0.73; 95% confidence interval, 0.64-0.84) had a lower risk of ischemic stroke than males. Patients who were categorized as low risk consistently had an event rate Heart Association, Inc.

  9. Fuzzy Expert System for Heart Attack Diagnosis

    Science.gov (United States)

    Hassan, Norlida; Arbaiy, Nureize; Shah, Noor Aziyan Ahmad; Afizah Afif@Afip, Zehan

    2017-08-01

    Heart attack is one of the serious illnesses and reported as the main killer disease. Early prevention is significant to reduce the risk of having the disease. The prevention efforts can be strengthen through awareness and education about risk factor and healthy lifestyle. Therefore the knowledge dissemination is needed to play role in order to distribute and educate public in health care management and disease prevention. Since the knowledge dissemination in medical is important, there is a need to develop a knowledge based system that can emulate human intelligence to assist decision making process. Thereby, this study utilized hybrid artificial intelligence (AI) techniques to develop a Fuzzy Expert System for Diagnosing Heart Attack Disease (HAD). This system integrates fuzzy logic with expert system, which helps the medical practitioner and people to predict the risk and as well as diagnosing heart attack based on given symptom. The development of HAD is expected not only providing expert knowledge but potentially become one of learning resources to help citizens to develop awareness about heart-healthy lifestyle.

  10. African-Americans and Heart Disease, Stroke

    Science.gov (United States)

    ... Thromboembolism Aortic Aneurysm More African-Americans and Heart Disease, Stroke Updated:Aug 22,2017 Heart disease is the ... a marathon.” Learn more: Family History and Heart Disease, Stroke Make the Effort to Prevent Heart Disease with ...

  11. American Indian and Alaska Native Heart Disease and Stroke

    Science.gov (United States)

    ... Hearts® WISEWOMAN American Indian and Alaska Native Heart Disease and Stroke Fact Sheet Recommend on Facebook Tweet Share Compartir ... Census Bureau. American Indian and Alaska Native Heart Disease and Stroke Facts Heart Disease is the first and stroke ...

  12. Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients

    Science.gov (United States)

    Wintermark, Max; Sanelli, Pina C.; Albers, Gregory W.; Bello, Jacqueline A.; Derdeyn, Colin P.; Hetts, Steven W.; Johnson, Michele H.; Kidwell, Chelsea S.; Lev, Michael H.; Liebeskind, David S.; Rowley, Howard A.; Schaefer, Pamela W.; Sunshine, Jeffrey L.; Zaharchuk, Greg; Meltzer, Carolyn C.

    2014-01-01

    In the article entitled “Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients: A Joint Statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery”, we are proposing a simple, pragmatic approach that will allow the reader to develop an optimal imaging algorithm for stroke patients at their institution. PMID:23948676

  13. One-Year Outcomes After Minor Stroke or High-Risk Transient Ischemic Attack: Korean Multicenter Stroke Registry Analysis.

    Science.gov (United States)

    Park, Hong-Kyun; Kim, Beom Joon; Han, Moon-Ku; Park, Jong-Moo; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Cha, Jae-Kwan; Kim, Dae-Hyun; Nah, Hyun-Wook; Park, Tai Hwan; Park, Sang-Soon; Lee, Kyung Bok; Lee, Jun; Hong, Keun-Sik; Cho, Yong-Jin; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi-Sun; Kim, Joon-Tae; Choi, Kang-Ho; Kim, Dong-Eog; Ryu, Wi-Sun; Choi, Jay Chol; Johansson, Saga; Lee, Su Jin; Lee, Won Hee; Lee, Ji Sung; Lee, Juneyoung; Bae, Hee-Joon

    2017-11-01

    Patients with minor ischemic stroke or transient ischemic attack are at high risk of recurrent stroke and vascular events, which are potentially disabling or fatal. This study aimed to evaluate contemporary subsequent vascular event risk after minor ischemic stroke or transient ischemic attack in Korea. Patients with minor ischemic stroke or high-risk transient ischemic attack admitted within 7 days of symptom onset were identified from a Korean multicenter stroke registry database. We estimated 3-month and 1-year event rates of the primary outcome (composite of stroke recurrence, myocardial infarction, or all-cause death), stroke recurrence, a major vascular event (composite of stroke recurrence, myocardial infarction, or vascular death), and all-cause death and explored differences in clinical characteristics and event rates according to antithrombotic strategies at discharge. Of 9506 patients enrolled in this study, 93.8% underwent angiographic assessment and 72.7% underwent cardiac evaluations; 25.1% had symptomatic stenosis or occlusion of intracranial arteries. At discharge, 95.2% of patients received antithrombotics (antiplatelet polytherapy, 37.1%; anticoagulation, 15.3%) and 86.2% received statins. The 3-month cumulative event rate was 5.9% for the primary outcome, 4.3% for stroke recurrence, 4.6% for a major vascular event, and 2.0% for all-cause death. Corresponding values at 1 year were 9.3%, 6.1%, 6.7%, and 4.1%, respectively. Patients receiving nonaspirin antithrombotic strategies or no antithrombotic agent had higher baseline risk profiles and at least 1.5× higher event rates for clinical event outcomes than those with aspirin monotherapy. Contemporary secondary stroke prevention strategies based on thorough diagnostic evaluation may contribute to the low subsequent vascular event rates observed in real-world clinical practice in Korea. © 2017 American Heart Association, Inc.

  14. Heart Attack or Sudden Cardiac Arrest: How Are They Different?

    Science.gov (United States)

    ... Attack or Sudden Cardiac Arrest: How Are They Different? Updated:Mar 15,2018 People often use these ... The heart attack symptoms in women can be different than men. What is cardiac arrest? Sudden cardiac ...

  15. Why a polysomnogram should become part of the diagnostic evaluation of stroke and transient ischemic attack.

    Science.gov (United States)

    Grigg-Damberger, Madeleine

    2006-02-01

    Neurologists need to recognize, diagnose, and treat obstructive sleep apnea (OSA) in patients with stroke or transient ischemic attack (TIA). Increasing medical evidence suggests that OSA is an independent risk factor for stroke and TIA. Stroke (or TIA) is more likely a cause, rather than a consequence, of OSA because PSG studies have shown: 1) apneas in stroke are typically obstructive, not central or Cheyne-Stokes in type; 2) apneas are just as frequent and severe in patients with either TIA or stroke; 3) OSA severity is not influenced by the acuteness or location of the stroke; 4) untreated OSA patients have more strokes, stroke morbidity, and mortality than those who are treated. OSA alone can induce hypertension, especially in younger men. A causal relationship has recently been demonstrated between OSA and hypertension. A distinctive feature of OSA-induced hypertension is loss of the normal nighttime fall in blood pressure ("nondippers"). Data from the Sleep Heart Health Study showed a dose-response association between OSA severity and the presence of hypertension 4 years later. Hypertension or ischemic heart disease usually develops in untreated patients with OSA over time without particular worsening of OSA. Studies have shown sleep itself is not a risk factor for stroke because most stroke and TIAs begin between 6 am and noon, while the individual is awake. However, OSA promptly be considered in stroke beginning during sleep because 88% of strokes that develop during sleep occur in "nondippers." Premature death in OSA patients is most often cardiovascular, but occurs while the patients are awake. The risk of myocardial infarction is increased 20-fold in untreated OSA. Treating OSA patients with continuous positive airway pressure can prevent or improve hypertension, reduce abnormal elevations of inflammatory cytokines and adhesion molecules, reduce excessive sympathetic tone, avoid increased vascular oxidative stress, reverse coagulation abnormalities, and

  16. Dolichoectasia and Small Vessel Disease in Young Patients With Transient Ischemic Attack and Stroke.

    Science.gov (United States)

    Thijs, Vincent; Grittner, Ulrike; Fazekas, Franz; McCabe, Dominick J H; Giese, Anne-Katrin; Kessler, Christof; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Schmidt, Reinhold; Tanislav, Christian; Putaala, Jukka; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt; Enzinger, Christian

    2017-09-01

    We evaluated whether basilar dolichoectasia is associated with markers of cerebral small vessel disease in younger transient ischemic attack and ischemic stroke patients. We used data from the SIFAP1 study (Stroke in Young Fabry Patients), a large prospective, hospital-based, screening study for Fabry disease in young (ischemic attack/stroke patients in whom detailed clinical data and brain MRI were obtained, and stroke subtyping with TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment) was performed. Dolichoectasia was found in 508 of 3850 (13.2%) of patients. Dolichoectasia was associated with older age (odds ratio per decade, 1.26; 95% confidence interval, 1.09-1.44), male sex (odds ratio, 1.96; 95% confidence interval, 1.59-2.42), and hypertension (odds ratio, 1.39; 95% confidence interval, 1.13-1.70). Dolichoectasia was more common in patients with small infarctions (33.9% versus 29.8% for acute lesions, P =0.065; 29.1% versus 16.5% for old lesions, P ischemic attack and ischemic stroke. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2017 American Heart Association, Inc.

  17. The prevalence of peripheral arteriopathy is higher in ischaemic stroke as compared with transient ischaemic attack and intracerebral haemorrhage.

    Science.gov (United States)

    Huttner, Hagen B; Köhrmann, Martin; Mauer, Christoph; Lücking, Hannes; Kloska, Stephan; Doerfler, Arnd; Schwab, Stefan; Schellinger, Peter D

    2010-08-01

    There is little data on the association of peripheral arterial disease and stroke. We aimed to assess the prevalence of peripheral arterial disease in acute stroke and to identify the predisposing factors for peripheral arterial disease in a stroke cohort. We enrolled all consecutive patients who were admitted to our stroke- and neurocritical care units with the diagnosis of a transient ischaemic attack, ischaemic or haemorrhagic stroke over a period of 5 months. As controls, we analysed 50 nonvascular neurological patients who were matched to age. Upon admission, assessment of the ankle brachial index was performed in all patients. The only exclusion criteria was decompensated congestive heart failure. Altogether, we compared 374 stroke patients (95 transient ischaemic attack, 231 ischaemic, and 48 haemorrhagic strokes) and 50 nonstroke controls. The prevalence of peripheral arterial disease in the control group was 14%. There was a trend towards a higher prevalence of peripheral arterial disease in stroke patients (chi(2)-test: P=0.051; prevalence peripheral arterial disease in transient ischaemic attack: 16.8%, ischaemic stroke: 32%, and haemorrhagic stroke: 20.8%). A higher proportion of ischaemic stroke patients were peripheral arterial disease-positive, compared with transient ischaemic attack patients (P=0.005) and controls (P=0.011), respectively. Multivariate regression analyses identified the parameters age, arterial hypertension, current or former smokers and a history of cardiovascular events to be predisposing factors of peripheral arterial disease. This study represents the first systematic investigation of the prevalence of peripheral arterial disease in stroke. By now, it is clear that: * peripheral arterial disease is more commonly found in stroke than in nonstroke patients * ischaemic stroke patients show the highest prevalence of peripheral arterial disease, and * peripheral arterial disease in stroke is related to common vascular risk factors.

  18. Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus.

    Science.gov (United States)

    Chen, Weiqi; Pan, Yuesong; Jing, Jing; Zhao, Xingquan; Liu, Liping; Meng, Xia; Wang, Yilong; Wang, Yongjun

    2017-06-01

    We aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events) trial. In total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of METS and DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS, 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither, METS only, DM only, and both, respectively. After 90 days of follow-up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89-3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95% CI 1.98-3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different METS or DM status for the risk of recurrent stroke ( P =0.82 for interaction in the fully adjusted model of CDS) was observed. Using the METS (IDF) criteria demonstrated similar results. Concurrent METS and DM was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  19. Prediction of Recurrent Stroke or Transient Ischemic Attack After Noncardiogenic Posterior Circulation Ischemic Stroke.

    Science.gov (United States)

    Zhang, Changqing; Wang, Yilong; Zhao, Xingquan; Liu, Liping; Wang, ChunXue; Pu, Yuehua; Zou, Xinying; Pan, Yuesong; Wong, Ka Sing; Wang, Yongjun

    2017-07-01

    Posterior circulation ischemic stroke (IS) is generally considered an illness with a poor prognosis. However, there are no effective rating scales to predict recurrent stroke following it. Therefore, our aim was to identify clinical or radiological measures that could assist in predicting recurrent cerebral ischemic episodes. We prospectively enrolled 723 noncardiogenic posterior circulation IS patients with onset of symptoms Stroke risk factors, admission symptoms and signs, topographical distribution and responsible cerebral artery of acute infarcts, and any recurrent IS or transient ischemic attack (TIA) within 1 year were assessed. Cox regression was used to identify risk factors associated with recurrent IS or TIA within the year after posterior circulation IS. A total of 40 patients (5.5%) had recurrent IS or TIA within 1 year of posterior circulation IS. Multivariate Cox regression identified chief complaint with dysphagia (hazard ratio [HR], 4.16; 95% confidence interval [CI], 1.69-10.2; P =0.002), repeated TIAs within 3 months before the stroke (HR, 15.4; 95% CI, 5.55-42.5; P <0.0001), responsible artery stenosis ≥70% (HR, 7.91; 95% CI, 1.00-62.6; P =0.05), multisector infarcts (HR, 5.38; 95% CI, 1.25-23.3; P =0.02), and not on antithrombotics treatment at discharge (HR, 3.06; 95% CI, 1.09-8.58; P =0.03) as independent predictors of recurrent IS or TIA. Some posterior circulation IS patients are at higher risk for recurrent IS or TIA. Urgent assessment and preventive treatment should be offered to these patients as soon as possible. © 2017 American Heart Association, Inc.

  20. Self-reported heart attack in Mexican-American elders: examination of incidence, prevalence, and 7-year mortality.

    Science.gov (United States)

    Otiniano, Max E; Ottenbacher, Kenneth J; Markides, Kyriakos S; Ray, Laura A; Du, Xianglin L

    2003-07-01

    To examine the prevalence, incidence, and mortality of self-reported heart attack in older Mexican Americans and to identify significant factors associated with heart attack. Cross-sectional and longitudinal study. Baseline and three follow-up interviews in five southwestern states (Arizona, California, Colorado, New Mexico, and Texas) of the Hispanic Established Population for the Epidemiological Study of the Elderly. Three thousand fifty Mexican Americans aged 65 to 107 (mean age = 73). Sociodemographic factors (age, sex, marital status, language of interview, health insurance coverage, living arrangements, and financial strain) and health factors (smoking, alcohol consumption, obesity, diabetes mellitus, hypertension, stroke, cancer, hip fracture, arthritis, depression, limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and mortality) were determined at baseline (1993-94). New heart attacks were assessed at follow-ups in 1995-96, 1998-99, and 2000-01. Vital status was determined over the 7-year follow-up. Prevalence of self-reported heart attack was 9.1% at baseline. Incidence of self-reported heart attack was 6.1%, 9.1%, and 7.9%, respectively, for the three subsequent follow-ups. Older age, male sex, diabetes mellitus, hypertension, and stroke were significantly associated with heart attack at baseline. Age was a significant predictor for new heart attack at each follow-up. Having ADL (odds ratio (OR) = 2.91, 95% confidence interval (CI) = 2.19-3.86) and IADL (OR = 2.25, CI = 1.72-2.94) disabilities was significantly associated with self-reported heart attack. Subjects with heart attack were significantly more likely to die at 7 years (hazard ratio = 1.57, 95% CI = 1.29-1.91). Of those with self-reported heart attack, 42.4% had died of heart attack as the underlying cause of death by 7-year follow-up. In Mexican Americans, self-reported heart attack was associated with being older and male and having diabetes

  1. Sleep Apnea and Heart Disease, Stroke

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Sleep Apnea and Heart Disease, Stroke Updated:Mar 16, ... be life-threatening. It’s a condition known as sleep apnea, in which the person may experience pauses ...

  2. Flu and Heart Disease and Stroke

    Science.gov (United States)

    ... disease includes but is not limited to coronary artery disease [heart attack or myocardial infarction, acute coronary ... Privacy FOIA No Fear Act OIG 1600 Clifton Road Atlanta , GA 30329-4027 USA 800-CDC-INFO ( ...

  3. Targeting Pioglitazone Hydrochloride Therapy After Stroke or Transient Ischemic Attack According to Pretreatment Risk for Stroke or Myocardial Infarction.

    Science.gov (United States)

    Kernan, Walter N; Viscoli, Catherine M; Dearborn, Jennifer L; Kent, David M; Conwit, Robin; Fayad, Pierre; Furie, Karen L; Gorman, Mark; Guarino, Peter D; Inzucchi, Silvio E; Stuart, Amber; Young, Lawrence H

    2017-11-01

    There is growing recognition that patients may respond differently to therapy and that the average treatment effect from a clinical trial may not apply equally to all candidates for a therapy. To determine whether, among patients with an ischemic stroke or transient ischemic attack and insulin resistance, those at higher risk for future stroke or myocardial infarction (MI) derive more benefit from the insulin-sensitizing drug pioglitazone hydrochloride compared with patients at lower risk. A secondary analysis was conducted of the Insulin Resistance Intervention After Stroke trial, a double-blind, placebo-controlled trial of pioglitazone for secondary prevention. Patients were enrolled from 179 research sites in 7 countries from February 7, 2005, to January 15, 2013, and were followed up for a mean of 4.1 years through the study's end on July 28, 2015. Eligible participants had a qualifying ischemic stroke or transient ischemic attack within 180 days of entry and insulin resistance without type 1 or type 2 diabetes. Pioglitazone or matching placebo. A Cox proportional hazards regression model was created using baseline features to stratify patients above or below the median risk for stroke or MI within 5 years. Within each stratum, the efficacy of pioglitazone for preventing stroke or MI was calculated. Safety outcomes were death, heart failure, weight gain, and bone fracture. Among 3876 participants (1338 women and 2538 men; mean [SD] age, 63 [11] years), the 5-year risk for stroke or MI was 6.0% in the pioglitazone group among patients at lower baseline risk compared with 7.9% in the placebo group (absolute risk difference, -1.9% [95% CI, -4.4% to 0.6%]). Among patients at higher risk, the risk was 14.7% in the pioglitazone group vs 19.6% for placebo (absolute risk difference, -4.9% [95% CI, -8.6% to 1.2%]). Hazard ratios were similar for patients below or above the median risk (0.77 vs 0.75; P = .92). Pioglitazone increased weight less among patients at

  4. Four-year follow-up of transient ischemic attacks, strokes, and mimics: a retrospective transient ischemic attack clinic cohort study.

    Science.gov (United States)

    Dutta, Dipankar; Bowen, Emily; Foy, Chris

    2015-05-01

    There is limited information on outcomes from rapid access transient ischemic attack (TIA) clinics. We present 4-year outcomes of TIAs, strokes, and mimics from a UK TIA clinic database. All patients referred between April 2010 and May 2012 were retrospectively identified and outcomes determined. End points were stroke, myocardial infarction, any vascular event (TIA, stroke, or myocardial infarction), and all-cause death. Data were analyzed by survival analysis. Of 1067 patients, 31.6% were TIAs, 18% strokes, and 50.4% mimics. Median assessment time was 4.5 days from onset and follow-up was for 34.9 months. Subsequent strokes occurred in 7.1% of patients with TIA, 10.9% of patients with stroke, and 2.0% of mimics at the end of follow-up. Stroke risk at 90 days was 1.3% for patients diagnosed as TIA or stroke. Compared with mimics, hazard ratios for subsequent stroke were 3.88 (1.90-7.91) for TIA and 5.84 (2.81-12.11) for stroke. Hazard ratio for any subsequent vascular event was 2.91 (1.97-4.30) for TIA and 2.83 (1.81-4.41) for stroke. Hazard ratio for death was 1.68 (1.10-2.56) for TIA and 2.19 (1.38-3.46) for stroke. Our results show a lower 90-day stroke incidence after TIA or minor stroke than in earlier studies, suggesting that rapid access daily TIA clinics may be having a significant effect on reducing strokes. © 2015 American Heart Association, Inc.

  5. Association of Osteopontin, Neopterin, and Myeloperoxidase With Stroke Risk in Patients With Prior Stroke or Transient Ischemic Attacks: Results of an Analysis of 13 Biomarkers From the Stroke Prevention by Aggressive Reduction in Cholesterol Levels Trial.

    Science.gov (United States)

    Ganz, Peter; Amarenco, Pierre; Goldstein, Larry B; Sillesen, Henrik; Bao, Weihang; Preston, Gregory M; Welch, K Michael A

    2017-12-01

    Established risk factors do not fully identify patients at risk for recurrent stroke. The SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) evaluated the effect of atorvastatin on stroke risk in patients with a recent stroke or transient ischemic attack and no known coronary heart disease. This analysis explored the relationships between 13 plasma biomarkers assessed at trial enrollment and the occurrence of outcome strokes. We conducted a case-cohort study of 2176 participants; 562 had outcome strokes and 1614 were selected randomly from those without outcome strokes. Time to stroke was evaluated by Cox proportional hazards models. There was no association between time to stroke and lipoprotein-associated phospholipase A 2 , monocyte chemoattractant protein-1, resistin, matrix metalloproteinase-9, N-terminal fragment of pro-B-type natriuretic peptide, soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1, or soluble CD40 ligand. In adjusted analyses, osteopontin (hazard ratio per SD change, 1.362; P strokes. After adjustment for the Stroke Prognostic Instrument-II and treatment, osteopontin, neopterin, and myeloperoxidase remained independently associated with outcome strokes. The addition of these 3 biomarkers to Stroke Prognostic Instrument-II increased the area under the receiver operating characteristic curve by 0.023 ( P =0.015) and yielded a continuous net reclassification improvement (29.1%; P stroke and improved risk classification when added to a clinical risk algorithm. URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00147602. © 2017 American Heart Association, Inc.

  6. Marital history and survival after a heart attack.

    Science.gov (United States)

    Dupre, Matthew E; Nelson, Alicia

    2016-12-01

    Heart disease is the leading cause of death in the United States and nearly one million Americans will have a heart attack this year. Although the risks associated with a heart attack are well established, we know surprisingly little about how marital factors contribute to survival in adults afflicted with heart disease. This study uses a life course perspective and longitudinal data from the Health and Retirement Study to examine how various dimensions of marital life influence survival in U.S. older adults who suffered a heart attack (n = 2197). We found that adults who were never married (odds ratio [OR] = 1.73), currently divorced (OR = 1.70), or widowed (OR = 1.34) were at significantly greater risk of dying after a heart attack than adults who were continuously married; and the risks were not uniform over time. We also found that the risk of dying increased by 12% for every additional marital loss and decreased by 7% for every one-tenth increase in the proportion of years married. After accounting for more than a dozen socioeconomic, psychosocial, behavioral, and physiological factors, we found that current marital status remained the most robust indicator of survival following a heart attack. The implications of the findings are discussed in the context of life course inequalities in chronic disease and directions for future research. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Pioglitazone after Ischemic Stroke or Transient Ischemic Attack.

    Science.gov (United States)

    Kernan, Walter N; Viscoli, Catherine M; Furie, Karen L; Young, Lawrence H; Inzucchi, Silvio E; Gorman, Mark; Guarino, Peter D; Lovejoy, Anne M; Peduzzi, Peter N; Conwit, Robin; Brass, Lawrence M; Schwartz, Gregory G; Adams, Harold P; Berger, Leo; Carolei, Antonio; Clark, Wayne; Coull, Bruce; Ford, Gary A; Kleindorfer, Dawn; O'Leary, John R; Parsons, Mark W; Ringleb, Peter; Sen, Souvik; Spence, J David; Tanne, David; Wang, David; Winder, Toni R

    2016-04-07

    Patients with ischemic stroke or transient ischemic attack (TIA) are at increased risk for future cardiovascular events despite current preventive therapies. The identification of insulin resistance as a risk factor for stroke and myocardial infarction raised the possibility that pioglitazone, which improves insulin sensitivity, might benefit patients with cerebrovascular disease. In this multicenter, double-blind trial, we randomly assigned 3876 patients who had had a recent ischemic stroke or TIA to receive either pioglitazone (target dose, 45 mg daily) or placebo. Eligible patients did not have diabetes but were found to have insulin resistance on the basis of a score of more than 3.0 on the homeostasis model assessment of insulin resistance (HOMA-IR) index. The primary outcome was fatal or nonfatal stroke or myocardial infarction. By 4.8 years, a primary outcome had occurred in 175 of 1939 patients (9.0%) in the pioglitazone group and in 228 of 1937 (11.8%) in the placebo group (hazard ratio in the pioglitazone group, 0.76; 95% confidence interval [CI], 0.62 to 0.93; P=0.007). Diabetes developed in 73 patients (3.8%) and 149 patients (7.7%), respectively (hazard ratio, 0.48; 95% CI, 0.33 to 0.69; Pischemic stroke or TIA, the risk of stroke or myocardial infarction was lower among patients who received pioglitazone than among those who received placebo. Pioglitazone was also associated with a lower risk of diabetes but with higher risks of weight gain, edema, and fracture. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00091949.).

  8. Exercise Following a Heart Attack: Some Special Considerations.

    Science.gov (United States)

    Fardy, Paul S.

    This paper presents information on the effectiveness of exercise programs for heart attack victims. Some of the observations come from unpublished results of a two year experiment of the National Exercise and Heart Disease Project. The paper first establishes that a group exercise program with trained supervision is advantageous for people with…

  9. Learn What a Heart Attack Feels Like--It Could Save Your Life

    Science.gov (United States)

    Learn What a Heart Attack Feels Like— It Could Save Your Life. This fact sheet tells you about heart attack signs. It also tells you what to do ... your life. 1. Know the signs of a heart attack. 2. Understand that heart attacks are not all ...

  10. Clinical and Demographic Characteristics Associated With Suboptimal Primary Stroke and Transient Ischemic Attack Prevention: Retrospective Analysis.

    Science.gov (United States)

    Turner, Grace M; Calvert, Melanie; Feltham, Max G; Ryan, Ronan; Finnikin, Samuel; Marshall, Tom

    2018-03-01

    Primary prevention of stroke and transient ischemic attack (TIA) is important to reduce the burden of these conditions; however, prescribing of prevention drugs is suboptimal. We aimed to identify individual clinical and demographic characteristics associated with potential missed opportunities for prevention therapy with lipid-lowering, anticoagulant, or antihypertensive drugs before stroke/TIA. We analyzed anonymized electronic primary care records from a UK primary care database that covers 561 family practices. Patients with first-ever stroke/TIA, ≥18 years, with diagnosis between January 1, 2009, and December 31, 2013, were included. Missed opportunities for prevention were defined as people with clinical indications for lipid-lowering, anticoagulant, or antihypertensive drugs but not prescribed these drugs before their stroke/TIA. Mixed-effect logistic regression models evaluated the relationship between missed opportunities and individual clinical/demographic characteristics. The inclusion criteria were met by 29 043 people with stroke/TIA. Patients with coronary heart disease, chronic kidney disease, peripheral arterial disease, or diabetes mellitus were at less risk of a missed opportunity for prescription of lipid-lowering and antihypertensive drugs. However, patients with a 10-year cardiovascular disease risk ≥20% but without these diagnoses had increased risk of having a missed opportunity for prescription of lipid-lowering drugs or antihypertensive drugs. Women were less likely to be prescribed anticoagulants but more likely to be prescribed antihypertensive drugs. The elderly (≥85 years of age) were less likely to be prescribed all 3 prevention drugs, compared with people aged 75 to 79 years. Knowing the patient characteristics predictive of missed opportunities for stroke prevention may help primary care identify and appropriately manage these patients. Improving the management of these groups may reduce their risk and potentially prevent

  11. Being active after your heart attack

    Science.gov (United States)

    ... 6 weeks, you may be able to start swimming, but stay out of very cold or very ... American College of Cardiology/American Heart Association Task Force on practice guidelines (Writing Committee to Revise the ...

  12. Make the call, don't miss a beat: Heart Attack Information for Women

    Science.gov (United States)

    ... Other resources Learn more about heart disease and heart attacks. Make the Call, Don't Miss a Beat ... symptoms Learn the 7 most common signs of heart attack in men and women. Chest pain or discomfort " ...

  13. Heart Disease and Stroke in Women

    Centers for Disease Control (CDC) Podcasts

    2009-05-11

    This women's health podcast focuses on the impact of heart disease and stroke in women and includes steps to prevent these conditions.  Created: 5/11/2009 by Office of Women’s Health (OWH) and National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 5/11/2009.

  14. Knowledge of heart attack symptoms and risk factors among native Thais: a street-intercept survey method.

    Science.gov (United States)

    Poomsrikaew, Ornwanya; Ryan, Catherine J; Zerwic, Julie J

    2010-10-01

    This study aimed to determine Thais' knowledge of heart attack symptoms and risk factors and whether that knowledge was related to age, gender or education. Via a street-intercept survey method, a convenience sample of people aged ≥ 35 years (n = 192) was recruited. Mean age was 47 ± 9.6 years (range 35-81), and 55.2% were female. Participants identified on average 5.6 of 9 heart attack symptoms (SD 1.8) and 5.3 of 8 heart attack risk factors (SD 2.1). However, 66.7% mistakenly thought the chest discomfort would be severe, sharp and stabbing, and many subjects erroneously selected symptoms that are actually stroke symptoms. There were no gender or educational differences in knowledge of heart attack symptoms and risk factors. Older adults recognized fewer total symptoms than did younger adults. These findings could direct health-care providers to help the Thai population differentiate symptoms of heart attack from stroke. © 2010 Blackwell Publishing Asia Pty Ltd.

  15. Effect of High-Dose Atorvastatin on Renal Function in Subjects With Stroke or Transient Ischemic Attack in the SPARCL Trial

    DEFF Research Database (Denmark)

    Amarenco, Pierre; Callahan, Alfred, III; Campese, Vito M.

    2014-01-01

    by Aggressive Reduction in Cholesterol Levels (SPARCL) trial assessed the effect of statin treatment on the risk of nonfatal and fatal stroke in subjects with a noncardioembolic stroke or transient ischemic attack, no known coronary heart disease, and low-density lipoprotein cholesterol between 2.6 and 4.9 mmol...... ischemic attack with and without chronic kidney disease, and that atorvastatin treatment may prevent eGFR decline in patients with stroke and diabetes mellitus. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00147602....

  16. Quality of Care and Ischemic Stroke Risk After Hospitalization for Transient Ischemic Attack: Findings From Get With The Guidelines-Stroke.

    Science.gov (United States)

    O'Brien, Emily C; Zhao, Xin; Fonarow, Gregg C; Schulte, Phillip J; Dai, David; Smith, Eric E; Schwamm, Lee H; Bhatt, Deepak L; Xian, Ying; Saver, Jeffrey L; Reeves, Mathew J; Peterson, Eric D; Hernandez, Adrian F

    2015-10-01

    Patients with transient ischemic attack (TIA) are at increased risk for ischemic stroke. We derived a prediction rule for 1-year ischemic stroke risk post-TIA, examining estimated risk, receipt of inpatient quality of care measures for TIA, and the presence or absence of stroke at 1 year post discharge. We linked 67 892 TIA Get With The Guidelines-Stroke patients >65 years (2003-2008) to Medicare inpatient claims to obtain longitudinal outcomes. Using Cox proportional hazards modeling in a split sample, we identified baseline demographics and clinical characteristics associated with ischemic stroke admission during the year post-TIA, and developed a Get With The Guidelines Ischemic Stroke after TIA Risk Score; performance was examined in the validation sample. Quality of care was estimated by a global defect-free care measure, and individual performance measures within estimated risk score quintiles. The overall hospital admission rate for ischemic stroke during the year post-TIA was 5.7%. Patients with ischemic stroke were more likely to be older, black, and have higher rates of smoking, previous stroke, diabetes mellitus, previous myocardial infarction, heart failure, and atrial fibrillation. The Risk Score showed moderate discriminative performance (c-statistic=0.606); highest quintile patients were less likely to receive statins, smoking cessation counseling, and defect-free care. Although not associated with 1-year ischemic stroke, DCF was associated with a significantly lower risk of all-cause mortality. TIA patients with high estimated ischemic stroke risk are less likely to receive defect-free care than low-risk patients. Standardized risk assessment and delivery of optimal inpatient care are needed to reduce this risk-treatment mismatch. © 2015 American Heart Association, Inc.

  17. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack

    DEFF Research Database (Denmark)

    Easton, J Donald; Lopes, Renato D; Bahit, M Cecilia

    2012-01-01

    In the ARISTOTLE trial, the rate of stroke or systemic embolism was reduced by apixaban compared with warfarin in patients with atrial fibrillation (AF). Patients with AF and previous stroke or transient ischaemic attack (TIA) have a high risk of stroke. We therefore aimed to assess the efficacy...

  18. Smoking Cessation Intervention After Ischemic Stroke or Transient Ischemic Attack. A Randomized Controlled Pilot Trial

    DEFF Research Database (Denmark)

    Brunner Frandsen, Nicole; Sørensen, Margit; Hyldahl, Tanja Kirstine

    2012-01-01

    BACKGROUND: Smoking cessation is widely recommended for secondary stroke prevention. However, little is known about the efficacy of smoking cessation intervention after stroke or transient ischemic attack (TIA). METHODS: Ninety-four smokers under age 76, admitted with ischemic stroke or TIA were...... to the results from other studies. Intensive smoking cessation intervention was not superior to short smoking cessation intervention. Thus, other factors than intensity of smoking cessation intervention might influence the smoking cessation rates after stroke or TIA....

  19. Awareness of heart attack symptoms among US adults in 2007, and changes in awareness from 2001 to 2007.

    Science.gov (United States)

    Fang, Jing; Gillespie, Cathleen; Keenan, Nora L; Greenlund, Kurt J

    2011-05-01

    Timely access to emergency care, prompt receipt of advanced treatment and survival from heart attack is dependent on both the early recognition of heart attack symptoms, by both victims and bystanders, and by immediately calling the emergency services. The objective of this study is to measure the awareness of heart attack symptoms and the emergency response among US adults. We analyzed data from the Behavioral Risk Factor Surveillance System's module on heart attack and stroke, which was conducted in 17 states/territories in 2001 and 12 states/territories in 2007. The module included five questions related to heart attack symptoms, one decoy question and one question regarding the first action to take if someone is having a heart attack. Age-adjusted prevalence of awareness was estimated, and odds ratios were calculated. Differences between 2001 and 2007 were assessed for five states that used the module in both years. In 2007, among 76,864 adults, awareness of individual heart attack symptoms ranged from 49% (pain in jaw, neck or back) to 92% (chest pain). Although 97% of adults recognized at least one symptom, only 10.7% recognized all five symptoms, knew that 'sudden trouble seeing in one or both eyes' was not a symptom of heart attack and recognized the need to call the emergency services. This estimate varied significantly by age, sex, race/ethnicity and level of education. The estimate was significantly higher for women (12.2%) than men (7.7%), White (11.6%) than Black (5.7%) or Hispanic people (4.5%), those with a higher level of education (13.5%) than lower educational level (4.5%) and for those with coronary heart disease (16.2%) than without the disease (9.5%). Comparison of awareness between 2001 (the referent) and 2007, in five states, revealed that awareness of all symptoms and calling the emergency services, were 9.7 and 10.3% for 2001 and 2007, respectively (p heart attack symptoms among adults in 12 states was low and little improvement was

  20. Silent stroke in patients with transient ischemic attack or minor ischemic stroke. The Dutch TIA Trial Study Group

    NARCIS (Netherlands)

    Herderscheê, D.; Hijdra, A.; Algra, A.; Koudstaal, P. J.; Kappelle, L. J.; van Gijn, J.

    1992-01-01

    BACKGROUND AND PURPOSE: We studied silent stroke (i.e., infarcts on computed tomographic scan not related to later symptoms) in patients after transient ischemic attack or minor ischemic stroke. METHODS: Ours is a cross-sectional study of 2,329 patients who were randomized in a secondary prevention

  1. Applying the Principles of Homicide by Heart Attack.

    Science.gov (United States)

    Hlavaty, Leigh; Sung, LokMan

    2016-06-01

    Homicide by heart attack is a well-established model in forensic pathology that describes death elicited during or immediately after a criminal act where a threat or fear of physical injury is present. After its introduction nearly 4 decades ago, the principle has undergone a handful of modifications but still maintains its core concepts. All cases of this nature during a 20-year period at the Wayne County Medical Examiner's Office were compared and contrasted for demographics, circumstances and scene investigation, and autopsy and toxicology findings. Of the cases fulfilling the previously established criteria for homicide by heart attack, more than 80% displayed significant changes because of hypertension. This finding coincides with the high prevalence of hypertension in our urban population and highlights the significance of this disease. Also present were minor external and internal injuries in select cases, which reinforce the understanding that physical contact between the decedent and assailant does not preclude this diagnosis.

  2. Recognizing a heart attack: the process of determining illness.

    Science.gov (United States)

    Scherck, K A

    1997-07-01

    To examine the process by which patients with acute myocardial infarction recognize illness and the need for medical treatment. Descriptive, exploratory, qualitative. The coronary care and progressive care units of two midwestern medical centers. Thirty men and women with a diagnosis of acute myocardial infarction. Open-ended interviews were conducted on the fourth or fifth day of hospitalization. All interviews were recorded on audiotape and transcribed. Data were analyzed by using grounded theory methods. Findings of the study indicated that determining illness and the need for medical attention was often a difficult process involving phases. The first phase involved attending to or ignoring bodily sensations as they come and go or additional sensations develop. Some subjects moved precipitously to seeking treatment; others took days to attend to bodily sensations. The second phase involved comparing sensations with those from a previously experienced illness or with the subject's concept of sensations likely to accompany common ailments such as indigestion or flu or more serious illnesses such as ulcer, gallbladder disease, or heart attack. The quality of sensations experienced had an important influence on assigning probable cause and deciding that medical attention is warranted. The disruptive nature of signs and symptoms and how closely signs and symptoms matched the subject's prototype for a heart attack greatly influenced the determination that illness was present and healthcare was needed. These findings have implications for educating the public about the complex and variable manifestations of a heart attack.

  3. De novo Diagnosis of Fabry Disease among Italian Adults with Acute Ischemic Stroke or Transient Ischemic Attack.

    Science.gov (United States)

    Romani, Ilaria; Borsini, Walter; Nencini, Patrizia; Morrone, Amelia; Ferri, Lorenzo; Frusconi, Sabrina; Donadio, Vincenzo Angelo; Liguori, Rocco; Donati, Maria Alice; Falconi, Serena; Pracucci, Giovanni; Inzitari, Domenico

    2015-11-01

    Cerebrovascular complications are often the first cause of hospitalization in patients with Fabry disease (FD). Screenings for FD among stroke patients have yielded discrepant results, likely as a result of heterogeneous or incomplete assessment. We designed a study to identify FD among adults 60 years of age or younger who were consecutively admitted for acute ischemic stroke or transient ischemic attack (TIA) to a stroke neurology service in Italy. Patients with first-ever or recurrent events were included, irrespective of gender, risk factors, or stroke type. We screened male patients using α-galactosidase A enzyme assay, and female patients using DNA sequencing. FD was eventually established after a broad multidisciplinary discussion. We screened 108 patients (61% males, median age: 48 years); 84% of these patients had stroke. De novo FD diagnosis was established in 3 patients (2.8%; 95% confidence interval, .57-8.18): a 59-year-old man with recurrent lacunar-like strokes and multiple risk factors; a 42-year-old woman with recurrent cryptogenic minor strokes; and a 32-year-old woman with recurrent strokes previously attributed to Behçet's disease. Screened patients were systematically asked for typical FD symptoms; each of the de novo patients reported one or more of the following: episodes of hand/foot pain during fever, angiokeratoma, and family history of heart disease. In all of the patients events were recurrent, and lacunar-like infarcts characterized their brain imaging. Prevalence of FD among nonselected adults 60 years of age or younger with acute ischemic stroke or TIA is not negligible. A systematic search for FD in a stroke setting, using a comprehensive clinical, biochemical, and genetic screening protocol, may be worthwhile. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. Division for Heart Disease and Stroke Prevention: Data Trends & Maps

    Data.gov (United States)

    U.S. Department of Health & Human Services — The CDC Division for Heart Disease and Stroke Prevention's Data Trends & Maps online tool allows searching for and view of health indicators related to Heart...

  5. Predicting asymptomatic coronary artery disease in patients with ischemic stroke and transient ischemic attack: the PRECORIS score.

    Science.gov (United States)

    Calvet, David; Song, Dongbeom; Yoo, Joonsang; Turc, Guillaume; Sablayrolles, Jean-Louis; Choi, Byoung Wook; Heo, Ji Hoe; Mas, Jean-Louis

    2014-01-01

    Identifying occult coronary artery stenosis may improve secondary prevention of stroke patients. The aim of this study was to derive and validate a simple score to predict severe occult coronary artery stenosis in stroke patients. We derived a score from a French hospital-based cohort of consecutive patients (n=300) who had an ischemic stroke or a transient ischemic attack and no previous history of coronary heart disease (Predicting Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke and Transient Ischemic Attack [PRECORIS] score) and validated the score in a similar Korean cohort (n=1602). In both cohorts, severe coronary artery stenosis was defined by the presence of at least 1≥50% coronary artery stenosis as detected by 64-section CT coronary angiography. A 5-point score (Framingham Risk Score-predicted 10-year coronary heart disease risk [≥20%=3; 10-19%=1; disease or 3-vessel disease were considered (C-statistic=0.83 [0.74-0.92] and 0.70 [0.66-0.74] in derivation and validation cohorts, respectively). The prevalence of occult≥50% coronary artery stenosis and ≥50% left main trunk or 3-vessel disease increased gradually with the PRECORIS score, reaching 44.2% and 13.5% in derivation cohort and 49.8% and 12.8% in validation cohort in patients with a PRECORIS score≥4. The PRECORIS score can identify a population of stroke or transient ischemic attack patients with a high prevalence of occult severe coronary artery stenosis.

  6. Revised and updated recommendations for the establishment of primary stroke centers: a summary statement from the brain attack coalition.

    Science.gov (United States)

    Alberts, Mark J; Latchaw, Richard E; Jagoda, Andy; Wechsler, Lawrence R; Crocco, Todd; George, Mary G; Connolly, E S; Mancini, Barbara; Prudhomme, Stephen; Gress, Daryl; Jensen, Mary E; Bass, Robert; Ruff, Robert; Foell, Kathy; Armonda, Rocco A; Emr, Marian; Warren, Margo; Baranski, Jim; Walker, Michael D

    2011-09-01

    The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures. Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center.

  7. Brain-Heart Interaction: Cardiac Complications After Stroke.

    Science.gov (United States)

    Chen, Zhili; Venkat, Poornima; Seyfried, Don; Chopp, Michael; Yan, Tao; Chen, Jieli

    2017-08-04

    Neurocardiology is an emerging specialty that addresses the interaction between the brain and the heart, that is, the effects of cardiac injury on the brain and the effects of brain injury on the heart. This review article focuses on cardiac dysfunction in the setting of stroke such as ischemic stroke, brain hemorrhage, and subarachnoid hemorrhage. The majority of post-stroke deaths are attributed to neurological damage, and cardiovascular complications are the second leading cause of post-stroke mortality. Accumulating clinical and experimental evidence suggests a causal relationship between brain damage and heart dysfunction. Thus, it is important to determine whether cardiac dysfunction is triggered by stroke, is an unrelated complication, or is the underlying cause of stroke. Stroke-induced cardiac damage may lead to fatality or potentially lifelong cardiac problems (such as heart failure), or to mild and recoverable damage such as neurogenic stress cardiomyopathy and Takotsubo cardiomyopathy. The role of location and lateralization of brain lesions after stroke in brain-heart interaction; clinical biomarkers and manifestations of cardiac complications; and underlying mechanisms of brain-heart interaction after stroke, such as the hypothalamic-pituitary-adrenal axis; catecholamine surge; sympathetic and parasympathetic regulation; microvesicles; microRNAs; gut microbiome, immunoresponse, and systemic inflammation, are discussed. © 2017 American Heart Association, Inc.

  8. Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Blake Catherine

    2009-02-01

    Full Text Available Abstract Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing, modifiable risk factors (hypertension, abnormal blood lipids and lipoproteins, cigarette smoking, physical inactivity, obesity and diabetes mellitus. Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention. Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population. A Cochrane review highlighted as priority, the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease. Methods A single blind randomised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack (TIA and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure, lipid profile, smoking and diabetic status and lifestyle factors of habitual smoking, exercise and healthy eating participation. Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale, the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test. A total of 144 patients, over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA, will be recruited from Dublin community stroke services and two tertiary T.I.A clinics. Exclusion criteria will include oxygen dependence, unstable cardiac conditions, uncontrolled diabetes, major medical conditions, claudication, febrile illness, pregnancy or cognitive impairment. Participants will be block-statified, randomly allocated to one of two groups using a pre-prepared computer generated randomisation schedule. Both groups will receive a two hour education class on risk reduction post stroke. The

  9. Quantitative Measurement of Physical Activity in Acute Ischemic Stroke and Transient Ischemic Attack

    DEFF Research Database (Denmark)

    Strømmen, Anna Maria; Christensen, Thomas; Jensen, Kai

    2014-01-01

    the feasibility of using accelerometers to quantitatively and continuously measure physical activity simultaneously from all 4 extremities and the hip in patients with acute ischemic stroke and transient ischemic attack. Our study provides quantitative evidence of physical inactivity in patients with acute......BACKGROUND AND PURPOSE: The purpose of this study was to quantitatively measure and describe the amount and pattern of physical activity in patients within the first week after acute ischemic stroke and transient ischemic attack using accelerometers. METHODS: A total of 100 patients with acute...... ischemic stroke or transient ischemic attack admitted to our acute stroke unit wore Actical accelerometers attached to both wrists and ankles and the hip for ≤7 days. Patients were included within 72 hours of symptom onset. Accelerometer output was measured in activity counts (AC). Patients were tested...

  10. Heart and Stroke Foundation of Ontario (HSFO) high blood pressure strategy's hypertension management initiative study protocol

    OpenAIRE

    Tobe, Sheldon W; Lum-Kwong, Margaret Moy; Perkins, Nancy; Von Sychowski, Shirley; Sebaldt, Rolf J; Kiss, Alex

    2008-01-01

    Abstract Background Achieving control of hypertension prevents target organ damage at both the micro and macrovascular level and is a highly cost effective means of lowering the risk for heart attack and stroke particularly in people with diabetes. Clinical trials demonstrate that blood pressure control can be achieved in a large proportion of people. Translating this knowledge into widespread practice is the focus of the Hypertension Management Initiative, which began in 2004 with the goal o...

  11. Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes).

    Science.gov (United States)

    Easton, J Donald; Aunes, Maria; Albers, Gregory W; Amarenco, Pierre; Bokelund-Singh, Sara; Denison, Hans; Evans, Scott R; Held, Peter; Jahreskog, Marianne; Jonasson, Jenny; Minematsu, Kazuo; Molina, Carlos A; Wang, Yongjun; Wong, K S Lawrence; Johnston, S Claiborne

    2017-09-05

    patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720. © 2017 American Heart Association, Inc.

  12. Healthy Heart Handbook for Women

    Science.gov (United States)

    ... who use high-dose birth control pills (oral contraceptives) are more likely to have a heart attack ... given to people who arrive at a hospital emergency department with a suspected heart attack or stroke. ...

  13. Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand

    Directory of Open Access Journals (Sweden)

    Jittima Saengsuwan

    2017-01-01

    Full Text Available Stroke is a global burden. It is not known whether patients who are most at risk of stroke (recurrent stroke or recurrent transient ischaemic attack have enough knowledge of stroke risk factors and warning signs. The aim of this study was to assess the knowledge of stroke risk factors and warning signs in this high-risk population. We performed a cross-sectional questionnaire-based study of patients with recurrent stroke or recurrent TIA admitted to Srinagarind Hospital and Khon Kaen Hospital, Thailand. A total of 140 patients were included in the study (age 65.6±11.3 years [mean ± SD], 62 females. Using an open-ended questionnaire, nearly one-third of patients (31.4% could not name any risk factors for stroke. The most commonly recognized risk factors were hypertension (35%, dyslipidemia (28.6%, and diabetes (22.9%. Regarding stroke warning signs, the most commonly recognized warning signs were sudden unilateral weakness (61.4%, sudden trouble with speaking (25.7%, and sudden trouble with walking, loss of balance, or dizziness (21.4%. Nineteen patients (13.6% could not identify any warning signs. The results showed that knowledge of stroke obtained from open-ended questionnaires is still unsatisfactory. The healthcare provider should provide structured interventions to increase knowledge and awareness of stroke in these patients.

  14. Pandora's Box: mitochondrial defects in ischaemic heart disease and stroke.

    Science.gov (United States)

    Andalib, Sasan; Divani, Afshin A; Michel, Tanja M; Høilund-Carlsen, Poul F; Vafaee, Manouchehr S; Gjedde, Albert

    2017-04-05

    Ischaemic heart disease and stroke are vascular events with serious health consequences worldwide. Recent genetic and epigenetic techniques have revealed many genetic determinants of these vascular events and simplified the approaches to research focused on ischaemic heart disease and stroke. The pathogenetic mechanisms of ischaemic heart disease and stroke are complex, with mitochondrial involvement (partially or entirely) recently gaining substantial support. Not only can mitochondrial reactive oxygen species give rise to ischaemic heart disease and stroke by production of oxidised low-density lipoprotein and induction of apoptosis, but the impact on pericytes contributes directly to the pathogenesis. Over the past two decades, publications implicate the causative role of nuclear genes in the development of ischaemic heart disease and stroke, in contrast to the potential role of mitochondrial DNA (mtDNA) in the pathophysiology of the disorders, which is much less understood, although recent studies do demonstrate that the involvement of mitochondria and mtDNA in the development of ischaemic heart disease and stroke is likely to be larger than originally thought, with the novel discovery of links among mitochondria, mtDNA and vascular events. Here we explore the molecular events and mtDNA alterations in relation to the role of mitochondria in ischaemic heart disease and stroke.

  15. Increasing Incidence of Hospitalization for Stroke and Transient Ischemic Attack in Young Adults: A Registry-Based Study.

    Science.gov (United States)

    Tibæk, Maiken; Dehlendorff, Christian; Jørgensen, Henrik S; Forchhammer, Hysse B; Johnsen, Søren P; Kammersgaard, Lars P

    2016-05-11

    Studies have reported increasing incidence of ischemic stroke in adults younger than 50 to 55 years. Information on temporal trends of other stroke subtypes and transient ischemic attack (TIA) is sparse. The aim of this study was to investigate temporal trends of the incidence of hospitalizations for TIA and stroke including sex- and subtype-specific trends in young adults aged 15 to 30 years. From the Danish National Patient Register, we identified all cases of first-ever stroke and TIA (age 15-30 years) in Denmark, who were hospitalized during the study period of 1994 to 2012. Incidence rates and estimated annual percentage changes (EAPCs) were estimated by using Poisson regression. During the study period, 4156 cases of first-ever hospitalization for stroke/TIA were identified. The age-standardized incidence rates of hospitalizations for stroke increased significantly (EAPC 1.83% [95% CI 1.11-2.55%]) from 11.97/100 000 person-years (PY) in 1994 to 16.77/100 000 PY in 2012. TIA hospitalizations increased from 1.93/100 000 PY in 1994 to 5.81/100 000 PY in 2012 and after 2006 more markedly in men than in women (EAPC 16.61% [95% CI 10.45-23.12%]). The incidence of hospitalizations for ischemic stroke was markedly lower among men, but increased significantly from 2006 (EAPC 14.60% [95% CI 6.22-23.63%]). The incidences of hospitalizations for intracerebral hemorrhage and subarachnoid hemorrhage remained stable during the study period. The incidence rates of first-time hospitalizations for ischemic stroke and TIA in young Danish adults have increased substantially since the mid 1990s. The increase was particularly prominent in the most recent years. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  16. Sodium Valproate, a Histone Deacetylase Inhibitor, Is Associated With Reduced Stroke Risk After Previous Ischemic Stroke or Transient Ischemic Attack.

    Science.gov (United States)

    Brookes, Rebecca L; Crichton, Siobhan; Wolfe, Charles D A; Yi, Qilong; Li, Linxin; Hankey, Graeme J; Rothwell, Peter M; Markus, Hugh S

    2018-01-01

    A variant in the histone deacetylase 9 ( HDAC9 ) gene is associated with large artery stroke. Therefore, inhibiting HDAC9 might offer a novel secondary preventative treatment for ischemic stroke. The antiepileptic drug sodium valproate (SVA) is a nonspecific inhibitor of HDAC9. We tested whether SVA therapy given after ischemic stroke was associated with reduced recurrent stroke rate. Data were pooled from 3 prospective studies recruiting patients with previous stroke or transient ischemic attack and long-term follow-up: the South London Stroke Register, The Vitamins to Prevent Stroke Study, and the Oxford Vascular Study. Patients receiving SVA were compared with patients who received antiepileptic drugs other than SVA using survival analysis and Cox Regression. A total of 11 949 patients with confirmed ischemic event were included. Recurrent stroke rate was lower in patient taking SVA (17 of 168) than other antiepileptic drugs (105 of 530; log-rank survival analysis P =0.002). On Cox regression, controlling for potential cofounders, SVA remained associated with reduced stroke (hazard ratio=0.44; 95% confidence interval: 0.3-0.7; P =0.002). A similar result was obtained when patients taking SVA were compared with all cases not taking SVA (Cox regression, hazard ratio=0.47; 95% confidence interval: 0.29-0.77; P =0.003). These results suggest that exposure to SVA, an inhibitor of HDAC, may be associated with a lower recurrent stroke risk although we cannot exclude residual confounding in this study design. This supports the hypothesis that HDAC9 is important in the ischemic stroke pathogenesis and that its inhibition, by SVA or a more specific HDAC9 inhibitor, is worthy of evaluation as a treatment to prevent recurrent ischemic stroke. © 2017 The Authors.

  17. Heart Disease, Stroke, or Other Cardiovascular Disease and Adult Vaccination

    Science.gov (United States)

    ... Adult Diseases Resources Heart Disease, Stroke, or Other Cardiovascular Disease and Adult Vaccination Language: English (US) Español (Spanish) ... important step in staying healthy. If you have cardiovascular disease, talk with your doctor about getting your vaccinations ...

  18. Mortality, stroke, and heart failure in atrial fibrillation cohorts after ablation versus propensity-matched cohorts.

    Science.gov (United States)

    Jarman, Julian We; Hunter, Tina D; Hussain, Wajid; March, Jamie L; Wong, Tom; Markides, Vias

    2017-01-01

    We sought to determine from key clinical outcomes whether catheter ablation of atrial fibrillation (AF) is associated with increased survival. Using routinely collected hospital data, ablation patients were matched to two control cohorts using direct and propensity score methodology. Four thousand nine hundred ninety-one ablation patients were matched 1:1 with general AF controls without ablation. Five thousand four hundred seven ablation patients were similarly matched to controls who underwent cardioversion. We examined the rates of ischemic stroke or transient ischemic attack (stroke/TIA), heart failure hospitalization, and death. Matched populations had very similar comorbidity profiles, including nearly identical CHA 2 DS 2 -VASc risk distribution ( p =0.6948 and p =0.8152 vs general AF and cardioversion cohorts). Kaplan-Meier models showed increased survival after ablation for all outcomes compared with both control cohorts ( p vs general AF, p =0.0087 for stroke/TIA, p vs cardioversion). Cox regression models also showed improved survival after ablation for all outcomes compared with the general AF cohort (hazard ratio [HR]=0.4, 95% confidence interval [95% CI]: 0.3-0.6, p stroke/TIA; HR=0.4, 95% CI: 0.2-0.6, p stroke/TIA; HR=0.4, 95% CI: 0.3-0.6, p stroke/TIA, and heart failure compared with a matched general AF population and a matched population who underwent cardioversion. Potential confounding of outcomes was minimized by very tight cohort matching.

  19. Increased Risk of Pregnancy Complications After Stroke : The FUTURE Study (Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation)

    NARCIS (Netherlands)

    van Alebeek, Mayte E; de Vrijer, Myrthe; Arntz, Renate M; Maaijwee, Noortje A M M; Synhaeve, Nathalie E; Schoonderwaldt, Hennie; van der Vlugt, Maureen J; van Dijk, Ewoud J; de Heus, Roel; Rutten-Jacobs, Loes C A; de Leeuw, Frank-Erik

    BACKGROUND AND PURPOSE: The study goal was to investigate the prevalence of pregnancy complications and pregnancy loss in women before, during, and after young ischemic stroke/transient ischemic attack. METHODS: In the FUTURE study (Follow-Up of Transient Ischemic Attack and Stroke Patients and

  20. Prevalence of renal dysfunction in ischaemic stroke and transient ischaemic attack patients with or without atrial fibrillation.

    Science.gov (United States)

    Laible, M; Horstmann, S; Rizos, T; Rauch, G; Zorn, M; Veltkamp, R

    2015-01-01

    Chronic kidney disease (CKD) is associated with a higher risk of stroke and atrial fibrillation (AF). There are limited data on the comorbidity of renal dysfunction and AF in stroke patients. Our aim was to determine the frequency of kidney dysfunction in ischaemic stroke patients with and without AF. In a prospectively collected, single center cohort of acute ischaemic stroke and transient ischaemic attack (TIA) patients, glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease equation on admission. Renal function was graded into five categories (cat.): cat. 1, eGRF ≥90 ml/min/1.73 m(2); cat. 2, 60-89; cat. 3, 30-59; cat. 4, 15-29; cat. 5, stroke, 547 TIA; median age 71.0) were included. Median eGFR was 78.6 ml/min/1.73 m(2) (interquartile range 61/95); 21.1% were in cat. 3, 2.1% in cat. 4, 0.7% in cat. 5. In all, 535 patients (23.5%) suffered from AF; 28.0% of these were in cat. 3, 2.6% and 0.8% in cat. 4 and cat. 5, respectively. In multivariable analysis, age [odds ratio (OR) 1.1], diabetes (OR 1.8), heart failure (OR 1.7) and AF (OR 1.4) were independently associated with kidney dysfunction (eGFR stroke patients than in the general population and more common in AF-related stroke. These findings may have implications for the choice of anticoagulants. © 2014 EAN.

  1. Perception of Recurrent Stroke Risk among Black, White and Hispanic Ischemic Stroke and Transient Ischemic Attack Survivors: The SWIFT Study

    Science.gov (United States)

    Boden-Albala, Bernadette; Carman, Heather; Moran, Megan; Doyle, Margaret; Paik, Myunghee C.

    2011-01-01

    Objectives Risk modification through behavior change is critical for primary and secondary stroke prevention. Theories of health behavior identify perceived risk as an important component to facilitate behavior change; however, little is known about perceived risk of vascular events among stroke survivors. Methods The SWIFT (Stroke Warning Information and Faster Treatment) study includes a prospective population-based ethnically diverse cohort of ischemic stroke and transient ischemic attack survivors. We investigate the baseline relationship between demographics, health beliefs, and knowledge on risk perception. Regression models examined predictors of inaccurate perception. Results Only 20% accurately estimated risk, 10% of the participants underestimated risk, and 70% of the 817 study participants significantly overestimated their risk for a recurrent stroke. The mean perceived likelihood of recurrent ischemic stroke in the next 10 years was 51 ± 7%. We found no significant differences by race-ethnicity with regard to accurate estimation of risk. Inaccurate estimation of risk was associated with attitudes and beliefs [worry (p risk factors. Conclusion This paper provides a unique perspective on how factors such as belief systems influence risk perception in a diverse population at high stroke risk. There is a need for future research on how risk perception can inform primary and secondary stroke prevention. Copyright © 2011 S. Karger AG, Basel PMID:21894045

  2. Patients' perceptions of their heart attack and recovery: the influence of epidemiological "evidence" and personal experience.

    Science.gov (United States)

    Wiles, R

    1998-06-01

    Secondary prevention of heart disease is widely viewed as likely to be more successful and cost effective than primary prevention. However, people's willingness to adopt lifestyle change is a complex issue in which people's perceptions of disease causation and risk as well as a range of socio-economic factors are important. This paper reports on a qualitative study of people following heart attack which examines their understandings of heart attack and the salience that lifestyle advice has in the light of these understandings. In-depth, qualitative interviews were conducted with 25 people recovering from heart attack. Each person was interviewed twice: at around two weeks and five months following their heart attack. The study found that information about recovery provided by health professionals was based on a simplified version of epidemiological evidence. This information played a central role in people's understandings about the nature of heart attack and their future risk in the early weeks following heart attack. However, as interviewees came to terms with the shock of the event, they tended to lose their trust in "official" accounts of cause and recovery and evidence from lay epidemiology that contradicted official accounts tended to emerge. This evidence encouraged interviewees to question the explanatory power of official accounts and to view the adoption of long-term lifestyle change as an action that would not guarantee protection from a further heart attack. This was true whether or not people's experiences of recovery reflected those "predicted" by health professionals although those awaiting further surgery or tests tended to maintain trust in official accounts over a longer period. It is concluded that the failure of official accounts to acknowledge the random nature of the occurrence of heart attack, the severity of heart attack and the level of recovery from heart attack is a central feature in people's reluctance to view lifestyle change as a

  3. Evolution of DWI signal abnormalities after transient ischemic attack and minor ischaemic stroke

    LENUS (Irish Health Repository)

    Merwick, A

    2011-05-01

    Background: Diffusion weighted imaging (DWI) signal abnormality after transient ischaemic attack (TIA) predicts early stroke, independently of other risk markers included in the ABCD3-I score. Early stroke recurrence detected on follow-up DWI after the acute-phase DWI may identify patients at high risk for subsequent clinicalstrokesstroke, cognitive impairment, and seizures. We aimed to determine the evolution of acute DWI lesions and rate of new ischaemic lesion (NIL) occurrence on follow-up DWI after TIA and minor stroke.\\r\

  4. Increasing Incidence of Hospitalization for Stroke and Transient Ischemic Attack in Young Adults

    DEFF Research Database (Denmark)

    Tibæk, Maiken; Dehlendorff, Christian; Jørgensen, Henrik S

    2016-01-01

    BACKGROUND: Studies have reported increasing incidence of ischemic stroke in adults younger than 50 to 55 years. Information on temporal trends of other stroke subtypes and transient ischemic attack (TIA) is sparse. The aim of this study was to investigate temporal trends of the incidence of hosp......-time hospitalizations for ischemic stroke and TIA in young Danish adults have increased substantially since the mid 1990s. The increase was particularly prominent in the most recent years.......BACKGROUND: Studies have reported increasing incidence of ischemic stroke in adults younger than 50 to 55 years. Information on temporal trends of other stroke subtypes and transient ischemic attack (TIA) is sparse. The aim of this study was to investigate temporal trends of the incidence...... of hospitalizations for TIA and stroke including sex- and subtype-specific trends in young adults aged 15 to 30 years. METHODS AND RESULTS: From the Danish National Patient Register, we identified all cases of first-ever stroke and TIA (age 15-30 years) in Denmark, who were hospitalized during the study period...

  5. Transient ischaemic attack and stroke risk: pilot of a primary care electronic decision support tool

    Directory of Open Access Journals (Sweden)

    Ranta A

    2013-06-01

    Full Text Available INTRODUCTION: Transient ischaemic attacks (TIAs indicate high risk for stroke and rapid management reduces stroke burden. Rapid specialist access to initiate timely management is often challenging to achieve. AIM: To assess the feasibility of implementing a TIA/Stroke electronic decision support (EDS tool intended to aid general practitioners (GPs in the timely management of TIAs. METHODS: An eight-week pilot provided access to the TIA/Stroke EDS to selected GPs in the MidCentral district, with subsequent patient record review and a post-pilot user satisfaction survey. RESULTS: Eleven patients from eight practices were entered into the tool and when EDS-rendered advice was followed, diagnosis was accurate and management was in accordance with New Zealand TIA guidelines. No adverse outcomes resulted and user feedback was positive. DISCUSSION: Results indicate that wider implementation of the TIA/Stroke EDS tool is feasible.

  6. The Effect of Sleep Disordered Breathing on the Outcome of Stroke and Transient Ischemic Attack

    DEFF Research Database (Denmark)

    Birkbak, Johannes; Clark, Alice J; Rod, Naja Hulvej

    2014-01-01

    The primary objective was to systematically review the literature on how sleep disordered breathing (SDB) affects recurrence and death among stroke or transient ischemic attack (TIA) patients. A secondary objective was to evaluate how treatment of SDB with continuous positive airway pressure (CPAP...

  7. Heart rate is a prognostic risk factor for myocardial infarction: a post hoc analysis in the PERFORM (Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic attack) study population.

    Science.gov (United States)

    Fox, Kim; Bousser, Marie-Germaine; Amarenco, Pierre; Chamorro, Angel; Fisher, Marc; Ford, Ian; Hennerici, Michael G; Mattle, Heinrich P; Rothwell, Peter M

    2013-10-09

    Elevated resting heart rate is known to be detrimental to morbidity and mortality in cardiovascular disease, though its effect in patients with ischemic stroke is unclear. We analyzed the effect of baseline resting heart rate on myocardial infarction (MI) in patients with a recent noncardioembolic cerebral ischemic event participating in PERFORM. We compared fatal or nonfatal MI using adjusted Cox proportional hazards models for PERFORM patients with baseline heart rate heart rate was analyzed as a continuous variable. Other cerebrovascular and cardiovascular outcomes were also explored. Heart rate ≥70 bpm was associated with increased relative risk for fatal or nonfatal MI (HR 1.32, 95% CI 1.03-1.69, P=0.029). For every 5-bpm increase in heart rate, there was an increase in relative risk for fatal and nonfatal MI (11.3%, P=0.0002). Heart rate ≥70 bpm was also associated with increased relative risk for a composite of fatal or nonfatal ischemic stroke, fatal or nonfatal MI, or other vascular death (excluding hemorrhagic death) (Pheart rate, there were increases in relative risk for fatal or nonfatal ischemic stroke, fatal or nonfatal MI, or other vascular death (4.7%, Pheart rate ≥70 bpm places patients with a noncardioembolic cerebral ischemic event at increased risk for MI. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Risk Factors and Cognitive Relevance of Cortical Cerebral Microinfarcts in Patients With Ischemic Stroke or Transient Ischemic Attack.

    Science.gov (United States)

    Wang, Zhaolu; van Veluw, Susanne J; Wong, Adrian; Liu, Wenyan; Shi, Lin; Yang, Jie; Xiong, Yunyun; Lau, Alexander; Biessels, Geert Jan; Mok, Vincent C T

    2016-10-01

    It was recently demonstrated that cerebral microinfarcts (CMIs) can be detected in vivo using 3.0 tesla (T) magnetic resonance imaging. We investigated the prevalence, risk factors, and the longitudinal cognitive consequence of cortical CMIs on 3.0T magnetic resonance imaging, in patients with ischemic stroke or transient ischemic attack. A total of 231 patients undergoing 3.0T magnetic resonance imaging were included. Montreal Cognitive Assessment was used to evaluate global cognitive functions and cognitive domains (memory, language, and attention visuospatial and executive functions). Cognitive changes were represented by the difference in Montreal Cognitive Assessment score between baseline and 28-month after stroke/transient ischemic attack. The cross-sectional and longitudinal associations between cortical CMIs and cognitive functions were explored using ANCOVA and regression models. Cortical CMIs were observed in 34 patients (14.7%), including 13 patients with acute (hyperintense on diffusion-weighted imaging) and 21 with chronic CMIs (isointense on diffusion-weighted imaging). Atrial fibrillation was a risk factor for all cortical CMIs (odds ratio, 4.8; 95% confidence interval, 1.5-14.9; P=0.007). Confluent white matter hyperintensities was associated with chronic CMIs (odds ratio, 2.8; 95% confidence interval, 1.0-7.8; P=0.047). The presence of cortical CMIs at baseline was associated with worse visuospatial functions at baseline and decline over 28-month follow-up (β=0.5; 95% confidence interval, 0.1-1.0; P=0.008, adjusting for brain atrophy, white matter hyperintensities, lacunes, and microbleeds). Cortical CMIs are a common finding in patients with stroke/transient ischemic attack. Associations between CMI with atrial fibrillation and white matter hyperintensities suggest that these lesions have a heterogeneous cause, involving microembolism and cerebral small vessel disease. CMI seemed to preferentially impact visuospatial functions as assessed by a

  9. Age-specific trends of atrial fibrillation-related ischaemic stroke and transient ischaemic attack, anticoagulant use and risk factor profile in Chinese population: a 15-year study.

    Science.gov (United States)

    Soo, Yannie; Chan, Nathan; Leung, Kam Tat; Chen, Xiang-Yan; Mok, Vincent; Wong, Lawrence; Leung, Thomas

    2017-09-01

    Prevalence of atrial fibrillation (AF) is increasing globally, and the fivefold increase in stroke risk constitutes significant healthcare burden. We aim to evaluate the trends of AF-related stroke and transient ischaemic attack (AF-stroke/TIA), prior anticoagulant use and their risk factors in different age groups in Chinese population. Data were retrieved from the stroke registry at Prince of Wales Hospital. We compared the data at 5-year intervals over a 15-year period (years 1999, 2004, 2009 and 2014). A total of 3894 patients were included, 712 patients had AF-stroke/TIA. Over the 15 years, the total number of ischaemic stroke/TIA fluctuated slightly during the period from year 1999 to 2009, and increased by 21.5% in the year 2014. While AF-stroke/TIA increased continuously with time by 282.1%. Increasing trend of AF-stroke/TIA was observed in all age groups. Absolute growth was highest in patients aged ≥80 years; relative growth was most pronounced in those between 65 and 72 years (>3.5 fold increase). Throughout the 15 years, >70% of AF-stroke/TIA occurred in non-anticoagulated patients, and this proportion increased with age. Increasing trends in both hypertension and ischaemic heart disease were also observed in patients with AF aged ≥73 years. AF-stroke/TIA has increased continuously by >2.5 fold in Chinese population over a 15-year period, with the majority of AF-stroke/TIA occurring in non-anticoagulated patients. Strategic planning is needed to optimise anticoagulant use, particularly non-vitamin K antagonist oral anticoagulants in elderly patients, low-income group and those with ischaemic heart disease requiring concomitant antiplatelet therapy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Cardiorespiratory Fitness after Transient Ischemic Attack and Minor Ischemic Stroke : Baseline Data of the MoveIT Study

    NARCIS (Netherlands)

    Boss, H. Myrthe; Deijle, Inger A.; Van Schaik, Sander M.; de Melker, Edwin C.; van den Berg, Bob T.J.; Weinstein, Henry C.; Geerlings, Mirjam I.; Kappelle, L. Jaap; Van den Berg-Vos, Renske M.

    2017-01-01

    Background Cardiorespiratory fitness (CRF) is reduced in patients with stroke. It is unclear whether it is also reduced in patients with a transient ischemic attack (TIA) or minor stroke. We investigated the CRF in patients with a recent TIA or minor stroke and explored which determinants are

  11. Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis.

    Science.gov (United States)

    Ji, Ruijun; Schwamm, Lee H; Pervez, Muhammad A; Singhal, Aneesh B

    2013-01-01

    Approximately 10% to 14% of ischemic strokes occur in young adults. To investigate the yield of diagnostic tests, neuroimaging findings, and treatment of ischemic strokes in young adults. We retrospectively reviewed data from our Get with the Guidelines-Stroke database from 2005 through 2010. University hospital tertiary stroke center. A total of 215 consecutive inpatients aged 18 to 45 years with ischemic stroke/transient ischemic attack. The mean (SD) age was 37.5 (7) years; 51% were male. There were high incidence rates of hypertension (20%), diabetes mellitus (11%), dyslipidemia (38%), and smoking (34%). Relevant abnormalities were shown on cerebral angiography in 136 of 203 patients, on cardiac ultrasonography in 100 of 195, on Holter monitoring in 2 of 192; and on hypercoagulable panel in 30 of 189 patients. Multiple infarcts were observed in 31% and were more prevalent in individuals younger than age 35 years. Relevant arterial lesions were frequently detected in the middle cerebral artery (23%), internal carotid artery (13%), and vertebrobasilar arteries (13%). Cardioembolic stroke occurred in 47% (including 17% with isolated patent foramen ovale), and 11% had undetermined stroke etiology. The median National Institutes of Health Stroke Scale score was 3 (interquartile range, 0-9) and 81% had good outcome at hospital discharge. Of the 29 patients receiving thrombolysis (median National Institutes of Health Stroke Scale score, 14; interquartile range, 9-17), 55% had good outcome at hospital discharge and none developed symptomatic brain hemorrhage. This study shows the contemporary profile of ischemic stroke in young adults admitted to a tertiary stroke center. Stroke etiology can be determined in nearly 90% of patients with modern diagnostic tests. The causes are heterogeneous; however, young adults have a high rate of traditional vascular risk factors. Thrombolysis appears safe and short-term outcomes are favorable.

  12. 'Heart attack' symptoms and decision-making: the case of older rural women.

    Science.gov (United States)

    Jackson, M N G; McCulloch, B J

    2014-01-01

    analysis. The study showed that women had difficulty identifying heart attack symptoms when they did not have previous exposure to the symptoms either through personal experience or educational programs. Individuals incorrectly identified symptoms of a heart attack by associating symptoms with sleep problems, stroke, arthritis, stiffness in the neck, influenza, nerve damage, osteoporosis, bone cancer, tooth infection, and a pulled muscle. Misdiagnosis of symptoms most often led to a delay in seeking treatment in these women. Additionally, the women in this study discussed a reluctance to access care because of concerns related to maintaining their privacy, belief that the ambulance would take too long to reach them, and they did not want to bother their relatives for help. The findings of this study suggest implications for educational programs and interventions in rural environments and provide information that can facilitate better-informed communication between healthcare professionals and rural women.

  13. CDC Vital Signs: Heart Age - Is Your Heart Older Than You?

    Science.gov (United States)

    ... age. About 3 in 4 heart attacks and strokes are due to risk factors that increase heart age. Problem US adults have ... and reduce the risk of heart attack and stroke. Doctors, nurses, and other ... the effect of risk factors on their heart health. Help patients choose a ...

  14. A Diagnostic Score for Insulin Resistance in Nondiabetic Patients with Ischemic Stroke or Transient Ischemic Attack.

    Science.gov (United States)

    Xu, Jin; Viscoli, Catherine M; Ford, Gary A; Gorman, Mark; Kernan, Walter N

    2016-07-01

    We sought to develop an instrument to screen for insulin resistance in nondiabetic patients with recent ischemic stroke or transient ischemic attack (TIA). Subjects were 7262 nondiabetic patients aged greater than or equal to 40 years with ischemic strokes or TIA within the past 6 months. Features were analyzed in bivariate analysis for association with insulin resistance, measured by the homeostasis model assessment of insulin resistance (HOMA-IR). Features significantly associated with HOMA-IR (P validation cohort. In the enhanced model, the aROC was .78 in the validation cohort. Our 2 scoring systems performed well in identifying stroke patients with insulin resistance, but they are probably not sufficiently accurate for high-stake clinical decisions. We suggest strategies for improving the accuracy of future instruments. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Acute Limb Ischemia and Outcomes With Vorapaxar in Patients With Peripheral Artery Disease: Results From the Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With Atherosclerosis-Thrombolysis in Myocardial Infarction 50 (TRA2°P-TIMI 50).

    Science.gov (United States)

    Bonaca, Marc P; Gutierrez, J Antonio; Creager, Mark A; Scirica, Benjamin M; Olin, Jeffrey; Murphy, Sabina A; Braunwald, Eugene; Morrow, David A

    2016-03-08

    Patients with peripheral artery disease (PAD) are at heightened risk of acute limb ischemia (ALI), a morbid event that may result in limb loss. We investigated the causes, sequelae, and predictors of ALI in a contemporary population with symptomatic PAD and whether protease-activated receptor 1 antagonism with vorapaxar reduced ALI overall and by type. The Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With Atherosclerosis-Thrombolysis in Myocardial Infarction 50 (TRA2°P-TIMI 50) was a randomized, double-blind, placebo-controlled trial of vorapaxar in stable patients, including 3787 with symptomatic PAD. ALI was a prespecified adjudicated end point using a formal definition. A total of 150 ALI events occurred in 108 patients during follow-up (placebo 3-year rate, 3.9%; 1.3% annualized). For patients with symptomatic PAD, previous peripheral revascularization, smoking, and the ankle-brachial index were predictive of ALI. The majority of ALI events occurred as a result of surgical graft thrombosis (56%), followed by native vessel in situ thrombosis (27%). Stent thrombosis and thromboembolism caused ALI in 13% and 5%, respectively. Amputation occurred in 17.6% presenting with ALI. Vorapaxar reduced first ALI events by 41% (hazard ratio, 0.58; 95% confidence interval, 0.39-0.86; P=0.006) and total ALI events by 41% (94 versus 56 events; risk ratio, 0.59; 95% confidence interval, 0.38-0.93; P=0.022). The efficacy of vorapaxar was consistent across types of ALI. In selected patients with symptomatic PAD and without atrial fibrillation, ALI occurs at a rate of 1.3%/y, is most frequently caused by acute bypass graft thrombosis or in situ thrombosis of a diseased vessel, and often results in limb loss. Vorapaxar reduces ALI in patients with symptomatic PAD with consistency across type, including PAD resulting from surgical graft thrombosis and in-situ thrombosis. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00526474

  16. Heart diseases and strokes in young people

    Directory of Open Access Journals (Sweden)

    N.V. Pizova

    2014-01-01

    Full Text Available The paper shows the relevance of the problem associated with the diagnosis and treatment of stroke in young patients aged 15-45 years. It considers the major causes of acute cerebrovascular accidents in young people, including pregnant women. Diseases, such patent foramen ovale, mitral valve prolapse, infective endocarditis, and postpartum cardiomyopathy, are described in detail. The basic principles of the diagnosis and therapy of ischemic stroke at a young age are given. The mainstay of therapy for acute ischemic stroke is stated to include two procedures: reperfusion and neuronal protection.

  17. Stress Hyperglycemia and Prognosis of Minor Ischemic Stroke and Transient Ischemic Attack: The CHANCE Study (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events).

    Science.gov (United States)

    Pan, Yuesong; Cai, Xueli; Jing, Jing; Meng, Xia; Li, Hao; Wang, Yongjun; Zhao, Xingquan; Liu, Liping; Wang, David; Johnston, S Claiborne; Wei, Tiemin; Wang, Yilong

    2017-11-01

    We aimed to determine the association between stress hyperglycemia and risk of new stroke in patients with a minor ischemic stroke or transient ischemic attack. A subgroup of 3026 consecutive patients from 73 prespecified sites of the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) were analyzed. Stress hyperglycemia was measured by glucose/glycated albumin (GA) ratio. Glucose/GA ratio was calculated by fasting plasma glucose divided by GA and categorized into 4 even groups according to the quartiles. The primary outcome was a new stroke (ischemic or hemorrhagic) at 90 days. We assessed the association between glucose/GA ratio and risk of stroke by multivariable Cox regression models adjusted for potential covariates. Among 3026 patients included, a total of 299 (9.9%) new stroke occurred at 3 months. Compared with patients with the lowest quartile, patients with the highest quartile of glucose/GA ratio was associated with an increased risk of stroke at 3 months after adjusted for potential covariates (12.0% versus 9.2%; adjusted hazard ratio, 1.46; 95% confidence interval, 1.06-2.01). Similar results were observed after further adjusted for fasting plasma glucose. We also observed that higher level of glucose/GA ratio was associated with an increased risk of stroke with a threshold of 0.29 using a Cox regression model with restricted cubic spline. Stress hyperglycemia, measured by glucose/GA ratio, was associated with an increased risk of stroke in patients with a minor ischemic stroke or transient ischemic attack. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589. © 2017 American Heart Association, Inc.

  18. Impact of heart rate on admission on mortality and morbidity in acute ischaemic stroke patients - results from VISTA.

    Science.gov (United States)

    Nolte, C H; Erdur, H; Grittner, U; Schneider, A; Piper, S K; Scheitz, J F; Wellwood, I; Bath, P M W; Diener, H-C; Lees, K R; Endres, M

    2016-12-01

    Elevated heart rate (HR) is associated with worse outcomes in patients with cardiovascular disease. Its predictive value in acute stroke patients is less well established. We investigated the effects of HR on admission in acute ischaemic stroke patients. Using the Virtual International Stroke Trials Archive (VISTA) database, the association between HR in acute stroke patients without atrial fibrillation and the pre-defined composite end-point of (recurrent) ischaemic stroke, transient ischaemic attack (TIA), myocardial infarction (MI) and vascular death within 90 days was analysed. Pre-defined secondary outcomes were the composite end-point components and any death, decompensated heart failure and degree of functional dependence according to the modified Rankin Scale after 90 days. HR was analysed as a categorical variable (quartiles). In all, 5606 patients were available for analysis (mean National Institutes of Health Stroke Scale 13; mean age 67 years; mean HR 77 bpm; 44% female) amongst whom the composite end-point occurred in 620 patients (11.1%). Higher HR was not associated with the composite end-point. The frequencies of secondary outcomes were 3.2% recurrent stroke (n = 179), 0.6% TIA (n = 35), 1.8% MI (n = 100), 6.8% vascular death (n = 384), 15.0% any death (n = 841) and 2.2% decompensated heart failure (n = 124). Patients in the highest quartile (HR> 86 bpm) were at increased risk for any death [adjusted hazard ratio (95% confidence interval) 1.40 (1.11-1.75)], decompensated heart failure [adjusted hazard ratio 2.20 (1.11-4.37)] and worse modified Rankin Scale [adjusted odds ratio 1.29 (1.14-1.52)]. In acute stroke patients, higher HR (>86 bpm) is linked to mortality, heart failure and higher degree of dependence after 90 days but not to recurrent stroke, TIA or MI. © 2016 EAN.

  19. Methodological Factors in Determining Risk of Dementia After Transient Ischemic Attack and Stroke: (III) Applicability of Cognitive Tests.

    Science.gov (United States)

    Pendlebury, Sarah T; Klaus, Stephen P; Thomson, Ross J; Mehta, Ziyah; Wharton, Rose M; Rothwell, Peter M

    2015-11-01

    Cognitive assessment is recommended after stroke but there are few data on the applicability of short cognitive tests to the full spectrum of patients. We therefore determined the rates, causes, and associates of untestability in a population-based study of all transient ischemic attack (TIA) and stroke. Patients with TIA or stroke prospectively recruited (2002-2007) into the Oxford Vascular Study had ≥1 short cognitive test (mini-mental state examination, telephone interview of cognitive status, Montreal cognitive assessment, and abbreviated mental test score) at baseline and on follow-up to 5 years. Among 1097 consecutive assessed survivors (mean: age/SD, 74.8/12.1 years; 378 TIA), numbers testable with a short cognitive test at baseline, 1, 6, 12, and 60 months were 835/1097 (76%), 778/947 (82%), 756/857 (88%), 692/792 (87%), and 472/567 (83%). Eighty-eight percent (331/378) of assessed patients with TIA were testable at baseline compared with only 46% (133/290) of major stroke (Pstroke effects at baseline (153/262 [58%]: dysphasia/anarthria/hemiparesis=84 [32%], drowsiness=58 [22%], and acute confusion=11 [4%]), whereas sensory deficits caused relatively more problems with testing at later time points (24/63 [38%] at 5 years). Substantial numbers of patients with TIA and stroke are untestable with short cognitive tests. Future studies should report data on untestable patients and those with problems with testing in whom the likelihood of dementia is high. © 2015 American Heart Association, Inc.

  20. Balance and Gait Impairment in Transient Ischemic Attack and Minor Stroke.

    Science.gov (United States)

    Batchelor, Frances A; Williams, Susan B; Wijeratne, Tissa; Said, Catherine M; Petty, Sandra

    2015-10-01

    There has been little research into gait and balance impairment in transient ischemic attack (TIA) and minor stroke, despite these conditions affecting large numbers of people and the potential impact on function. The aim of this study was to determine the impact of TIA and minor stroke on gait and balance. Twelve people with TIA or minor stroke without previous gait/balance problems and 12 age- and sex-matched controls were recruited. Participants (mean age 67 years) underwent a comprehensive assessment including physiological, balance, and gait measures (clinical and computerized [NeuroCom/GAITRite]). Matched-pairs analysis was undertaken. Groups were similar in body mass index, vision, leg proprioception/strength, and reaction time. Cognition was worse in the TIA/minor stroke group: mean Montreal Cognitive Assessment score 22.2 versus 26.6, P = .001. People with TIA/minor stroke were significantly worse on all but one clinical test. Median scores for TIA/minor stroke versus control were as follows: Timed Up and Go (TUG), 9.4 versus 7.6 seconds, P = .019; TUG dual task, 12.3 versus 8.5 seconds, P = .012; Four Square Step Test, 10.9 versus 7.2 seconds, P = .006. Mean Step Test score for TIA/minor stroke versus control was 14.1 versus 17.7, P = .021. The TIA/minor stroke group also had significantly worse performance on computerized tests: increased turn time/sway, increased step length, slower comfortable/fast gait speeds, and greater proportion of gait cycle spent in double support. This study found that people with TIA/minor stroke have gait and balance dysfunction despite having no obvious physiological impairments. Intervention studies aimed at improving balance and gait in this population are needed. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Mortality from heart attack in Belgrade population during the period 1990-2004

    Directory of Open Access Journals (Sweden)

    Ratkov Isidora

    2008-01-01

    Full Text Available INTRODUCTION In most countries, cardiovascular diseases are the leading disorders, with ischemic heart diseases being the leading cause of death. According to WHO data, every year about 17 million people die of cardiovascular diseases, which is 30% of all deaths. Ischemic heart diseases contribute from one-third to one-half of all deaths due to cardiovascular diseases. Three point eight million men and 3.4 million women in the world die every year from ischemic heart diseases, and in Europe about 2 million. The highest mortality rate from ischemic heart diseases occurs in India, China and Russia. OBJECTIVE The aim of this descriptive epidemiological study was to determine heart attack mortality in Belgrade population during the period 1990-2004. METHOD In the study, we conducted investigation of Belgrade population during the period 1990-2004. Mortality data were obtained from the city institution for statistics. The mortality rates were calculated based on the total Belgrade population obtained from the mean values for the last two register years (1991 and 2002. The mortality rates were standardized using the direct method of standardization according to the world (Segi standard population. RESULTS In the Belgrade population during the period 1990-2004, the participation of mortality rate due to heart attack among deaths from cardiovascular diseases was 17% in males and 10% in females. In Belgrade male population, mean standardized mortality rates (per 100,000 habitants were 50.5 for heart attack, 8.3 for chronic ischemic heart diseases and 4.6 for angina pectoris, while in females the rates were 30.8, 6.7 and 4.2, respectively. Mortality from ischemic heart diseases and from heart attack was higher in males than in females. During the studied 15-year period, on average 755 males and 483 females died due to heart attack every year. Mean standardized mortality rates per 100,000 habitants were 50.0 in male and 31.1 in female population. Males

  2. Heart attack risk perception biases among hypertension patients: the role of educational level and worry.

    Science.gov (United States)

    Peterson, Laurel M; Helweg-Larsen, Marie; Volpp, Kevin G; Kimmel, Stephen E

    2012-01-01

    Risk biases such as comparative optimism (thinking one is better off than similar others) and risk inaccuracy (misestimating one's risk compared to one's calculated risk) for health outcomes are common. Little research has investigated racial or socioeconomic differences in these risk biases. Results from a survey of individuals with poorly controlled hypertension (N=813) indicated that participants showed (1) comparative optimism for heart attack risk by underestimating their heart attack risk compared to similar others, and (2) risk inaccuracy by overestimating their heart attack risk compared to their calculated heart attack risk. More highly educated participants were more comparatively optimistic because they rated their personal risk as lower; education was not related to risk inaccuracy. Neither race nor the federal poverty level was related to risk biases. Worry partially mediated the relationship between education and personal risk. Results are discussed as they relate to the existing literature on risk perception.

  3. Mortality and morbidity during and after Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: results by sex.

    Science.gov (United States)

    Oparil, Suzanne; Davis, Barry R; Cushman, William C; Ford, Charles E; Furberg, Curt D; Habib, Gabriel B; Haywood, L Julian; Margolis, Karen; Probstfield, Jeffrey L; Whelton, Paul K; Wright, Jackson T

    2013-05-01

    To determine whether an angiotensin-converting enzyme inhibitor (lisinopril) or calcium channel blocker (amlodipine) is superior to a diuretic (chlorthalidone) in reducing cardiovascular disease incidence in sex subgroups, we carried out a prespecified subgroup analysis of 15 638 women and 17 719 men in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Total follow-up (active treatment + passive surveillance using national administrative databases to ascertain deaths and hospitalizations) was 8 to 13 years. The primary outcome was fatal coronary heart disease or nonfatal myocardial infarction. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (coronary heart disease death, nonfatal myocardial infarction, stroke, angina, coronary revascularization, heart failure [HF], or peripheral vascular disease), and end-stage renal disease. In-trial rates of HF, stroke, and combined cardiovascular disease were significantly higher for lisinopril compared with chlorthalidone, and rates of HF were significantly higher for amlodipine compared with chlorthalidone in both men and women. There were no significant treatment sex interactions. These findings did not persist through the extension period with the exception of the HF result for amlodipine versus chlorthalidone, which did not differ significantly by sex. For both women and men, rates were not lower in the amlodipine or lisinopril groups than in the chlorthalidone group for either the primary coronary heart disease outcome or any other cardiovascular disease outcome, and chlorthalidone-based treatment resulted in the lowest risk of HF. Neither lisinopril nor amlodipine is superior to chlorthalidone for initial treatment of hypertension in either women or men. Clinical Trial Registration- clinicaltrials.gov; Identifier: NCT00000542.

  4. Stroke-like migraine attacks after radiation therapy syndrome: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Andrew Ian Goldfinch, MBBS

    2017-09-01

    Full Text Available Stroke-like migraine attacks after radiation therapy syndrome is a late complication of cranial radiation. It typically presents as reversible, unilateral cortical signs and symptoms such as confusion, hemiparesis, seizures, and headaches. Magnetic resonance imaging is also required for diagnosis, demonstrating cortical linear gadolinium enhancement. Typically, these magnetic resonance imaging findings resolve as patients experience partial or complete improvement in their symptoms and signs after a few weeks. Although a very rare condition, it is becoming increasingly observed as survival rates from brain tumors improve. In this report, we describe a typical case of stroke-like migraine attacks after radiation therapy syndrome and present a review of the literature.

  5. Preventable Deaths from Heart Disease and Stroke PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    2013-09-03

    This 60 second public service announcement is based on the September 2013 CDC Vital Signs report. More than 800,000 Americans die each year from heart disease and stroke. Learn how to manage all the major risk factors.  Created: 9/3/2013 by Centers for Disease Control and Prevention (CDC).   Date Released: 9/3/2013.

  6. Predicting Coronary Heart Disease and Stroke: The FINRISK Calculator.

    Science.gov (United States)

    Vartiainen, Erkki; Laatikainen, Tiina; Peltonen, Markku; Puska, Pekka

    2016-06-01

    The FINRISK risk calculator predicts 10-year risk for coronary heart disease, stroke incidence, and their combination. The model is based on 10-year cohort follow-up from 3 different cohorts in 1982, 1987, and 1992 from a random population sample in 3 areas in Finland. Coronary heart disease, stroke, and their combination are predicted by smoking, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, diabetes, and family history. The Internet-based calculator is commonly used in Finland in health services to assess the need for hypertension and hypercholesterolemia treatment and is used also in patients' counseling. Copyright © 2016 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

  7. Risk of stroke and cardiovascular events after ischemic stroke or transient ischemic attack in patients with type 2 diabetes or metabolic syndrome: secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

    DEFF Research Database (Denmark)

    Callahan, Alfred; Amarenco, Pierre; Goldstein, Larry B

    2011-01-01

    To perform a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial, which tested the effect of treatment with atorvastatin in reducing stroke in subjects with a recent stroke or transient ischemic attack, to explore the effects of treatment...

  8. Transient Ischemic Attack and Ischemic Stroke in Danon Disease with Formation of Left Ventricular Apical Thrombus despite Normal Systolic Function

    Directory of Open Access Journals (Sweden)

    Takeshi Tsuda

    2017-01-01

    Full Text Available Danon disease is a rare X-linked dominant skeletal and cardiac muscle disorder presenting with hypertrophic cardiomyopathy, Wolf-Parkinson-White syndrome, skeletal myopathy, and mild intellectual disability. Early morbidity and mortality due to heart failure or sudden death are known in Danon disease, more in males than in females. Here, we present a 17-year-old female adolescent with Danon disease and severe concentric hypertrophy with normal left ventricular (LV systolic function, who has been complaining of intermittent headache and weakness for about 3 years, initially diagnosed with hemiplegic migraine. Subsequently, her neurological manifestation progressed to transient ischemic attack (TIA and eventually to ischemic stroke confirmed by CT scan with 1-day history of expressive aphasia followed by persistent left side weakness and numbness. Detailed echocardiogram for the first time revealed a small LV apical thrombus with unchanged severe biventricular hypertrophy and normal systolic function. This unexpected LV apical thrombus may be associated with a wide spectrum of neurological deficits ranging from TIA to ischemic stroke in Danon disease. Possibility of cerebral ischemic events should be suspected in Danon disease when presenting with neurological deficits even with normal systolic function. Careful assessment for LV apical thrombus is warranted in such cases.

  9. Dysfunction of Right Heart in Attack Period of Bronchial Asthma in Children

    Directory of Open Access Journals (Sweden)

    V.А. Kondratiev

    2015-11-01

    Full Text Available There were performed Doppler echocardiography investigations of functional state of the right heart in 42 children aged 5–17 years old in attack period of bronchial asthma of moderate to severe degree. Changes of intra-cardiac hemodynamics of the right heart in children in attack period of bronchial asthma were characterized by disturbance of systolic and diastolic function of the right ventricle and right atrium. Combined systolic-diastolic variant of the right ventricle dysfunction was typical for attack period of bronchial asthma in children and developed in 95.5 % of cases. Elevation of pressure in pulmonary artery was typical and significantly more often occurred in severe asthma attack, herewith pulmonary hypertension of the second degree predominated.

  10. Decreased nighttime heart rate variability is associated with increased stroke risk

    DEFF Research Database (Denmark)

    Binici, Zeynep; Mouridsen, Mette Rauhe; Køber, Lars

    2011-01-01

    Prediction of stroke in healthy individuals is challenging and there is a diurnal variation of stroke onset. We hypothesized that heart rate variability with a focus on nighttime heart rate variability will predict the risk of stroke in apparently healthy middle-age and elderly subjects....

  11. Effect of atorvastatin in elderly patients with a recent stroke or transient ischemic attack

    DEFF Research Database (Denmark)

    Chaturvedi, S.; Zivin, J.; Breazna, A.

    2009-01-01

    for a treatment-age interaction was not significant (p = 0.52). The risk of stroke or TIA (HR 0.79, p = 0.01), major coronary events (HR 0.68, p = 0.035), any coronary heart disease event (HR 0.61, p = 0.0006), and revascularization procedures (HR 0.55, p = 0.0005) was reduced in the elderly group. CONCLUSIONS...

  12. Unusual case of recurrent SMART (stroke-like migraine attacks after radiation therapy syndrome

    Directory of Open Access Journals (Sweden)

    Ramnath Santosh Ramanathan

    2016-01-01

    Full Text Available Stroke-like migraine attacks after radiation therapy (SMART syndrome is a rare delayed complication of cerebral radiation therapy. A 53-year-old female initially presented with headache, confusion and left homonymous hemianopia. Her medical history was notable for cerebellar hemangioblastoma, which was treated with radiation in 1987. Her initial brain MRI (magnetic resonance imaging revealed cortical enhancement in the right temporo-parieto-occipital region. She improved spontaneously in 2 weeks and follow-up scan at 4 weeks revealed no residual enhancement or encephalomalacia. She presented 6 weeks later with aphasia. Her MRI brain revealed similar contrast-enhancing cortical lesion but on the left side. Repeat CSF studies was again negative other than elevated protein. She was treated conservatively and recovered completely within a week. Before diagnosing SMART syndrome, it is important to rule out tumor recurrence, encephalitis, posterior reversible encephalopathy syndrome (PRES and stroke. Typically the condition is self-limiting, and gradually resolves.

  13. Unusual case of recurrent SMART (stroke-like migraine attacks after radiation therapy) syndrome.

    Science.gov (United States)

    Ramanathan, Ramnath Santosh; Sreedher, Gayathri; Malhotra, Konark; Guduru, Zain; Agarwal, Deeksha; Flaherty, Mary; Leichliter, Timothy; Rana, Sandeep

    2016-01-01

    Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare delayed complication of cerebral radiation therapy. A 53-year-old female initially presented with headache, confusion and left homonymous hemianopia. Her medical history was notable for cerebellar hemangioblastoma, which was treated with radiation in 1987. Her initial brain MRI (magnetic resonance imaging) revealed cortical enhancement in the right temporo-parieto-occipital region. She improved spontaneously in 2 weeks and follow-up scan at 4 weeks revealed no residual enhancement or encephalomalacia. She presented 6 weeks later with aphasia. Her MRI brain revealed similar contrast-enhancing cortical lesion but on the left side. Repeat CSF studies was again negative other than elevated protein. She was treated conservatively and recovered completely within a week. Before diagnosing SMART syndrome, it is important to rule out tumor recurrence, encephalitis, posterior reversible encephalopathy syndrome (PRES) and stroke. Typically the condition is self-limiting, and gradually resolves.

  14. Epidemiology of non-fatal cerebrovascular stroke and transient ischemic attacks in Al Quseir, Egypt

    Directory of Open Access Journals (Sweden)

    El-Tallawy HN

    2013-11-01

    Full Text Available Hamdy N El-Tallawy,1 Wafaa MA Farghaly,1 Ghaydaa A Shehata,1 Nabil M Abdel-Hakeem,2 Tarek A Rageh,1 Reda Badry,1 Mahmoud R Kandil1 1Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University Hospital, 2Department of Neurology, Faculty of Medicine, Al-Azhar University, Assiut branch, Assuit, Egypt Background and purpose: Stroke is a medical emergency that can cause permanent neurological damage, complications, and disability. We aim to determine the epidemiology of non-fatal cerebrovascular stroke (CVS and transient ischemic attacks (TIAs in Al Quseir City, Red Sea, Egypt. Methods: The total population (n=33,285 was screened through a door to door study by three specialists of neurology and 15 female social workers (for demographic data collection. All suspected stroke patients were subjected to a full clinical examination, computerized tomography (CT and/or magnetic resonance imaging (MRI of their brain, blood sugar, lipogram, serum uric acid, complete blood cells, blood urea, and serum creatinine, as well as evaluated by Barthel Index and Scandinavian Stroke Scale. Carotid doppler, echocardiography, and thyroid functions were done for selected cases. Results: CVS was recorded among 130 patients out of 19,848 subjects aged 20 years and more, yielding a total prevalence of 6.55/1,000 population. From June 1, 2010 to May 31, 2011, 36 patients were recorded to have stroke within 1-year, yielding an incidence rate of 1.81/1,000. Prevalence and incidence rates were higher among males than females, and both indices increased steadily with advancing age to reach the highest prevalence (37.02/1,000 and incidence rate (9.5/1,000 among aged persons 60 years and more. Conclusion: The prevalence of non-fatal stroke in Al Quseir city (6.55/1,000 was at the lower range of that recorded in developing countries (5–10/1,000 and slightly higher than that recorded in industrialized countries (5/1,000 population. Ischemic stroke is the most

  15. Stroke-like migraine attacks after radiation therapy syndrome: Case report and review of the literature.

    Science.gov (United States)

    Singh, Achint K; Tantiwongkosi, Bundhit; Moise, Anna-Marieta; Altmeyer, Wilson B

    2017-12-01

    A 26-year-old female presented with vision loss accompanied by migraine-like headaches. A contrast-enhanced magnetic resonance imaging of the brain was performed which revealed findings suggestive of stroke-like migraine attacks after radiation therapy (SMART) syndrome. SMART syndrome is a delayed complication of brain radiation characterized by neurologic symptoms including migraine-like headaches, seizures, and hemispheric impairment. The purpose of this article is to make the readers aware of this rare complication of brain irradiation. Appropriate diagnosis of SMART syndrome is essential to avoid invasive tests.

  16. Does uninsurance affect the health outcomes of the insured? Evidence from heart attack patients in California.

    Science.gov (United States)

    Daysal, N Meltem

    2012-07-01

    In this paper, I examine the impact of uninsured patients on the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999-2006). My results indicate that uninsured patients have an economically significant effect that increases the mortality rate of insured heart attack patients. I show that these results are not driven by alternative explanations, including reverse causality, patient composition effects, sample selection or unobserved trends and that they are robust to a host of specification checks. The primary channel for the observed spillover effects is increased hospital uncompensated care costs. Although data limitations constrain my capacity to check how hospitals change their provision of care to insured heart attack patients in response to reduced revenues, the evidence I have suggests a modest increase in the quantity of cardiac services without a corresponding increase in hospital staff. Copyright © 2012 Elsevier B.V. All rights reserved.

  17. Predictors of influenza vaccination uptake among adults with a history of heart attack.

    Science.gov (United States)

    Jiménez-García, Rodrigo; Hernández-Barrera, Valentín; de Andres, Ana Lopez; Jimenez-Trujillo, Isabel; Esteban, Jesus; Gil, Angel; Carrasco-Garrido, Pilar

    2010-07-01

    Influenza vaccination can reduce morbidity and mortality caused by cardiovascular diseases. This study sought to evaluate influenza vaccination coverage among adults with a history of heart attack and to determine which variables were associated with vaccine uptake. A total of 716 adults reported having suffered a heart attack. The coverage among sufferers was 67.9% as against 35% for non sufferers. The variables that were significantly associated with a higher likelihood of receiving the vaccine among sufferers were: higher age; male gender, no smoking habit, "Physician visits in the preceding four weeks"; and, "Blood pressure control in the preceding three months". A descriptive study was conducted using individual data from adults aged ≥40 years included in the year 2006/7 Spanish Health Survey and comparing subjects with a history of heart attack with those who had not suffered this event. The number of participants surveyed was 20,060. Subjects were classified as heart attack sufferers if they answered affirmatively to the question: "Has your doctor told you that you have suffered a heart attack?" To assess influenza vaccination status we considered the response to the question, "Did you have a 'flu shot in the latest campaign?". Independent variables included sociodemographic, health-related, lifestyles and periodic control of cardiovascular risk factors. Influenza vaccination coverage among subjects who have suffered a heart attack is below desirable levels. Multiple strategies focused on providers and patients are needed to improve influenza vaccination coverage among these high risk subjects, particularly now with the emerging H1N1 pandemic.

  18. Valsartan in the treatment of heart attack survivors

    Directory of Open Access Journals (Sweden)

    Bodh I Jugdutt

    2006-06-01

    Full Text Available Bodh I JugduttDivision of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, CanadaAbstract: Survivors of myocardial infarction (MI are at high risk of disability and death. This is due to infarct-related complications such as heart failure, cardiac remodeling with progressive ventricular dilation, dysfunction, and hypertrophy, and arrhythmias including ventricular and atrial fibrillation. Angiotensin (Ang II, the major effector molecule of the renin–angiotensin–aldosterone system (RAAS is a major contributor to these complications. RAAS inhibition, with angiotensin-converting enzyme (ACE inhibitors were first shown to reduce mortality and morbidity after MI. Subsequently, angiotensin receptor blockers (ARBs, that produce more complete blockade of the effects of Ang II at the Ang II type 1 (AT1 receptor, were introduced and the ARB valsartan was shown to be as effective as an ACE inhibitor in reducing mortality and morbidity in high-risk post-MI suvivors with left ventricular (LV systolic dysfunction and and/or heart failure and in heart failure patients, respectively, in two major trials (VALIANT and Val-HeFT. Both these trials used an ACE inhibitor as comparator on top of background therapy. Evidence favoring the use of valsartan for secondary prevention in post-MI survivors is reviewed.Keywords: valsartan, myocardial infarction, infarct survivors, remodeling, heart failure

  19. Clinical Correlates, Ethnic Differences, and Prognostic Implications of Perivascular Spaces in Transient Ischemic Attack and Ischemic Stroke.

    Science.gov (United States)

    Lau, Kui-Kai; Li, Linxin; Lovelock, Caroline E; Zamboni, Giovanna; Chan, Tsz-Tai; Chiang, Man-Fung; Lo, Kin-Ting; Küker, Wilhelm; Mak, Henry Ka-Fung; Rothwell, Peter M

    2017-06-01

    Perivascular spaces (PVSs) are considered markers of small vessel disease. However, their long-term prognostic implications in transient ischemic attack/ischemic stroke patients are unknown. Ethnic differences in PVS prevalence are also unknown. Two independent prospective studies were conducted, 1 comprising predominantly whites with transient ischemic attack/ischemic stroke (OXVASC [Oxford Vascular] study) and 1 comprising predominantly Chinese with ischemic stroke (University of Hong Kong). Clinical and imaging correlates, prognostic implications for stroke and death, and ethnic differences in basal ganglia (BG) and centrum semiovale (CS) PVSs were studied with adjustment for age, sex, vascular risk factors, and scanner strength. Whites with transient ischemic attack/ischemic stroke (n=1028) had a higher prevalence of both BG and CS-PVSs compared with Chinese (n=974; >20 BG-PVSs: 22.4% versus 7.1%; >20 CS-PVSs: 45.8% versus 10.4%; P stroke (adjusted hazard ratio compared with 20 PVSs: HR, 1.82; 1.18-2.80; P =0.011) but not intracerebral hemorrhage ( P =0.10) or all-cause mortality ( P =0.16). CS-PVSs were not associated with recurrent stroke ( P =0.57) or mortality ( P =0.072). Prognostic associations were similar in both cohorts. Over and above ethnic differences in frequency of PVSs in transient ischemic attack/ischemic stroke patients, BG and CS-PVSs had similar risk factors, but although >20 BG-PVSs were associated with an increased risk of recurrent ischemic stroke, CS-PVSs were not. © 2017 The Authors.

  20. Recurrent stroke after transient ischaemic attack or minor ischaemic stroke: does the distinction between small and large vessel disease remain true to type? Dutch TIA Trial Study Group.

    OpenAIRE

    Kappelle, L J; van Latum, J C; van Swieten, J C; Algra, A; Koudstaal, P J; van Gijn, J

    1995-01-01

    The incidence and vascular type of recurrent ischaemic stroke was studied in patients with supratentorial transient ischaemic attacks or non-disabling ischaemic strokes, who were treated with aspirin (30 or 283 mg). Patients were divided into groups with small vessel disease (SVD) (n = 1216) or large vessel disease (LVD) (n = 1221) on the grounds of their clinical features and CT at baseline. Patients with evidence of both SVD and LVD (n = 180) were excluded from further analyses. During foll...

  1. Is opium addiction a risk factor for ischemic heart disease and ischemic stroke?

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Rezvani

    2012-01-01

    Full Text Available Background: The main source of studies about effects of opium consumption on heart and brain attacks originates from Iran Therefore the aim of the present study was to assess opium addiction as a probable influencing factor for ischemic heart disease and ischemic stroke. Materials and Methods: A cross-sectional study was carried out in two Cardiology and Neurology clinics in Eastern Iran in 2011. Diagnosis of Ischemic Heart Disease (IHD and Ischemic Stroke (IS was made by Cardiologist and Stroke Neurologist respectively. The influence of gender, hypertension, diabetes, hyperlipidemia, cigarette smoking, oral and inhaled opium consumption on distribution of IHD and IS were evaluated. Results: Five hundred fifty eight patients (307 females, 251 males with mean age 56.2 years enrolled the study. On adjusted odds ratios of our whole 558 patients, only hypertension and diabetes had a significant influence on occurrence of IHD; (P = 0.000 and P = 0.000 respectively. Oral and inhaled routes of opium addiction did not have a significant effect on occurrence of IHD; [OR = 1.172, 95% CI = 0.624-2.203, P = 0.621] and [OR = 1.820, 95% CI = 0.811-4.085, P = 0.147] respectively. Hypertension and diabetes were significant risk factors of IS in our 558 patients at multivariate analysis; (P = 0.000, P = 0.020. Oral opium addiction was as significant protective factor of IS in our study group; OR = 0.211, 95% CI = 0.079-0.564, P = 0.002, while inhaled opium addiction did not have a significant effect on occurrence of IS in our patients at; OR = 1.760, 95% CI = 0.760-4.076, P = 0.187. Conclusion: Oral opium consumption is a protective factor of IS but not IHD. Inhaled opium addiction does not have a significant influence on occur r ence of IS and IHD.

  2. Is opium addiction a risk factor for ischemic heart disease and ischemic stroke?

    Science.gov (United States)

    Rezvani, Mohammad Reza; Ghandehari, Kavian

    2012-10-01

    The main source of studies about effects of opium consumption on heart and brain attacks originates from Iran Therefore the aim of the present study was to assess opium addiction as a probable influencing factor for ischemic heart disease and ischemic stroke. A cross-sectional study was carried out in two Cardiology and Neurology clinics in Eastern Iran in 2011. Diagnosis of Ischemic Heart Disease (IHD) and Ischemic Stroke (IS) was made by Cardiologist and Stroke Neurologist respectively. The influence of gender, hypertension, diabetes, hyperlipidemia, cigarette smoking, oral and inhaled opium consumption on distribution of IHD and IS were evaluated. Five hundred fifty eight patients (307 females, 251 males) with mean age 56.2 years enrolled the study. On adjusted odds ratios of our whole 558 patients, only hypertension and diabetes had a significant influence on occurrence of IHD; (P = 0.000 and P = 0.000) respectively. Oral and inhaled routes of opium addiction did not have a significant effect on occurrence of IHD; [OR = 1.172, 95% CI = 0.624-2.203, P = 0.621] and [OR = 1.820, 95% CI = 0.811-4.085, P = 0.147] respectively. Hypertension and diabetes were significant risk factors of IS in our 558 patients at multivariate analysis; (P = 0.000, P = 0.020). Oral opium addiction was as significant protective factor of IS in our study group; OR = 0.211, 95% CI = 0.079-0.564, P = 0.002, while inhaled opium addiction did not have a significant effect on occurrence of IS in our patients at; OR = 1.760, 95% CI = 0.760-4.076, P = 0.187. Oral opium consumption is a protective factor of IS but not IHD. Inhaled opium addiction does not have a significant influence on occurrence of IS and IHD.

  3. Patent Foramen Ovale in Young Adults with Cryptogenic Stroke or Transient Ischemic Attack

    Directory of Open Access Journals (Sweden)

    Mohsen Mahdinezhad Kashani

    2009-09-01

    Full Text Available Background: Stroke, one of the most important causes of morbidity and mortality in the world, is of great importance in young adults (15-45 years, amongst whom the causes of stroke and transient ischemic attack (TIA are different from those in older ages and a significant portion of them have no known etiology. Patent foramen ovale (PFO is considered a probable cause in this group.Methods: Patients between 15 and 45 years of age with TIA or stroke were examined and evaluated for causes of cerebrovascular accidents. Patients with no definite cause for stroke or TIA, except for PFO, despite our extensive evaluations were categorized as cryptogenic. The controls were comprised of those between 15 and 45 years old who underwent transesophageal echocardiography (TEE for reasons other than stroke. The frequency of PFO and its characteristics were compared between the two groups.Results: The case group comprised 48 patients with cryptogenic stroke (n=31 and TIA (n=17, and the control group consisted of 57 patients. The age distribution of the groups was normal, and there was no significant difference between the age and gender of the two groups. The frequency of PFO in the case and control groups was 52% and 25%, respectively (p value=0.003, odds ratio=3.33, confidence interval=1.46-7.63. The exaggerated motion of the interatrial septum (IAS in the case and control groups was 18.8% and 0%, respectively. Right-to-left shunt at rest in the case and control groups was 78% and 28%, respectively (significant differences. The differences in terms of PFO size, number of bubbles, and atrial septal aneurysm were not significant between the two groups.Conclusion: PFO had a relation with stroke and TIA in the young adults, and right-to-left shunt at rest and exaggerated motion of the IAS could increase the possibility of paradoxical emboli. It seems that the presence of atrial septal aneurysm, number of bubbles, and PFO size did not increase the risk of

  4. Formation and function of acute stroke-ready hospitals within a stroke system of care recommendations from the brain attack coalition.

    Science.gov (United States)

    Alberts, Mark J; Wechsler, Lawrence R; Jensen, Mary E Lee; Latchaw, Richard E; Crocco, Todd J; George, Mary G; Baranski, James; Bass, Robert R; Ruff, Robert L; Huang, Judy; Mancini, Barbara; Gregory, Tammy; Gress, Daryl; Emr, Marian; Warren, Margo; Walker, Michael D

    2013-12-01

    Many patients with an acute stroke live in areas without ready access to a Primary or Comprehensive Stroke Center. The formation of care facilities that meet the needs of these patients might improve their care and outcomes and guide them and emergency responders to such centers within a stroke system of care. The Brain Attack Coalition conducted an electronic search of the English medical literature from January 2000 to December 2012 to identify care elements and processes shown to be beneficial for acute stroke care. We used evidence grading and consensus paradigms to synthesize recommendations for Acute Stroke-Ready Hospitals (ASRHs). Several key elements for an ASRH were identified, including acute stroke teams, written care protocols, involvement of emergency medical services and emergency department, and rapid laboratory and neuroimaging testing. Unique aspects include the use of telemedicine, hospital transfer protocols, and drip and ship therapies. Emergent therapies include the use of intravenous tissue-type plasminogen activator and the reversal of coagulopathies. Although many of the care elements are similar to those of a Primary Stroke Center, compliance rates of ≥67% are suggested in recognition of the staffing, logistical, and financial challenges faced by rural facilities. ASRHs will form the foundation for acute stroke care in many settings. Recommended elements of an ASRH build on those proven to improve care and outcomes at Primary Stroke Centers. The ASRH will be a key component for patient care within an evolving stroke system of care.

  5. Does Uninsurance Affect the Health Outcomes of the Insured? Evidence from Heart Attack Patients in California

    NARCIS (Netherlands)

    Meltem Daysal, N.

    2012-01-01

    Abstract: In this paper, I examine the impact of uninsured patients on the health of the insured, focusing on one health outcome - the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California

  6. Does uninsurance affect the health outcomes of the insured? Evidence from heart attack patients in California

    NARCIS (Netherlands)

    Meltem Daysal, N.

    2012-01-01

    In this paper, I examine the impact of uninsured patients on the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999–2006). My results indicate that uninsured patients have an economically

  7. Cardiac Outcomes After Ischemic Stroke or Transient Ischemic Attack: Effects of Pioglitazone in Patients With Insulin Resistance Without Diabetes Mellitus.

    Science.gov (United States)

    Young, Lawrence H; Viscoli, Catherine M; Curtis, Jeptha P; Inzucchi, Silvio E; Schwartz, Gregory G; Lovejoy, Anne M; Furie, Karen L; Gorman, Mark J; Conwit, Robin; Abbott, J Dawn; Jacoby, Daniel L; Kolansky, Daniel M; Pfau, Steven E; Ling, Frederick S; Kernan, Walter N

    2017-05-16

    Insulin resistance is highly prevalent among patients with atherosclerosis and is associated with an increased risk for myocardial infarction (MI) and stroke. The IRIS trial (Insulin Resistance Intervention after Stroke) demonstrated that pioglitazone decreased the composite risk for fatal or nonfatal stroke and MI in patients with insulin resistance without diabetes mellitus, after a recent ischemic stroke or transient ischemic attack. The type and severity of cardiac events in this population and the impact of pioglitazone on these events have not been described. We performed a secondary analysis of the effects of pioglitazone, in comparison with placebo, on acute coronary syndromes (MI and unstable angina) among IRIS participants. All potential acute coronary syndrome episodes were adjudicated in a blinded fashion by an independent clinical events committee. The study cohort was composed of 3876 IRIS participants, mean age 63 years, 65% male, 89% white race, and 12% with a history of coronary artery disease. Over a median follow-up of 4.8 years, there were 225 acute coronary syndrome events, including 141 MIs and 84 episodes of unstable angina. The MIs included 28 (19%) with ST-segment elevation. The majority of MIs were type 1 (94, 65%), followed by type 2 (45, 32%). Serum troponin was 10× to 100× upper limit of normal in 49 (35%) and >100× upper limit of normal in 39 (28%). Pioglitazone reduced the risk of acute coronary syndrome (hazard ratio, 0.71; 95% confidence interval, 0.54-0.94; P =0.02). Pioglitazone also reduced the risk of type 1 MI (hazard ratio, 0.62; 95% confidence interval, 0.40-0.96; log-rank P =0.03), but not type 2 MI (hazard ratio, 1.05; 95% confidence interval, 0.58-1.91; P =0.87). Similarly, pioglitazone reduced the risk of large MIs with serum troponin >100× upper limit of normal (hazard ratio, 0.44; 95% confidence interval, 0.22-0.87; P =0.02), but not smaller MIs. Among patients with insulin resistance without diabetes mellitus

  8. A REVIEW ON THE DETECTION OF HEART ATTACK USING DATA MINING BY ACO TECHNIQUE

    OpenAIRE

    Pise Satish Prakashrao*1, Anoop Singh 2 & Ritesh Kumar Yadav3

    2018-01-01

    The goal of data mining is to extract knowledge from huge amount of data. Now a day’s data mining technique used in the field of medical diagnose of critical diesis and clinical data. In this research propose model give a solution to predict heart diseases. In this paper proposes a novel approach of applying the Ant Colony Optimization technique (ACO) for extracting the Association Rules (AR) from the database to detect heart attack. This algorithm is broadly are many types of heart disease ...

  9. Lifestyle interventions for secondary disease prevention in stroke and transient ischaemic attack: a systematic review.

    Science.gov (United States)

    Lennon, Olive; Galvin, Rose; Smith, Kathryn; Doody, Catherine; Blake, Catherine

    2014-08-01

    Secondary prevention in ischaemic stroke and transient ischaemic attack (TIA) is dominated by pharmacological interventions with evidence for non-pharmacological interventions being less robust. This systematic review and meta-analysis examines the impact of lifestyle interventions on secondary prevention in stroke or TIA. A systematic literature search was performed. Randomised controlled trials (RCTs) examining the effectiveness of intervention packages incorporating any key component of health education/promotion/counselling on lifestyle and/or aerobic exercise compared to usual care ± a sham intervention in participants with ischaemic stroke or TIA were included. Outcomes of interest were mortality, cardiovascular disease (CVD) event rates, cardiovascular risk factors including blood pressure, lipid profiles and physical activity participation. Methodological quality was assessed. Statistical analyses determining treatment effect were conducted using Cochrane Review Manager Software. Seventeen RCTs were included. Data pooled from eight studies with a total of 2478 patients, demonstrated no effect in favour of lifestyle interventions compared to routine or sham interventions on mortality (risk ratio (RR) = 1.13 (95% confidence interval (CI), 0.85-1.52), I(2) = 0%). Data relating to CVD events were pooled from four studies (1013 patients), demonstrated non-significant findings (RR = 1.16 (95% CI, 0.80--1.71), I(2) = 0%). Similar results were reported for total cholesterol. Physical activity participation demonstrated significant improvement [SMD 0.24 (95% CI, 0.08-0.41), l (2) = 47%]. Blood pressure reductions were noted but were non-significant when corrected for multimodal packages including enhanced pharmacotherapy compliance. There is currently insufficient high quality research to support lifestyle interventions post-stroke or TIA on mortality, CVD event rates and cardio-metabolic risk factor profiles. Promising blood pressure reductions were noted in

  10. Comprehensive Cardiac Rehabilitation for Secondary Prevention After Transient Ischemic Attack or Mild Stroke: PSYCHOLOGICAL PROFILE AND OUTCOMES.

    Science.gov (United States)

    Prior, Peter L; Hachinski, Vladimir; Chan, Richard; Unsworth, Karen; Mytka, Sharon; Harnadek, Michael; OʼCallaghan, Christina; Suskin, Neville

    2017-11-01

    Having previously reported that comprehensive cardiac rehabilitation (CCR) is effective for secondary prevention post-transient ischemic attack (TIA)/mild nondisabling stroke (MNDS), we present psychometric findings for the same sample that elucidate subacute TIA/MNDS psychological outcomes and test whether CCR would be independently associated with psychological improvements. In this prospective cohort trial patients with ≥1 risk factor, recruited from a stroke prevention clinic within 12 months (mean = 11.5 weeks) post-TIA/MNDS, entered CCR. Of the 110 recruited patients, 100 (mean age = 65.4 years; 46 females) entered CCR and 80 completed CCR (mean duration = 7.6 months). At CCR entry, 16.5% and 39.2% screened positively for depression and anxiety, decreasing nonsignificantly at exit to 4.2%, and significantly to 16.9% (P = .008), respectively. Age-corrected deficits occurred more frequently than expected (P ≤ .03); at entry, mental health status (13.3%), clock-drawing (31.6%), oral-verbal fluency (16.9%), word-list learning (11.2%), and recall (12.6%); at exit, clock-drawing (30.0%). Entry-to-exit, mean depression, anxiety, mental and physical health status, word-list learning, memory, digit-symbol coding, and oral-verbal fluency scores improved significantly (P ≤ .031). No reliable change indices were significant. Psychological service recipients improved significantly more than nonrecipients in depression (P = .049). Baseline North American Adult Reading Test score predicted exercise attendance (R = 0.275; P = .044); New York Heart Association (NYHA) class and depression score predicted exit physical health status (R = 0.770, P psychological improvements. CCR psychological treatment may benefit depression. Subacute NYHA class and depression may later affect quality of life.

  11. Women at risk for cardiovascular disease lack knowledge of heart attack symptoms.

    Science.gov (United States)

    Flink, Laura E; Sciacca, Robert R; Bier, Michael L; Rodriguez, Juviza; Giardina, Elsa-Grace V

    2013-03-01

    It is not known whether cardiovascular disease (CVD) risk level is related to knowledge of the leading cause of death of women or heart attack symptoms. Women with higher CVD risk estimated by Framingham Risk Score (FRS) or metabolic syndrome (MS) have lower CVD knowledge. Women visiting primary care clinics completed a standardized behavioral risk questionnaire. Blood pressure, weight, height, waist size, fasting glucose, and lipid profile were assessed. Women were queried regarding CVD knowledge. Participants (N = 823) were Hispanic women (46%), non-Hispanic white (37%), and non-Hispanic black (8%). FRS was determined in 278: low (63%), moderate (29%), and high (8%); 24% had ≥3 components of MS. The leading cause of death was answered correctly by 54%, heart attack symptoms by 67%. Knowledge was lowest among racial/ethnic minorities and those with less education (both Pheart attack symptoms (P = 0.018), but not after multivariable adjustment. Women with higher FRS were less likely to know heart attack symptoms. Efforts to target those at higher CVD risk must persist, or the most vulnerable may suffer disproportionately, not only because of risk factors but also inadequate knowledge. © 2013 Wiley Periodicals, Inc.

  12. Depression and coronary artery disease -real heart attack

    International Nuclear Information System (INIS)

    Farooqi, S.; Ahmed, B.

    2001-01-01

    Both depression and ischaemic heart disease are said to become the leading causes of morbidity and mortality in developing countries during the next two decades. The relationship between these two disorders has long been speculated but only recently addressed scientifically. A Medline search was conducted to obtain the articles that address the association between depressive disorders and coronary artery disease (CAD). Most studies following large cohorts over a period ranging from 4.5 to 27 years have shown that depression is associated with a significantly high risk of developing CAD. These studies also show that patients who have depression following myocardial infarction hat poorer prognosis on major cardiac end points like reoccurrence of myocardial infarction and death as compared to the non-depressed group. The psychosocial variables associated with depression like social isolation, acute and chronic stressful life events are also associated with increased risk of developing CAD. The mechanisms underlying this association between depression and CAD are unknown at present. The effectiveness of psychosocial interventions in reducing this increased risks have been demonstrated while the trials assessing the efficacy and safety of anti depressed drugs are underway. The implications of these finding are discussed in the context of developing countries. (author)

  13. Risk of Stroke/Transient Ischemic Attack or Myocardial Infarction with Herpes Zoster: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Zhang, Yanting; Luo, Ganfeng; Huang, Yuanwei; Yu, Qiuyan; Wang, Li; Li, Ke

    2017-08-01

    Accumulating evidence indicates that herpes zoster (HZ) may increase the risk of stroke/transient ischemic attack (TIA) or myocardial infarction (MI), but the results are inconsistent. We aim to explore the relationship between HZ and risk of stroke/TIA or MI and between herpes zoster ophthalmicus (HZO) and stroke. We estimated the relative risk (RR) and 95% confidence intervals (CIs) with the meta-analysis. Cochran's Q test and Higgins I 2 statistic were used to check for heterogeneity. HZ infection was significantly associated with increased risk of stroke/TIA (RR = 1.30, 95% CI: 1.17-1.46) or MI (RR = 1.18, 95% CI: 1.07-1.30). The risk of stroke after HZO was 1.91 (95% CI 1.32-2.76), higher than that after HZ. Subgroup analyses revealed increased risk of ischemic stroke after HZ infection but not hemorrhagic stroke. The risk of stroke was increased more at 1 month after HZ infection than at 1-3 months, with a gradual reduced risk with time. The risk of stroke after HZ infection was greater with age less than 40 years than 40-59 years and more than 60 years. Risk of stroke with HZ infection was greater without treatment than with treatment and was greater in Asia than Europe and America but did not differ by sex. Our study indicated that HZ infection was associated with increased risk of stroke/TIA or MI, and HZO infection was the most marked risk factor for stroke. Further studies are needed to explore whether zoster vaccination could reduce the risk of stoke/TIA or MI. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Reduced response to activated protein C is associated with risk of stroke and transient ischaemic attack (abstract)

    NARCIS (Netherlands)

    Bom, J.G. van der; Bots, M.L.; Haverkate, F.; Slagboom, P.E.; Meijer, P.; Hofman, A.; Grobbee, D.E.; Kluft, C.

    1996-01-01

    Objective: To investigate the association of activated protein C (APC) response and of the factor V Leiden mutation with myocardial infarction, stroke and transient ischémie attack. Design: Population-based case control study. Setting: A district of Rotterdam, the Netherlands. Participants: From the

  15. Population-based effectiveness and safety of different antiplatelet regimens as secondary prevention for ischemic stroke/Transient ischemic attack

    NARCIS (Netherlands)

    Noorsyahdy, Alfi; De Boer, Anthonius; Deneer, Vera H.M.; Ten Berg, Jurrien M.; Souverein, Patrick C.; Klungel, Olaf H.

    2016-01-01

    Background: Different antiplatelet regimens are used for secondary prevention after ischemic stroke (IS)/transient ischemic attack (TIA), but studies on the relative effectiveness and safety of each regimen in daily practice are lacking. Objectives: To assess the relative effectiveness and safety of

  16. Heart rate variability and baroreceptor sensitivity in acute stroke: a systematic review.

    Science.gov (United States)

    Yperzeele, Laetitia; van Hooff, Robbert-Jan; Nagels, Guy; De Smedt, Ann; De Keyser, Jacques; Brouns, Raf

    2015-08-01

    Autonomic nervous system dysfunction is common after acute stroke and is associated with elevated risk of cardiac arrhythmia and mortality. Heart rate variability and baroreceptor sensitivity have been investigated as parameters of autonomic nervous system dysfunction for the prediction of stroke outcome. We performed a systematic literature review on heart rate variability and baroreceptor sensitivity as parameters for autonomic nervous function in acute stroke. Twenty-two studies were included. Associations between heart rate variability or baroreceptor sensitivity and stroke severity, early and late complications, dependency and mortality were reported. However, interpretability of most studies and extrapolation to general stroke population are limited due to many confounding factors such as varying methodology, small sample sizes, survival selection, and exclusion of patients with frequently occurring comorbidities in stroke. Key issues, such as the effect of thrombolytic therapy on autonomic function, autonomic nervous system dysfunction in the hyperacute phase of stroke, and correlation with the risk of recurrent stroke have not been investigated. Also, nonlinear techniques have remained largely unexplored in this domain, in spite of their advantage to provide more solid evaluation in the occurrence of arrhythmia. Cardiac autonomic dysfunction, represented by reduced heart rate variability or impaired baroreceptor sensitivity, is associated with stroke severity, early and late complications, dependency, and mortality. Large-scale prospective studies applying internationally accepted standards of measures for analysis of heart rate variability and baroreceptor sensitivity are needed in patients with acute stroke. © 2015 World Stroke Organization.

  17. Applying Magneto-rheology to Reduce Blood Viscosity and Suppress Turbulence to Prevent Heart Attacks

    Science.gov (United States)

    Tao, R.

    Heart attacks are the leading causes of death in USA. Research indicates one common thread, high blood viscosity, linking all cardiovascular diseases. Turbulence in blood circulation makes different regions of the vasculature vulnerable to development of atherosclerotic plaque. Turbulence is also responsible for systolic ejection murmurs and places heavier workload on heart, a possible trigger of heart attacks. Presently, neither medicine nor method is available to suppress turbulence. The only method to reduce the blood viscosity is to take medicine, such as aspirin. However, using medicine to reduce the blood viscosity does not help suppressing turbulence. In fact, the turbulence gets worse as the Reynolds number goes up with the viscosity reduction by the medicine. Here we report our new discovery: application of a strong magnetic field to blood along its flow direction, red blood cells are polarized in the magnetic field and aggregated into short chains along the flow direction. The blood viscosity becomes anisotropic: Along the flow direction the viscosity is significantly reduced, but in the directions perpendicular to the flow the viscosity is considerably increased. In this way, the blood flow becomes laminar, turbulence is suppressed, the blood circulation is greatly improved, and the risk for heart attacks is reduced. While these effects are not permanent, they last for about 24 hours after one magnetic therapy treatment.

  18. Blood Pressure and Risk of Vascular Dementia: Evidence From a Primary Care Registry and a Cohort Study of Transient Ischemic Attack and Stroke.

    Science.gov (United States)

    Emdin, Connor A; Rothwell, Peter M; Salimi-Khorshidi, Gholamreza; Kiran, Amit; Conrad, Nathalie; Callender, Thomas; Mehta, Ziyah; Pendlebury, Sarah T; Anderson, Simon G; Mohseni, Hamid; Woodward, Mark; Rahimi, Kazem

    2016-06-01

    Vascular dementia is the second most common form of dementia but reliable evidence on age-specific associations between blood pressure (BP) and risk of vascular dementia is limited and some studies have reported negative associations at older ages. In a cohort of 4.28 million individuals, free of known vascular disease and dementia and identified from linked electronic primary care health records in the United Kingdom (Clinical Practice Research Datalink), we related BP to time to physician-diagnosed vascular dementia. We further determined associations between BP and dementia in a prospective population-based cohort of incident transient ischemic attack and stroke (Oxford Vascular Study). For a median follow-up of 7.0 years, 11 114 initial presentations of vascular dementia were observed in the primary care cohort after exclusion of the first 4 years of follow-up. The association between usual systolic BP and risk of vascular dementia decreased with age (hazard ratio per 20 mm Hg higher systolic BP, 1.62; 95% confidence interval, 1.13-2.35 at 30-50 years; 1.26, 1.18-1.35 at 51-70 years; 0.97, 0.92-1.03 at 71-90 years; P trend=0.006). Usual systolic BP remained predictive of vascular dementia after accounting for effect mediation by stroke and transient ischemic attack. In the population-based cohort, prior systolic BP was predictive of 5-year risk of dementia with no evidence of negative association at older ages. BP is positively associated with risk of vascular dementia, irrespective of preceding transient ischemic attack or stroke. Previous reports of inverse associations in old age could not be confirmed. © 2016 American Heart Association, Inc.

  19. Prominent deep medullary veins: a predictive biomarker for stroke risk from transient ischemic attack?

    Science.gov (United States)

    Duan, Yang; Xu, Zhihua; Li, Hongyi; Cai, Xiaonan; Chang, Cancan; Yang, Benqiang

    2018-05-01

    Background Deep medullary veins (DMVs) are a biomarker of severity and prognosis in patients with acute cerebral infarction. However, their clinical significance remains unclear in patients with transient ischemic attack (TIA). Purpose To determine whether prominent deep medullary veins (PDMVs) are a predictive biomarker for stroke risk after TIA. Material and Methods Clinical and imaging data of 49 patients with TIA and 49 sex- and age-matched controls were studied. PDMVs were defined as DMVs with a score of 3 (TDMVs) or asymmetric DMVs (ADMVs), and the relationship between PDMVs and clinical features was analyzed. The DMV score based on susceptibility weighted imaging (SWI) ranged from 0 (not visible) to 3 (very prominent) and was calculated for both hemispheres separately. A different score in each hemisphere was defined as ADMVs and an equal score was defined as symmetric DMVs. The asymmetry and score of DMVs were compared between the two groups and with respect to the time from TIA onset to imaging analysis. Results Agreement between neuroradiologists for the DMV asymmetry/score on SWI was excellent. The frequency of ADMVs and TDMVs was significantly higher in patients with TIA than controls ( P  0.05); PDMVs were not correlated with age, blood pressure, or diabetes. However, PDMVs were associated with the ABCD2 score (≥4), clinical symptoms, and duration of TIA (≥10 min). Conclusion Prominent deep medullary veins is a predictive biomarker for the risk of stroke in many patients having suffered from TIA.

  20. Denial and Self-Image in Stroke, Lung Cancer, and Heart Disease Patients

    Science.gov (United States)

    Levine, Jacob; Zigler, Edward

    1975-01-01

    Stroke, lung cancer, and heart disease patients were found to employ denial, as indicated by the relatively small difference between their real and ideal selves before and after the onset of illness. The greatest amount of denial was found for stroke patients. Cancer patients displayed more denial than did heart patients. (Author)

  1. A qualitative study exploring patients' experiences of standard care or cardiac rehabilitation post minor stroke and transient ischaemic attack.

    Science.gov (United States)

    Hillsdon, Kaye M; Kersten, Paula; Kirk, Hayden J S

    2013-09-01

    To explore individuals' experiences of receiving either standard care or comprehensive cardiac rehabilitation post minor stroke or transient ischaemic attack. A qualitative study using semi-structured interviews, alongside a randomized controlled trial, exploring the effectiveness of comprehensive cardiac rehabilitation compared with standard care. Interviews were transcribed verbatim and subjected to thematic analysis. Individuals' homes. People who have experienced a minor stroke or transient ischaemic attack and who were partaking in a secondary prevention randomized controlled trial (6-7 months post the event, 17 males, five females; mean age 67 years). Not relevant. Not relevant. Four themes were identified: information delivery, comparing oneself with others, psychological impact, attitudes and actions regarding risk factor reduction. Participants indicated a need for improved information delivery, specific to their own risk factors and lifestyle changes. Many experienced psychological impact as a result of their minor stroke. Participants were found to make two types of social comparison; the comparison of self to another affected by stroke, and the comparison of self to cardiac patients. Comprehensive cardiac rehabilitation was reported to have positive effects on people's motivation to exercise. Following a minor stroke, many individuals do not recall information given or risk factors specific to them. Downward comparison with individuals who have had a cardiovascular event led to some underplaying the significance of their minor stroke.

  2. Factors influencing body image in individuals after a first heart attack.

    Science.gov (United States)

    Zarek, Aleksandra; Barański, Jarosław

    Experiencing a heart attack can change the attitude of patients towards their corporeality. Body image may significantly influence the recovery of patients, their adherence to medical recommendations, and adopting a healthy lifestyle. The aim of this study was to analyze the relationship between body image and personality characteristics, as well as sociodemographic, physical and medical factors in patients after a first myocardial infarction. The study comprised 160 patients after a first heart attack (80 women and 80 men) aged 34–65 years (mean = 53.44; SD = 6.40). Body image was measured with the Body Image Questionnaire, and personality was analyzed according to the Adjective Check List. The level of body satisfaction was shaped by two dimensions of personality (Sociability, Weakness and inhibition) and by respondents’ gender. In respondents’ personality profile, lower body satisfaction was associated with elevated Weakness and inhibition and with lowered Sociability. Women were less satisfied with their bodies than men. The significance attributed to one’s own body was shaped by two dimensions of personality (Expansiveness, Weakness and inhibition) and by respondents’ age. Patients with a higher degree of Expansiveness, a lower degree of Weakness and inhibition and more advanced in age gave greater priority to corporeality. Improving body image in persons after a first heart attack should be combined with the development of personality abilities important for self-efficacy and social competency.

  3. Heart Attack

    Science.gov (United States)

    ... and Nutrition Healthy Food Choices Weight Loss and Diet Plans Nutrients and Nutritional Info Sugar and Sugar Substitutes Exercise and Fitness Exercise Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health ...

  4. Emotional and cognitive changes during and post a near fatal heart attack and one-year after: a case study.

    Science.gov (United States)

    Lane, Andrew M; Godfrey, Richard

    2010-01-01

    This case study reports on changes in emotions before and during an unexpected heart rate in a young, apparently healthy male with a life-long history of exercise in the absence of family history of heart problems. He completed the Brunel Mood Scale (Terry et al. , 2003) to assess emotions before, during, and after the heart attack, and also describing his thoughts during these periods. Results indicate he experienced unpleasant emotions in the build up to the heart attack, feelings he attributed at the time to frustration to achieve fitness goals. He maintained an exercise regime prior to having a heart attack, a finding consistent with previous research suggesting that early diagnosis, although vital for survival, is not likely to be identified among seemingly healthy individuals. During the heart attack, he experienced a rapid emotional change characterised by a rapid increase in anger coupled with thoughts of needing to survive. The intensity of emotions and regulation strategies employed before and during the heart attack provide insight this experience, and we suggest future research should investigate emotional change during adverse conditions. Key pointsThe present case study details emotions experienced and attempts to regulate these emotions before, during and post a heart attack. Unpleasant emotions experienced before the heart were attributed to lack of progress toward fitness goals, a perception that is plausible as he was a regular exerciser.Early identification of heart attack is critical as "Time is Muscle" (Whyte et al., 2009) and therefore even people perceived to be at low risk should consider the possibility of such an eventuality, and seek medical treatment early in the process.

  5. Community-based case-control study of childhood stroke risk associated with congenital heart disease.

    Science.gov (United States)

    Fox, Christine K; Sidney, Stephen; Fullerton, Heather J

    2015-02-01

    A better understanding of the stroke risk factors in children with congenital heart disease (CHD) could inform stroke prevention strategies. We analyzed pediatric stroke associated with CHD in a large community-based case-control study. From 2.5 million children (aged hemorrhagic strokes and randomly selected age- and facility-matched stroke-free controls (3 per case). We determined exposure to CHD (diagnosed before stroke) and used conditional logistic regression to analyze stroke risk factors. CHD was identified in 15 of 412 cases (4%) versus 7 of 1236 controls (0.6%). Cases of childhood stroke (occurring between ages 29 days to 20 years) with CHD had 19-fold (odds ratio, 19; 95% confidence interval 4.2-83) increased stroke risk compared to controls. History of CHD surgery was associated with >30-fold (odds ratio, 31; confidence interval 4-241) increased risk of stroke in children with CHD when compared with controls. After excluding perioperative strokes, the history of CHD surgery still increased the childhood stroke risk (odds ratio, 13; confidence interval 1.5-114). The majority of children with stroke and CHD were outpatients at the time of stroke, and almost half the cases who underwent cardiac surgery had their stroke >5 years after the most recent procedure. An estimated 7% of ischemic and 2% of hemorrhagic childhood strokes in the population were attributable to CHD. CHD is an important childhood stroke risk factor. Children who undergo CHD surgery remain at elevated risk outside the perioperative period and would benefit from optimized long-term stroke prevention strategies. © 2014 American Heart Association, Inc.

  6. Association of Osteopontin, Neopterin, and Myeloperoxidase With Stroke Risk in Patients With Prior Stroke or Transient Ischemic Attacks

    DEFF Research Database (Denmark)

    Ganz, Peter; Amarenco, Pierre; Goldstein, Larry B

    2017-01-01

    from those without outcome strokes. Time to stroke was evaluated by Cox proportional hazards models. RESULTS: There was no association between time to stroke and lipoprotein-associated phospholipase A2, monocyte chemoattractant protein-1, resistin, matrix metalloproteinase-9, N-terminal fragment of pro...

  7. Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).

    Science.gov (United States)

    Dhruva, Sanket S; Huang, Chenxi; Spatz, Erica S; Coppi, Andreas C; Warner, Frederick; Li, Shu-Xia; Lin, Haiqun; Xu, Xiao; Furberg, Curt D; Davis, Barry R; Pressel, Sara L; Coifman, Ronald R; Krumholz, Harlan M

    2017-07-01

    Randomized trials of hypertension have seldom examined heterogeneity in response to treatments over time and the implications for cardiovascular outcomes. Understanding this heterogeneity, however, is a necessary step toward personalizing antihypertensive therapy. We applied trajectory-based modeling to data on 39 763 study participants of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to identify distinct patterns of systolic blood pressure (SBP) response to randomized medications during the first 6 months of the trial. Two trajectory patterns were identified: immediate responders (85.5%), on average, had a decreasing SBP, whereas nonimmediate responders (14.5%), on average, had an initially increasing SBP followed by a decrease. Compared with those randomized to chlorthalidone, participants randomized to amlodipine (odds ratio, 1.20; 95% confidence interval [CI], 1.10-1.31), lisinopril (odds ratio, 1.88; 95% CI, 1.73-2.03), and doxazosin (odds ratio, 1.65; 95% CI, 1.52-1.78) had higher adjusted odds ratios associated with being a nonimmediate responder (versus immediate responder). After multivariable adjustment, nonimmediate responders had a higher hazard ratio of stroke (hazard ratio, 1.49; 95% CI, 1.21-1.84), combined cardiovascular disease (hazard ratio, 1.21; 95% CI, 1.11-1.31), and heart failure (hazard ratio, 1.48; 95% CI, 1.24-1.78) during follow-up between 6 months and 2 years. The SBP response trajectories provided superior discrimination for predicting downstream adverse cardiovascular events than classification based on difference in SBP between the first 2 measurements, SBP at 6 months, and average SBP during the first 6 months. Our findings demonstrate heterogeneity in response to antihypertensive therapies and show that chlorthalidone is associated with more favorable initial response than the other medications. © 2017 American Heart Association, Inc.

  8. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions

    OpenAIRE

    Shams, Tanzila; Zaidat, Osama; Yavagal, Dileep; Xavier, Andrew; Jovin, Tudor; Janardhan, Vallabh

    2016-01-01

    Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interv...

  9. Stroke and Cerebrovascular Diseases Registry

    Science.gov (United States)

    2017-09-11

    Stroke; Acute Stroke; Acute Brain Injury; Ischemic Stroke; Hemorrhagic Stroke; Transient Ischemic Attack; Subarachnoid Hemorrhage; Cerebral Ischemia; Cerebral Infarction; Cerebral Stroke; Venous Sinus Thrombosis, Cranial

  10. Stroke volume of the heart and thoracic fluid content during head-up and head-down tilt in humans

    DEFF Research Database (Denmark)

    van Lieshout, J J; Harms, M P M; Pott, F

    2005-01-01

    The stroke volume (SV) of the heart depends on the diastolic volume but, for the intact organism, central pressures are applied widely to express the filling of the heart.......The stroke volume (SV) of the heart depends on the diastolic volume but, for the intact organism, central pressures are applied widely to express the filling of the heart....

  11. Fibrinogen concentration and risk of ischemic stroke and acute coronary events in 5113 patients with transient ischemic attack and minor ischemic stroke

    NARCIS (Netherlands)

    Rothwell, PM; Howard, SC; Power, DA; Gutnikov, SA; Algra, A; van Gijn, J; Clark, TG; Murphy, MFG; Warlow, CP

    2004-01-01

    Background and Purpose - Fibrinogen is an independent risk factor for coronary events in population-based studies and in patients with coronary heart disease, but there is uncertainty about prediction of stroke, particularly in secondary prevention. Methods - We studied unpublished data from 3

  12. Susceptibility-weighted imaging in stroke-like migraine attacks after radiation therapy syndrome

    International Nuclear Information System (INIS)

    Khanipour Roshan, Sara; Salmela, Michael B.; McKinney, Alexander M.

    2015-01-01

    Stroke-like migraine attacks after radiation therapy (SMART) syndrome has a characteristic clinical presentation and postcontrast T1WI MRI appearance. Susceptibility-weighted imaging (SWI) may help distinguish SMART from other disorders that may have a similar postcontrast MRI appearance. The MRI examinations of four patients with SMART syndrome are described herein, each of which included SWI, FLAIR, DWI, and postcontrast T1WI on the presenting and follow-up MRI examinations. In each, the initial SWI MRI demonstrated numerous susceptibility hypointensities <5 mm in size throughout the cerebrum, particularly within the periventricular white matter (PVWM), presumably related to radiation-induced cavernous hemangiomas (RICHs). By follow-up MRI, each postcontrast examination had demonstrated resolution of the gyriform enhancement on T1WI, without susceptibility hypointensities on SWI within those previously enhancing regions. These preliminary findings suggest that SWI may help identify SMART syndrome or at least help discriminate it from other disorders, by the findings of numerous susceptibility hypointensities on SWI likely representing RICHs, gyriform enhancement on T1WI, and postsurgical findings or appropriate clinical history. (orig.)

  13. Cerebrovascular instability in a subset of patients with stroke and transient ischemic attack.

    Science.gov (United States)

    Friberg, L; Olsen, T S

    1991-10-01

    In six patients, we observed remarkably unsteady blood flow and indications of vasospasms on the arteriolar level in connection with episodes of focal cerebral ischemia. The patients originated from a prospective consecutive study of 53 patients with stroke and transient ischemic attack who had been examined by cerebral angiography and rapidly repeated regional cerebral blood flow measurements using the intracarotid xenon 133 method. In 47 patients, regional cerebral blood flow values, flow patterns, and clinical condition were stable during the repeated regional cerebral blood flow measurements. In six patients, pronounced regional hypoperfusion and hyperperfusion developed during the course of examination. In the hypoperfused regions, flow was transiently reduced to values consistent with ischemia, and in four of these patients this was accompanied by transient neurological deficits. The arteriogram and isotope angiograms ruled out spasms of large arteries or thromboembolism. A condition of cerebrovascular instability on the arteriolar level probably was induced by the examination procedure. These patients were hypersensitive to the provoking stimuli either habitually or as a consequence of previous ischemic accidents. It is suggested that in some patients with focal cerebral ischemia, the primary cause might be spasms of the smallest resistance vessels rather than thromboembolism.

  14. EMOTIONAL AND COGNITIVE CHANGES DURING AND POST A NEAR FATAL HEART ATTACK AND ONE-YEAR AFTER: A CASE STUDY

    Directory of Open Access Journals (Sweden)

    Andrew M. Lane

    2010-09-01

    Full Text Available This case study reports on changes in emotions before and during an unexpected heart rate in a young, apparently healthy male with a life-long history of exercise in the absence of family history of heart problems. He completed the Brunel Mood Scale (Terry et al. , 2003 to assess emotions before, during, and after the heart attack, and also describing his thoughts during these periods. Results indicate he experienced unpleasant emotions in the build up to the heart attack, feelings he attributed at the time to frustration to achieve fitness goals. He maintained an exercise regime prior to having a heart attack, a finding consistent with previous research suggesting that early diagnosis, although vital for survival, is not likely to be identified among seemingly healthy individuals. During the heart attack, he experienced a rapid emotional change characterised by a rapid increase in anger coupled with thoughts of needing to survive. The intensity of emotions and regulation strategies employed before and during the heart attack provide insight this experience, and we suggest future research should investigate emotional change during adverse conditions

  15. The High Frequency of Guideline-Approved and Guideline-Disapproved Medication Use in Stroke and Transient Ischemic Attack.

    Science.gov (United States)

    Jackova, Jana; Sedova, Petra; Brown, Robert D; Bryndziar, Tomas; Zvolsky, Miroslav; Bednarik, Josef; Mikulik, Robert

    2016-11-01

    Administration of evidence-based pharmacotherapy improves stroke outcome while the use of non-evidence-based medications may not be of benefit and leads to unnecessary patient care costs. The aim of our study was to determine the frequency of guideline-approved and guideline-disapproved pharmacotherapy use in acute stroke management in the Czech Republic (CR). Using the ICD-10 codes, 500 stroke and transient ischemic attack (TIA) patients were randomly selected (random selection of 10 hospitals and then 50 patients from each hospital) from the National Registry of Hospitalized Patients for strokes occurring in 2011. Discharge summaries were reviewed for medications prescribed during hospitalization and at discharge. Of the 500 requested discharge summaries, 484 were available for review (response rate 97%). Up to 479 (96%) summaries were sufficient for evaluation and of these, 393 were confirmed to have a stroke or TIA diagnosis. Brain imaging (computed tomography or magnetic resonance imaging) was performed in 97% of the 393 cases. Intravenous thrombolysis was administered to 7% of patients with ischemic stroke (rate was 0%-25% in different hospitals). Up to 97% of patients with ischemic events (TIA or ischemic stroke) were treated with antiplatelets or anticoagulants. At least 1 non-evidence-based medication was administered to 28% of the 393 patients (rate was 5%-89% in different hospitals). Guideline-disapproved pharmacotherapy is common in stroke and TIA patients in the CR and processes should be put into place to lessen the frequency of their use. The use of guideline-approved medications is also high and should be further promoted. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Poststroke Epilepsy Is Associated With a High Mortality After a Stroke at Young Age: Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation Study.

    Science.gov (United States)

    Arntz, Renate M; Rutten-Jacobs, Loes C A; Maaijwee, Noortje A M; Schoonderwaldt, Hennie C; Dorresteijn, Lucille D A; van Dijk, Ewoud J; de Leeuw, Frank-Erik

    2015-08-01

    Poststroke epilepsy is a common complication after a young stroke. We investigated the association between poststroke epilepsy and mortality. We performed a prospective cohort study among 631 patients with a first-ever transient ischemic attack or ischemic stroke, aged 18 to 50 years. Survival analysis and Cox proportional hazard analysis were used to estimate cumulative mortality and hazard ratios for patients with and without epilepsy. After mean follow-up of 12.5 years (SD 8.6), 76 (12.0%) developed poststroke epilepsy. Case fatality was 27.4% for patients with poststroke epilepsy and 2.1% for those without. Poststroke epilepsy was associated with 30-day mortality (hazard ratio, 4.8; 95% confidence interval, 1.7-14.0) and long-term mortality (hazard ratio, 1.8; 95% confidence interval, 1.2-2.9). Epilepsy is a common problem after a young stroke and is associated with an increased short-term and long-term mortality. © 2015 American Heart Association, Inc.

  17. Smartphone Based Heart Attack Risk Prediction System with Statistical Analysis and Data Mining Approaches

    Directory of Open Access Journals (Sweden)

    M. Raihan

    2017-11-01

    Full Text Available Nowadays, Ischemic Heart Disease (IHD (Heart Attack is ubiquitous and one of the major reasons of death worldwide. Early screening of people at risk of having IHD may lead to minimize morbidity and mortality. A simple approach is proposed in this paper to predict risk of developing heart attack using smartphone and data mining. Clinical data from 835 patients was collected, analyzed and also correlated with their risk existing clinical symptoms which may suggest underlying non detected IHD. A user friendly Android application was developed by incorporating clinical data obtained from patients who admitted with chest pain in a cardiac hospital. Upon user input of risk factors, the application categorizes the level of IHD risks of the user as high, low or medium. It was found by analyzing and correlating the data that there was a significant correlation of having an IHD and the application results in high & low, medium & low and medium & high categories; where the p values were 0.0001, 0.0001 and 0.0001 respectively. The experimental results showed that the sensitivity and accuracy of the proposed technique were 89.25 % and 76.05 % respectively, whereas, using C4.5 decision tree, accuracy was found 86% and sensitivity was obtained 91.6%. Existing tools need mandatory input of lipid values which makes them underutilized by general people; though these risk calculators bear significant academic importance. Our research is motivated to reduce that limitation and promote a risk evaluation on time.

  18. Long-term use of ticagrelor in patients with prior heart attack: ticagrelor plus aspirin versus aspirin monotherapy.

    Science.gov (United States)

    Amico, Frank; Schlesinger, Alex; Mazzoni, Jennifer

    2016-01-01

    Review of: Bonaca MP, Bhatt DL, Cohen M, et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015;372:1791-1800. This Practice Pearl reviews the recent study Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared With Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54 (PEGASUS-TIMI 54). It challenges the current standard of care of 12 months of dual antiplatelet followed by aspirin indefinitely. The study demonstrated that patients who received ticagrelor, either the 60 mg or 90 mg twice daily plus aspirin, showed a decreased risk of cardiovascular death, myocardial infarction, or stroke. The PEGASUS-TIMI 54 trial also proved that the benefit of ticagrelor was seen early and continued to accrue over time, with a median of 33 months of follow-up, meaning that the benefit persists over time. It is important to note that both doses of the ticagrelor were associated with higher incidence of bleeding, but the rates of fatal bleeding did not show any difference between the ticagrelor or placebo.

  19. US State-level income inequality and risks of heart attack and coronary risk behaviors: longitudinal findings.

    Science.gov (United States)

    Pabayo, Roman; Kawachi, Ichiro; Gilman, Stephen E

    2015-07-01

    To examine prospectively the association between US state income inequality and incidence of heart attack. We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,445). Respondents completed interviews at baseline (2001-2002) and follow-up (2004-2005). Weighted multilevel modeling was used to determine if US state-level income inequality (measured by the Gini coefficient) at baseline was a predictor of heart attack during follow-up, controlling for individual-level and state-level covariates. In comparison to residents of US states in the lowest quartile of income inequality, those living in the second [Adjusted Odds Ratio (AOR) = 1.71, 95 % CI 1.16-2.53)], third (AOR = 1.81, 95 % CI 1.28-2.57), and fourth (AOR = 2.04, 95 % CI 1.26-3.29) quartiles were more likely to have a heart attack. Similar findings were obtained when we excluded those who had a heart attack prior to baseline. This study is one of the first to empirically show the longitudinal relationship between income inequality and coronary heart disease. Living in a state with higher income inequality increases the risk for heart attack among US adults.

  20. Heart lesion after the first attack of the rheumatic Fever 22 years experience in single centre.

    Science.gov (United States)

    Bejiqi, Ramush A; Retkoceri, Ragip; Zeka, Naim; Bejiqi, Hana; Retkoceri, Arber

    2015-02-01

    Acute rheumatic fever and its sequels, rheumatic heart diseases, remain major unsolved preventable health problems in Kosovo population, particularly among the disadvantages indigenous Albanian and Egyptians people. In Kosovo, despite of performing secondary prophylaxis with benzathine penicillin, acute rheumatic fever hospitalization rates have remained essentially unchanged for the last 20 years. The role of echocardiography in the diagnosis of acute rheumatic carditis was established over the last 20 years. In this study we aimed to determine the prevalence of rheumatic heart disease in children from Kosovo population with first attack of acute rheumatic fever. Also, we presented that echocardiography examination detects a greater prevalence of rheumatic heart disease than other diagnostic procedures. We aimed to compare the sensitivity and specificity of cardiac auscultation, ECG record, lab analysis to echocardiography and to determine the feasibility of specific age in this setting. To optimize accurate diagnosis of rheumatic fever and rheumatic heart disease, we utilized two group models. In the first group of 388 children, hospitalized and treated before 1999, diagnosis of rheumatic fever was decided basing on the clinical and laboratory findings whereas in second group (221 children treated from1999 to 2010) clinical and lab diagnosis were amplified also on the detection by echocardiography. In second group, using echocardiography as a method of diagnosis and assessment children with rheumatic fever, we found high rates of undetected rheumatic heart disease in this high-risk group population. Echocardiographic examination of children with rheumatic fever for rheumatic heart disease may over diagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.

  1. Heart Lesion After the First Attack of the Rheumatic Fever 22 Years Experience in Single Centre

    Science.gov (United States)

    Bejiqi, Ramush A.; Retkoceri, Ragip; Zeka, Naim; Bejiqi, Hana; Retkoceri, Arber

    2015-01-01

    Background: Acute rheumatic fever and its sequels, rheumatic heart diseases, remain major unsolved preventable health problems in Kosovo population, particularly among the disadvantages indigenous Albanian and Egyptians people. In Kosovo, despite of performing secondary prophylaxis with benzathine penicillin, acute rheumatic fever hospitalization rates have remained essentially unchanged for the last 20 years. The role of echocardiography in the diagnosis of acute rheumatic carditis was established over the last 20 years. Aims: In this study we aimed to determine the prevalence of rheumatic heart disease in children from Kosovo population with first attack of acute rheumatic fever. Also, we presented that echocardiography examination detects a greater prevalence of rheumatic heart disease than other diagnostic procedures. We aimed to compare the sensitivity and specificity of cardiac auscultation, ECG record, lab analysis to echocardiography and to determine the feasibility of specific age in this setting. Methods: To optimize accurate diagnosis of rheumatic fever and rheumatic heart disease, we utilized two group models. In the first group of 388 children, hospitalized and treated before 1999, diagnosis of rheumatic fever was decided basing on the clinical and laboratory findings whereas in second group (221 children treated from1999 to 2010) clinical and lab diagnosis were amplified also on the detection by echocardiography. Conclusion: In second group, using echocardiography as a method of diagnosis and assessment children with rheumatic fever, we found high rates of undetected rheumatic heart disease in this high-risk group population. Echocardiographic examination of children with rheumatic fever for rheumatic heart disease may over diagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded. PMID:25870479

  2. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... Ischemic Attack TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood clot blocks an artery for a short time. The only difference between a stroke ...

  3. Health and cost benefits associated with the use of metoprolol in heart attack patients.

    Science.gov (United States)

    Fernández-Jiménez, Rodrigo; Ibanez, Borja

    2014-11-01

    Heart attack (myocardial infarction) is a highly prevalent entity worldwide. Widespread implementation of reperfusion strategies has dramatically reduced the mortality associated with infarction. Paradoxically, the mortality reduction has significantly increased the incidence of chronic heart failure (HF). Treatment of HF, once present, represents a huge socioeconomic burden on individuals and healthcare systems. The possibility of preventing rather than treating post-infarction HF would be of paramount importance. Given that infarct size is the main determinant of adverse post-infarction outcomes (including chronic HF), therapies able to reduce infarct size are needed. The single administration of intravenous metoprolol before reperfusion has been recently shown to reduce infarct size and reduce the cases of chronic HF in a proof-of-concept trial. If confirmed in larger trials, this low-cost therapy is expected to have a major health and socioeconomic impact.

  4. B vitamins in patients with recent transient ischaemic attack or stroke in the VITAmins TO Prevent Stroke (VITATOPS) trial: a randomised, double-blind, parallel, placebo-controlled trial.

    Science.gov (United States)

    2010-09-01

    serious adverse reactions and no significant differences in common adverse effects between the treatment groups. Daily administration of folic acid, vitamin B6, and vitamin B12 to patients with recent stroke or transient ischaemic attack was safe but did not seem to be more effective than placebo in reducing the incidence of major vascular events. These results do not support the use of B vitamins to prevent recurrent stroke. The results of ongoing trials and an individual patient data meta-analysis will add statistical power and precision to present estimates of the effect of B vitamins. Australia National Health and Medical Research Council, UK Medical Research Council, Singapore Biomedical Research Council, Singapore National Medical Research Council, Australia National Heart Foundation, Royal Perth Hospital Medical Research Foundation, and Health Department of Western Australia. Copyright 2010 Elsevier Ltd. All rights reserved.

  5. Snoring as a risk factor for ischaemic heart disease and stroke in men.

    OpenAIRE

    Koskenvuo, M; Kaprio, J; Telakivi, T; Partinen, M; Heikkilä, K; Sarna, S

    1987-01-01

    The association of snoring with ischaemic heart disease and stroke was studied prospectively in 4388 men aged 40-69. The men were asked, in a questionnaire sent to them, whether they snored habitually, frequently, occasionally, or never. Hospital records and death certificates were checked for the next three years to establish how many of the men developed ischaemic heart disease or stroke: the numbers were 149 and 42, respectively. Three categories of snoring were used for analysis: habitual...

  6. Health care in patients 1 year post-stroke in general practice : research on the utilisation of the Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident

    NARCIS (Netherlands)

    de Weerd, L.; Rutgers, A.W.F.; Groenier, K.H.; van der Meer, K.

    2012-01-01

    This study evaluates the kind of aftercare that ischaemic stroke patients receive and the extent that aftercare fulfils the criteria of the 'Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident'. Fifty-seven patients were interviewed 1 year post-stroke about secondary

  7. Population-based study of ABCD2 score, carotid stenosis, and atrial fibrillation for early stroke prediction after transient ischemic attack: the North Dublin TIA study.

    LENUS (Irish Health Repository)

    Sheehan, Orla C

    2010-05-01

    Transient ischemic attack (TIA) etiologic data and the ABCD(2) score may improve early stroke risk prediction, but studies are required in population-based cohorts. We investigated the external validity of the ABCD(2) score, carotid stenosis, and atrial fibrillation for prediction of early recurrent stroke after TIA.

  8. Impact of the New American Heart Association/American Stroke Association Definition of Stroke on the Results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial.

    Science.gov (United States)

    Al Kasab, Sami; Lynn, Michael J; Turan, Tanya N; Derdeyn, Colin P; Fiorella, David; Lane, Bethany F; Janis, L Scott; Chimowitz, Marc I

    2017-01-01

    An American Heart Association/American Stroke Association (AHA/ASA) writing committee has recently recommended that tissue evidence of cerebral infarction associated with temporary symptoms (CITS) lasting Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. We compared outcomes in the medical (n = 227) and stenting (n = 224) groups in SAMMPRIS using the following primary end point (new components in bold): any stroke, CITS, or death within 30 days after enrollment or within 30 days after a revascularization procedure for the qualifying lesion during follow-up; or ischemic stroke or CITS in the territory of the qualifying artery beyond 30 days. We also compared the use of brain magnetic resonance imaging (MRI) after transient ischemic attacks (TIAs) in both treatment groups. By considering CITS as equivalent to stroke, the number of primary end points increased from 34 to 43 in the medical group and from 52 to 66 in the stenting group of SAMMPRIS. The Kaplan-Meier curves for the primary end points in the 2 groups were significantly different (P = .009). The percentage of patients with reported TIAs who underwent brain MRI was 69% in the medical group and 61% in the stenting group (P = .40). Using the AHA/ASA definition of stroke resulted in a substantially higher primary end point rate in both treatment groups and an even higher benefit from medical therapy over stenting than originally shown in SAMMPRIS. The higher rate of CITS in the stenting group was not due to ascertainment bias. Published by Elsevier Inc.

  9. Renal dysfunction and chronic kidney disease in ischemic stroke and transient ischemic attack: A population-based study.

    Science.gov (United States)

    Hayden, Derek; McCarthy, Christine; Akijian, Layan; Callaly, Elizabeth; Ní Chróinín, Danielle; Horgan, Gillian; Kyne, Lorraine; Duggan, Joseph; Dolan, Eamon; O' Rourke, Killian; Williams, David; Murphy, Sean; O'Meara, Yvonne; Kelly, Peter J

    2017-10-01

    Background and purpose The prevalence of chronic kidney disease (estimated glomerular filtration rate (eGFR) chronic kidney disease (CKD)) in ischemic stroke and transient ischemic attack (TIA) is unknown, as estimates have been based on single-point estimates of renal function. Studies investigating the effect of renal dysfunction (eGFR < 60 mL/min per 1.73 m 2 , renal dysfunction) on post-stroke outcomes are limited to hospitalized cohorts and have provided conflicting results. Methods We investigated rates, determinants and outcomes of renal dysfunction in ischemic stroke and TIA in the North Dublin Population Stroke Study. We also investigate the persistence of renal dysfunction in 90-day survivors to determine the prevalence of CKD. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using Kaplan-Meier survival curves and Cox proportional hazards modeling. Results In 547 patients (ischemic stroke in 76.4%, TIA in 23.6%), the mean eGFR at presentation was 63.7 mL/min/1.73 m 2 (SD 22.1). Renal dysfunction was observed in 44.6% (244/547). Among 90-day survivors, 31.2% (139/446) met criteria for CKD. After adjusting for age and stroke severity, eGFR < 45 mL/min/1.73 m 2 (hazard ratio 2.53, p = 0.01) independently predicted 28-day fatality but not at two years. Poor post-stroke functional outcome (Modified Rankin Scale 3-5) at two years was more common in those with renal dysfunction (52.5% vs. 20.6%, p < 0.001). After adjusting for age, stroke severity and pre-stroke disability, renal dysfunction (OR 2.17, p = 0.04) predicted poor functional outcome. Conclusion Renal dysfunction and CKD are common in ischemic stroke and TIA. Renal dysfunction is associated with considerable post-stroke morbidity and mortality. Further studies are needed to investigate if modifiable mechanisms underlie these associations.

  10. Ultrasensitive cardiac troponin I antibody based nanohybrid sensor for rapid detection of human heart attack.

    Science.gov (United States)

    Bhatnagar, Deepika; Kaur, Inderpreet; Kumar, Ashok

    2017-02-01

    An ultrasensitive cardiac troponin I antibody conjugated with graphene quantum dots (GQD) and polyamidoamine (PAMAM) nanohybrid modified gold electrode based sensor was developed for the rapid detection of heart attack (myocardial infarction) in human. Screen printed gold (Au) electrode was decorated with 4-aminothiophenol for amine functionalization of the Au surface. These amino groups were further coupled with carboxyl functionalities of GQD with EDC-NHS reaction. In order to enhance the sensitivity of the sensor, PAMAM dendrimer was successively embedded on GQD through carbodiimide coupling to provide ultra-high surface area for antibody immobilization. The activated cardiac troponin I (cTnI) monoclonal antibody was immobilized on PAMAM to form nanoprobe for sensing specific heart attack marker cTnI. Various concentrations of cardiac marker, cTnI were electrochemically measured using cyclic voltammetry (CV) and differential pulse voltammetry (DPV) in human blood serum. The modifications on sensor surface were characterized by FTIR and AFM techniques. The sensor is highly specific to cTnI and showed negligible response to non-specific antigens. The sensitivity of the sensor was 109.23μAcm -2 μg -1 and lower limit of detection of cTnI was found 20fgmL -1 . Copyright © 2016 Elsevier B.V. All rights reserved.

  11. [The daily rhythm of heart attack morbidity and mortality may be influenced by the time of sunrise].

    Science.gov (United States)

    Kriszbacher, Ildikó; Csoboth, Ildikó; Boncz, Imre; Bódis, József

    2008-11-16

    The morbidity and mortality of a myocardial infarction show characteristic seasonal and diurnal changes that may be influenced by the time of sunrise and the number of hours with daylight during the day. We wish to study whether the time of sunrise and the number of hours with daylight influence the seasonality of heart attack morbidity and mortality, and whether these have an effect on the diurnal rhythm of a heart attack. We have carried out the retrospective analysis of patients received at Hungarian hospitals with the diagnose of an acute heart attack ( n = 32,329) and those deceased due to a heart attack ( n = 5,142) between 2004 and 2005. Data were gained from the data-base of the National Health Insurance Fund according to the International Classification of Diseases. Positive correlation showed between the time of sunrise and both the incidence of an acute myocardial infarction and related mortality ( p heart attack morbidity and mortality, however, other factors are assumed to take a role as well.

  12. A Modified Definition for Obstructive Sleep Apnea in Home Sleep Apnea Testing after Stroke or Transient Ischemic Attack.

    Science.gov (United States)

    Patel, Namita; Raissi, Afsaneh; Elias, Sara; Kamra, Maneesha; Kendzerska, Tetyana; Murray, Brian J; Boulos, Mark I

    2018-02-07

    Home sleep apnea testing (HSAT) underestimates obstructive sleep apnea (OSA) severity. Overnight oxygen desaturation has been shown to be a strong predictor of incident stroke, and may be helpful in determining which patients with lower apnea-hypopnea indices (AHIs) should be offered treatment. To examine whether a modified definition for OSA that uses oxygen desaturation (i.e., AHI 5-14.9 per hour and lowest O 2 desaturation ≤88%), as compared to an AHI ≥ 15 per hour, would impact: (1) changes in Epworth Sleepiness Scale scores post-continuous positive airway pressure (CPAP) initiation; (2) CPAP compliance rates; and (3) the accuracy of automated versus manual scoring of HSAT. One hundred and six patients with a prior stroke or transient ischemic attack (TIA) underwent HSAT. Epworth Sleepiness Scale and CPAP compliance were measured at baseline and 3-6 months. Median age was 67.5 years, 57.5% male, and 76.4% presented with stroke. Fifty-nine patients were diagnosed with OSA; of these 54.2% met criteria for the "modified definition" for OSA (AHI 5-14.9 per hour with oxygen desaturation) and 45.8% met criteria for the "classic definition" for OSA (AHI ≥15). The modified (versus classic) definition had: (1) a greater decrease in ESS (P = .05) post-CPAP initiation; (2) comparable CPAP compliance rates; and (3) comparable automatically versus manually scored AHIs (Spearman's rho = .96, Cohen's Kappa ≥ .75 for both definitions, P definition of OSA that uses a lower AHI cutoff and includes an oxygen desaturation cutoff in the setting of HSAT for stroke or transient ischemic attack (TIA) patients may improve daytime sleepiness post-CPAP initiation, while not significantly affecting CPAP compliance rates nor the accuracy of automated scoring. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Patent foramen ovale closure following cryptogenic stroke or transient ischaemic attack: Long-term follow-up of 301 cases.

    Science.gov (United States)

    Mirzaali, Mikaeil; Dooley, Maureen; Wynne, Dylan; Cooter, Nina; Lee, Lorraine; Haworth, Peter; Saha, Romi; Gainsborough, Nicola; Hildick-Smith, David

    2015-11-15

    Patent foramen ovale has been identified as a conduit for paradoxical embolism resulting in cryptogenic stroke or transient ischemic attack (TIA). We aimed to establish rates of death, recurrent stroke or TIA among patients undergoing PFO closure for stroke or TIA at our unit. A retrospective analysis of all PFO closure patients was performed between May 2004 and January 2013. Follow up was performed by mortality tracing using the Medical Research Information Service of the Office of National Statistics. With regard to stroke or TIA recurrence, written consent forms and questionnaires were mailed with follow up telephone calls. Medical notes and imaging records were consulted where adverse events were noted. 301 patients aged 48.6 ± 11.0 years, 54.4% male, with ≥1 thromboembolic neurovascular event had percutaneous PFO closure with one of eight devices, with successful implantation in 99% of cases. Follow-up duration was 40.2 ± 26.2 months (range 1.3-105.3); complete in 301 patients for mortality (100%) and 283 patients (94.0%) for neurovascular events. Two patients died during follow-up (respiratory failure n = 1; road traffic accident n = 1). Recurrent stroke (MRI or CT confirmed) was observed in five patients (0.5%; 0.55 per 100 person-years) and TIA in 9 (1.1%; 0.98 per 100 person-years). Atrial fibrillation requiring treatment was documented in 14 patients (1.7%). Percutaneous PFO closure in patients with cryptogenic stroke or TIA is a safe treatment with a low incidence of procedural complications and recurrent neurovascular events. Registry data like these may help to demonstrate the utility of PFO closure in stroke. © 2015 Wiley Periodicals, Inc.

  14. Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack.

    Science.gov (United States)

    Arba, F; Quinn, T; Hankey, G J; Ali, M; Lees, K R; Inzitari, D

    2017-02-01

    Small vessel disease (SVD) and Alzheimer's disease (AD) are two common causes of cognitive impairment and dementia, traditionally considered as distinct processes. The relationship between radiological features suggestive of AD and SVD was explored, and the association of each of these features with cognitive status at 1 year was investigated in patients with stroke or transient ischaemic attack. Anonymized data were accessed from the Virtual International Stroke Trials Archive (VISTA). Medial temporal lobe atrophy (MTA; a marker of AD) and markers of SVD were rated using validated ordinal visual scales. Cognitive status was evaluated with the Mini Mental State Examination (MMSE) 1 year after the index stroke. Logistic regression models were used to investigate independent associations between (i) baseline SVD features and MTA and (ii) all baseline neuroimaging features and cognitive status 1 year post-stroke. In all, 234 patients were included, mean (±SD) age 65.7 ± 13.1 years, 145 (62%) male. Moderate to severe MTA was present in 104 (44%) patients. SVD features were independently associated with MTA (P stroke, hypertension and diabetes mellitus, MTA was the only radiological feature independently associated with cognitive impairment, defined using thresholds of MMSE ≤ 26 (odds ratio 1.94; 95% confidence interval 1.28-2.94) and MMSE ≤ 23 (odds ratio 2.31; 95% confidence interval 1.48-3.62). In patients with ischaemic cerebrovascular disease, SVD features are associated with MTA, which is a common finding in stroke survivors. SVD and AD type neurodegeneration coexist, but the AD marker MTA, rather than SVD markers, is associated with post-stroke cognitive impairment. © 2016 EAN.

  15. Motor Impairments in Transient Ischemic Attack Increase the Odds of a Subsequent Stroke: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Neha Lodha

    2017-06-01

    Full Text Available Background and purposeTransient ischemic attack (TIA increases the risk for a subsequent stroke. Typical symptoms include motor weakness, gait disturbance, and loss of coordination. The association between the presence of motor impairments during a TIA and the chances of a subsequent stroke has not been examined. In the current meta-analysis, we examine whether the odds of a stroke are greater in TIA individuals who experience motor impairments as compared with those who do not experience motor impairments.MethodsWe conducted a systematic search of electronic databases as well as manual searches of the reference lists of retrieved articles. The meta-analysis included studies that reported an odds ratio relating motor impairments to a subsequent stroke, or the number of individuals with or without motor impairments who experienced a subsequent stroke. We examined these studies using rigorous meta-analysis techniques including random effects model, forest and funnel plots, I2, publication bias, and fail-safe analysis.ResultsTwenty-four studies with 15,129 participants from North America, Australia, Asia, and Europe qualified for inclusion. An odds ratio of 2.11 (95% CI, 1.67–2.65, p = 0.000 suggested that the chances of a subsequent stroke are increased by twofolds in individuals who experience motor impairments during a TIA compared with those individuals who have no motor impairments.ConclusionThe presence of motor impairments during TIA is a significantly high-risk clinical characteristic for a subsequent stroke. The current evidence for motor impairments following TIA relies exclusively on the clinical reports of unilateral motor weakness. A comprehensive examination of motor impairments in TIA will enhance TIA prognosis and restoration of residual motor impairments.

  16. Closure of Patent Foramen Ovale Versus Medical Therapy in Patients With Cryptogenic Stroke or Transient Ischemic Attack: Updated Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Ntaios, George; Papavasileiou, Vasileios; Sagris, Dimitrios; Makaritsis, Konstantinos; Vemmos, Konstantinos; Steiner, Thorsten; Michel, Patrik

    2018-02-01

    Previous systematic reviews and meta-analyses compared the efficacy and safety of patent foramen ovale (PFO) closure versus medical treatment in patients with cryptogenic stroke or transient ischemic attack (TIA). Recently, new evidence from randomized trials became available. We searched PubMed until September 24, 2017, for trials comparing PFO closure with medical treatment in patients with cryptogenic stroke/TIA using the items: stroke or cerebrovascular accident or TIA and patent foramen ovale or paradoxical embolism and trial or study. Among 851 identified articles, 5 were eligible. In 3627 patients with 3.7-year mean follow-up, there was significant difference in ischemic stroke recurrence (0.53 versus 1.1 per 100 patient-years, respectively; odds ratio [OR], 0.43; 95% confidence intervals (CI), 0.21-0.90; relative risk reduction, 50.5%; absolute risk reduction, 2.11%; and number needed to treat to prevent 1 event, 46.5 for 3.7 years). There was no significant difference in TIAs (0.78 versus 0.98 per 100 patient-years, respectively; OR, 0.80; 95% CI, 0.53-1.19) and all-cause mortality (0.18 versus 0.23 per 100 patient-years, respectively; OR, 0.73; 95% CI, 0.34-1.56). New-onset atrial fibrillation occurred more frequently in the PFO closure arm (1.3 versus 0.25 per 100 patient-years, respectively; OR, 5.15; 95% CI, 2.18-12.15) and resolved in 72% of cases within 45 days, whereas rates of myocardial infarction (0.12 versus 0.09 per 100 patient-years, respectively; OR, 1.22; 95% CI, 0.25-5.91) and any serious adverse events (7.3 versus 7.3 per 100 patient-years, respectively; OR, 1.07; 95% CI, 0.92-1.25) were similar. In patients with cryptogenic stroke/TIA and PFO who have their PFO closed, ischemic stroke recurrence is less frequent compared with patients receiving medical treatment. Atrial fibrillation is more frequent but mostly transient. There is no difference in TIA, all-cause mortality, or myocardial infarction. © 2018 American Heart Association, Inc.

  17. Poor Long-Term Functional Outcome After Stroke Among Adults Aged 18 to 50 Years: Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) Study

    NARCIS (Netherlands)

    Synhaeve, N.E.; Arntz, R.M.; Maaijwee, N.A.M.M.; Rutten-Jacobs, L.C.A.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Kort, P.L.M. de; Dijk, E.J. van; Leeuw, F.E. de

    2014-01-01

    BACKGROUND AND PURPOSE: Stroke in young adults has a dramatic effect on life; therefore, we investigated the long-term functional outcome after transient ischemic attack, ischemic stroke, or intracerebral hemorrhage in adults aged 18 to 50 years. METHODS: We studied 722 young patients with

  18. Poststroke Epilepsy Is Associated With a High Mortality After a Stroke at Young Age: Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation Study

    NARCIS (Netherlands)

    Arntz, R.M.; Rutten-Jacobs, L.C.A.; Maaijwee, N.A.M.M.; Schoonderwaldt, H.C.; Dorresteijn, L.D.; Dijk, E.J. van; Leeuw, F.E. de

    2015-01-01

    BACKGROUND AND PURPOSE: Poststroke epilepsy is a common complication after a young stroke. We investigated the association between poststroke epilepsy and mortality. METHODS: We performed a prospective cohort study among 631 patients with a first-ever transient ischemic attack or ischemic stroke,

  19. Major stroke in a 19-year-old patient with a univentricular heart

    DEFF Research Database (Denmark)

    Riemann, Mads; Idorn, Lars; Wagner, Aase

    2013-01-01

    Patients with univentricular heart malformations are at increased risk of suffering from thromboembolic events. We present a case of a 19-year-old woman born with a univentricular heart who suffered a major stroke while being treated with only salicylic acid. At least 20% of patients...

  20. Prediction of Ischemic Heart Disease and Stroke in Survivors of Childhood Cancer

    NARCIS (Netherlands)

    Chow, Eric J.; Chen, Yan; Hudson, Melissa M.; Feijen, Elizabeth A. M.; Kremer, Leontien C.; Border, William L.; Green, Daniel M.; Meacham, Lillian R.; Mulrooney, Daniel A.; Ness, Kirsten K.; Oeffinger, Kevin C.; Ronckers, Cécile M.; Sklar, Charles A.; Stovall, Marilyn; van der Pal, Helena J.; van Dijk, Irma W. E. M.; van Leeuwen, Flora E.; Weathers, Rita E.; Robison, Leslie L.; Armstrong, Gregory T.; Yasui, Yutaka

    2018-01-01

    Purpose We aimed to predict individual risk of ischemic heart disease and stroke in 5-year survivors of childhood cancer. Patients and Methods Participants in the Childhood Cancer Survivor Study (CCSS; n = 13,060) were observed through age 50 years for the development of ischemic heart disease and

  1. Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based study.

    Science.gov (United States)

    Li, Linxin; Yiin, Gabriel S; Geraghty, Olivia C; Schulz, Ursula G; Kuker, Wilhelm; Mehta, Ziyah; Rothwell, Peter M

    2015-09-01

    A third of transient ischaemic attacks (TIAs) and ischaemic strokes are of undetermined cause (ie, cryptogenic), potentially undermining secondary prevention. If these events are due to occult atheroma, the risk-factor profile and coronary prognosis should resemble that of overt large artery events. If they have a cardioembolic cause, the risk of future cardioembolic events should be increased. We aimed to assess the burden, outcome, risk factors, and long-term prognosis of cryptogenic TIA and stroke. In a population-based study in Oxfordshire, UK, among patients with a first TIA or ischaemic stroke from April 1, 2002, to March 31, 2014, we compared cryptogenic events versus other causative subtypes according to the TOAST classification. We compared markers of atherosclerosis (ie, risk factors, coronary and peripheral arterial disease, asymptomatic carotid stenosis, and 10-year risk of acute coronary events) and of cardioembolism (ie, risk of cardioembolic stroke, systemic emboli, and new atrial fibrillation [AF] during follow-up, and minor-risk echocardiographic abnormalities and subclinical paroxysmal AF at baseline in patients with index events between 2010 and 2014). Among 2555 patients, 812 (32%) had cryptogenic events (incidence of cryptogenic stroke 0·36 per 1000 population per year, 95% CI 0·23-0·49). Death or dependency at 6 months was similar after cryptogenic stroke compared with non-cardioembolic stroke (23% vs 27% for large artery and small vessel subtypes combined; p=0·26) as was the 10-year risk of recurrence (32% vs 27%; p=0·91). However, the cryptogenic group had fewer atherosclerotic risk factors than the large artery disease (pdisease (p=0·001), and cardioembolic (p=0·008) groups. Compared with patients with large artery events, those with cryptogenic events had less hypertension (adjusted odds ratio [OR] 0·41, 95% CI 0·30-0·56; pdisease (0·27, 0·17-0·45; pdisease (adjusted OR 0·64, 95% CI 0·37-1·11; p=0·11) or acute coronary

  2. Dual or mono antiplatelet therapy for patients with acute ischemic stroke or transient ischemic attack: systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Geeganage, Chamila M; Diener, Hans-Christoph; Algra, Ale; Chen, Christopher; Topol, Eric J; Dengler, Reinhard; Markus, Hugh S; Bath, Matthew W; Bath, Philip M W

    2012-04-01

    Antiplatelets are recommended for patients with acute noncardioembolic stroke or transient ischemic attack. We compared the safety and efficacy of dual versus mono antiplatelet therapy in patients with acute ischemic stroke or transient ischemic attack. Completed randomized controlled trials of dual versus mono antiplatelet therapy in patients with acute (≤3 days) ischemic stroke/transient ischemic attack were identified using electronic bibliographic searches. The primary outcome was recurrent stroke (ischemic, hemorrhagic, unknown; fatal, nonfatal). Comparison of binary outcomes between treatment groups was analyzed with random effect models and described using risk ratios (95% CI). Twelve completed randomized trials involving 3766 patients were included. In comparison with mono antiplatelet therapy, dual therapy (aspirin+dipyridamole and aspirin+clopidogrel) significantly reduced stroke recurrence, dual 58 (3.3%) versus mono 91 (5.0%; risk ratio, 0.67; 95% CI, 0.49-0.93); composite vascular event (stroke, myocardial infarction, vascular death), dual 74 (4.4%) versus mono 106 (6%; risk ratio, 0.75; 95% CI, 0.56-0.99); and the combination of stroke, transient ischemic attack, acute coronary syndrome, and all death, dual 100 (1.7%) versus mono 136 (9.1%; risk ratio, 0.71; 95% CI, 0.56-0.91); dual therapy was also associated with a nonsignificant trend to increase major bleeding, dual 15 (0.9%) versus mono 6 (0.4%; risk ratio, 2.09; 95% CI, 0.86-5.06). Dual antiplatelet therapy appears to be safe and effective in reducing stroke recurrence and combined vascular events in patients with acute ischemic stroke or transient ischemic attack as compared with mono therapy. These results need to be tested in prospective studies.

  3. Diagnosing Paroxysmal Atrial Fibrillation in Patients With Ischemic Strokes and Transient Ischemic Attacks Using Echocardiographic Measurements of Left Atrium Function

    DEFF Research Database (Denmark)

    Skaarup, Kristoffer Grundtvig; Christensen, Hanne Krarup; Høst, Nis

    2016-01-01

    Twenty-five to 35 percentage of stroke cases are cryptogenic, and it has been demonstrated that paroxysmal atrial fibrillation (AF) is the causal agent in up to 25% of these incidents. The purpose of this study was to investigate if left atrial (LA) parameters have value for diagnosing paroxysmal...... AF in patients with ischemic stroke (IS) and transient ischemic attack (TIA). We retrospectively analyzed 219 patients who after acute IS or TIA underwent a transthoracic echocardiographic examination. Patients were designated as patients with paroxysmal AF if they had one or more reported incidents...... of AF before or after their echocardiographic examination. Patients in the paroxysmal AF group were significantly older and had higher CHA2DS2-VASc score than patients without paroxysmal AF (p

  4. Unrealistic pessimism about risk of coronary heart disease and stroke in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Asimakopoulou, Koula G.; Skinner, T. Chas; Spimpolo, Jennifer

    2008-01-01

    Objective: We examined the accuracy of type 2 diabetes (T2D) patients' risk estimates of developing coronary heart disease (CHD)/having a stroke as a consequence of diabetes and their mood about these risks. Methods: Patients reported their perceived risks of developing CHD/having a stroke...... disease risk and mood was also seen where higher risk of actual and perceived CHD/stroke was related to worse mood. A positive relationship between mood and extent of perceptual error was further observed; the more inaccurate patients' perceptions of CHD/stroke risk were, the better their mood. Mood...... and rated their mood about these risks using a self-report measure. Using an objective risk calculator, they were then told their actual risk of CHD and stroke and their mood was re-assessed. Results: Patients' estimates of their risk of CHD/stroke were grossly inflated. A negative relationship between...

  5. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Jauch, Edward C; Saver, Jeffrey L; Adams, Harold P; Bruno, Askiel; Connors, J J Buddy; Demaerschalk, Bart M; Khatri, Pooja; McMullan, Paul W; Qureshi, Adnan I; Rosenfield, Kenneth; Scott, Phillip A; Summers, Debbie R; Wang, David Z; Wintermark, Max; Yonas, Howard

    2013-03-01

    The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.

  6. Prognostic Significance of Blood Pressure Variability on Beat-to-Beat Monitoring After Transient Ischemic Attack and Stroke.

    Science.gov (United States)

    Webb, Alastair J S; Mazzucco, Sara; Li, Linxin; Rothwell, Peter M

    2018-01-01

    Visit-to-visit and day-to-day blood pressure (BP) variability (BPV) predict an increased risk of cardiovascular events but only reflect 1 form of BPV. Beat-to-beat BPV can be rapidly assessed and might also be predictive. In consecutive patients within 6 weeks of transient ischemic attack or nondisabling stroke (Oxford Vascular Study), BPV (coefficient of variation) was measured beat-to-beat for 5 minutes (Finometer), day-to-day for 1 week on home monitoring (3 readings, 3× daily), and on awake ambulatory BP monitoring. BPV after 1-month standard treatment was related (Cox proportional hazards) to recurrent stroke and cardiovascular events for 2 to 5 years, adjusted for mean systolic BP. Among 520 patients, 26 had inadequate beat-to-beat recordings, and 22 patients were in atrial fibrillation. Four hundred five patients had all forms of monitoring. Beat-to-beat BPV predicted recurrent stroke and cardiovascular events independently of mean systolic BP (hazard ratio per group SD, stroke: 1.47 [1.12-1.91]; P =0.005; cardiovascular events: 1.41 [1.08-1.83]; P =0.01), including after adjustment for age and sex (stroke: 1.47 [1.12-1.92]; P =0.005) and all risk factors (1.40 [1.00-1.94]; P =0.047). Day-to-day BPV was less strongly associated with stroke (adjusted hazard ratio, 1.29 [0.97-1.71]; P =0.08) but similarly with cardiovascular events (1.41 [1.09-1.83]; P =0.009). BPV on awake ambulatory BP monitoring was nonpredictive (stroke: 0.89 [0.59-1.35]; P =0.59; cardiovascular events: 1.08 [0.77-1.52]; P =0.65). Despite a weak correlation ( r =0.119; P =0.02), beat-to-beat BPV was associated with risk of recurrent stroke independently of day-to-day BPV (1.41 [1.05-1.90]; P =0.02). Beat-to-beat BPV predicted recurrent stroke and cardiovascular events, independently of mean systolic BP and risk factors but short-term BPV on ambulatory BP monitoring did not. Beat-to-beat BPV may be a useful additional marker of cardiovascular risk. © 2017 The Authors.

  7. Optimism and death: predicting the course and consequences of depression trajectories in response to heart attack.

    Science.gov (United States)

    Galatzer-Levy, Isaac R; Bonanno, George A

    2014-12-01

    The course of depression in relation to myocardial infarction (MI), commonly known as heart attack, and the consequences for mortality are not well characterized. Further, optimism may predict both the effects of MI on depression as well as mortality secondary to MI. In the current study, we utilized a large population-based prospective sample of older adults (N=2,147) to identify heterogeneous trajectories of depression from 6 years prior to their first-reported MI to 4 years after. Findings indicated that individuals were at significantly increased risk for mortality when depression emerged after their first-reported MI, compared with resilient individuals who had no significant post-MI elevation in depression symptomatology. Individuals with chronic depression and those demonstrating pre-event depression followed by recovery after MI were not at increased risk. Further, optimism, measured before MI, prospectively differentiated all depressed individuals from participants who were resilient. © The Author(s) 2014.

  8. Recovery From Heart Attack, Biomedicalization, and the Production of a Contingent Health Citizenship.

    Science.gov (United States)

    Langdridge, Darren

    2017-07-01

    In this article, I explore the experience of recovery from a heart attack through an analytic autoethnography. I discuss the tensions inherent in biomedical subjectivities of health and ill-health during cardiac recovery through three key themes: (a) the transfer of responsibility and becoming a subject "at risk," (b) technologies of biomedicine and the disciplining of subjectivities, and (c) the transformation of a body toward a new pharmaceuticalized bodily normal. Through an analysis driven by the biomedicalization thesis of Clarke, alongside work on biopower and the governmentality of health by Foucault, Rose, and Rabinow, I seek to provide new insights into the process of cardiac recovery and the relationship between individual experience and broader socio-political processes. Key to this analysis is a focus on the contingent subjectivities brought into being through biomedicalization that constitute a new form of health citizenship that is otherwise not accounted for in narratives of recovery.

  9. The Association Between Antihypertensive Medication Nonadherence and Visit-to-Visit Variability of Blood Pressure: Findings From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.

    Science.gov (United States)

    Kronish, Ian M; Lynch, Amy I; Oparil, Suzanne; Whittle, Jeff; Davis, Barry R; Simpson, Lara M; Krousel-Wood, Marie; Cushman, William C; Chang, Tara I; Muntner, Paul

    2016-07-01

    Low adherence to antihypertensive medication has been hypothesized to increase visit-to-visit variability (VVV) of blood pressure (BP). We assessed the association between antihypertensive medication adherence and VVV of BP in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). VVV of BP was calculated using SD independent of mean, SD, and average real variability across study visits conducted 6 to 28 months after randomization. Participants who reported taking heart disease or nonfatal myocardial infarction, stroke, heart failure, or mortality risk. In conclusion, improving medication adherence may lower VVV of BP. However, VVV of BP is associated with cardiovascular outcomes independent of medication adherence. © 2016 American Heart Association, Inc.

  10. AN EFFICIENT APPROACH FOR DETECTION OF HEART ATTACK USING NOBLE ANT COLONY OPTIMIZATION CONCEPT OF DATA MINING

    OpenAIRE

    Pise Satish Prakashrao*1, Anoop Singh 2 & Ritesh Kumar Yadav3

    2018-01-01

    The goal of data mining is to extract knowledge from large amounts of data. Data Mining is an interdisciplinary field that focuses on machine learning, statistics and databases. In this article, we highlight a new framework that uses a combination of data extraction and ant colony optimization to collect heart disease such as early heart attacks to protect them and reduce mortality rates. This study focused on the formulation and implementation of an improved and reliable model for the diagno...

  11. Lifestyle risk factors for ischemic stroke and transient ischemic attack in young adults in the Stroke in Young Fabry Patients study.

    Science.gov (United States)

    von Sarnowski, Bettina; Putaala, Jukka; Grittner, Ulrike; Gaertner, Beate; Schminke, Ulf; Curtze, Sami; Huber, Roman; Tanislav, Christian; Lichy, Christoph; Demarin, Vida; Basic-Kes, Vanja; Ringelstein, E Bernd; Neumann-Haefelin, Tobias; Enzinger, Christian; Fazekas, Franz; Rothwell, Peter M; Dichgans, Martin; Jungehulsing, Gerhard J; Heuschmann, Peter U; Kaps, Manfred; Norrving, Bo; Rolfs, Arndt; Kessler, Christof; Tatlisumak, Turgut

    2013-01-01

    Although many stroke patients are young or middle-aged, risk factor profiles in these age groups are poorly understood. The Stroke in Young Fabry Patients (sifap1) study prospectively recruited a large multinational European cohort of patients with cerebrovascular events aged 18 to 55 years to establish their prevalence of Fabry disease. In a secondary analysis of patients with ischemic stroke or transient ischemic attack, we studied age- and sex-specific prevalences of various risk factors. Among 4467 patients (median age, 47 years; interquartile range, 40-51), the most frequent well-documented and modifiable risk factors were smoking (55.5%), physical inactivity (48.2%), arterial hypertension (46.6%), dyslipidemia (34.9%), and obesity (22.3%). Modifiable less well-documented or potentially modifiable risk factors like high-risk alcohol consumption (33.0%) and short sleep duration (20.6%) were more frequent in men, and migraine (26.5%) was more frequent in women. Women were more often physically inactive, most pronouncedly at ages young patients with acute ischemic cerebrovascular events, modifiable risk factors were highly prevalent, particularly in men and older patients. These data emphasize the need for vigorous primary and secondary prevention measures already in young populations targeting modifiable lifestyle vascular risk factors.

  12. Family History in Young Patients With Stroke.

    Science.gov (United States)

    Thijs, Vincent; Grittner, Ulrike; Dichgans, Martin; Enzinger, Christian; Fazekas, Franz; Giese, Anne-Katrin; Kessler, Christof; Kolodny, Edwin; Kropp, Peter; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Rothwell, Peter M; Schmidt, Reinhold; Tanislav, Christian; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt

    2015-07-01

    Family history of stroke is an established risk factor for stroke. We evaluated whether family history of stroke predisposed to certain stroke subtypes and whether it differed by sex in young patients with stroke. We used data from the Stroke in Fabry Patients study, a large prospective, hospital-based, screening study for Fabry disease in young patients (aged stroke in whom cardiovascular risk factors and family history of stroke were obtained and detailed stroke subtyping was performed. A family history of stroke was present in 1578 of 4232 transient ischemic attack and ischemic stroke patients (37.3%). Female patients more often had a history of stroke in the maternal lineage (P=0.027) than in the paternal lineage. There was no association with stroke subtype according to Trial of Org 10172 in Acute Stroke Treatment nor with the presence of white matter disease on brain imaging. Patients with dissection less frequently reported a family history of stroke (30.4% versus 36.3%; P=0.018). Patients with a parental history of stroke more commonly had siblings with stroke (3.6% versus 2.6%; P=0.047). Although present in about a third of patients, a family history of stroke is not specifically related to stroke pathogenic subtypes in patients with young stroke. Young women with stroke more often report stroke in the maternal lineage. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2015 American Heart Association, Inc.

  13. The cardiac model of rehabilitation for reducing cardiovascular risk factors post transient ischaemic attack and stroke: a randomized controlled trial.

    Science.gov (United States)

    Kirk, Hayden; Kersten, Paula; Crawford, Pamela; Keens, Angela; Ashburn, Ann; Conway, Joy

    2014-04-01

    To evaluate the feasibility and effectiveness of a standard National Health Service cardiac rehabilitation programme on risk factor reduction for patients after a minor stroke and transient ischaemic attack. Single-blind randomized controlled trial. Cardiac rehabilitation classes. Twenty-four patients. All participants received standard care. In addition, the intervention group undertook an eight-week cardiac rehabilitation programme consisting of weekly exercise and education classes. Cardiovascular disease risk score; lipid profiles; resting blood pressure; C-reactive protein (measured with a high sensitive assay) and fibrinogen levels; blood glucose; obesity; physical activity levels; subjective health status (SF-36); Hospital Anxiety and Depression Scale. Group comparison with independent t-tests showed a significantly greater improvement in the cardiovascular disease risk score for participants in the intervention group compared to standard care (intervention 25.7 ± 22.8 to 23.15 ± 18.3, control 25.03 ± 15.4 to 27.12 ± 16.1, t = -1.81, P rehabilitation programmes are a feasible and effective means of reducing the risk of future cardiovascular events for patients after minor stroke and transient ischaemic attack.

  14. When and why do heart attacks occur? Cardiovascular triggers and their potential role.

    Science.gov (United States)

    Schwartz, Bryan G; Mayeda, Guy S; Burstein, Steven; Economides, Christina; Kloner, Robert A

    2010-01-01

    Coronary heart disease affects 7.6% of the population in the United States, where > 900,000 myocardial infarctions (MIs) occur annually. Approximately half of all MIs have an identifiable clinical trigger. Myocardial ischemia, MI, sudden cardiac death, and thrombotic stroke each occur with circadian variation and peak after waking in the morning. In addition, physical exertion and mental stress are common precipitants of MI. Waking in the morning, physical exertion, and mental stress influence a number of physiologic parameters, including blood pressure, heart rate, plasma epinephrine levels, coronary blood flow, platelet aggregability, and endothelial function. Upregulation of sympathetic output and catecholamines increase myocardial oxygen demand and can decrease myocardial oxygen supply and promote thrombosis. Ischemia ensues when myocardial oxygen demand exceeds supply. Increases in blood pressure and ventricular contractility increase intravascular shear stress and may cause vulnerable atherosclerotic plaques to rupture, forming a nidus for thrombosis that can precipitate MI. Numerous clinical triggers of MI have been identified, including blizzards, the Christmas and New Year's holidays, experiencing an earthquake, the threat of violence, job strain, Mondays for the working population, sexual activity, overeating, smoking cigarettes, smoking marijuana, using cocaine, and particulate air pollution. Avoiding clinical triggers or participating in therapies that prevent clinical triggers from precipitating cardiac events could potentially postpone clinical events by several years and improve cardiovascular morbidity and mortality. Direct or indirect evidence suggests that the risk of triggered MIs is reduced with β-blockers, aspirin, statins, stress management, and transcendental meditation.

  15. The role of the emergency services in the optimisation of primary angioplasty: experience from London and the Heart Attack Team.

    Science.gov (United States)

    Dalby, Miles; Whitbread, Mark

    2013-08-22

    Early ambulance services often confined their activities to a "scoop and run" approach, conveying sick patients quickly to the nearest emergency department. With the advent of modern ST-elevation myocardial infarction (STEMI) management and primary percutaneous coronary intervention (PPCI), the role of the emergency medical service (EMS) has expanded significantly. This review discusses the critical and evolving collaboration between the EMS and the heart attack centre. Speed of reperfusion is a major determinant of outcome in STEMI and, whilst the patient delay (symptom to call time) has a central role in this, system delay (first medical contact to balloon time) is linked to mortality and is used to measure the response of a PPCI programme and is a key element of contemporary guidelines. In addition to rapid diagnosis and transfer to the heart attack centre, the EMS has to deliver a growing number of established treatments including resuscitation and drug therapy. EMS also continually needs to develop expertise in new techniques such as advanced management of cardiac arrest patients, including automated cardiopulmonary resuscitation, and will need to deliver newer therapies if trials support their use, including cooling and preconditioning. Ultimately, the EMS has a central role in the management of STEMI patients which needs to be fully aligned with the heart attack centres. This integration of services is perhaps best regarded as the Heart Attack Team.

  16. First-Ever Stroke and Transient Ischemic Attack Incidence and 30-Day Case-Fatality Rates in a Population-Based Study in Argentina

    DEFF Research Database (Denmark)

    Bahit, M Cecilia; Coppola, Mariano L; Riccio, Patricia M

    2016-01-01

    BACKGROUND AND PURPOSE: Epidemiological data about stroke are scarce in low- and middle-income Latin-American countries. We investigated annual incidence of first-ever stroke and transient ischemic attack (TIA) and 30-day case-fatality rates in a population-based setting in Tandil, Argentina....... METHODS: We prospectively identified all first-ever stroke and TIA cases from overlapping sources between January 5, 2013, and April 30, 2015, in Tandil, Argentina. We calculated crude and standardized incidence rates. We estimated 30-day case-fatality rates. RESULTS: We identified 334 first-ever strokes.......1% (95% CI, 14.2-36.6) for intracerebral hemorrhage, and 1.9% (95% CI, 0.4-5.8) for TIA. CONCLUSIONS: This study provides the first prospective population-based stroke and TIA incidence and case-fatality estimate in Argentina. First-ever stroke incidence was lower than that reported in previous Latin...

  17. Antithrombotic therapy for stroke prevention in atrial fibrillation and mechanical heart valves.

    Science.gov (United States)

    Eikelboom, John W; Hart, Robert G

    2012-05-01

    Cardioembolic strokes account for one-sixth of all strokes and are an important potentially preventable cause of morbidity and mortality. Vitamin K antagonists (e.g., warfarin) are effective for the prevention of cardioembolic stroke in patients with atrial fibrillation (AF) and in those with mechanical heart valves but because of their inherent limitations are underutilized and often suboptimally managed. Antiplatelet therapies have been the only alternatives to warfarin for stroke prevention in AF but although they are safer and more convenient they are much less efficacious. The advent of new oral anticoagulant drugs offers the potential to reduce the burden of cardioembolic stroke by providing access to effective, safe, and more convenient therapies. New oral anticoagulants have begun to replace warfarin for stroke prevention in some patients with AF, based on the favorable results of recently completed phase III randomized controlled trials, and provide for the first time an alternative to antiplatelet therapy for patients deemed unsuitable for warfarin. The promise of the new oral anticoagulants in patients with mechanical heart valves is currently being tested in a phase II trial. If efficacy and safety are demonstrated, the new oral anticoagulants will provide an alternative to warfarin for patients with mechanical heart valves and may also lead to increased use of mechanical valves for patients who would not have received them in the past because of the requirement for long term warfarin therapy. Copyright © 2012 Wiley Periodicals, Inc.

  18. Executive function, but not memory, associates with incident coronary heart disease and stroke.

    Science.gov (United States)

    Rostamian, Somayeh; van Buchem, Mark A; Westendorp, Rudi G J; Jukema, J Wouter; Mooijaart, Simon P; Sabayan, Behnam; de Craen, Anton J M

    2015-09-01

    To evaluate the association of performance in cognitive domains executive function and memory with incident coronary heart disease and stroke in older participants without dementia. We included 3,926 participants (mean age 75 years, 44% male) at risk for cardiovascular diseases from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) with Mini-Mental State Examination score ≥24 points. Scores on the Stroop Color-Word Test (selective attention) and the Letter Digit Substitution Test (processing speed) were converted to Z scores and averaged into a composite executive function score. Likewise, scores of the Picture Learning Test (immediate and delayed memory) were transformed into a composite memory score. Associations of executive function and memory were longitudinally assessed with risk of coronary heart disease and stroke using multivariable Cox regression models. During 3.2 years of follow-up, incidence rates of coronary heart disease and stroke were 30.5 and 12.4 per 1,000 person-years, respectively. In multivariable models, participants in the lowest third of executive function, as compared to participants in the highest third, had 1.85-fold (95% confidence interval [CI] 1.39-2.45) higher risk of coronary heart disease and 1.51-fold (95% CI 0.99-2.30) higher risk of stroke. Participants in the lowest third of memory had no increased risk of coronary heart disease (hazard ratio 0.99, 95% CI 0.74-1.32) or stroke (hazard ratio 0.87, 95% CI 0.57-1.32). Lower executive function, but not memory, is associated with higher risk of coronary heart disease and stroke. Lower executive function, as an independent risk indicator, might better reflect brain vascular pathologies. © 2015 American Academy of Neurology.

  19. Trends in stroke incidence. The Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Truelsen, T; Prescott, E; Grønbaek, M

    1997-01-01

    in men, whose annual rate ratio was 0.97 (95% CI, 0.95 to 0.99), but not in women, whose annual rate ratio was 0.98 (95% CI, 0.95 to 1.00). Throughout four observed periods the stroke incidence among men remained significantly higher than that for women. CONCLUSIONS: During the period from 1976 to 1993......BACKGROUND AND PURPOSE: Stroke incidence has increased in some countries and decreased in others. After 20 years of intensive antihypertensive treatment the latter could be expected, and we have evaluated the sex-specific temporal trends in stroke incidence using 17 years of follow...... at least one of the two first examinations as well as the total cohort including nonresponders. Subjects between 45 and 84 years of age were followed from March 1, 1976 until March 1, 1993. Changes in age-specific stroke incidence were calculated by means of Poisson regression analysis. RESULTS...

  20. Secular trends in ischemic stroke subtypes and stroke risk factors.

    Science.gov (United States)

    Bogiatzi, Chrysi; Hackam, Daniel G; McLeod, A Ian; Spence, J David

    2014-11-01

    Early diagnosis and treatment of a stroke improves patient outcomes, and knowledge of the cause of the initial event is crucial to identification of the appropriate therapy to maximally reduce risk of recurrence. Assumptions based on historical frequency of ischemic subtypes may need revision if stroke subtypes are changing as a result of recent changes in therapy, such as increased use of statins. We analyzed secular trends in stroke risk factors and ischemic stroke subtypes among patients with transient ischemic attack or minor or moderate stroke referred to an urgent transient ischemic attack clinic from 2002 to 2012. There was a significant decline in low-density lipoprotein cholesterol and blood pressure, associated with a significant decline in large artery stroke and small vessel stroke. The proportion of cardioembolic stroke increased from 26% in 2002 to 56% in 2012 (Prisk factors was observed, with a significant decline in stroke/transient ischemic attack caused by large artery atherosclerosis and small vessel disease. As a result, cardioembolic stroke/transient ischemic attack has increased significantly. Our findings suggest that more intensive investigation for cardiac sources of embolism and greater use of anticoagulation may be warranted. © 2014 American Heart Association, Inc.

  1. Epidemiology of nonfatal stroke and transient ischemic attack in Al-Kharga District, New Valley, Egypt

    Directory of Open Access Journals (Sweden)

    Farghaly WM

    2013-11-01

    Full Text Available Wafaa MA Farghaly,1 Hamdy N El-Tallawy,1 Ghaydaa A Shehata,1 Tarek A Rageh,1 Nabil M Abdel-Hakeem,2 Mohamed A Abd Elhamed,1 Bastawy MA Al-Fawal,3 Reda Badry1 1Department of Neurology, Faculty of Medicine, Assiut University, Assiut, 2Department of Neurology, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut, 3Aswan Health Insurance Hospital, Ministry of Health, Aswan, Egypt Background: Stroke is a medical emergency. Nonfatal stroke may cause permanent neurologic damage, complications, and disability. The aim of this study was to determine the epidemiology of nonfatal stroke in Al-Kharga District, New Valley, Egypt. Methods: The total population (62,583 was screened via a door-to-door study by three neurology specialists and 15 female social workers for demographic data collection. All subjects with probable stroke were subjected to a full clinical examination, neuroimaging (computed tomography and/or magnetic resonance imaging of the brain, and laboratory investigations including blood sugar, lipid profile, serum uric acid, a complete blood count, blood urea, and serum creatinine. Stroke severity and outcome were assessed using the Scandinavian Stroke Scale and Barthel Index. Carotid Doppler, echocardiography, and thyroid function tests were done in selected cases. Results: During the study period (June 1, 2005 to May 31, 2008, 351 subjects were diagnosed as having suffered a cerebrovascular stroke at some point during their lives, yielding a total lifetime prevalence of 5.6 per 1,000 population. Of these, 156 subjects were identified as having suffered a stroke during the year from January 1 to December 31, 2007, with an incidence rate of 2.5 per 1,000. Both prevalence and incidence rates were higher in urban (5.8 per 1,000 and 2.6 per 1,000, respectively than rural communities (5.2 per 1,000 and 2.3 per 1,000, and were higher in males (6.1 per 1,000 and 2.7 per 1,000, respectively than in females (5.1 per 1,000 and 2.3 per 1

  2. Prevalence, Incidence, Prognosis, Early Stroke Risk, and Stroke-Related Prognostic Factors of Definite or Probable Transient Ischemic Attacks in China, 2013

    Directory of Open Access Journals (Sweden)

    Bin Jiang

    2017-06-01

    Full Text Available The epidemiological characteristics of transient ischemic attacks (TIAs in China are unclear. In 2013, we conducted a nationally representative, door-to-door epidemiological survey on TIA in China using a complex, multistage, probability sampling design. Results showed that the weighted prevalence of TIA in China was 103.3 [95% confidence interval (CI: 83.9–127.2] per 100,000 in the population, 92.4 (75.0–113.8 per 100,000 among men, and 114.7 (87.2–151.0 per 100,000 among women. The weighted incidence of TIA was 23.9 (17.8–32.0 per 100,000 in the population, 21.3 (14.3–31.5 per 100,000 among men, and 26.6 (17.0–41.7 per 100,000 among women. No difference in average prognosis was found between TIA and stroke in the population. Weighted risk of stroke among TIA patients was 9.7% (6.5–14.3%, 11.1% (7.5–16.1%, and 12.3% (8.4–17.7% at 2, 30, and 90 days, respectively. The risk of stroke was higher among male patients with a history of TIA than among female patients with a history of TIA (OR: 2.469; 95% CI: 1.172–5.201; P = 0.018, and higher among TIA patients with hypertension than among TIA patients without hypertension (OR: 2.671; 1.547–4.613; P < 0.001. It can be concluded that there are an estimated 1.35 million TIA patients nationwide, with 0.31 million new cases of TIA annually in China. TIA patients were not better managed prior to a stroke event. Early risk of stroke among TIA patients is high. Sex and hypertension may be stroke-associated prognostic factors among TIA patients. TIA clinics and surveillance should be integrated into the national health-care system.

  3. Poor long-term functional outcome after stroke among adults aged 18 to 50 years: Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) study.

    Science.gov (United States)

    Synhaeve, Nathalie E; Arntz, Renate M; Maaijwee, Noortje A M; Rutten-Jacobs, Loes C A; Schoonderwaldt, Henny C; Dorresteijn, Lucille D A; de Kort, Paul L M; van Dijk, Ewoud J; de Leeuw, Frank-Erik

    2014-04-01

    Stroke in young adults has a dramatic effect on life; therefore, we investigated the long-term functional outcome after transient ischemic attack, ischemic stroke, or intracerebral hemorrhage in adults aged 18 to 50 years. We studied 722 young patients with first-ever stroke admitted between January 1, 1980, and November 1, 2010. Functional outcome was assessed by stroke subtype with the modified Rankin Scale and Instrumental Activities of Daily Living scale. After a mean follow-up of 9.1 (SD, 8.2) years, 32.0% of all patients had a poor functional outcome (modified Rankin Scale, >2); for ischemic stroke, this was 36.5%, for intracerebral hemorrhage 49.3%, and for transient ischemic attack 16.8%. At follow-up, 10.8% of transient ischemic attack, 14.6% of ischemic stroke, and 18.2% of intracerebral hemorrhage patients had a poor outcome as assessed by Instrumental Activities of Daily Living (ischemic stroke or intracerebral hemorrhage in young adults, 1 of 8 survivors is still dependent in daily life.

  4. Optimizing the Definitions of Stroke, Transient Ischemic Attack, and Infarction for Research and Application in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Anne L. Abbott

    2017-10-01

    Full Text Available Background and purposeUntil now, stroke and transient ischemic attack (TIA have been clinically based terms which describe the presence and duration of characteristic neurological deficits attributable to intrinsic disorders of particular arteries supplying the brain, retina, or (sometimes the spinal cord. Further, infarction has been pathologically defined as death of neural tissue due to reduced blood supply. Recently, it has been proposed we shift to definitions of stroke and TIA determined by neuroimaging results alone and that neuroimaging findings be equated with infarction.MethodsWe examined the scientific validity and clinical implications of these proposals using the existing published literature and our own experience in research and clinical practice.ResultsWe found that the proposals to change to imaging-dominant definitions, as published, are ambiguous and inconsistent. Therefore, they cannot provide the standardization required in research or its application in clinical practice. Further, we found that the proposals are scientifically incorrect because neuroimaging findings do not always correlate with the clinical status or the presence of infarction. In addition, we found that attempts to use the proposals are disrupting research, are otherwise clinically unhelpful and do not solve the problems they were proposed to solve.ConclusionWe advise that the proposals must not be accepted. In particular, we explain why the clinical focus of the definitions of stroke and TIA should be retained with continued sub-classification of these syndromes depending neuroimaging results (with or without other information and that infarction should remain a pathological term. We outline ways the established clinically based definitions of stroke and TIA, and use of them, may be improved to encourage better patient outcomes in the modern era.

  5. Association between self-perceived psychological stress and transitory ischaemic attack and minor stroke: A case-control study.

    Science.gov (United States)

    Ramírez-Moreno, J M; Muñoz Vega, P; Espada, S; Bartolomé Alberca, S; Aguirre, J; Peral, D

    2017-12-22

    Stroke has a complex aetiopathogenesis influenced by numerous risk factors. There is growing interest in the study of the pathophysiological changes associated with stress and their potential relationship with cerebrovascular disease. The purpose of this paper is to assess the strength of association between exposure to stress and stroke. We conducted a case-control study (1:1) to compare exposure to stress in a group of patients with a history of a first transient ischaemic attack (TIA) or minor stroke and in a control group. Participants were asked a subjective question about their perception of stress in the previous months and completed the standardised Effort-Reward Imbalance (ERI) questionnaire. Logistic regression models were used for data analysis. The study included data on 50 cases and 50 controls. There were no significant differences in demographic variables and economic, social, and employment status between cases and controls. Fifty percent of the cases reported moderate to severe stress, compared to 30% of controls (OR: 2.33; 95% CI: 1.02-5.30; P=.041). ERI questionnaire results found that greater effort at work (OR: 1.48; 95% CI: 1.19-1.83) and greater commitment is associated with stroke (OR: 1.34; 95% CI: 1.17-1.54), while higher reward constitutes a protective factor against the disease (OR: 0.71; 95% CI: 0.61-0.82). There is a strong association between self-perceived psychological stress and TIA. The imbalance between effort and reward at work is also clearly related to TIA. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Ischemic Stroke in Children and Young Adults With Congenital Heart Disease.

    Science.gov (United States)

    Mandalenakis, Zacharias; Rosengren, Annika; Lappas, Georgios; Eriksson, Peter; Hansson, Per-Olof; Dellborg, Mikael

    2016-02-23

    Patients with congenital heart disease (CHD) may be at increased risk of ischemic stroke due to residual shunts, arrhythmias, and other cardiovascular abnormalities. We studied the relative risk and potential factors for developing ischemic stroke in children and young adults with CHD in Sweden. All patients in the Swedish Patient Register with a diagnosis of CHD, born between 1970 and 1993, were identified and compared with 10 controls for each patient, matched for age, sex, and county and randomly selected from the general population. Follow-up data through 2011 were collected for both groups. Of 25 985 children and young adults with CHD (51.5% male, 48.5% female), 140 (0.5%) developed ischemic stroke. The hazard ratio for CHD patients developing ischemic stroke was 10.8 (95% CI, 8.5-13.6) versus controls. All major Marelli groups had significantly increased risk, but because of small CHD-group sizes, only atrial septal defect/patent foramen ovale, double-inlet ventricle, and aortic coarctation displayed significantly increased risk. In multivariate analysis of CHD patients, congestive heart failure carried the highest risk for developing ischemic stroke (hazard ratio 6.9 [95% CI, 4.7-10.3]), followed by hypertension and atrial fibrillation, which were also significantly associated with increased risk of ischemic stroke. The risk of developing ischemic stroke was almost 11 times higher in young patients with CHD than in the general population, although absolute risk is low. Cardiovascular comorbidities were strongly associated with the development of ischemic stroke in young CHD patients. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  7. Preexisting Heart Disease Underlies Newly Diagnosed Atrial Fibrillation After Acute Ischemic Stroke.

    Science.gov (United States)

    Rizos, Timolaos; Horstmann, Solveig; Dittgen, Felix; Täger, Tobias; Jenetzky, Ekkehart; Heuschmann, Peter; Veltkamp, Roland

    2016-02-01

    Whether newly diagnosed atrial fibrillation (nAF) after stroke reflects underlying heart disease and represents an increased risk of cardioembolic stroke, or whether it is triggered by neurogenic mechanisms remains uncertain. We investigated, whether cardiovascular risk factors and echocardiographic parameters in patients with nAF are similar to patients with known AF (kAF) and differ from patients without AF. Consecutive acute ischemic stroke patients were enrolled into a prospective stroke database. All patients with echocardiography were included and univariable and multivariable testing was applied to compare clinical characteristics and echocardiographic findings among patients with nAF, kAF, and no AF. A total of 1397 patients were included (male, 62.3%; median age, 71 years). AF was present in 320 (22.9%) patients. Of those, nAF was present in 36.2% (116/320) and kAF in 63.8% (204/320). No clinical or echocardiographic factor was independently associated with detection of nAF compared with kAF but a trend toward larger left atrial diameters in patients with kAF was observed (P=0.070). In contrast, patients with nAF were more often female (Pstroke severity in patients with nAF and kAF was similar, patients without AF had less severe strokes. Stroke patients with nAF and with kAF share common cardiovascular risk factors, have similar echocardiographic findings and suffer equally severe strokes. We conclude that preexisting heart disease is the major cause of AF that is first diagnosed after stroke. © 2016 American Heart Association, Inc.

  8. Increased risk of stroke and transient ischemic attack in 5-year survivors of Hodgkin lymphoma

    DEFF Research Database (Denmark)

    De Bruin, Marie L; Dorresteijn, Lucille D A; van't Veer, Mars B

    2009-01-01

    without radiotherapy). Treatment with chemotherapy was not associated with an increased risk. Hypertension, diabetes mellitus, and hypercholesterolemia were associated with the occurrence of ischemic cerebrovascular disease, whereas smoking and overweight were not. CONCLUSIONS: Patients treated...... Cox regression techniques to study treatment-related factors and other risk factors. All statistical tests were two-sided. RESULTS: After a median follow-up of 17.5 years, 96 patients developed cerebrovascular disease (55 strokes, 31 TIAs, and 10 with both TIA and stroke; median age = 52 years). Most......, after prolonged follow-up. The cumulative incidence of ischemic stroke or TIA 30 years after Hodgkin lymphoma treatment was 7% (95% CI = 5% to 8%). Radiation to the neck and mediastinum was an independent risk factor for ischemic cerebrovascular disease (hazard ratio = 2.5, 95% CI = 1.1 to 5.6 vs...

  9. External Counterpulsation Increases Beat-to-Beat Heart Rate Variability in Patients with Ischemic Stroke.

    Science.gov (United States)

    Xiong, Li; Tian, Ge; Wang, Li; Lin, Wenhua; Chen, Xiangyan; Leung, Thomas Wai Hong; Soo, Yannie Oi Yan; Wong, Lawrence Ka Sing

    2017-07-01

    External counterpulsation (ECP) is a noninvasive method used to augment cerebral perfusion in ischemic stroke. However, the response of beat-to-beat heart rate variability (HRV) in patients with ischemic stroke during ECP remains unknown. Forty-eight patients with unilateral ischemic stroke at the subacute stage and 14 healthy controls were recruited. Beat-to-beat heart rate before, during, and after ECP was monitored. The frequency components of HRV were calculated using power spectral analysis. Very low frequency (VLF; <.04 Hz), low frequency (LF; .04-.15 Hz), high frequency (HF; .15-.40 Hz), total power spectral density (TP; <.40 Hz), and LF/HF ratio were calculated. In stroke patients, although there were no statistical differences in all of the HRV components, the HRV at VLF showed a trend of increase during ECP compared with baseline in the left-sided stroke patients (P = .083). After ECP, the HRV at LF and TP remained higher than baseline in the right-sided stroke patients (LF, 209.4 versus 117.9, P = .050; TP, 1275.6 versus 390.2, P = .017, respectively). Besides, the HRV at TP also increased after ECP compared with baseline in the left-sided stroke patients (563.0 versus 298.3, P = .029). Irrespective of the side of the ischemia, patients showed an increased beat-to-beat HRV after ECP. Additionally, sympathetic and parasympathetic cardiac modulations were increased after ECP in patients after right-sided subacute stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  10. Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack

    DEFF Research Database (Denmark)

    Hankey, Graeme J; Patel, Manesh R; Stevens, Susanna R

    2012-01-01

    In ROCKET AF, rivaroxaban was non-inferior to adjusted-dose warfarin in preventing stroke or systemic embolism among patients with atrial fibrillation (AF). We aimed to investigate whether the efficacy and safety of rivaroxaban compared with warfarin is consistent among the subgroups of patients ...

  11. Cancer and heart attack survivors' expectations of employment status: results from the English Longitudinal Study of Ageing.

    Science.gov (United States)

    Duijts, Saskia F A; van der Beek, Allard J; Bleiker, Eveline M A; Smith, Lee; Wardle, Jane

    2017-08-07

    Sociodemographic, health- and work-related factors have been found to influence return to work in cancer survivors. It is feasible though that behavioural factors, such as expectation of being at work, could also affect work-related outcomes. Therefore, the effect of earlier identified factors and expectation of being at work on future employment status in cancer survivors was explored. To assess the degree to which these factors specifically concern cancer survivors, a comparison with heart attack survivors was made. Data from the English Longitudinal Study of Ageing were used. Cancer and heart attack survivors of working age in the UK were included and followed up for 2 years. Baseline characteristics of both cancer and heart attack survivors were compared regarding employment status. Univariate and multivariate regression analyses were performed in survivors at work, and the interaction between independent variables and diagnose group was assessed. In cancer survivors at work (N = 159), alcohol consumption, participating in moderate or vigorous sport activities, general health and participation were univariate associated with employment status at two-year follow-up. Only fair general health (compared to very good general health) remained statistically significant in the multivariate model (OR 0.31; 95% CI 0.13-0.76; p = 0.010). In heart attack survivors at work (N = 78), gender, general health and expectation of being at work were univariate associated with employment status at follow-up. Female gender (OR 0.03; 95% CI 0.00-0.57; p = 0.018) and high expectation of being at work (OR 10.68; 95% CI 1.23-93.92; p = 0.033) remained significant in the multivariate model. The influence of gender (p = 0.066) and general health (p = 0.020) regarding employment status was found to differ significantly between cancer and heart attack survivors. When predicting future employment status in cancer survivors in the UK, general health is the most relevant factor

  12. Graphene quantum dots FRET based sensor for early detection of heart attack in human.

    Science.gov (United States)

    Bhatnagar, Deepika; Kumar, Vanish; Kumar, Ashok; Kaur, Inderpreet

    2016-05-15

    Cardiac immunosensor for early detection of heart attack (myocardial infarction) was developed using amine functionalized graphene quantum dots (afGQDs) conjugated with antibody anti-cardiac Troponin I (anti-cTnI) to detect cardiac marker antigen Troponin I (cTnI) in blood based on fluorescence resonance energy transfer (FRET) between conjugate and graphene (quencher) only in 10 min. The anti-cTnI was covalently conjugated to afGQDs through carbodiimide coupling reaction. The conjugate was characterized by zeta potential UV-vis spectroscopy and field emission scanning electron microscopy (FESEM). The sensing performance of the sensor was studied with respect to changes in the photon count and photoluminescence of GQDs based on interaction of target cTnI with its specific anti-cTnI antibody. The sensor is highly specific and shows negligible response to non-specific antigens. The sensor displayed a linear response to cTnI from 0.001 to 1000 ng mL(-1) with a limit of detection of 0.192 pg mL(-1). Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Plasma d-Dimer and Incident Ischemic Stroke and Coronary Heart Disease: The Atherosclerosis Risk in Communities Study.

    Science.gov (United States)

    Folsom, Aaron R; Gottesman, Rebecca F; Appiah, Duke; Shahar, Eyal; Mosley, Thomas H

    2016-01-01

    Epidemiological studies have documented that plasma d-dimer, a fibrin degradation product, is a risk marker for coronary heart disease, but there is limited prospective evidence for stroke. Given that thrombosis is a key mechanism for many strokes, we studied whether d-dimer is a risk marker for ischemic stroke incidence in the Atherosclerosis Risk in Communities (ARIC) Study. We measured d-dimer in 11 415 ARIC participants free of stroke and coronary heart disease in 1992 to 1995. We followed them for stroke, stroke subtype, and coronary heart disease events through 2012. Over a median of 18 years of follow-up, 719 participants had incident strokes (628 ischemic and 91 hemorrhagic). d-dimer was associated positively with risk of total, ischemic, and cardioembolic strokes, with risk elevated primarily for the highest quintile of d-dimer. After adjustment for other cardiovascular risk factors, the hazard ratio for the highest versus lowest quintile of d-dimer was 1.30 (95% confidence interval, 1.02-1.67) for total stroke, 1.33 (95% confidence interval, 1.02-1.73) for ischemic stroke, and 1.79 (95% confidence interval, 1.08-2.95) for cardioembolic stroke. There was no association with hemorrhagic, lacunar, or nonlacunar stroke categories. d-dimer was positively but weakly associated with coronary heart disease incidence. A higher basal plasma d-dimer concentration in the general population is a risk marker for ischemic stroke, especially cardioembolic stroke. © 2015 American Heart Association, Inc.

  14. Addition of 24 hour heart rate variability parameters to the cardiovascular health study stroke risk score and prediction of incident stroke : The cardiovascular health study

    NARCIS (Netherlands)

    Bodapati, R.K.; Kizer, J.R.; Kop, W.J.; Stein, P.K.

    2017-01-01

    Background Heart rate variability (HRV) characterizes cardiac autonomic functioning. The association of HRV with stroke is uncertain. We examined whether 24‐hour HRV added predictive value to the Cardiovascular Health Study clinical stroke risk score (CHS‐SCORE), previously developed at the baseline

  15. Changes of deceleration and acceleration capacity of heart rate in patients with acute hemispheric ischemic stroke

    Directory of Open Access Journals (Sweden)

    Xu YH

    2016-03-01

    Full Text Available Yan-Hong Xu,1 Xing-De Wang,2 Jia-Jun Yang,1 Li Zhou,2 Yong-Chao Pan1 1Department of Neurology, 2Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China Background and purpose: Autonomic dysfunction is common after stroke, which is correlated with unfavorable outcome. Phase-rectified signal averaging is a newly developed technique for assessing cardiac autonomic function, by detecting sympathetic and vagal nerve activity separately through calculating acceleration capacity (AC and deceleration capacity (DC of heart rate. In this study, we used this technique for the first time to investigate the cardiac autonomic function of patients with acute hemispheric ischemic stroke. Methods: A 24-hour Holter monitoring was performed in 63 patients with first-ever acute ischemic stroke in hemisphere and sinus rhythm, as well as in 50 controls with high risk of stroke. DC, AC, heart rate variability parameters, standard deviation of all normal-to-normal intervals (SDNN, and square root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals (RMSSD were calculated. The National Institutes of Health Stroke Scale (NIHSS was used to assess the severity of stroke. We analyzed the changes of DC, AC, SDNN, and RMSSD and also studied the correlations between these parameters and NIHSS scores. Results: The R–R (R wave to R wave on electrocardiogram intervals, DC, AC, and SDNN in the cerebral infarction group were lower than those in controls (P=0.003, P=0.002, P=0.006, and P=0.043, but the difference of RMSSD and the D-value and ratio between absolute value of AC (|AC| and DC were not statistically significant compared with those in controls. The DC of the infarction group was significantly correlated with |AC|, SDNN, and RMSSD (r=0.857, r=0.619, and r=0.358; P=0.000, P=0.000, and P=0.004. Correlation analysis also showed that DC, |AC|, and SDNN

  16. Statins and the Risk of Intracerebral Hemorrhage in Patients With Previous Ischemic Stroke or Transient Ischemic Attack

    DEFF Research Database (Denmark)

    Gaist, David; Goldstein, Larry B; Cea Soriano, Lucía

    2017-01-01

    of preadmission statin use with the risk of ICH in patients with a history of IS or TIA in a population-based cohort. METHODS: The Health Improvement Network primary care database in the United Kingdom was used to identify new users of low-dose aspirin and a matched comparison. Both cohorts were followed......BACKGROUND AND PURPOSE: Although there is no overall association between statin use and intracerebral hemorrhage (ICH), whether there is an increased risk among those with a history of ischemic stroke (IS) or transient ischemic attack (TIA) remains controversial. We evaluated the relationship...... to identify incident cases of ICH, with validation by manual review of patient records and linkage to hospitalization data. In a nested case-control study, we compared the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for ICH based on statin use in the subgroup of individuals with history...

  17. Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis.

    NARCIS (Netherlands)

    Homocysteine Studies Collab, .

    2002-01-01

    CONTEXT: It has been suggested that total blood homocysteine concentrations are associated with the risk of ischemic heart disease (IHD) and stroke. OBJECTIVE: To assess the relationship of homocysteine concentrations with vascular disease risk. DATA SOURCES: MEDLINE was searched for articles

  18. Trends in Mortality from Ischemic Heart Disease, Stroke, and Stomach Cancer: from past to future

    NARCIS (Netherlands)

    M. Amiri (Masoud)

    2010-01-01

    textabstractThe common occurrence of chronic diseases – such as ischemic heart diseases (IHD, stroke, and stomach cancer in most populations and the attendant mortality, loss of independence, impaired quality of life, and social and economic costs are compelling reasons for public health

  19. Risk of stroke and bleeding in patients with heart failure and chronic kidney disease

    DEFF Research Database (Denmark)

    Melgaard, Line; Overvad, Thure Filskov; Skjøth, Flemming

    2018-01-01

    AIMS: The aim of this study was to assess the prognostic value of chronic kidney disease (CKD) in relation to ischaemic stroke, intracranial haemorrhage, major bleeding, and all-cause death in heart failure patients without atrial fibrillation. METHODS AND RESULTS: In this observational cohort...

  20. Vital Signs – Preventable Deaths from Heart Disease and Stroke

    Centers for Disease Control (CDC) Podcasts

    2013-09-03

    This podcast is based on the September 2013 CDC Vital Signs report. More than 800,000 Americans die each year from heart disease and stroke. Learn how to manage all the major risk factors.  Created: 9/3/2013 by Centers for Disease Control and Prevention (CDC).   Date Released: 9/3/2013.

  1. Rehabilitation of Older Persons Disabled by Cancer, Stroke, and Heart Disease.

    Science.gov (United States)

    Finnerty-Fried, Pamela; And Others

    1986-01-01

    Rehabilitation of older persons disabled by cancer, stroke, or heart disease is discussed. Aspects of each disability are described, and the importance of timely and appropriate intervention with older persons is emphasized. Barriers generally faced by older disabled persons are briefly outlined. (Author)

  2. Factors associated with coronary artery disease and stroke in adults with congenital heart disease

    NARCIS (Netherlands)

    Bokma, Jouke P.; Zegstroo, Ineke; Kuijpers, Joey M.; Konings, Thelma C.; van Kimmenade, Roland R. J.; van Melle, Joost P.; Kiès, Philippine; Mulder, Barbara J. M.; Bouma, Berto J.

    2017-01-01

    To determine factors associated with coronary artery disease (CAD) and ischaemic stroke in ageing adult congenital heart disease (ACHD) patients. We performed a multicentre case-control study, using data from the national CONgenital CORvitia (CONCOR) registry to identify ACHD patients within five

  3. Family history as a risk factor for early-onset stroke/transient ischemic attack among adults in the United States.

    Science.gov (United States)

    Mvundura, Mercy; McGruder, Henraya; Khoury, Muin J; Valdez, Rodolfo; Yoon, Paula W

    2010-01-01

    Stroke is a major cause of morbidity and death in the United States. We tested the association between familial risk for stroke and prevalence of the disease among US adults and assessed the use of family history of stroke as a risk assessment tool for the disease. Using data from the 2005 HealthStyles survey (n = 4,819), we explored the association between familial stroke risk (stratified as high, moderate or low) and the prevalence of stroke and related health conditions. We evaluated the clinical validity (sensitivity, specificity) of family history of stroke as an indicator of stroke risk. Stroke and the related medical conditions were self-reported. Independent of other risk factors, people with a high familial risk for stroke were 4 times more likely to have had a stroke (95% confidence interval, CI, 2.6-6.0) than people with moderate or low familial risk. They were also 1.3 times (95% CI 1.1-1.6) more likely to have high blood pressure and 1.5 times (95% CI 1.3-2.0) more likely to have congestive heart failure. The sensitivity and specificity of using family history alone, high blood pressure alone or both risk factors to estimate stroke risk were 52 and 83%, 53 and 74%, and 29 and 95%, respectively. Despite several limitations typical of self-reported surveys, we find that in this sample of US adults, family history of stroke was significantly associated with the risk for stroke and high blood pressure as well as related conditions. Family history of stroke, alone or combined with other risk factors, can be a useful tool in assessing stroke risk among US adults. Copyright © 2009 S. Karger AG, Basel.

  4. Stroke in Commercial Flights.

    Science.gov (United States)

    Álvarez-Velasco, Rodrigo; Masjuan, Jaime; DeFelipe, Alicia; Corral, Iñigo; Estévez-Fraga, Carlos; Crespo, Leticia; Alonso-Cánovas, Araceli

    2016-04-01

    Stroke on board aircraft has been reported in retrospective case series, mainly focusing on economy class stroke syndrome. Data on the actual incidence, pathogenesis, and prognosis of stroke in commercial flights are lacking. A prospective registry was designed to include all consecutive patients referred from an international airport (40 million passengers a year) to our hospital with a diagnosis of ischemic stroke or transient ischemic attack and onset of symptoms during a flight or immediately after landing. Forty-four patients (32 ischemic strokes and 12 transient ischemic attacks) were included over a 76-month period (January 2008 to April 2014). The estimated incidence of stroke was 1 stroke in 35 000 flights. Pathogeneses of stroke or transient ischemic attack were atherothrombotic in 16 (36%), economy class stroke syndrome in 8 (18%), cardioembolic in 7 (16%), arterial dissection in 4 (9%), lacunar stroke in 4 (9%), and undetermined in 5 (12%) patients. Carotid stenosis >70% was found in 12 (27%) of the patients. Overall prognosis was good, and thrombolysis was applied in 44% of the cases. The most common reason for not treating patients who had experienced stroke onset midflight was the delay in reaching the hospital. Only 1 patient with symptom onset during the flight prompted a flight diversion. We found a low incidence of stroke in the setting of air travel. Economy class stroke syndrome and arterial dissection were well represented in our sample. However, the main pathogenesis was atherothrombosis with a high proportion of patients with high carotid stenosis. © 2016 American Heart Association, Inc.

  5. Screening, prevalence and ethnic variation of diabetes mellitus in people with acute stroke and transient ischaemic attack: a cross-sectional study in Northland, New Zealand.

    Science.gov (United States)

    Wong, Steven Wm; McGrath, Nicole N

    2016-06-10

    To assess our prevalence and screening rate for diabetes and pre-diabetes in people presenting with acute stroke and transient ischaemic attack (TIA) in Northland, New Zealand, as well as identifying discrepancies between Māori and non-Māori, rates of atrial fibrillation (AF) and effect of metformin on stroke. Data was collected retrospectively on people diagnosed with stroke or TIA in Northland, between 1 January 2014 and 31 December 2014. 345 people presented with acute stroke/TIA. 49.5% had dysglycaemia: 24.3% diabetes, 25.2% pre-diabetes. An HbA1c was performed on 70.4%. Māori had more diabetes (41.6%) than non-Māori (19.4%), with an HbA1c 12 mmol/mol (3.2%) higher, and were 12 years younger on average. There was no difference in AF prevalence between people with and without diabetes, and in the proportion of severe stroke (total anterior circulation infarction) between people with diabetes on metformin and those not. The prevalence of dysglycaemia in acute stroke/TIA in Northland is high. The goal of universal HbA1c screening in stroke is not being met. Māori have stroke younger, and a higher prevalence of diabetes may partially explain this. No association between diabetes and AF was found, nor evidence that metformin may be protective against larger strokes.

  6. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality

    DEFF Research Database (Denmark)

    (Tybjaerg-Hansen, A.) The Fibrinogen Studies Collaboration.The Copenhagen City Heart Study; Tybjærg-Hansen, Anne

    2009-01-01

    CONTEXT: Circulating concentration of lipoprotein(a) (Lp[a]), a large glycoprotein attached to a low-density lipoprotein-like particle, may be associated with risk of coronary heart disease (CHD) and stroke. OBJECTIVE: To assess the relationship of Lp(a) concentration with risk of major vascular...... searches of reference lists, and discussion with collaborators. DATA EXTRACTION: Individual records were provided for each of 126,634 participants in 36 prospective studies. During 1.3 million person-years of follow-up, 22,076 first-ever fatal or nonfatal vascular disease outcomes or nonvascular deaths...... were recorded, including 9336 CHD outcomes, 1903 ischemic strokes, 338 hemorrhagic strokes, 751 unclassified strokes, 1091 other vascular deaths, 8114 nonvascular deaths, and 242 deaths of unknown cause. Within-study regression analyses were adjusted for within-person variation and combined using meta...

  7. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality

    DEFF Research Database (Denmark)

    (Tybjaerg-Hansen, A.) The Fibrinogen Studies Collaboration.The Copenhagen City Heart Study; Tybjærg-Hansen, Anne

    2009-01-01

    CONTEXT: Circulating concentration of lipoprotein(a) (Lp[a]), a large glycoprotein attached to a low-density lipoprotein-like particle, may be associated with risk of coronary heart disease (CHD) and stroke. OBJECTIVE: To assess the relationship of Lp(a) concentration with risk of major vascular...... were recorded, including 9336 CHD outcomes, 1903 ischemic strokes, 338 hemorrhagic strokes, 751 unclassified strokes, 1091 other vascular deaths, 8114 nonvascular deaths, and 242 deaths of unknown cause. Within-study regression analyses were adjusted for within-person variation and combined using meta-analysis...... broadly continuous in shape. In the 24 cohort studies, the rates of CHD in the top and bottom thirds of baseline Lp(a) distributions, respectively, were 5.6 (95% confidence interval [CI], 5.4-5.9) per 1000 person-years and 4.4 (95% CI, 4.2-4.6) per 1000 person-years. The risk ratio for CHD, adjusted...

  8. The association of atopy with incidence of ischemic heart disease, stroke, and diabetes.

    Science.gov (United States)

    Skaaby, Tea; Husemoen, Lise Lotte Nystrup; Thuesen, Betina Heinsbæk; Jeppesen, Jørgen; Linneberg, Allan

    2015-03-01

    Allergy is a systemic inflammatory disease that could theoretically affect the risk of cardiovascular disease (CVD) and diabetes through inflammatory pathways or mast cell-induced coronary spasm. Whether allergy is associated with an increased risk of CVD and diabetes is largely unknown. We investigated the association between atopy as assessed by IgE sensitization, a well-accepted biomarker of allergy, and incidence of ischemic heart disease, stroke, and diabetes in five Danish population-based cohorts. A total of 14,849 participants were included in the study. Atopy was defined as serum-specific IgE positivity to inhalant allergens. The Danish National Diabetes Register enabled identification of incident diabetes. Likewise, the Danish Registry of Causes of Death and the Danish National Patient Register provided information on fatal and non-fatal ischemic heart disease and stroke. Data were analyzed by Cox regression analyses with age as underlying time axis and adjusted for study cohort, gender, education, body mass index, alcohol intake, smoking habits, physical activity during leisure time, serum lipids, and blood pressure. The prevalence of atopy was 26.9 % (n = 3,994). There were 1,170, 817, and 1,063 incident cases of ischemic heart disease, stroke, and diabetes, respectively (median follow-up 11.2 years). The hazard ratios, HRs (95 % confidence intervals, CIs) for atopics versus non-atopics: for ischemic heart disease (HR 1.00, 95 % CI 0.86, 1.16), stroke (HR 1.18, 95 % CI 0.99, 1.41), and diabetes (HR 1.06, 95 % CI 0.91, 1.23). Our results did not support the hypothesis that atopy is associated with higher risk of ischemic heart disease, stroke, or diabetes. However, a small-moderately increased risk cannot be excluded from our data.

  9. Healthy Heart Collaboration and Developed Toolkit

    Science.gov (United States)

    Impact: EPA is raising awareness of heart disease and its link to air pollution and other environmental factors as a partner in Million Hearts, a national initiative to prevent heart attacks and strokes. The talk will provide an up to date review of the evidence linking air poll...

  10. Use of Outpatient Cardiac Rehabilitation Among Heart Attack Survivors - 20 States and the District of Columbia, 2013 and Four States, 2015.

    Science.gov (United States)

    Fang, Jing; Ayala, Carma; Luncheon, Cecily; Ritchey, Matthew; Loustalot, Fleetwood

    2017-08-25

    Heart disease is the leading cause of death in the United States (1). Each year, approximately 790,000 adults have a myocardial infarction (heart attack), including 210,000 that are recurrent heart attacks (2). Cardiac rehabilitation (rehab) includes exercise counseling and training, education for heart-healthy living, and counseling to reduce stress. Cardiac rehab provides patients with education regarding the causes of heart attacks and tools to initiate positive behavior change, and extends patients' medical management after a heart attack to prevent future negative sequelae (3). A systematic review has shown that after a heart attack, patients using cardiac rehab were 53% (95% confidence interval [CI] = 41%-62%) less likely to die from any cause and 57% (95% CI = 21%-77%) less likely to experience cardiac-related mortality than were those who did not use cardiac rehab (3). However, even with long-standing national recommendations encouraging use of cardiac rehab (4), the intervention has been underutilized. An analysis of 2005 Behavioral Risk Factor Surveillance System (BRFSS) data found that only 34.7% of adults who reported a history of a heart attack also reported subsequent use of cardiac rehab (5). To update these estimates, CDC used the most recent BRFSS data from 2013 and 2015 to assess the use of cardiac rehab among adults following a heart attack. Overall use of cardiac rehab was 33.7% in 20 states and the District of Columbia (DC) in 2013 and 35.5% in four states in 2015. Cardiac rehab use was underutilized overall and differences were evident by sex, age, race/ethnicity, level of education, cardiovascular risk status, and by state. Increasing use of cardiac rehab after a heart attack should be encouraged by health systems and supported by the public health community.

  11. Symptomatic carotid stenosis and stroke risk in patients with transient ischemic attack according to the tissue-based definition.

    Science.gov (United States)

    Al-Khaled, Mohamed; Scheef, Björn

    2016-10-01

    Symptomatic carotid stenosis (sCS), a common cause of transient ischemic attack (TIA), is correlated with higher stroke risk. We investigated the frequency and associated factors of sCS in patients with TIA and the association between sCS and stroke risk following TIA. Over a three-year period (2011-2013), 861 consecutive patients with TIA, who were admitted to the Department of Neurology at the University of Lübeck, Germany, were included in a monocenter study and prospectively evaluated. Diagnosis of TIA was in accordance with the tissue-based definition (transient neurological symptoms without evidence of infarction by brain imaging). Of 827 patients (mean age, 70 ± 13.2 years; 49.7% women), 64 patients (7.7%; 95% confidence interval [CI], 5.9%-9.7%) exhibited sCS and 3 patients (0.3%) showed an occlusion of the corresponding internal carotid artery. Logistic regression revealed that sCS was associated with male sex (odds ratio [OR], 2.7; 95% CI, 1.2-3.6; p = 0.012), amaurosis fugax (OR, 8.1; 95% CI, 3.4-19-4; p risk was higher in patients with sCS than in those without sCS (6.3% vs. 0.1%; p risk (2.6%) did not differ between the groups (4.7% vs. 2.5%; p = 0.29). SCS appears to be associated with a higher risk of stroke in patients with TIA defined according to the tissue-based definition.

  12. Tracks FAQs: How Do Heart Attack Hospitalization Rates In My Community Compare With Other Counties Or States?

    Centers for Disease Control (CDC) Podcasts

    2011-09-01

    In this podcast, CDC Tracking experts discuss how to compare heart attack hospitalization rates in your community with other counties or states. Do you have a question for our Tracking experts? Please e-mail questions to trackingsupport@cdc.gov.  Created: 9/1/2011 by National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Environmental Health Tracking Branch.   Date Released: 9/1/2011.

  13. Significance of estimated glomerular filtration rate in predicting brain or heart attacks in obese and non-obese populations.

    Science.gov (United States)

    Sato, Yuji; Fujimoto, Shouichi; Konta, Tsuneo; Iseki, Kunitoshi; Moriyama, Toshiki; Yamagata, Kunihiro; Tsuruya, Kazuhiko; Kimura, Kenjiro; Narita, Ichiei; Kondo, Masahide; Asahi, Koichi; Kurahashi, Issei; Ohashi, Yasuo; Watanabe, Tsuyoshi

    2015-10-01

    The Japanese Specific Health Checkup mainly focuses on metabolic syndrome for preventing cardiovascular events. Subjects are stratified by measuring waist circumference, body mass index, blood pressure, triglycerides, and fasting plasma glucose. However, estimated glomerular filtration rate (eGFR) is not considered essential. A longitudinal cohort study assessed the association of eGFR with new-onset brain or heart attacks in a large Japanese nationwide Specific Health Checkup database. A total of 109,349 Japanese subjects (mean age 63.2 years, 39.5 % men) were examined for the events 2 years later. The odds ratios were calculated for new events in the total and subgroup populations divided by BMI proteinuria (dipstick test ≥1+), lower eGFR, and higher systolic and diastolic BP, fasting plasma glucose, hemoglobin A1c, and triglycerides (TG). Rates of new-onset brain or heart attacks were 3.1 and 4.0 % in the groups of non-obese and obese subjects, respectively. In the total population, eGFR as well as higher BMI (≥25 kg/m(2)), higher BP (high-normal hypertension or greater), higher TG (≥150 mg/dl), and proteinuria were significant risk factors for developing brain or heart attacks. The eGFR was significant in non-obese subjects, but not in the obese. As the ultimate aim of 'Specific Health Checkup' is to prevent cardiovascular events, our study suggests that eGFR should be evaluated in non-obese subjects.

  14. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood clot blocks an ... a short time. The only difference between a stroke and TIA is that with TIA the blockage ...

  15. Comparing Asian American Women's Knowledge, Self-Efficacy, and Perceived Risk of Heart Attack to Other Racial and Ethnic Groups: The mPED Trial.

    Science.gov (United States)

    Fukuoka, Yoshimi; Lisha, Nadra E; Vittinghoff, Eric

    2017-09-01

    The aim of the study was to compare knowledge and awareness of heart attacks/heart disease and perceived risk for future heart attack in Asian/Pacific Islander women, compared to other racial and ethnic groups. In this cross-sectional study, 318 women enrolled in a mobile phone-based physical activity education trial were analyzed. Heart attack knowledge, self-efficacy for recognizing and responding to heart attack symptoms, and perceived risk for a future heart attack were measured. Analyses were conducted using logistic, proportional odds, and linear regression models, depending on the outcome and adjusting for age. Pairwise differences between Asian/Pacific Islanders and the other four groups were assessed using a Bonferroni correction (p perceived risk did not differ among the groups. Forty-six percent of the Asian American women, compared to 25% of Caucasian women, falsely believed "breast cancer is the number one cause of death for women (p = 0.002)." In addition, Asian/Pacific Islander women were less likely to report "arm pain, numbness, tingling, or radiating" as one of the heart attack symptoms compared to the Caucasian and the multiracial group (34%, 63% [p < 0.001], and 66% [p = 0.004], respectively). These findings highlight the urgent need to develop effective, tailored campaigns to close the knowledge gap between Asian/Pacific Islander women and Caucasian women.

  16. The need for emergency surgical treatment in carotid-related stroke in evolution and crescendo transient ischemic attack.

    Science.gov (United States)

    Capoccia, Laura; Sbarigia, Enrico; Speziale, Francesco; Toni, Danilo; Biello, Antonella; Montelione, Nunzio; Fiorani, Paolo

    2012-06-01

    The purpose of this study was to examine the safety of emergency carotid endarterectomy (CEA) in patients with carotid stenosis and unstable neurological symptoms. This prospective, single-center study involved patients with stroke in evolution (SIE) or fluctuating stroke or crescendo transient ischemic attack (cTIA) related to a carotid stenosis ≥ 50% who underwent emergency surgery. Preoperative workup included National Institute of Health Stroke Scale (NIHSS) neurological assessment on admission, immediately before surgery and at discharge, carotid duplex scan, brain contrast-enhanced head computed tomography (CT) or magnetic resonance imaging (MRI). End points were perioperative (30-day) neurological mortality, NIHSS score variation, and hemorrhagic or ischemic stroke recurrence. Patients were evaluated according to clinical presentation (SIE or cTIA), timing of surgery, and presence of brain infarction on neuroimaging. Between January 2005 and December 2009, 48 patients were submitted to emergency surgery. CEAs were performed from 1 to 24 hours from onset of symptoms (mean, 10.16 ± 7.75). Twenty-six patients presented an SIE with a worsening NIHSS score between admission and surgery, and 22 presented ≥ 3 cTIAs with a normal NIHSS score (= 0) immediately before surgery. An ischemic brain lesion was detected in four patients with SIE and eight patients with cTIA. All patients with cTIA presented a persistent NIHSS normal score before and after surgery. Twenty-five patients with SIE presented an NIHSS score improvement after surgery. Mean NIHSS score was 5.30 ± 2.81 before surgery and 0.54 ± 0.77 at discharge in the SIE group (P hemorrhagic transformation of an undetected brain ischemic lesion after surgery, with progressive neurological deterioration and death (2%). Due to the absence of randomized controlled trials of CEA for neurologically unstable patients, data currently available do not support a policy of emergency CEA in those patients. Our results

  17. Combined effects of family history of CVD and heart rate on ischemic stroke incidence among Inner Mongolians in China.

    Science.gov (United States)

    Zhou, Yipeng; Tian, Yunfan; Zhong, Chongke; Batu, Buren; Xu, Tian; Li, Hongmei; Zhang, Mingzhi; Wang, Aili; Zhang, Yonghong

    2016-05-01

    This study aimed to evaluate the combined effects of family history of cardiovascular diseases (FHCVD) and heart rate on ischemic stroke incidence among Inner Mongolians in China. A prospective cohort study was conducted among 2589 participants aged 20 years and older from Inner Mongolia, China. The participants were divided into four groups according to status of FHCVD and heart rate and followed up from June 2002 to July 2012. Cox proportional hazards models were used to evaluate the combined effects of FHCVD and heart rate on the incidence of ischemic stroke. A total of 76 ischemic stroke occurred during the follow-up period. The observed ischemic stroke cases tended to be older and male, and had higher prevalence of smoking, drinking, hypertension and FHCVD as well as higher systolic and diastolic blood pressures at baseline compared with those who did not experience ischemic stroke. Age- and gender-adjusted hazard ratio (95% confidence interval) of ischemic stroke in the participants with both FHCVD and heart rate ≥ 80 were 2.89 (1.51-5.53), compared with those without FHCVD and heart rate < 80. After multiple adjustment, the association between ischemic stroke risk and both FHCVD and heart rate ≥ 80 remained statistically significant (hazard ratio, 2.47; 95% confidence interval: 1.22-5.01). Our main finding that participants with both FHCVD and faster heart rate have the highest risk of ischemic stroke suggests that faster heart rate may increase the risk of ischemic stroke among people with FHCVD.

  18. Patent Foramen Ovale in Young Adults with Cryptogenic Stroke or Transient Ischemic Attack

    Directory of Open Access Journals (Sweden)

    Afsoon Fazlinezhad

    2009-09-01

    Results: The case group comprised 48 patients with cryptogenic stroke (n=31 and TIA (n=17, and the control group consisted of 57 patients. The age distribution of the groups was normal, and there was no significant difference between the age and gender of the two groups. The frequency of PFO in the case and control groups was 52% and 25%, respectively (p value=0.003, odds ratio=3.33, confidence interval=1.46-7.63. The exaggerated motion of the interatrial septum (IAS in the case and control groups was 18.8% and 0%, respectively. Right-to-left shunt at rest in the case and control groups was 78% and 28%, respectively (significant differences. The differences in terms of PFO size, number of bubbles, and atrial septal aneurysm were not significant between the two groups. Conclusion: PFO had a relation with stroke and TIA in the young adults, and right-to-left shunt at rest and exaggerated motion of the IAS could increase the possibility of paradoxical emboli. It seems that the presence of atrial septal aneurysm, number of bubbles, and PFO size did not increase the risk of cerebrovascular accidents.

  19. Echocardiographic evaluation of right ventricular stroke work index in advanced heart failure: a new index?

    Science.gov (United States)

    Frea, Simone; Bovolo, Virginia; Bergerone, Serena; D'Ascenzo, Fabrizio; Antolini, Marina; Capriolo, Michele; Canavosio, Federico Giovanni; Morello, Mara; Gaita, Fiorenzo

    2012-12-01

    Right ventricular (RV) function plays a pivotal role in advanced heart failure patients, especially for screening those who may benefit from left ventricular assist device (LVAD) implantation. We introduce RV contraction pressure index (RVCPI) as a new echo-Doppler parameter of RV function. The accuracy of RVCPI in detecting RV failure was compared with the criterion standard, the RV stroke work index (RVSWI) obtained through right heart catheterization in advanced heart failure patients referred for heart transplantation or LVAD implantation. Right heart catheterization and echo-Doppler were simultaneously performed in 94 consecutive patients referred to our center for advanced heart failure (ejection fraction (EF) 24 ± 8.8%, 40% NYHA functional class IV). RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. Simplified RVCPI (sRVCPI) was derived as TAPSE × (RV - right atrial pressure gradient). Close positive correlation between sRVCPI and RVSWI was found (r = 0.68; P rights reserved.

  20. Physical Activity and Exercise Engagement in Patients Diagnosed with Transient Ischemic Attack and Mild/Non-disabling Stroke: A Commentary on Current Perspectives

    Directory of Open Access Journals (Sweden)

    James Faulkner

    2014-03-01

    Full Text Available Individuals diagnosed with a transient ischemic attack (TIA or mild/non-disabling stroke are at high risk of cardiovascular or recurrent cerebrovascular (stroke, TIA events. Pharmacological intervention (ie anti-platelet and anti-coagulant medication is considered the cornerstone of secondary prevention care for this population group. However, recent research has explored the utility of non-pharmacological interventions (eg exercise, diet, education in improving health outcomes and reducing the risk of secondary events in patients with TIA or mild/non-disabling stroke. This commentary discusses the efficacy of implementing exercise interventions as a part of the secondary care program for acute and non-acute TIA and stroke patients. Current perspectives and future research initiatives are also discussed.

  1. The time of sunrise and the number of hours with daylight may influence the diurnal rhythm of acute heart attack mortality.

    Science.gov (United States)

    Kriszbacher, Ildikó; Bódis, József; Boncz, Imre; Koppan, Agnes; Koppan, Miklós

    2010-04-01

    We investigated whether the time of sunrise and the number of daylight hours have an effect on the seasonality, or the daily rhythm of heart attack mortality. We analyzed retrospectively data of patients admitted to hospitals with the diagnosis of heart attack (n=32,329) and patients who deceased of a heart attack (n=5142) between January 1, 2004 and December 31, 2005 in Hungary. Heart attack mortality was highest during winter, while lowest number of events was recorded during summer . The daily peak of diurnality was between 6:00 am and 12:00 pm (33.77%). A positive correlation was found between the time of sunrise, time of sunset and the mortality caused by myocardial infarction (pheart attack mortality we found a negative correlation (r=-0.105, pheart attack mortality. Our data suggest, that the occurrence and the mortality of heart attack may be related to the time of sunrise and the number of daylight hours. Copyright 2008 Elsevier Ireland Ltd. All rights reserved.

  2. Brain imaging and cognitive predictors of stroke and Alzheimer disease in the Framingham Heart Study.

    Science.gov (United States)

    Weinstein, Galit; Beiser, Alexa S; Decarli, Charles; Au, Rhoda; Wolf, Philip A; Seshadri, Sudha

    2013-10-01

    Exposure to vascular risk factors has a gradual deleterious effect on brain MRI and cognitive measures. We explored whether a pattern of these measures exists that predicts stroke and Alzheimer disease (AD) risk. A cognitive battery was administered to 1679 dementia and stroke-free Framingham offspring (age, >55 years; mean, 65.7±7.0) between 1999 and 2004; participants were also free of other neurological conditions that could affect cognition and >90% also had brain MRI examination. We related cognitive and MRI measures to risks of incident stroke and AD ≤10 years of follow-up. As a secondary analysis, we explored these associations in The Framingham Heart Study original cohort (mean age, 67.5±7.3 and 84.8±3.3 years at the cognitive assessment and MRI examination, respectively). A total of 55 Offspring participants sustained strokes and 31 developed AD. Offspring who scored stroke (hazard ratio [HR], 2.27; 95% confidence interval [CI], 1.06-4.85) and AD (HR, 3.60; 95% CI, 1.52-8.52); additional cognitive tests also predicted AD. Participants with low (20 percentile) white matter hyperintensity volume had a higher risk of stroke (HR, 1.97; 95% CI, 1.03-3.77 and HR, 2.74; 95% CI, 1.51-5.00, respectively) but not AD. Hippocampal volume at the bottom quintile predicted AD in the offspring and original cohorts (HR, 4.41; 95% CI, 2.00-9.72 and HR, 2.37; 95% CI, 1.12-5.00, respectively). A stepwise increase in stroke risk was apparent with increasing numbers of these cognitive and imaging markers. Specific patterns of cognitive and brain structural measures observed even in early aging predict stroke risk and may serve as biomarkers for risk prediction.

  3. Use of ABCD2 risk scoring system to determine the short-term stroke risk in patients presenting to emergency department with transient ischaemic attack

    International Nuclear Information System (INIS)

    Ozpolat, C.; Denizbasi, A.; Onur, O.; Eroglu, S.E.

    2013-01-01

    Objective: To determine the 3-day stroke risk of patients presenting to emergency department with transient ischaemic attack, and to evaluate the predictive value of ABCD2 (Age, Blood pressure, Clinical features, Duration of symptoms and Diabetes) score for these patients. Methods: The prospective study was conducted on patients with diagnosis of transient ischaemic attack who were divided into low (0-3 points), medium (4-5 points) and high (6-7 points) risk groups according to their ABCD2 scores. The sensitivity of the scoring system on estimation of the risk of stroke in 3 days was evaluated through receiver operating characteristic curve. SPSS 15 was used for data analysis. Results: Of the 64 patients in the study, none of the low-risk group had stroke. Stroke was present in 4 of 33 (12.12%) medium-risk patients, while there were 4 in 18 (22.22%) in the high-risk group. Sensitivity and specificity of each ABCD2 score for 3rd day stroke risk was calculated. In the receiver operating curve generated by these calculations, the c statistics was determined as 0.76 (95% CI: 0.64, 0.86; p<0.01) and the most appropriate cut-off score to dichotomise the study group was determined as 4. Conclusions: In transient ischaemic attack patients with an ABCD2 score of four or higher had a markedly increased short-term stroke risk, while those with a lower score were quite safe. It is appropriate to hospitalise patients with a score of four or more and investigate for underlying cause and initiate treatment. (author)

  4. Self-reported stress and risk of stroke: the Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Nielsen, Naja; Boysen, Gudrun

    2003-01-01

    BACKGROUND AND PURPOSE: Lay people often mention stress as one of the most important risk factors for stroke. Stress might trigger a cerebrovascular event directly or could be associated with higher levels of blood pressure or an unfavorable lifestyle. To examine these possibilities, we analyzed...... the association between self-reported stress frequency and intensity and risk of stroke. METHODS: Data from the second examination, 1981 to 1983, of participants in the Copenhagen City Heart Study were analyzed with Cox regression after a mean of 13 years of follow-up. A total of 5604 men and 6970 women were...... included, and 929 first-ever strokes occurred, of which 207 (22%) were fatal within 28 days after onset of symptoms. The stress frequency categories were never/hardly ever, monthly, weekly, or daily. The stress intensity categories were never/hardly ever, light, moderate, or high. RESULTS: Subjects...

  5. Apathy, not depressive symptoms, as a predictor of semantic and phonemic fluency task performance in stroke and transient ischemic attack.

    Science.gov (United States)

    Fishman, Keera N; Ashbaugh, Andrea R; Lanctôt, Krista L; Cayley, Megan L; Herrmann, Nathan; Murray, Brian J; Sicard, Michelle; Lien, Karen; Sahlas, Demetrios J; Swartz, Richard H

    2017-09-15

    This study examined the relationship between apathy and cognition in patients with cerebrovascular disease. Apathy may result from damage to frontal subcortical circuits causing dysexecutive syndromes, but apathy is also related to depression. We assessed the ability of apathy to predict phonemic fluency and semantic fluency performance after controlling for depressive symptoms in 282 individuals with stroke and/or transient ischemic attack. Participants (N = 282) completed the Phonemic Fluency Test, Semantic Fluency Test, Center for Epidemiologic Studies Depression Scale, and Apathy Evaluation Scale. A cross-sectional correlational design was utilized. Using hierarchical linear regressions, apathy scores significantly predicted semantic fluency performance (β = -.159, p = .020), but not phonemic fluency performance (β = -.112, p = .129) after scaling scores by age and years of education and controlling for depressive symptoms. Depressive symptoms entered into the first step of both hierarchical linear regressions did not predict semantic fluency (β = -.035, p = .554) or phonemic fluency (β = -.081, p = .173). Apathy and depressive symptoms were moderately correlated, r(280) = .58, p < .001. The results of this study are consistent with research supporting a differentiation between phonemic and semantic fluency tasks, whereby phonemic fluency tasks primarily involve frontal regions, and semantic fluency tasks involve recruitment of more extended networks. The results also highlight a distinction between apathy and depressive symptoms and suggest that apathy may be a more reliable predictor of cognitive deficits than measures of mood in individuals with cerebrovascular disease. Apathy may also be more related to cognition due to overlapping motivational and cognitive frontal subcortical circuitry. Future research should explore whether treatments for apathy could be a novel target for improving cognitive outcomes after stroke.

  6. PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis

    NARCIS (Netherlands)

    de Groot, P. C. M.; Dekkers, O. M.; Romijn, J. A.; Dieben, S. W. M.; Helmerhorst, F. M.

    2011-01-01

    BACKGROUND: Patients with polycystic ovary syndrome (PCOS) are at risk of arterial disease. We examined the risk of (non) fatal coronary heart disease (CHD) or stroke in patients with PCOS and ovulatory women without PCOS, and assessed whether obesity might explain a higher risk of CHD or stroke.

  7. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Billinger, Sandra A; Arena, Ross; Bernhardt, Julie; Eng, Janice J; Franklin, Barry A; Johnson, Cheryl Mortag; MacKay-Lyons, Marilyn; Macko, Richard F; Mead, Gillian E; Roth, Elliot J; Shaughnessy, Marianne; Tang, Ada

    2014-08-01

    This scientific statement provides an overview of the evidence on physical activity and exercise recommendations for stroke survivors. Evidence suggests that stroke survivors experience physical deconditioning and lead sedentary lifestyles. Therefore, this updated scientific statement serves as an overall guide for practitioners to gain a better understanding of the benefits of physical activity and recommendations for prescribing exercise for stroke survivors across all stages of recovery. Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and indicate gaps in current knowledge. Physical inactivity after stroke is highly prevalent. The assessed body of evidence clearly supports the use of exercise training (both aerobic and strength training) for stroke survivors. Exercise training improves functional capacity, the ability to perform activities of daily living, and quality of life, and it reduces the risk for subsequent cardiovascular events. Physical activity goals and exercise prescription for stroke survivors need to be customized for the individual to maximize long-term adherence. The recommendation from this writing group is that physical activity and exercise prescription should be incorporated into the management of stroke survivors. The promotion of physical activity in stroke survivors should emphasize low- to moderate-intensity aerobic activity, muscle-strengthening activity, reduction of sedentary behavior, and risk management for secondary prevention of stroke. © 2014 American Heart Association, Inc.

  8. The association of atopy with incidence of ischemic heart disease, stroke, and diabetes

    DEFF Research Database (Denmark)

    Skaaby, Tea; Husemoen, Lise Lotte Nystrup; Thuesen, Betina Heinsbæk

    2015-01-01

    Allergy is a systemic inflammatory disease that could theoretically affect the risk of cardiovascular disease (CVD) and diabetes through inflammatory pathways or mast cell-induced coronary spasm. Whether allergy is associated with an increased risk of CVD and diabetes is largely unknown. We...... investigated the association between atopy as assessed by IgE sensitization, a well-accepted biomarker of allergy, and incidence of ischemic heart disease, stroke, and diabetes in five Danish population-based cohorts. A total of 14,849 participants were included in the study. Atopy was defined as serum......-specific IgE positivity to inhalant allergens. The Danish National Diabetes Register enabled identification of incident diabetes. Likewise, the Danish Registry of Causes of Death and the Danish National Patient Register provided information on fatal and non-fatal ischemic heart disease and stroke. Data were...

  9. A qualitative study of younger men's experience of heart attack (myocardial infarction).

    Science.gov (United States)

    Merritt, Christopher J; de Zoysa, Nicole; Hutton, Jane M

    2017-09-01

    The effects of heart attack, or myocardial infarction (MI), across psychosocial domains may be particularly acute in younger adults, for whom serious health events are non-normative. MI morbidity is declining in Western countries, but in England MI numbers have plateaued for the under-45 cohort, where approximately 90% of patients are male. Qualitative research on younger adults' experience of MI is limited, and no study has sampled exclusively under-45s. This study aimed to understand how a sample of men under 45 adjusted to and made sense of MI. Qualitative research design based on semi-structured in-depth interviews. Ten men aged under 45 who had experienced MI in the past 3-6 months were purposively recruited and interviewed. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. Seven superordinate themes were identified. This article focuses in depth on the three most original themes: (1) 'I'm less of a man', which described experiences of losing 'maleness' (strength, independence, ability to provide) post-MI; (2) 'Shortened horizons', which covered participants' sense of foreshortened future and consequent reprioritization; and (3) 'Life loses its colour', describing the loss of pleasure from lifestyle-related changes. Themes broadly overlapped with the qualitative literature on younger adult MI. However, some themes (e.g., loss of 'maleness' post-MI, and ambivalence towards MI risk factors) appeared unique to this study. Themes were also discussed in relation to risk factors for anxiety and depression and how this might inform clinical care for a younger, male population. Statement of contribution What is already known on this subject? Myocardial infarction (MI) morbidity is not declining in England for under-45s. Adjustment to MI is particularly challenging for younger adults, perhaps because it is non-normative. However, little is known about the experience of MI in younger adults. What does this study add? This

  10. Kidney stones may increase the risk of coronary heart disease and stroke

    Science.gov (United States)

    Peng, Jian-Ping; Zheng, Hang

    2017-01-01

    Abstract Background: We aimed to quantitatively assess the potential relationship between kidney stones and coronary heart disease or stroke. Methods: A meta-analysis was conducted on eligibly studies published before 31 May 2016 in PubMed or Embase. The data were pooled, and the relationship was assessed by the random-effect model with inverse variance-weighted procedure. The results were expressed as relative risk (RR) with 95% confidence intervals (95%CI). Results: Eight studies of 11 cohorts (n = 11) were included in our analysis with 3,658,360 participants and 157,037 cases. We found that a history of kidney stones was associated with increased risk of coronary heart disease (CHD) (RR = 1.24; 95%CI: 1.14–1.36; I2 = 79.0%, n = 11); similar effect on myocardial infarction, a serious condition of CHD, was observed (RR = 1.24; 95%CI: 1.10–1.40; I2 = 80.4%, n = 8). We also found that a history of kidney stones may increase the risk of stroke (RR = 1.21, 95%CI: 1.06–1.38; I2 = 54.7%, n = 4). In subgroup analysis, the risk of coronary heart disease was higher in men (RR = 1.23, 95%CI: 1.02–1.49) while the risk for stroke was higher in women (RR = 1.12; 95%CI: 1.03–1.21). No obvious publications bias was detected (Egger test: P = .47). Conclusion: Kidney stones are associated with increased risk of coronary heart disease and stroke, and the effect may differ by sex. PMID:28834909

  11. Polyphenols and Oxidative Stress in Atherosclerosis-Related Ischemic Heart Disease and Stroke

    OpenAIRE

    Cheng, Yu-Chen; Sheen, Jer-Ming; Hu, Wen Long; Hung, Yu-Chiang

    2017-01-01

    Good nutrition could maintain health and life. Polyphenols are common nutrient mainly derived from fruits, vegetables, tea, coffee, cocoa, mushrooms, beverages, and traditional medicinal herbs. They are potential substances against oxidative-related diseases, for example, cardiovascular disease, specifically, atherosclerosis-related ischemic heart disease and stroke, which are health and economic problems recognized worldwide. In this study, we reviewed the risk factors for atherosclerosis, i...

  12. Risk factors for heart disease and stroke among diabetic persons, by disability status.

    Science.gov (United States)

    Okoro, Catherine A; Denny, Clark H; Greenlund, Kurt J; Benjamin, Stephanie M; Strine, Tara W; Balluz, Lina S; Mokdad, Ali H

    2005-01-01

    To determine whether disabled diabetic persons have a higher prevalence of risk factors for heart disease and stroke than do diabetic persons without disability. RESEARCH, DESIGN, AND METHODS: Data were analyzed for noninstitutionalized adults in 27 states and the District of Columbia that participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2001 and/or 2003. Logistic regression analysis was used to estimate the adjusted prevalence and odds ratios of disabled diabetic persons, by sociodemographic characteristics. The logit form of each model was used to estimate conditional marginal probabilities of risk factors for heart disease and stroke among diabetic persons, by disability status. Diabetic persons with disability were more likely than those without disability to have more risk factors for heart disease and stroke, including insufficient leisure-time physical activity or inactivity (adjusted prevalence: 75.2% vs. 63.3%; Pvs. 43.3%; Pvs. 48.4%; P=.038), and hypertension (63.9% vs. 56.6%; Ptwo or more, three or more, and four or more risk factors (97.2% vs. 95.6%, 83.5% vs. 74.0%, 56.5% vs. 41.1%, and 22.2% vs. 13.6%, respectively; Pstroke. Health care guidelines specifically targeting diabetic patients with disability may be needed to aid health care providers in addressing these risk factors.

  13. Early menopause predicts future coronary heart disease and stroke: the Multi-Ethnic Study of Atherosclerosis.

    Science.gov (United States)

    Wellons, Melissa; Ouyang, Pamela; Schreiner, Pamela J; Herrington, David M; Vaidya, Dhananjay

    2012-10-01

    Cardiovascular disease is the number one killer of women. Identifying women at risk of cardiovascular disease has tremendous public health importance. Early menopause is associated with increased cardiovascular disease events in some predominantly white populations, but not consistently. Our objective was to determine if self-reported early menopause (menopause at an age menopause (either natural menopause or surgical removal of ovaries at an age menopause. In survival curves, women with early menopause had worse coronary heart disease and stroke-free survival (log rank P = 0.008 and P = 0.0158). In models adjusted for age, race/ethnicity, Multi-ethnic Study Atherosclerosis site, and traditional cardiovascular disease risk factors, this risk for coronary heart disease and stroke remained (hazard ratio, 2.08; 95% CI, 1.17-3.70; and hazard ratio, 2.19; 95% CI, 1.11-4.32, respectively). Early menopause is positively associated with coronary heart disease and stroke in a multiethnic cohort, independent of traditional cardiovascular disease risk factors.

  14. Cerebral correlates of heart rate variations during a spontaneous panic attack in the fMRI scanner.

    Science.gov (United States)

    Spiegelhalder, Kai; Hornyak, Magdolna; Kyle, Simon David; Paul, Dominik; Blechert, Jens; Seifritz, Erich; Hennig, Jürgen; Tebartz van Elst, Ludger; Riemann, Dieter; Feige, Bernd

    2009-12-01

    We report the first published case study of a suddenly occurring panic attack in a patient with no prior history of panic disorder during combined functional magnetic resonance imaging (fMRI, 1.5 Tesla) and electrocardiogram (ECG) recording. The single case was a 46-year-old woman who developed a panic attack near the planned end of the fMRI acquisition session, which therefore had to be aborted. Correlational analysis of heart rate fluctuations and fMRI data revealed a significant negative association in the left middle temporal gyrus. Additionally, regions-of-interest (ROI) analyses indicated significant positive associations in the left amygdala, and trends towards significance in the right amygdala and left insula.

  15. Cerebral microbleeds are not associated with long-term cognitive outcome in patients with transient ischemic attack or minor stroke.

    Science.gov (United States)

    Brundel, Manon; Kwa, Vincent I H; Bouvy, Willem H; Algra, Ale; Kappelle, L Jaap; Biessels, Geert Jan

    2014-01-01

    Cerebral microbleeds have been related to cerebrovascular disease and dementia. They occur more frequently in patients with ischemic stroke than in the general population, but their relation to cognition in these patients is uncertain, particularly in the long run. We examined the relationship between microbleeds in patients with a transient ischemic attack (TIA) or minor ischemic stroke, and cognitive performance 4 years later. Participants were recruited from a prospective multicenter cohort of patients with a TIA or minor ischemic stroke (n=397). They underwent magnetic resonance imaging (MRI), including a T2*-weighted sequence, within 3 months after their ischemic event. Microbleeds, atrophy, lacunae and white matter hyperintensities (WMH) were rated visually. Cognitive status was examined in 94% of all patients who were still alive after a mean interval of 3.8 years by the Dutch version of the Telephone Interview for Cognitive Status (TICS; n=280) or by an Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) obtained from a close relative if a TICS could not be obtained (n=48). The relationship between presence of microbleeds and TICS or IQCODE score was assessed with linear regression analyses adjusted for age, sex, educational level and time interval between MRI and cognitive evaluation. The mean age was 65±12 years at inclusion. The vascular event at inclusion was a TIA in 170 patients (52%) and a minor ischemic stroke in 155 patients (47%). Microbleeds were present in 11.6% of the patients. Patients with microbleeds were significantly older than patients without microbleeds (70±9 vs. 64±12 years), more often had hypertension, and had more cerebral atrophy, WMH and lacunae on MRI (all pTICS score was 35.3±5.9 for patients with microbleeds (n=29) and 34.6±5.2 for patients without microbleeds (n=251); the adjusted mean difference (95% CI) was 1.69 (-0.01 to 3.38). The total IQCODE score was 66.0±10.8 for patients with microbleeds (n=9

  16. "First-hit" heart attack risk calculators on the world wide web: implications for laypersons and healthcare practitioners.

    Science.gov (United States)

    Roberts, Elved B; Ramnath, Rajesh; Fallows, Stephen; Sykes, Kevin

    2008-06-01

    Heart attack risk calculators are readily accessible on the world wide web, offering potentially powerful means of health education and risk awareness. Laypersons may be unaware of differences in applicability, risk calculation algorithms and output formats among such calculators. This study assesses the impact of basic web searching terms on type of calculator accessed and on the resulting risk score. Observational study. Seventy-two notional individual risk factor profiles were constructed, based on six combinations of presence or absence of smoking habit, hypercholesterolaemia, mixed hyperlipidaemia, hypertension and family history of premature coronary disease among males and females in age groups 30, 40, 50, 60, 70 and 80 years. The term heart attack risk calculator was entered into the Google, Yahoo, MSN, AltaVista and Excite search engines. The first five web pages purporting to contain heart attack risk calculators were included. Subpages of URLs leading to duplicate calculators were excluded. All search engines provided similar "hits" for the same search term. Framingham or PROCAM risk prediction models were the templates for all calculators. Different calculators often gave different absolute percentage risk scores for the same notional risk factor profiles. Differences were clinically insignificant in most cases when comparisons were made between bracketed risk scores within 5% of one another. One calculator gave disproportionately high risk estimates for women compared to men with the same risk factor profile and compared to other calculators into which identical risk profiles were entered. Simple search terms resulted in appropriate "hits". All calculators were based on reputable risk assessment models. There was broad agreement across different calculators for the range of risk factor profiles entered, but one calculator gave inconsistent risk scores.

  17. Treatment with B vitamins and incidence of cancer in patients with previous stroke or transient ischemic attack: results of a randomized placebo-controlled trial.

    Science.gov (United States)

    Hankey, Graeme J; Eikelboom, John W; Yi, Qilong; Lees, Kennedy R; Chen, Christopher; Xavier, Denis; Navarro, Jose C; Ranawaka, Udaya K; Uddin, Wasim; Ricci, Stefano; Gommans, John; Schmidt, Reinhold

    2012-06-01

    To determine the effect of B vitamin treatment on the incidence of cancer among patients with stroke or transient ischemic attack. A total of 8164 patients with recent stroke or transient ischemic attack were randomly allocated to double-blind treatment with 1 tablet daily of placebo or B vitamins (2 mg folic acid, 25 mg vitamin B(6), 500 μg vitamin B(12)) and followed for a median of 3.4 years for any cancer as an adverse event. There was no significant difference in the incidence of any cancer among participants assigned B vitamins compared with placebo (4.04% versus 4.59%; risk ratio, 0.86; 95% CI, 0.70-1.07) and no difference in cancer mortality (2.35% versus 2.09%; risk ratio, 1.09; 0.81-1.46). Among 1899 patients with diabetes, the incidence of cancer was higher among participants assigned B vitamins compared with placebo (5.35% versus 3.28%; adjusted risk ratio, 2.21; 1.31-3.73), whereas among 6168 patients without diabetes, the incidence of cancer was lower among participants assigned B vitamins compared with placebo (3.66% versus 5.03%; adjusted risk ratio, 0.67; 0.51-0.87; P for interaction=0.0001). Daily administration of folic acid, vitamin B(6), and vitamin B(12) to 8164 patients with recent stroke or transient ischemic attack for a median of 3.4 years had no significant effect, compared with placebo, on cancer incidence or mortality. However, a post hoc subgroup analysis raises the hypothesis that folic acid treatment may increase the incidence of cancer among diabetics and reduce the incidence of cancer among nondiabetics with a history of stroke or transient ischemic attack.

  18. Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Smith, Eric E; Saposnik, Gustavo; Biessels, Geert Jan; Doubal, Fergus N; Fornage, Myriam; Gorelick, Philip B; Greenberg, Steven M; Higashida, Randall T; Kasner, Scott E; Seshadri, Sudha

    2017-02-01

    Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to prevent stroke, the Stroke Council of the American Heart Association convened a writing committee to evaluate existing evidence, to discuss clinical considerations, and to offer suggestions for future research on stroke prevention in patients with 3 cardinal manifestations of silent cerebrovascular disease: silent brain infarcts, magnetic resonance imaging white matter hyperintensities of presumed vascular origin, and cerebral microbleeds. The writing committee found strong evidence that silent cerebrovascular disease is a common problem of aging and that silent brain infarcts and white matter hyperintensities are associated with future symptomatic stroke risk independently of other vascular risk factors. In patients with cerebral microbleeds, there was evidence of a modestly increased risk of symptomatic intracranial hemorrhage in patients treated with thrombolysis for acute ischemic stroke but little prospective evidence on the risk of symptomatic hemorrhage in patients on anticoagulation. There were no randomized controlled trials targeted specifically to participants with silent cerebrovascular disease to prevent stroke. Primary stroke prevention is indicated in patients with silent brain infarcts, white matter hyperintensities, or microbleeds. Adoption of standard terms and definitions for silent cerebrovascular disease, as provided by prior American Heart Association/American Stroke Association statements and by a consensus group, may facilitate diagnosis and communication of findings from radiologists to clinicians. © 2016 American Heart Association, Inc.

  19. Safety and efficacy of intensive vs. guideline antiplatelet therapy in high-risk patients with recent ischemic stroke or transient ischemic attack: rationale and design of the Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (TARDIS) trial (ISRCTN47823388).

    Science.gov (United States)

    Krishnan, Kailash; Beridze, Maia; Christensen, Hanne; Dineen, Rob; Duley, Lelia; Heptinstall, Stan; James, Marilyn; Markus, Hugh S; Pocock, Stuart; Ranta, Annemarei; Robinson, Thompson; Nikola, Nikola; Venables, Graham; Bath, Philip

    2015-10-01

    The risk of recurrence following a stroke or transient ischemic attack is high, especially immediately after the event. Because two antiplatelet agents are superior to one in patients with non-cardioembolic events, more intensive treatment might be even more effective. The sample size of 4100 patients will allow a shift to less recurrence, and less severe recurrence, to be detected (odds ratio 0·68) with 90% power at 5% significance. Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (ISRCTN47823388) is comparing the safety and efficacy of intensive (combined aspirin, clopidogrel, and dipyridamole) vs. guideline antiplatelet therapy, both given for one-month. This international collaborative parallel-group prospective randomized open-label blinded-end-point phase III trial plans to recruit 4100 patients with acute ischemic stroke or transient ischemic attack. Randomization and data collection are performed over a secure Internet site with real-time data validation and concealment of allocation. Outcomes, serious adverse events, and neuroimaging are adjudicated centrally with blinding to treatment allocation. The primary outcome is stroke recurrence and its severity ('ordinal recurrence' based on modified Rankin Scale) at 90 days, with masked assessment centrally by telephone. Secondary outcomes include vascular events, functional measures (disability, mood, cognition, quality of life), and safety (bleeding, death, serious adverse events). The trial has recruited more than 50% of its target sample size (latest number: 2399) and is running in 104 sites in 4 countries. One-third of patients presented with a transient ischemic attack. © 2015 The Author. International Journal of Stroke published by John Wiley & Sons Ltd on behalf of World Stroke Organization.

  20. Heart Age PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    2015-09-01

    This 60 second public service announcement is based on the September 2015 CDC Vital Signs report. Your heart age is the age of your heart and blood vessels as a result of your risk factors for heart attack and stroke. If you smoke or have high blood pressure, your heart age will be much higher than your actual age. Learn what you can do to lower your heart age and keep it low.  Created: 9/1/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 9/1/2015.

  1. Patient confidence regarding secondary lifestyle modification and knowledge of 'heart attack' symptoms following percutaneous revascularisation in Japan: a cross-sectional study.

    Science.gov (United States)

    Kitakata, Hiroki; Kohno, Takashi; Kohsaka, Shun; Fujino, Junko; Nakano, Naomi; Fukuoka, Ryoma; Yuasa, Shinsuke; Maekawa, Yuichiro; Fukuda, Keiichi

    2018-03-16

    To assess patient perspectives on secondary lifestyle modification and knowledge of 'heart attack' after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Observational cross-sectional study. A single university-based hospital centre in Japan. In total, 236 consecutive patients with CAD who underwent PCI completed a questionnaire (age, 67.4±10.1 years; women, 14.8%; elective PCI, 75.4%). The survey questionnaire included questions related to confidence levels about (1) lifestyle modification at the time of discharge and (2) appropriate recognition of heart attack symptoms and reactions to these symptoms on a four-point Likert scale (1=not confident to 4=completely confident). The primary outcome assessed was the patients' confidence level regarding lifestyle modification and the recognition of heart attack symptoms. Overall, patients had a high level of confidence (confident or completely confident,>75%) about smoking cessation, alcohol restriction and medication adherence. However, they had a relatively low level of confidence (heart attack, almost all respondents answered 'yes' to the item 'I should go to the hospital as soon as possible when I have a heart attack'; however, only 28% of the responders were confident in their ability to distinguish between heart attack symptoms and other conditions. There were substantial disparities in the confidence levels associated with lifestyle modification and recognition/response to heart attack. These gaps need to be studied further and disseminated to improve cardiovascular care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. B-type natriuretic peptide as a marker for heart failure in patients with acute stroke.

    Science.gov (United States)

    Koenig, Matthew A; Puttgen, H Adrian; Prabhakaran, Vivek; Reich, Daniel; Stevens, Robert D

    2007-09-01

    To determine whether serum N-terminal pro-B-type natriuretic peptide (N-BNP), a biomarker of myocardial wall stress, is specific to acute heart failure (HF) in patients hospitalized with stroke. Case-control study. Tertiary hospital, Neurosciences Critical Care Unit and Stroke Unit. Consecutive patients with acute ischemic or hemorrhagic stroke who were evaluated for HF. None. Cases and controls were classified, respectively, as patients with or without HF, defined according to modified Framingham criteria. Seventy-two patients were evaluated, 39 with ischemic stroke, 22 with aneurysmal subarachnoid hemorrhage (SAH), and 11 with intracerebral hemorrhage (ICH). Thirty-four patients (47%) met criteria for HF, and 47 patients (65%) had systolic or diastolic left ventricular (LV) dysfunction on echocardiogram. Serum N-BNP was measured a median of 48 h following the onset of stroke and was increased (> 900 pg/ml) in 56 patients (78%), with higher levels in non-survivors (11898 +/- 12741 vs 4073 +/-5691; p = 0.001). In a multiple regression model, N-BNP elevation was not independently associated with HF (OR 5.4, 95% CI 0.8-36.0, p = 0.084). At a cut-off of 900 pg/ml, the sensitivity of N-BNP for HF was 94%, specificity 37%, positive predictive value (PPV) 57%, and negative predictive value (NPV) 88%. For systolic or diastolic LV dysfunction, the sensitivity of N-BNP was 89%, specificity 44%, PPV 75%, and NPV 69%. These results demonstrate that N-BNP elevation is not specific to HF or LV dysfunction in patients with acute ischemic stroke, SAH, and ICH.

  3. [Stroke and transient ischemic attack-mimicking conditions: a prospective analysis of risk factors and clinical profiles at a general hospital].

    Science.gov (United States)

    García-Moncó, J C; Marrodán, A; Foncea Beti, N; Gómez Beldarrain, M

    2002-01-01

    Nonvascular structural entities can simulate stroke and transient ischemic attacks (TIA) in a variable percentage, but this issue has not been properly addressed in our environment. Their differentiation is important, since the management of patients with a true cerebrovascular accident differs considerably from that of mimicking conditions. To analyze prospectively those structural disorders that mimic stroke and TIA in the department of neurology of a general hospital and to determine if there are any distinctive risk factors and/or clinical presentations that would allow for their separation from true stroke and TIA. All patients admitted to our Department of Neurology with stroke or TIA were evaluated prospectively for a 4-year period. Those in whom a mimicking condition was disclosed were the subjects of this study. Their clinical features and vascular risk factors were compared with a sample of randomly selected patients with true stroke or TIA admitted during the same period. A total of 28 patients comprised the stroke-TIA mimicking group, 21 of them had a stroke-like syndrome and 7 a TIA-like syndrome. The mimicking group represented a 1.9% (2% of strokes and 1.6% of TIA) of all the patients with true cerebrovascular disorders admitted during the same period. Cancer, either primary or metastatic, was the single most frequent mimicking condition, accounting for two-thirds of the cases. Risk factors for stroke and TIA were significantly more frequent in the true stroke-TIA group without differences in age or sex, while the opposite is true in terms of prior or concurrent cancer. No single clinical profile allowed for a distinction between the two groups, although vertebrobasilar dysfunction suggested true ischemia, and vomiting, isolated dysarthria and dysarthria-clumsy hand occurred only in the true stroke-TIA group. Nonvascular conditions can cause signs and symptoms indistinguishable from true stroke and TIA, representing about 2% of the patients admitted

  4. Meta-analysis of Egg Consumption and Risk of Coronary Heart Disease and Stroke.

    Science.gov (United States)

    Alexander, Dominik D; Miller, Paula E; Vargas, Ashley J; Weed, Douglas L; Cohen, Sarah S

    2016-01-01

    The possible relationship between dietary cholesterol and cardiac outcomes has been scrutinized for decades. However, recent reviews of the literature have suggested that dietary cholesterol is not a nutrient of concern. Thus, we conducted a meta-analysis of egg intake (a significant contributor to dietary cholesterol) and risk of coronary heart disease (CHD) and stroke. A comprehensive literature search was conducted through August 2015 to identify prospective cohort studies that reported risk estimates for egg consumption in association with CHD or stroke. Random-effects meta-analysis was used to generate summary relative risk estimates (SRREs) for high vs low intake and stratified intake dose-response analyses. Heterogeneity was examined in subgroups where sensitivity and meta regression analyses were conducted based on increasing egg intake. A 12% decreased risk (SRRE = 0.88, 95% confidence interval [CI], 0.81-0.97) of stroke was observed in the meta-analysis of 7 studies of egg intake (high vs low; generally 1/d vs egg consumption and CHD. No clear dose-response trends were apparent in the stratified intake meta-analyses or the meta regression analyses. Based on the results of this meta-analysis, consumption of up to one egg daily may contribute to a decreased risk of total stroke, and daily egg intake does not appear to be associated with risk of CHD. Key Teaching Points: • The role of egg consumption in the risk of stroke and coronary heart disease has come under scrutiny over many years. • A comprehensive meta-analysis of prospective cohort studies that reported risk estimates for egg consumption in association with CHD or stroke was performed on the peer-reviewed epidemiologic literature through August 2015. • Overall, summary associations indicate that intake of up to 1 egg daily may be associated with reduced risk of total stroke. • Overall, summary associations show no clear association between egg intake and increased or decreased risk of CHD

  5. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Powers, William J; Rabinstein, Alejandro A; Ackerson, Teri; Adeoye, Opeolu M; Bambakidis, Nicholas C; Becker, Kyra; Biller, José; Brown, Michael; Demaerschalk, Bart M; Hoh, Brian; Jauch, Edward C; Kidwell, Chelsea S; Leslie-Mazwi, Thabele M; Ovbiagele, Bruce; Scott, Phillip A; Sheth, Kevin N; Southerland, Andrew M; Summers, Deborah V; Tirschwell, David L

    2018-03-01

    The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. The members of the writing group unanimously approved all recommendations except when relations with industry precluded members voting. Prerelease review of the draft guideline was performed by 4 expert peer reviewers and by the members of the Stroke Council's Scientific Statements Oversight Committee and Stroke Council Leadership Committee. These guidelines use the American College of Cardiology/American Heart Association 2015 Class of Recommendations and Levels of Evidence and the new American Heart Association guidelines format. These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. These guidelines are based on the best evidence currently available. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke. © 2018 American Heart Association, Inc.

  6. Coronary Heart Disease and Stroke in Adults Born Preterm - The Helsinki Birth Cohort Study.

    Science.gov (United States)

    Kajantie, Eero; Osmond, Clive; Eriksson, Johan G

    2015-11-01

    Adults born preterm have increased risk factors for cardiovascular disease. We studied the cumulative incidence of manifest coronary heart disease (CHD) and stroke in adults born preterm. We studied 19 015 people born in Helsinki, Finland, during 1924-44. Of them, 137 (0.7%) were born early (preterm (34 to preterm. For stroke, they were 0.84 (0.50, 1.39) and 0.86 (0.71, 1.06). HRs were little changed when adjusted for childhood and adult socio-economic position and birthweight for gestation standard deviation score. They were similar for first-ever events before or after 65 years, for haemorrhagic and thrombotic stroke, and for men and women, except that the HR for CHD for women born early preterm was 1.98 (1.18, 3.30). We found no increased risk of CHD or stroke up to old age in people born preterm, although women born early preterm had a higher rate of CHD. There is a discrepancy between increased risk factors in younger generations born preterm and little or no increase in manifest disease in older age. Uncovering reasons underlying this discrepancy may give important insights into the prevention of cardiovascular disease. © 2015 John Wiley & Sons Ltd.

  7. Major stroke in a 19-year-old patient with a univentricular heart

    Directory of Open Access Journals (Sweden)

    Riemann M

    2013-01-01

    Full Text Available Mads Riemann,1,2 Lars Idorn,3 Aase Wagner,4 Lars Søndergaard,3 Jørgen K Kanters1,21Department of Internal Medicine, Elsinore Hospital, Elsinore, Denmark; 2Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; 3Department of Cardiology, Copenhagen University Hospital, Section 2014, Rigshospitalet, Copenhagen, Denmark; 4Department of Radiology, Copenhagen University Hospital, Section 3023, Rigshospitalet, Copenhagen, DenmarkAbstract: Patients with univentricular heart malformations are at increased risk of suffering from thromboembolic events. We present a case of a 19-year-old woman born with a univentricular heart who suffered a major stroke while being treated with only salicylic acid. At least 20% of patients with univentricular hearts have been reported to experience thromboembolic events, of which 25% are fatal. Despite the high incidence of thromboembolic events, no consensus has been reached regarding the role of long-term anti-thrombotic treatment in this group of patients. This lack of consensus warrants future studies that compare the different therapeutic strategies.Keywords: univentricle, stroke, antithrombotic treatment

  8. Clinical case: paroxysmal tachycardia attack in a newborn with multiple heart rhabdomyomas

    Directory of Open Access Journals (Sweden)

    Chernenkov Yu.V.

    2016-03-01

    Full Text Available The purpose of the clinical observation is to study the early symptoms of multiple heart rhabdomiomas of a newborn; to draw the attention of specialists on one of the rarely occurred problems in the neonatal practice.

  9. Clinical case: paroxysmal tachycardia attack in a newborn with multiple heart rhabdomyomas

    OpenAIRE

    Chernenkov Yu.V.; Pozgaleva N.V.; Panina O.S.

    2016-01-01

    The purpose of the clinical observation is to study the early symptoms of multiple heart rhabdomiomas of a newborn; to draw the attention of specialists on one of the rarely occurred problems in the neonatal practice.

  10. Prolonged Cardiac Monitoring to Detect Atrial Fibrillation after Cryptogenic Stroke or Transient Ischemic Attack: A Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Dahal, Khagendra; Chapagain, Bikas; Maharjan, Raju; Farah, Hussam W; Nazeer, Ayesha; Lootens, Robert J; Rosenfeld, Alan

    2016-07-01

    The cause of ischemic stroke or transient ischemic attack (TIA) remains unclear after initial cardiac monitoring in approximately one-third of patients. Randomized controlled trials (RCTs) showed that the prolonged cardiac monitoring of patients with cryptogenic stroke or TIA increased detection of atrial fibrillation (AF). We aimed to perform a meta-analysis of all RCTs that evaluated the prolonged monitoring ≥7 days in patients with cryptogenic stroke or TIA. We searched PubMed, EMBASE, Cochrane CENTRAL, and relevant references for RCTs without language restriction (inception through December 2014) and performed meta-analysis using random effects model. Detection of AF, use of anticoagulation at follow-up, recurrent stroke or TIA, and mortality were major outcomes. Four RCTs with 1149 total patients were included in the meta-analysis. Prolonged cardiac monitoring ≥7 days compared to shorter cardiac monitoring of ≤48 hours duration increased the detection of AF (≥30 seconds duration) in patients after cryptogenic stroke or TIA (13.8% vs. 2.5%; odds ratio [OR], 6.4; 95% confidence interval [CI], 3.50-11.73; P vs. 5.2%; 5.68[3.3-9.77]; P stroke or TIA (0.78[0.40-1.55]; P = 0.48; I(2) , 0%) and mortality (1.33[0.29-6.00]; P = 0.71; I(2) , 0%] were observed between two strategies. Prolonged cardiac monitoring improves detection of atrial fibrillation and anti-coagulation use after cryptogenic stroke or TIA and therefore should be considered instead of shorter duration of cardiac monitoring. © 2015 Wiley Periodicals, Inc.

  11. Predictors of recurrent events in patients with cryptogenic stroke and patent foramen ovale within the CLOSURE I (Evaluation of the STARFlex Septal Closure System in Patients With a Stroke and/or Transient Ischemic Attack Due to Presumed Paradoxical Embolism Through a Patent Foramen Ovale) trial.

    Science.gov (United States)

    Elmariah, Sammy; Furlan, Anthony J; Reisman, Mark; Burke, David; Vardi, Moshe; Wimmer, Neil J; Ling, Shuqiong; Chen, Xiaohua; Kent, David M; Massaro, Joseph; Mauri, Laura

    2014-08-01

    This study sought to identify predictors of recurrent ischemic neurologic events within the CLOSURE I (Evaluation of the STARFlex Septal Closure System in Patients With a Stroke and/or Transient Ischemic Attack Due to Presumed Paradoxical Embolism Through a Patent Foramen Ovale) trial. The CLOSURE I trial found that transcatheter patent foramen ovale (PFO) closure using the STARFlex device was not superior to medical therapy in patients with cryptogenic stroke or transient ischemic attack (TIA) and PFO. The CLOSURE I trial is a multicenter, randomized trial of transcatheter PFO closure compared with medical therapy in patients who presented with cryptogenic stroke or TIA and had a PFO. We identified clinical predictors of recurrent ischemic stroke or TIA during 2 years of follow-up using Cox proportional hazards regression within the pooled intention-to-treat cohort. In 909 patients, the incidence of recurrent events was 5.7% with 25 patients suffering a recurrent stroke and 30 a TIA. Patients who had a recurrent event had higher body mass index (30.2 ± 6.2 vs. 28.3 ± 5.8%; p = 0.03) and more frequently had diabetes (19.2% vs. 7.1%; p = 0.0016), hypertension (46.2% vs. 30.1%; p = 0.015), and ischemic heart disease (3.8% vs. 0.9%; p = 0.05). Diabetes (hazard ratio [HR]: 3.39; 95% confidence interval [CI]: 1.69 to 6.84; p = 0.0007), index TIA (HR vs. stroke: 2.13; 95% CI: 1.20 to 3.80; p = 0.01), and the detection of atrial fibrillation after study enrollment (HR: 4.85; 95% CI: 2.05 to 11.47; p = 0.0003) independently predicted recurrent ischemic neurologic events. Recurrent neurologic events were more frequent in subjects with RoPE (Risk of Paradoxical Embolism) score ≤5 than those with >5 (14.5% vs. 4.2%; p Patent Foramen Ovale (PFO) [CLOSURE I]; NCT00201461). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  12. Incidence of stroke and coronary heart disease in the adult health study sample, 1958 - 78

    International Nuclear Information System (INIS)

    Kodama, Kazunori; Shimizu, Yukiko; Sawada, Hisao; Kato, Hiroo.

    1986-04-01

    Approximately 16,000 study subjects in the Adult Health Study sample who had received examination at least once during the 20 years (1958 - 78) in Hiroshima or Nagasaki and were found to have neither stroke nor coronary heart disease (CHD) at the initial examination were studied for the incidence of stroke and CHD and the relationship of these to atomic bomb radiation exposure. Their secular trends were also studied. Findings suggestive of a relationship between stroke and radiation exposure among Hiroshima females were first discovered for the years 1969 - 73, that is, 24 - 28 years after A-bomb exposure. In general, this association is supported by the present analysis. Stroke incidence continued to decrease during the present report's period of observation. Analysis by type showed that cerebral infarction and cerebral hemorrhage both decreased, but the decrease of the latter is especially remarkable. The trend to decrease is observed in both sexes and in both cities. A relationship between CHD and radiation exposure was, as noted for stroke, first observed only in Hiroshima females for the years 1969 - 73, but from this analysis it appears that the trend began earlier and the association is getting stronger with the passage of time. Analysis by type showed myocardial infarction (MI), but not angina pectoris, to be related to radiation exposure. The incidence rate for CHD, especially for MI, was almost constant during the observation period, it being 1.2/1,000 person-years on the average. Comparing by sex, the incidence rate was constant in males. In females, the pattern varied with time. There appear to be no between-city differences in secular trends - essentially constant. (author)

  13. Executive function, but not memory, associates with incident coronary heart disease and stroke

    DEFF Research Database (Denmark)

    Rostamian, Somayeh; van Buchem, Mark A; Westendorp, Rudi G J

    2015-01-01

    from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) with Mini-Mental State Examination score ≥24 points. Scores on the Stroop Color-Word Test (selective attention) and the Letter Digit Substitution Test (processing speed) were converted to Z scores and averaged into a composite.......57-1.32). CONCLUSION: Lower executive function, but not memory, is associated with higher risk of coronary heart disease and stroke. Lower executive function, as an independent risk indicator, might better reflect brain vascular pathologies....

  14. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality

    DEFF Research Database (Denmark)

    Collaboration, Emerging Risk Factors; Erqou, Sebhat; Kaptoge, Stephen

    2009-01-01

    CONTEXT: Circulating concentration of lipoprotein(a) (Lp[a]), a large glycoprotein attached to a low-density lipoprotein-like particle, may be associated with risk of coronary heart disease (CHD) and stroke. OBJECTIVE: To assess the relationship of Lp(a) concentration with risk of major vascular...... and nonvascular outcomes. STUDY SELECTION: Long-term prospective studies that recorded Lp(a) concentration and subsequent major vascular morbidity and/or cause-specific mortality published between January 1970 and March 2009 were identified through electronic searches of MEDLINE and other databases, manual...

  15. Do Stroke Patients Know Their Risk Factors?

    Science.gov (United States)

    Soomann, Maarja; Vibo, Riina; Kõrv, Janika

    2016-03-01

    Risk factor management is the key to stroke prevention. Although several studies have assessed the awareness of different risk factors in the general public, there are limited data available on how well acute stroke patients know their own risk factors. The aim of this study was to assess stroke patients' informedness of their own stroke risk factors. All consecutive eligible acute stroke and transient ischemic attack patients hospitalized at the Tartu University Hospital, Department of Neurology, during 9 months in 2010 were interviewed about different stroke risk factors within 72 hours from hospitalization. The respective information was also retrieved from medical records. Of the 341 patients admitted during the study period, 195 were eligible for the interview. Diabetes was the best known risk factor (89%) followed by hypertension (80%), atrial fibrillation (78%), previous stroke (77%), and heart failure and/or ischemic heart disease (66%). We found that acute stroke patients are best informed of their diabetes and worst informed of their ischemic heart disease and/or heart failure. There is, however, room for amelioration in the awareness of all of the studied risk factors. More attention should be addressed to explaining the risks and treatment options to patients at risk of stroke and the general population. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. The effect of matrix stiffness of injectable hydrogels on the preservation of cardiac function after a heart attack.

    Science.gov (United States)

    Plotkin, Marian; Vaibavi, Srirangam Ramanujam; Rufaihah, Abdul Jalil; Nithya, Venkateswaran; Wang, Jing; Shachaf, Yonatan; Kofidis, Theo; Seliktar, Dror

    2014-02-01

    This study compares the effect of four injectable hydrogels with different mechanical properties on the post-myocardial infarction left ventricle (LV) remodeling process. The bioactive hydrogels were synthesized from Tetronic-fibrinogen (TF) and PEG-fibrinogen (PF) conjugates; each hydrogel was supplemented with two levels of additional cross-linker to increase the matrix stiffness as measured by the shear storage modulus (G'). Infarcts created by ligating the left anterior descending coronary artery in a rodent model were treated with the hydrogels, and all four treatment groups showed an increase in wall thickness, arterial density, and viable cardiac tissue in the peri-infarct areas of the LV. Echocardiography and hemodynamics data of the PF/TF treated groups showed significant improvement of heart function associated with the attenuated effects of the remodeling process. Multi-factorial regression analysis indicated that the group with the highest modulus exhibited the best rescue of heart function and highest neovascularization. The results of this study demonstrate that multiple properties of an injectable bioactive biomaterial, and notably the matrix stiffness, provide the multifaceted stimulation necessary to preserve cardiac function and prevent adverse remodeling following a heart attack. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Family history and body mass index predict perceived risks of diabetes and heart attack among community-dwelling Caucasian, Filipino, Korean, and Latino Americans--DiLH Survey.

    Science.gov (United States)

    Fukuoka, Yoshimi; Choi, JiWon; S Bender, Melinda; Gonzalez, Prisila; Arai, Shoshana

    2015-07-01

    The purpose of the study was to explore the perceived risk for diabetes and heart attack and associated health status of Caucasian, Filipino, Korean, and Latino Americans without diabetes. A cross-sectional survey was conducted with 904 urban adults (mean age 44.3±16.1 years; 64.3% female) in English, Spanish or Korean between August and December 2013. Perceived risk for developing diabetes was indicated by 46.5% (n=421), and 14.3% (n=129) perceived themselves to be at risk for having a heart attack in their lifetime. Significant predictors of pessimistic diabetes risk perceptions: Filipino (adjusted odds ratio [AOR]=1.7; 95% CI: 1.04-2.86) and Korean (AOR=2.4; 1.33-4.48) ethnicity, family history of diabetes (AOR=1.4; 1.00-1.84), female gender (AOR=1.4; 1.04-1.96), high cholesterol (AOR= 1.6; 1.09-2.37) and higher body mass index (BMI) (AOR=1.1; 1.08-1.15). Predictors of pessimistic heart attack risk perceptions were family history of an early heart attack (AOR=2.9; 1.69-5.02), high blood pressure (AOR=2.4; 1.45-3.84), and higher BMI (AOR=1.1; 1.04-1.12) after controlling for socio-demographic factors. Older age, physical inactivity, smoking, and low HDL levels were not associated with risk perceptions. Multiple risk factors were predictive of greater perceived diabetes risk, whereas, only family history of heart attack, high blood pressure and increases in BMI significantly contributed to perceived risk of heart attack among ethnically diverse at risk middle-aged adults. It is important that healthcare providers address the discordance between an individual's risk perceptions and the presence of actual risk factors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Sacco, Ralph L; Kasner, Scott E; Broderick, Joseph P; Caplan, Louis R; Connors, J J Buddy; Culebras, Antonio; Elkind, Mitchell S V; George, Mary G; Hamdan, Allen D; Higashida, Randall T; Hoh, Brian L; Janis, L Scott; Kase, Carlos S; Kleindorfer, Dawn O; Lee, Jin-Moo; Moseley, Michael E; Peterson, Eric D; Turan, Tanya N; Valderrama, Amy L; Vinters, Harry V

    2013-07-01

    Despite the global impact and advances in understanding the pathophysiology of cerebrovascular diseases, the term "stroke" is not consistently defined in clinical practice, in clinical research, or in assessments of the public health. The classic definition is mainly clinical and does not account for advances in science and technology. The Stroke Council of the American Heart Association/American Stroke Association convened a writing group to develop an expert consensus document for an updated definition of stroke for the 21st century. Central nervous system infarction is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. Central nervous system infarction occurs over a clinical spectrum: Ischemic stroke specifically refers to central nervous system infarction accompanied by overt symptoms, while silent infarction by definition causes no known symptoms. Stroke also broadly includes intracerebral hemorrhage and subarachnoid hemorrhage. The updated definition of stroke incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.

  19. Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation

    DEFF Research Database (Denmark)

    Larsen, Bjørn Strøier; Kumarathurai, Preman; Falkenberg, Julie

    2015-01-01

    .3% had diagnosed AF before their stroke. The incidence of stroke in subjects with ESVEA and a CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score of ≥2 was 2...

  20. Heart and Stroke Foundation of Ontario (HSFO) high blood pressure strategy's hypertension management initiative study protocol.

    Science.gov (United States)

    Tobe, Sheldon W; Moy Lum-Kwong, Margaret; Perkins, Nancy; Von Sychowski, Shirley; Sebaldt, Rolf J; Kiss, Alex

    2008-12-10

    Achieving control of hypertension prevents target organ damage at both the micro and macrovascular level and is a highly cost effective means of lowering the risk for heart attack and stroke particularly in people with diabetes. Clinical trials demonstrate that blood pressure control can be achieved in a large proportion of people. Translating this knowledge into widespread practice is the focus of the Hypertension Management Initiative, which began in 2004 with the goal of improving the management of this chronic health condition by primary care providers and patients in the community. This study will test the effect of a systems change on the management of high blood pressure in real world practice in primary care in Ontario, Canada. The systems change intervention involves an interprofessional educational program bringing together physicians, nurses and pharmacists with tools for both providers and patients to facilitate blood pressure management. Each of two waves of subjects were enrolled over a 6 month period with the initial enrollment between waves separated by 9 months. Blood pressure will be measured with the BpTru automated blood pressure device. To determine the effectiveness of the intervention, a before and after analysis within all subjects will compare blood pressure at baseline to annual measurements for the three year study. To assess whether the intervention has an impact on blood pressure control independent of community trends, a betwen group comparison of baseline blood pressures in the delayed wave will be made with the immediate wave during the same time period, so that the immediate wave has experienced the intervention for at least 9 months. The total enrollment goal is 5,000 subjects. The practice locations include 10 Family Health Teams (FHTs) and 1 Community Health Centre (CHC) and approximately 49 primary care physicians, 15 nurse practitioners, 37 registered nurses and over 150 community pharmacists across the 11 communities

  1. Heart and Stroke Foundation of Ontario (HSFO high blood pressure strategy's hypertension management initiative study protocol

    Directory of Open Access Journals (Sweden)

    Von Sychowski Shirley

    2008-12-01

    Full Text Available Abstract Background Achieving control of hypertension prevents target organ damage at both the micro and macrovascular level and is a highly cost effective means of lowering the risk for heart attack and stroke particularly in people with diabetes. Clinical trials demonstrate that blood pressure control can be achieved in a large proportion of people. Translating this knowledge into widespread practice is the focus of the Hypertension Management Initiative, which began in 2004 with the goal of improving the management of this chronic health condition by primary care providers and patients in the community. Methods This study will test the effect of a systems change on the management of high blood pressure in real world practice in primary care in Ontario, Canada. The systems change intervention involves an interprofessional educational program bringing together physicians, nurses and pharmacists with tools for both providers and patients to facilitate blood pressure management. Each of two waves of subjects were enrolled over a 6 month period with the initial enrollment between waves separated by 9 months. Blood pressure will be measured with the BpTru ® automated blood pressure device. To determine the effectiveness of the intervention, a before and after analysis within all subjects will compare blood pressure at baseline to annual measurements for the three year study. To assess whether the intervention has an impact on blood pressure control independent of community trends, a betwen group comparison of baseline blood pressures in the delayed wave will be made with the immediate wave during the same time period, so that the immediate wave has experienced the intervention for at least 9 months. The total enrollment goal is 5,000 subjects. The practice locations include 10 Family Health Teams (FHTs and 1 Community Health Centre (CHC and approximately 49 primary care physicians, 15 nurse practitioners, 37 registered nurses and over 150

  2. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of the ARISTOTLE trial.

    Science.gov (United States)

    Easton, J Donald; Lopes, Renato D; Bahit, M Cecilia; Wojdyla, Daniel M; Granger, Christopher B; Wallentin, Lars; Alings, Marco; Goto, Shinya; Lewis, Basil S; Rosenqvist, Mårten; Hanna, Michael; Mohan, Puneet; Alexander, John H; Diener, Hans-Christoph

    2012-06-01

    In the ARISTOTLE trial, the rate of stroke or systemic embolism was reduced by apixaban compared with warfarin in patients with atrial fibrillation (AF). Patients with AF and previous stroke or transient ischaemic attack (TIA) have a high risk of stroke. We therefore aimed to assess the efficacy and safety of apixaban compared with warfarin in prespecified subgroups of patients with and without previous stroke or TIA. Between Dec 19, 2006, and April 2, 2010, patients were enrolled in the ARISTOTLE trial at 1034 clinical sites in 39 countries. 18,201 patients with AF or atrial flutter were randomly assigned to receive apixaban 5 mg twice daily or warfarin (target international normalised ratio 2·0-3·0). The median duration of follow-up was 1·8 years (IQR 1·4-2·3). The primary efficacy outcome was stroke or systemic embolism, analysed by intention to treat. The primary safety outcome was major bleeding in the on-treatment population. All participants, investigators, and sponsors were masked to treatment assignments. In this subgroup analysis, we estimated event rates and used Cox models to compare outcomes in patients with and without previous stroke or TIA. The ARISTOTLE trial is registered with ClinicalTrials.gov, number NTC00412984. Of the trial population, 3436 (19%) had a previous stroke or TIA. In the subgroup of patients with previous stroke or TIA, the rate of stroke or systemic embolism was 2·46 per 100 patient-years of follow-up in the apixaban group and 3·24 in the warfarin group (hazard ratio [HR] 0·76, 95% CI 0·56 to 1·03); in the subgroup of patients without previous stroke or TIA, the rate of stroke or systemic embolism was 1·01 per 100 patient-years of follow-up with apixaban and 1·23 with warfarin (HR 0·82, 95% CI 0·65 to 1·03; p for interaction=0·71). The absolute reduction in the rate of stroke and systemic embolism with apixaban versus warfarin was 0·77 per 100 patient-years of follow-up (95% CI -0·08 to 1·63) in patients with

  3. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death

    DEFF Research Database (Denmark)

    Almdal, Thomas; Scharling, Henrik; Jensen, Jan Skov

    2004-01-01

    BACKGROUND: Epidemiological studies have reported that patients with type 2 diabetes mellitus (DM) have increased mortality and morbidity from cardiovascular diseases, independent of other risk factors. However, most of these studies have been performed in selected patient groups. The purpose...... of the present study was prospectively to assess the impact of type 2 DM on cardiovascular morbidity and mortality in an unselected population. METHODS: A total of 13,105 subjects from the Copenhagen City Heart Study were followed up prospectively for 20 years. Adjusted relative risks of first, incident......, admission for, or death from ischemic heart disease, acute myocardial infarction, or stroke, as well as total mortality in persons with type 2 DM compared with healthy controls, were estimated. RESULTS: The relative risk of first, incident, and admission for myocardial infarction was increased 1.5- to 4...

  4. B vitamins and magnetic resonance imaging-detected ischemic brain lesions in patients with recent transient ischemic attack or stroke: the VITAmins TO Prevent Stroke (VITATOPS) MRI-substudy.

    Science.gov (United States)

    Cavalieri, Margherita; Schmidt, Reinhold; Chen, Christopher; Mok, Vincent; de Freitas, Gabriel R; Song, Swithin; Yi, Qilong; Ropele, Stefan; Grazer, Anja; Homayoon, Nina; Enzinger, Christian; Loh, Katherine; Wong, Ka Sing Lawrence; Wong, Adrian; Xiong, Yunyun; Chang, Hui Meng; Wong, Meng Cheong; Fazekas, Franz; Eikelboom, John W; Hankey, Graeme J

    2012-12-01

    Elevated concentrations of homocysteine are associated with cerebral small vessel disease (CSVD). B-vitamin supplementation with folate and vitamins B12 and B6 reduces homocysteine concentrations. In a substudy of the VITAmins TO Prevent Stroke (VITATOPS) trial, we assessed the hypothesis that the addition of once-daily supplements of B vitamins would reduce the progression of CSVD-related brain lesions. A total of 359 patients with recent stroke or transient ischemic attack, who were randomly allocated to double-blind treatment with placebo or b vitamins, underwent brain MRI at randomization and after 2 years of B-vitamin supplementation. MR images were analyzed blinded to treatment allocation. Outcomes related to the prespecified hypothesis were progression of white matter hyperintensities and incident lacunes. We also explored the effect of B-vitamin supplementation on the incidence of other ischemic abnormalities. After 2 years of treatment with b vitamins or placebo, there was no significant difference in white matter hyperintensities volume change (0.08 vs 0.13 cm3; P=0.419) and incidence of lacunes (8.0% vs 5.9%, P=0.434; odds ratio=1.38). In a subanalysis of patients with MRI evidence of severe CSVD at baseline, b-vitamin supplementation was associated with a significant reduction in white matter hyperintensities volume change (0.3 vs 1.7 cm3; P=0.039). Daily B-vitamin supplementation for 2 years did not significantly reduce the progression of brain lesions resulting from presumed CSVD in all patients with recent stroke or transient ischemic attack but may do so in the subgroup of patients with recent stroke or transient ischemic attack and severe CSVD. http://vitatops.highway1.com.au/. Unique identifier: NCT00097669 and ISRCTN74743444.

  5. Excess Stroke in Mexican Americans Compared with Non-Hispanic Whites: The Brain Attack Surveillance in Corpus Christi Project

    OpenAIRE

    Morgenstern, Lewis B.; Smith, Melinda A.; Lisabeth, Lynda D.; Risser, Jan M. H.; Uchino, Ken; Garcia, Nelda; Longwell, Paxton J.; McFarling, David A.; Akuwumi, Olubumi; Al-Wabil, Areej; Al-Senani, Fahmi; Brown, Devin L.; Moyé, Lemuel A.

    2004-01-01

    Mexican Americans are the largest subgroup of Hispanics, the largest minority population in the United States. Stroke is the leading cause of disability and third leading cause of death. The authors compared stroke incidence among Mexican Americans and non-Hispanic Whites in a population-based study. Stroke cases were ascertained in Nueces County, Texas, utilizing concomitant active and passive surveillance. Cases were validated on the basis of source documentation by board-certified neurolog...

  6. Total Dietary Fiber, and Selected Vegetable, Fruit, Legume and Cereal Fiber Intake and Risk of Heart Attack in Periodontitis Subjects

    Directory of Open Access Journals (Sweden)

    Nelson Wood

    2011-10-01

    Full Text Available Background: Epidemiological studies have found an association between periodontal disease and coronary artery disease(Arbes, Slade et al. 1999; Beck, Elter et al. 2001; Genco, Offenbacher et al. 2002, and have even implicated periodontal disease as a risk factor(Arbes, Slade et al. 1999; Beck, Elter et al. 2001, however have not proven causality(Hujoel, Drangholt et al. 2000. Although dietary amounts, sources, and types (soluble versus insoluble of fiber have been shown to reduce the risk of heart attack (Liu, Buring et al. 2002; Negri, Vecchia et al. 2003, this author is unaware of studies that have examined the association between food sources of dietary fiber and heart attack risk in subjects with periodontitis.This study was designed to determine whether total dietary fiber and fiber from different plant sources (vegetables, fruits, legumes, or cereals modified self-reported HA risk, as well as acute-phase inflammatory responses in subjects with periodontitis using NHANES III data.Objectives: The objective of this study was to investigate the association between total dietary fiber intake levels, and selected vegetables, fruits, legumes, and cereal fiber intake and the risk of self-reported history of heart attack (HA in periodontitis subjects using data available in the Third National Health and Nutrition Examination Survey (NHANES III.Materials and Methods: Adult participants in NHANES III were used in this study. Zero to thirty three (0-33 percent of sites with periodontal attachment loss > 3 mm was considered a healthy periodontium, while greater than thirty three percent (>33 of sites with periodontal attachment loss of > 3 mm as periodontitis. The outcome variable was the self-reported history of HA. Total dietary fiber, and monthly selected vegetable, fruit, legume and cereal consumption were divided into low and adequate levels. Data was analyzed by Kruskal-Wallis, ANOVA and multivariate analyses using SPSS ®. P<0.05 was used to

  7. Relationship Between Dietary Vitamin D and Deaths From Stroke and Coronary Heart Disease: The Japan Collaborative Cohort Study.

    Science.gov (United States)

    Sheerah, Haytham A; Eshak, Ehab S; Cui, Renzhe; Imano, Hironori; Iso, Hiroyasu; Tamakoshi, Akiko

    2018-02-01

    There is growing evidence about the importance of vitamin D for cardiovascular health. Therefore, we examined the relationship between dietary vitamin D intake and risk of mortality from stroke and coronary heart disease in Japanese population. A prospective study encompassing 58 646 healthy Japanese adults (23 099 men and 35  547 women) aged of 40 to 79 years in whom dietary vitamin D intake was determined via a self-administered food frequency questionnaire. The median follow-up period was 19.3 years (1989-2009). The hazard ratios and 95% confidence intervals of mortality were calculated using categories of vitamin D intake. During 965 970 person-years of follow-up, 1514 stroke and 702 coronary heart disease deaths were documented. Vitamin D intake was inversely associated with risk of mortality from total stroke especially intraparenchymal hemorrhage but not from coronary heart disease; the multivariable hazard ratios (95% confidence intervals) for the highest (≥440 IU/d) versus lowest (stroke and 0.66 (0.46-0.96; P for trend=0.04) for intraparenchymal hemorrhage. Dietary vitamin D intake seems to be inversely associated with mortality from stroke. © 2018 American Heart Association, Inc.

  8. Faith and use of complementary and alternative medicine among heart attack patients in a secular society.

    Science.gov (United States)

    Bekke-Hansen, Sidsel; Pedersen, Christina Gundgaard; Thygesen, Kristian; Christensen, Søren; Waelde, Lynn C; Zachariae, Robert

    2012-10-01

    To explore the associations of religious and spiritual faith (unambiguous, ambiguous and no faith), existential considerations and disease severity with use of complementary and alternative medicine (CAM) among heart patients in a secular society, and to address patients' perceived influence of CAM on their quality of life and heart disease. Prospective questionnaire study among 97 consecutively recruited patients (72.2% male; mean age 60.6 years) with acute coronary syndrome from a Danish cardiac university hospital unit. Total CAM use in the 6 months following hospitalisation. Altogether 24.7% used CAM with dietary/exercise counselling and dietary/nutritional supplements being the most prevalent types. In a final multivariate logistic regression model entering faith in God, faith in a spiritual power and previous CAM use, only unambiguous faith in God predicted CAM use following the event (OR: 11.24, CI: 2.19-57.65, p=0.004). No significant association was found between heart disease severity and CAM use. The majority of CAM treatments were rated as having some degree of positive influence on quality of life (75.9%) and the heart disease (58.6%). Faith among heart patients in a secular society was associated with CAM use. It may be speculated that believers in God were more inclined to use lifestyle-oriented CAM types such as dietary/exercise counselling. Patients' perceived benefits of CAM may be strong motivational factors for present or future use. However, considering the potential adverse effect of combining some complementary therapies with conventional medicine, an open dialogue on CAM use is warranted. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Stroke volume estimation in heart failure patients using bioimpedance: a realistic simulation of the forward problem

    International Nuclear Information System (INIS)

    Sokolovsky, R E; Zlochiver, S; Abboud, S

    2008-01-01

    Bioimpedance techniques may be appropriate for cardiac stroke volume (SV) monitoring since thoracic anatomical changes during the heart contraction reflect on the conductivity distribution. In some bioimpedance techniques, the electrical potential is calculated from the impedance distribution using Poisson's equation. That is called the forward problem and in many applications it is used inherently in the solution of the inverse problem—finding the impedance distribution from the electrical potentials. In this work, the forward problem was simulated using a realistic 3D hybrid phantom of the human thorax. The cardiac cycle of normal patients and patients suffering from cardiogenic pulmonary edema was simulated, including the effect of pulmonary blood perfusion during heart contraction. The forward problem was found to be most sensitive to SV when current was injected from the right breast toward the left scapula (−0.021 µV ml −1 ). Our simulations show that both the heart volume and lung conductivity affect the developing voltage; therefore in SV estimation, the lung conductivity and heart volume should be jointly estimated

  10. Limitations and pitfalls in measurements of right ventricular stroke volume in an animal model of right heart failure

    International Nuclear Information System (INIS)

    Vildbrad, Mads Dam; Andersen, Asger; Andersen, Thomas Krarup; Axelgaard, Sofie; Holmboe, Sarah; Andersen, Stine; Nielsen-Kudsk, Jens Erik; Ringgaard, Steffen

    2015-01-01

    Right heart failure occurs in various heart and pulmonary vascular diseases and may be fatal. We aimed to identify limitations in non-invasive measurements of right ventricular stroke volume in an animal model of right ventricular failure. Data from previous studies randomising rats to pulmonary trunk banding (PTB, n = 33) causing pressure-overload right ventricular failure or sham operation (n = 16) was evaluated retrospectively. We measured right ventricular stroke volume by high frequency echocardiography and magnetic resonance imaging (MRI). We found correlation between right ventricular stroke volume measured by echocardiography and MRI in the sham animals (r = 0.677, p = 0.004) but not in the PTB group. Echocardiography overestimated the stroke volume compared to MRI in both groups. Intra- and inter-observer variation did not explain the difference. Technical, physiological and anatomical issues in the pulmonary artery might explain why echocardiography over-estimates stroke volume. Flow acceleration close to the pulmonary artery banding can cause uncertainties in the PTB model and might explain the lack of correlation. In conclusion, we found a correlation in right ventricular stroke volume measured by echocardiography versus MRI in the sham group but not the PTB group. Echocardiography overestimated right ventricular stroke volume compared to MRI. (paper)

  11. Associations of estimated Δ-5-desaturase and Δ-6-desaturase activities with stroke risk factors and risk of stroke: the Kuopio Ischaemic Heart Disease Risk Factor Study.

    Science.gov (United States)

    Daneshmand, Roya; Kurl, Sudhir; Tuomainen, Tomi-Pekka; Virtanen, Jyrki K

    2017-02-01

    Stroke is a leading cause of morbidity and mortality. The role of PUFA in reducing the risk of stroke is uncertain. The concentrations of PUFA in the human body are determined both by dietary intake and by activities of desaturase enzymes. Desaturase enzymes have been associated with chronic diseases, but little is known about their association with stroke risk. We investigated the associations of Δ-6-desaturase (D6D) and Δ-5-desaturase (D5D) activities with stroke risk factors and risk of stroke among 1842 men from the prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor Study, aged 42-60 years and free of CVD at baseline in 1984-1989. ANCOVA and Cox regression models were used for the analyses. Whole serum desaturase activities were estimated as product:precursor ratios - γ-linolenic acid:linoleic acid for D6D and arachidonic acid:dihomo-γ-linolenic acid for D5D. Higher D6D activity was associated with higher systolic and diastolic blood pressure, BMI, serum insulin and TAG concentrations and worse homoeostatic model assessment (HOMA) indices. In contrast, higher D5D activity was associated with lower systolic and diastolic blood pressure, BMI, serum insulin, LDL-cholesterol, TAG and C-reactive protein concentrations, higher HDL-cholesterol concentration, and better HOMA indices. During the mean follow-up of 21·2 years, 202 stroke cases occurred. Neither D6D activity (multivariable-adjusted extreme-quartile hazard ratios (HR) 1·18; 95 % CI 0·80, 1·74) nor D5D activity (HR 1·06; 95 % CI 0·70, 1·60) were associated with stroke risk. In conclusion, higher D5D activity was favourably associated and higher D6D activity unfavourably associated with several stroke risk factors, but not with the risk of incident stroke.

  12. D-dimer and the Risk of Stroke and Coronary Heart Disease. The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

    Science.gov (United States)

    Zakai, Neil A; McClure, Leslie A; Judd, Suzanne E; Kissela, Brett; Howard, George; Safford, Monika; Cushman, Mary

    2017-02-28

    D-dimer, a biomarker of coagulation, is higher in blacks than in whites and has been associated with stroke and coronary heart disease (CHD). It was our objective to assess the association of higher D-dimer with stroke and CHD in blacks and whites. REGARDS recruited 30,239 black and white participants across the contiguous US and measured baseline D-dimer in stroke (n=646) and CHD (n=654) cases and a cohort random sample (n=1,104). Cox models adjusting for cardiovascular risk factors determined the hazard ratio (HR) for increasing D-dimer for cardiovascular disease with bootstrapping to assess the difference in HR for CHD versus stroke by race. D-dimer was higher with increasing age, female sex, diabetes, hypertension, pre-baseline cardiovascular disease and higher C-reactive protein (CRP). Accounting for cardiovascular risk factors, each doubling of D-dimer was associated with increased stroke (hazard ratio [HR] 1.15; 95 % confidence interval [CI] 1.01, 1.31) and CHD (HR 1.27; 95 % CI 1.11, 1.45) risk. The difference in the HR between CHD and stroke was 0.20 (95 % CI >0.00, 0.58) for blacks and 0.02 (95 % CI -0.30, 0.27) for whites. CRP mediated 22 % (95 % CI 5 %, 41 %) of the association between D-dimer and CHD and none of the association with stroke. Higher D-dimer increased the risk of stroke and CHD independent of cardiovascular risk factors and CRP, with perhaps a stronger association for CHD versus stroke in blacks than whites. These findings highlight potential different pathophysiology of vascular disease by disease site and race suggesting potential further studies targeting haemostasis in primary prevention of vascular disease.

  13. Are urinary polyaromatic hydrocarbons associated with adult hypertension, heart attack, and cancer? USA NHANES, 2011-2012.

    Science.gov (United States)

    Shiue, Ivy

    2015-11-01

    Links between environmental chemicals and human health have emerged over the last few decades, but the effects from polyaromatic hydrocarbons were less studied, compared to other commonly known environmental chemicals such as heavy metals, phthalates, arsenic, phenols and pesticides. Therefore, it was aimed to study the relationships of urinary polyaromatic hydrocarbons and adult cardiovascular disease and cancer using human sample in a national and population-based study in recent years. Data was retrieved from US National Health and Nutrition Examination Surveys, 2011-2012, including demographics, self-reported health conditions and urinary polyaromatic hydrocarbons. Statistical analyses included chi-square test, t test, survey-weighted logistic regression modeling and population attributable risk (PAR) estimation. Of 5560 American adults aged 20-80 and included in the statistical analysis, urinary polyaromatic hydrocarbons (representatively in one-third sample) were observed to be higher in people with cardiovascular disease and total cancer. In particular, urinary 4-hydroxyphenanthrene was associated with hypertension (odds ratio (OR) 1.33, 95% confidence interval (CI) 1.00-1.76, P = 0.048, PAR 5.1%), urinary 1-hydroxypyrene was significantly associated with heart attack (OR 1.47, 95%CI 1.05-2.06, P = 0.027, PAR 1.7%), and urinary 2-hydroxynapthalene (2-naphthol) was associated with cancer (OR 1.46, 95%CI 1.12-1.90, P = 0.008, PAR 3.9%). Urinary polyaromatic hydrocarbons were associated with adult hypertension, heart attack and cancer, although the causality cannot be established. From the research perspective, future studies with a longitudinal or experimental approach would be suggested. From the law and public health perspectives, regulation on minimizing exposure to polyaromatic hydrocarbons might need to be considered in future health and environmental policies and intervention programs.

  14. Electrocardiographic measures of left ventricular hypertrophy in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.

    Science.gov (United States)

    Ernst, Michael E; Davis, Barry R; Soliman, Elsayed Z; Prineas, Ronald J; Okin, Peter M; Ghosh, Alokananda; Cushman, William C; Einhorn, Paula T; Oparil, Suzanne; Grimm, Richard H

    2016-12-01

    Left ventricular hypertrophy (LVH) predicts cardiovascular risk in hypertensive patients. We analyzed baseline/follow-up electrocardiographies in 26,376 Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial participants randomized to amlodipine (A), lisinopril (L), or chlorthalidone (C). Prevalent/incident LVH was examined using continuous and categorical classifications of Cornell voltage. At 2 and 4 years, prevalence of LVH in the C group (5.57%; 6.14%) was not statistically different from A group (2 years: 5.47%; P = .806, 4 years: 6.54%; P = .857) or L group (2 years: 5.64%; P = .857, 4 years: 6.50%; P = .430). Incident LVH followed similarly, with no difference at 2 years for C (2.99%) compared to A (2.57%; P = .173) or L (3.16%; P = .605) and at 4 years (C = 3.52%, A = 3.29%, L = 3.71%; P = .521 C vs. A, P = .618 C vs. L). Mean Cornell voltage decreased comparably across treatment groups (Δ baseline, 2 years = +3 to -27 μV, analysis of variance P = .8612; 4 years = +10 to -17 μV, analysis of variance P = .9692). We conclude that risk reductions associated with C treatment in secondary end points of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial cannot be attributed to differential improvements in electrocardiography LVH. Copyright © 2016 American Society of Hypertension. All rights reserved.

  15. Long working hours and risk of coronary heart disease and stroke

    DEFF Research Database (Denmark)

    Kivimäki, Mika; Jokela, Markus; Nyberg, Solja T

    2015-01-01

    -response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrendEmployees who work......, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working......BACKGROUND: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. METHODS: We...

  16. Early Menopause Predicts Future Coronary Heart Disease and Stroke: The Multi-Ethnic Study of Atherosclerosis (MESA)

    Science.gov (United States)

    Wellons, Melissa; Ouyang, Pamela; Schreiner, Pamela J; Herrington, David M; Vaidya, Dhananjay

    2012-01-01

    Objective Cardiovascular disease is the number one killer of women. Identifying women at risk of cardiovascular disease has tremendous public health importance. Early menopause is associated with increased cardiovascular disease events in some predominantly white populations, but not consistently. Our objective was to determine if a self-reported early menopause (menopause at an age menopause (either natural menopause or surgical removal of ovaries at an age menopause. In survival curves, women with early menopause had worse coronary heart disease and stroke-free survival (log rank p=menopause is positively associated with coronary heart disease and stroke in a multiethnic cohort, independent of traditional cardiovascular disease risk factors. PMID:22692332

  17. Safety and efficacy of intensive vs. guideline antiplatelet therapy in high-risk patients with recent ischemic stroke or transient ischemic attack

    DEFF Research Database (Denmark)

    Christensen, Hanne Krarup

    2015-01-01

    the safety and efficacy of intensive (combined aspirin, clopidogrel, and dipyridamole) vs. guideline antiplatelet therapy, both given for one-month. This international collaborative parallel-group prospective randomized open-label blinded-end-point phase III trial plans to recruit 4100 patients with acute...... ischemic stroke or transient ischemic attack. Randomization and data collection are performed over a secure Internet site with real-time data validation and concealment of allocation. Outcomes, serious adverse events, and neuroimaging are adjudicated centrally with blinding to treatment allocation. STUDY...... OUTCOME: The primary outcome is stroke recurrence and its severity ('ordinal recurrence' based on modified Rankin Scale) at 90 days, with masked assessment centrally by telephone. Secondary outcomes include vascular events, functional measures (disability, mood, cognition, quality of life), and safety...

  18. Should Antihypertensive Treatment Recommendations Differ in Patients With and Without Coronary Heart Disease? (from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial [ALLHAT]).

    Science.gov (United States)

    Alderman, Michael H; Davis, Barry R; Piller, Linda B; Ford, Charles E; Baraniuk, M Sarah; Pressel, Sara L; Assadi, Mahshid A; Einhorn, Paula T; Haywood, L Julian; Ilamathi, Ekambaram; Oparil, Suzanne; Retta, Tamrat M

    2016-01-01

    Thiazide-type diuretics have been recommended for initial treatment of hypertension in most patients, but should this recommendation differ for patients with and without coronary heart disease (CHD)? The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized, double-blind hypertension treatment trial in 42,418 participants with high risk of combined cardiovascular disease (CVD) (25% with preexisting CHD). This post hoc analysis compares long-term major clinical outcomes in those assigned amlodipine (n = 9048) or lisinopril (n = 9,054) with those assigned chlorthalidone (n = 15,255), stratified by CHD status. After 4 to 8 years, randomized treatment was discontinued. Total follow-up (active treatment + passive surveillance using national databases for deaths and hospitalizations) was 8 to 13 years. For most CVD outcomes, end-stage renal disease, and total mortality, there were no differences across randomized treatment arms regardless of baseline CHD status. In-trial rates of CVD were significantly higher for lisinopril compared with chlorthalidone, and rates of heart failure were significantly higher for amlodipine compared with chlorthalidone in those with and without CHD (overall hazard ratios [HRs] 1.10, p heart failure in amlodipine compared with chlorthalidone (HR 1.12; p = 0.01) during extended follow-up did not differ by baseline CHD status. In conclusion, these results provide no reason to alter our previous recommendation to include a properly dosed diuretic (such as chlorthalidone 12.5 to 25 mg/day) in the initial antihypertensive regimen for most hypertensive patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. The magnitude and course of exercise-induced stroke volume changes determine the exercise tolerance in heart transplant recipients with heart failure and normal ejection fraction

    Czech Academy of Sciences Publication Activity Database

    Meluzín, J.; Hude, P.; Leinveber, P.; Jurák, Pavel; Soukup, L.; Viščor, Ivo; Špinarová, L.; Štěpánová, R.; Podroužková, H.; Vondra, Vlastimil; Langer, P.; Němec, P.

    2014-01-01

    Roč. 20, č. 1 (2014), s. 674-687 ISSN 1205-6626 R&D Projects: GA MŠk(CZ) LO1212 Keywords : heart failure * stroke volume index * exercise tolerance * bioimpedance Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 0.758, year: 2013

  20. Heart Lesion After the First Attack of the Rheumatic Fever 22 Years Experience in Single Centre

    OpenAIRE

    Bejiqi, Ramush A.; Retkoceri, Ragip; Zeka, Naim; Bejiqi, Hana; Retkoceri, Arber

    2015-01-01

    Background: Acute rheumatic fever and its sequels, rheumatic heart diseases, remain major unsolved preventable health problems in Kosovo population, particularly among the disadvantages indigenous Albanian and Egyptians people. In Kosovo, despite of performing secondary prophylaxis with benzathine penicillin, acute rheumatic fever hospitalization rates have remained essentially unchanged for the last 20 years. The role of echocardiography in the diagnosis of acute rheumatic carditis was estab...

  1. Sex Differences in the Association Between Insulin Resistance and Incident Coronary Heart Disease and Stroke Among Blacks Without Diabetes Mellitus: The Jackson Heart Study.

    Science.gov (United States)

    Effoe, Valery S; Wagenknecht, Lynne E; Echouffo Tcheugui, Justin B; Chen, Haiying; Joseph, Joshua J; Kalyani, Rita R; Bell, Ronny A; Wu, Wen-Chih H; Casanova, Ramon; Bertoni, Alain G

    2017-02-02

    Studies exploring the association between insulin resistance (IR) and cardiovascular disease in blacks have not been conclusive, especially for coronary heart disease (CHD). The McAuley index and homeostasis model assessment of IR (HOMA-IR) perform differently in predicting cardiovascular disease. We investigated this association in the Jackson Heart Study, a large longitudinal cohort of blacks. IR was estimated for 3565 participants without diabetes mellitus and cardiovascular disease at baseline using the McAuley index and HOMA-IR, and their associations with incident CHD and stroke (composite outcome) were compared. A lower McAuley index and higher HOMA-IR are indicative of IR. Cox regression analysis was used to estimate adjusted hazard ratios for incident CHD and/or stroke. There were 158 events (89 CHD-only, 58 stroke-only, and 11 CHD/stroke) over a median follow-up of 8.4 years. After adjustment for demographic factors, the risk of the composite outcome decreased with each SD increase in the McAuley index (hazard ratio 0.80; 95% CI: 0.67-0.96), with no attenuation after further accounting for CHD and stroke risk factors. When considered individually, McAuley index and HOMA-IR were associated with CHD (hazard ratio 0.71, 95% CI: 0.55-0.92 and hazard ratio 1.33, 95% CI: 1.03-1.72, respectively), but not stroke risk. The logHOMA-IR and CHD association was present in men, but not in women (P interaction =0.01). Both HOMA-IR and the McAuley index demonstrate strong associations with CHD but not stroke risk in blacks. The logHOMA-IR and CHD association was present in men, but not in women. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  2. Vertebrobasilar Flow Evaluation and Risk of Transient Ischaemic Attack and Stroke study (VERiTAS): rationale and design

    NARCIS (Netherlands)

    Amin-Hanjani, Sepideh; Rose-Finnell, Linda; Richardson, DeJuran; Ruland, Sean; Pandey, Dilip; Thulborn, Keith R.; Liebeskind, David S.; Zipfel, Gregory J.; Elkind, Mitchell S. V.; Kramer, Jeffrey; Silver, Frank L.; Kasner, Scott E.; Caplan, Louis R.; Derdeyn, Colin P.; Gorelick, Philip B.; Charbel, Fady T.; Jacobs, Tom P.; Xie, Hui; Simkus, Vic; Thulborn, Keith; Flannery, Michael P.; Ganin, Hagai; Grysecwicz, Rebecca; Khaja, Aslam; Pedelty, Laura; Testai, Fernando; Watson, Karriem; Mlinarevich, Nada; Vo, Katie; Foster, Glenn; Ford, Andria; Bradley, Abbie; Alger, Jeffrey; Godinez, Sergio; Saver, Jeffrey; Ali, Latisha; Kim, Doojin; Raychev, Radoslav; Song, Sarah; Ovbiagele, Bruce; Smith, Hannah; Hirsch, Joy; Dashnaw, Stephen; Meyers, Philip; McNeill-Simaan, Edwina; Mikulis, David; Fierstra, Jorn; Hlasny, Eugen; Casaubon, Leanne K.; Vergouwen, Mervyn; Martin del Campo, J. C.; Jaigobin, Cheryl S.; Astorga, Cherissa; Vaughan, Susan; Owens, Laura; Pandey, Dilip K.; Ruland, Sean D.; Kissela, Brett; Turan, Tanya N.; Gobin, Y. Pierre

    2010-01-01

    BACKGROUND: Over one-third of ischaemic strokes occur in the posterior circulation, and a leading cause is atherosclerotic vertebrobasilar disease. Symptomatic vertebrobasilar disease carries a high annual recurrent stroke risk, averaging 10-15% per year. Endovascular angioplasty and stenting are

  3. Depressive disorder, coronary heart disease, and stroke: dose-response and reverse causation effects in the Whitehall II cohort study.

    Science.gov (United States)

    Brunner, Eric J; Shipley, Martin J; Britton, Annie R; Stansfeld, Stephen A; Heuschmann, Peter U; Rudd, Anthony G; Wolfe, Charles D A; Singh-Manoux, Archana; Kivimaki, Mika

    2014-03-01

    Systematic reviews examining associations of depressive disorder with coronary heart disease and stroke produce mixed results. Failure to consider reverse causation and dose-response patterns may have caused inconsistencies in evidence. This prospective cohort study on depressive disorder, coronary heart disease, and stroke analysed reverse causation and dose-response effects using four 5-year and three 10-year observation cycles (total follow up 24 years) based on multiple repeat measures of exposure. Participants in the Whitehall II study (n = 10,036, 31,395 person-observations, age at start 44.4 years) provided up to six repeat measures of depressive symptoms via the 30-item General Health Questionnaire (GHQ-30) and one measure via Center for Epidemiologic Studies Depression Scale (CES-D). The cohort was followed up for major coronary events (coronary death/nonfatal myocardial infarction) and stroke (stroke death/morbidity) through the national mortality register Hospital Episode Statistics, ECG-screening, medical records, and self-report questionnaires. GHQ-30 caseness predicted stroke over 0-5 years (age-, sex- and ethnicity-adjusted HR 1.60, 95% CI 1.1-2.3) but not over 5-10 years (HR 0.94, 95% CI 0.6-1.4). Using the last 5-year observation cycle, cumulative GHQ-30 caseness was associated with incident coronary heart disease in a dose-response manner (1-2 times a case: HR 1.12, 95% CI 0.7-1.7; 3-4 times: HR 2.06, 95% CI 1.2-3.7), and CES-D caseness predicted coronary heart disease (HR 1.81, 95% CI 1.1-3.1). There was evidence of a dose-response effect of depressive symptoms on risk of coronary heart disease. In contrast, prospective associations of depressive symptoms with stroke appeared to arise wholly or partly through reverse causation.

  4. Stroke in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

    Greve, Anders Møller; Dalsgaard, Morten; Bang, Casper N

    2014-01-01

    , and poststroke survival a secondary outcome. Cox models treating AVR as a time-varying covariate were adjusted for atrial fibrillation and congestive heart failure, hypertension, age≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years and female sex (CHA2DS2-VASc...

  5. Treatment-resistant hypertension and the incidence of cardiovascular disease and end-stage renal disease: results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).

    Science.gov (United States)

    Muntner, Paul; Davis, Barry R; Cushman, William C; Bangalore, Sripal; Calhoun, David A; Pressel, Sara L; Black, Henry R; Kostis, John B; Probstfield, Jeffrey L; Whelton, Paul K; Rahman, Mahboob

    2014-11-01

    Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of ≥3 antihypertensive medication classes or controlled hypertension while treated with ≥4 antihypertensive medication classes. Although a high prevalence of aTRH has been reported, few data are available on its association with cardiovascular and renal outcomes. We analyzed data on 14 684 Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants to determine the association between aTRH (n=1870) with coronary heart disease, stroke, all-cause mortality, heart failure, peripheral artery disease, and end-stage renal disease. We defined aTRH as blood pressure not at goal (systolic/diastolic blood pressure ≥140/90 mm Hg) while taking ≥3 classes of antihypertensive medication or taking ≥4 classes of antihypertensive medication with blood pressure at goal during the year 2 ALLHAT study visit (1996-2000). Use of a diuretic was not required to meet the definition of aTRH. Follow-up occurred through 2002. The multivariable adjusted hazard ratios (95% confidence intervals) comparing participants with versus without aTRH were as follows: coronary heart disease (1.44 [1.18-1.76]), stroke (1.57 [1.18-2.08]), all-cause mortality (1.30 [1.11-1.52]), heart failure (1.88 [1.52-2.34]), peripheral artery disease (1.23 [0.85-1.79]), and end-stage renal disease (1.95 [1.11-3.41]). aTRH was also associated with the pooled outcomes of combined coronary heart disease (hazard ratio, 1.47; 95% confidence interval, 1.26-1.71) and combined cardiovascular disease (hazard ratio, 1.46; 95% confidence interval, 1.29-1.64). These results demonstrate that aTRH increases the risk for cardiovascular disease and end-stage renal disease. Studies are needed to identify approaches to prevent aTRH and reduce risk for adverse outcomes among individuals with aTRH. © 2014 American Heart Association, Inc.

  6. CHARACTERISTICS OF PATIENTS WITH CEREBRAL STROKE OR TRANSIENT ISCHEMIC ATTACK, INCLUDED INTO THE LIS-2 REGISTER (LYUBERTSY STUDY OF MORTALITY IN PATIENTS AFTER STROKE

    Directory of Open Access Journals (Sweden)

    S. Yu. Martsevich

    2015-01-01

    Full Text Available Aim. To provide final data on the three-year period of the inclusion of patients; to give most accurate "portrait" of patients hospitalized with a brain stroke within the framework of the LIS-2 register (Lyubertsy study of mortality in patients after stroke.Material and methods. All patients (n=960 admitted to the Lyubertsy district hospital №2 with stroke for the period from 01.2009 to 12.2011 were included into the study.Results. Men accounted for 37.5%, women - 62.5%, mean age was 71.1±9.8 years. The history of hypertension was present in 833 patients (86.8%, atrial fibrillation in 252 (26.8% patients, 199 (20.7% patients had previously undergone stroke. In-hospital mortality was 21.6% (207 patients had died; mean age 72.9±9.8 years. Low frequency of the antihypertensive therapy (34.5%, lipid-lowering therapy (0.7%, antiplatelet agents (5.7%, anticoagulation therapy prescription in patients with atrial fibrillation was detected.Conclusion. Insufficient assignment of drugs with a proven effect on the prognosis in patients with risk factors prior to the development of the reference stroke draws attention. High incidence of recurrent strokes indicates an underactive secondary prevention.

  7. Serious as a heart attack: health-related content of late-night comedy television.

    Science.gov (United States)

    Compton, Josh

    2006-01-01

    Although the medical community hoped that Vice President Dick Cheney's public experiences with heart problems and subsequent treatments would serve to raise awareness, educate the public about heart disease and treatment options, and showcase advances in cardiac care, late-night comedians saw Cheney's health problems as joke fodder. Comedians like Jay Leno, David Letterman, and Conan O'Brien ridiculed Cheney in their monologues, suggesting the vice president was frail, weak, and near death-certainly not a "poster boy" for contemporary cardiac care. This investigation presents a textual analysis of late-night comedy monologue jokes from July 25, 2000, to October 7, 2003. The themes that emerge in the jokes include Cheney's infirmity, his questionable fitness for office, and ridicule for his state-of-the-art defibrillator. Implications of health-related content in late-night comedy programs are offered, including the potential impacts on health knowledge and attitudes toward illness. This study takes an important step toward understanding health messages in an unconventional yet powerful media venue.

  8. Heart Health - Brave Heart

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Cover Story Heart Health Brave Heart Past Issues / Winter 2009 Table of Contents For ... you can have a good life after a heart attack." Lifestyle Changes Surviving—and thriving—after such ...

  9. Short-term effects of ambient particulates and gaseous pollutants on the incidence of transient ischaemic attack and minor stroke: a case-crossover study

    Directory of Open Access Journals (Sweden)

    Bedada Getahun

    2012-10-01

    Full Text Available Abstract Background While several studies have investigated the effects of short-term air pollution on cardiovascular disease, less is known about its effects on cerebrovascular disease, including stroke and transient ischaemic attack (TIA. The aim of the study was to assess the effects of short-term variation in air pollutants on the onset of TIA and minor stroke. Methods We performed secondary analyses of data collected prospectively in the North West of England in a multi-centre study (NORTHSTAR of patients with recent TIA or minor stroke. A case - crossover study was conducted to determine the association between occurrence of TIA and the concentration of ambient PM10 or gaseous pollutants. Results A total of 709 cases were recruited from the Manchester (n = 335 and Liverpool (n = 374 areas. Data for the Manchester cohort showed an association between ambient nitric oxide (NO and risk of occurrence of TIA and minor stroke with a lag of 3 days (odds ratio 1.06, 95% CI: 1.01 – 1.11, whereas negative association was found for the patients from Liverpool. Effects of similar magnitude, although not statistically significant, were generally observed with other pollutants. In a two pollutant model the effect of NO remained stronger and statistically significant when analysed in combination with CO or SO2, but was marginal in combination with NO2 or ozone and non-significant with PM10. There was evidence of effect modification by age, gender and season. Conclusions Our data suggest an association between NO and occurrence of TIA and minor stroke in Greater Manchester.

  10. Preliminary investigation of cardiopulmonary function in stroke patients with stable heart failure and exertional dyspnea

    Science.gov (United States)

    Liaw, Mei-Yun; Wang, Lin-Yi; Pong, Ya-Ping; Tsai, Yu-Chin; Huang, Yu-Chi; Yang, Tsung-Hsun; Lin, Meng-Chih

    2016-01-01

    Abstract The aim of this study was to investigate the relationships between pulmonary function, respiratory muscle strength, perceived dyspnea, degree of fatigue, and activity of daily living with motor function and neurological status in stroke patients with stable congestive heart failure (CHF). This was a cohort study in a tertiary care medical center. Stroke patients with CHF and exertional dyspnea (New York Heart Association class I–III) were recruited. The baseline characteristics included duration of disease, Brunnstrom stage, spirometry, resting heart rate, resting oxyhemoglobin saturation (SpO2), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), Borg scale, fatigue scale, and Barthel index. A total of 47 stroke patients (24 males, 23 females, mean age 65.9 ± 11.5 years) were included. The average Brunnstrom stages of affected limbs were 3.6 ± 1.3 over the proximal parts and 3.5 ± 1.4 over the distal parts of upper limbs, and 3.9 ± 0.9 over lower limbs. The average forced vital capacity (FVC) was 2.0 ± 0.8 L, with a predicted FVC% of 67.9 ± 18.8%, forced expiratory volume in the first second (FEV1) of 1.6 ± 0.7 L, predicted FEV1% of 70.6 ± 20.1%, FEV1/FVC of 84.2 ± 10.5%, and maximum mid-expiratory flow of 65.4 ± 29.5%. The average MIP and MEP were −52.9 ± 33.3 cmH2O and 60.8 ± 29.0 cmH2O, respectively. The Borg scale was 1.5 ± 0.8. MIP was negatively associated with the average Brunnstrom stage of the proximal (r = −0.318, P lower extremities (r = −0.288, P lower extremities (r = −0.311, P limbs. FVC was more strongly associated with MIP and MEP than predicted FVC%. FEV1/FVC may be used as a reference for the pulmonary dysfunction. PMID:27749577

  11. Dairy Intake and Coronary Heart Disease or Stroke – a population-based cohort study in the Netherlands

    NARCIS (Netherlands)

    Dalmeijer, G.W.; Struijk, E.A.; Schouw, van der Y.T.; Soedamah-Muthu, S.S.; Verschuren, W.M.M.; Geleijnse, J.M.

    2013-01-01

    AIM: This study aimed to investigate the relationship between total dairy intake and dairy subtypes (high-fat dairy, low-fat dairy, milk and milk products, cheese and fermented dairy) with incident coronary heart disease (CHD) and stroke. METHODS: EPIC-NL is a prospective cohort study among 33,625

  12. Prevalence of electrocardiographic ST-T changes during acute ischemic stroke in patients without known ischemic heart disease

    DEFF Research Database (Denmark)

    Jensen, Jesper K; Bak, Søren; Flemming Høilund-Carlsen, Poul

    2008-01-01

    We evaluated characteristics and prevalence of ST-segment depression and/or T-wave inversion in the resting electrocardiogram of 244 consecutive patients with acute ischemic stroke, but without ischemic heart disease. The prevalence of ST-T changes ranged from 13% to 16% and this is what to expect...

  13. Health Gain through Screening--Coronary Heart Disease and Stroke: Developing Primary Health Care Services for People with Intellectual Disability.

    Science.gov (United States)

    Wells, M. B.; Turner, S.; Martin, D. M.; Roy, A.

    1997-01-01

    A study of 120 British adults with intellectual disability found they had higher risk factors of developing coronary heart disease and stroke than the general population. There was a greater incidence of obesity and considerably lower physical activity levels than the general population. Several also had abnormal cholesterol readings. (CR)

  14. Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF.

    Science.gov (United States)

    Hankey, Graeme J; Patel, Manesh R; Stevens, Susanna R; Becker, Richard C; Breithardt, Günter; Carolei, Antonio; Diener, Hans-Christoph; Donnan, Geoffrey A; Halperin, Jonathan L; Mahaffey, Kenneth W; Mas, Jean-Louis; Massaro, Ayrton; Norrving, Bo; Nessel, Christopher C; Paolini, John F; Roine, Risto O; Singer, Daniel E; Wong, Lawrence; Califf, Robert M; Fox, Keith A A; Hacke, Werner

    2012-04-01

    In ROCKET AF, rivaroxaban was non-inferior to adjusted-dose warfarin in preventing stroke or systemic embolism among patients with atrial fibrillation (AF). We aimed to investigate whether the efficacy and safety of rivaroxaban compared with warfarin is consistent among the subgroups of patients with and without previous stroke or transient ischaemic attack (TIA). In ROCKET AF, patients with AF who were at increased risk of stroke were randomly assigned (1:1) in a double-blind manner to rivaroxaban 20 mg daily or adjusted dose warfarin (international normalised ratio 2·0-3·0). Patients and investigators were masked to treatment allocation. Between Dec 18, 2006, and June 17, 2009, 14 264 patients from 1178 centres in 45 countries were randomly assigned. The primary endpoint was the composite of stroke or non-CNS systemic embolism. In this substudy we assessed the interaction of the treatment effects of rivaroxaban and warfarin among patients with and without previous stroke or TIA. Efficacy analyses were by intention to treat and safety analyses were done in the on-treatment population. ROCKET AF is registered with ClinicalTrials.gov, number NCT00403767. 7468 (52%) patients had a previous stroke (n=4907) or TIA (n=2561) and 6796 (48%) had no previous stroke or TIA. The number of events per 100 person-years for the primary endpoint in patients treated with rivaroxaban compared with warfarin was consistent among patients with previous stroke or TIA (2·79% rivaroxaban vs 2·96% warfarin; hazard ratio [HR] 0·94, 95% CI 0·77-1·16) and those without (1·44%vs 1·88%; 0·77, 0·58-1·01; interaction p=0·23). The number of major and non-major clinically relevant bleeding events per 100 person-years in patients treated with rivaroxaban compared with warfarin was consistent among patients with previous stroke or TIA (13·31% rivaroxaban vs 13·87% warfarin; HR 0·96, 95% CI 0·87-1·07) and those without (16·69%vs 15·19%; 1·10, 0·99-1·21; interaction p=0·08

  15. Association of Breakfast Intake With Incident Stroke and Coronary Heart Disease: The Japan Public Health Center-Based Study.

    Science.gov (United States)

    Kubota, Yasuhiko; Iso, Hiroyasu; Sawada, Norie; Tsugane, Shoichiro

    2016-02-01

    The association between breakfast intake and the risk of cardiovascular disease, including stroke, among Asian people remains unknown. We sought to prospectively investigate whether the omission of breakfast is related to increased risks of stroke and coronary heart disease in general Japanese populations. A total of 82,772 participants (38,676 men and 44,096 women) aged 45 to 74 years without histories of cardiovascular disease or cancer were followed up from 1995 to 2010. Participants were classified as having breakfast 0 to 2, 3 to 4, 5 to 6, or 7 times/wk. The hazard ratios of cardiovascular disease were estimated using Cox proportional hazards models. During the 1 050 030 person-years of follow-up, we documented a total of 4642 incident cases, 3772 strokes (1051 cerebral hemorrhages, 417 subarachnoid hemorrhages, and 2286 cerebral infarctions), and 870 coronary heart disease. Multivariable analysis showed that those consuming no breakfast per week compared with those consuming breakfast everyday had hazard ratios (95% confidence interval; P for trend) of 1.14 (1.01-1.27; 0.013) for total cardiovascular disease, 1.18 (1.04-1.34; 0.007) for total stroke, and 1.36 (1.10-1.70; 0.004) for cerebral hemorrhage. Similar results were observed even after exclusion of early cardiovascular events. No significant association between the frequency of breakfast intake and the risk of coronary heart disease was observed. The frequency of breakfast intake was inversely associated with the risk of stroke, especially cerebral hemorrhage in Japanese, suggesting that eating breakfast everyday may be beneficial for the prevention of stroke. © 2016 American Heart Association, Inc.

  16. Antiplatelet therapy and the effects of B vitamins in patients with previous stroke or transient ischaemic attack: a post-hoc subanalysis of VITATOPS, a randomised, placebo-controlled trial.

    Science.gov (United States)

    Hankey, Graeme J; Eikelboom, John W; Yi, Qilong; Lees, Kennedy R; Chen, Christopher; Xavier, Denis; Navarro, Jose C; Ranawaka, Udaya K; Uddin, Wasim; Ricci, Stefano; Gommans, John; Schmidt, Reinhold

    2012-06-01

    Previous studies have suggested that any benefits of folic acid-based therapy to lower serum homocysteine in prevention of cardiovascular events might be offset by concomitant use of antiplatelet therapy. We aimed to establish whether there is an interaction between antiplatelet therapy and the effects of folic acid-based homocysteine-lowering therapy on major vascular events in patients with stroke or transient ischaemic attack enrolled in the vitamins to prevent stroke (VITATOPS) trial. In the VITATOPS trial, 8164 patients with recent stroke or transient ischaemic attack were randomly allocated to double-blind treatment with one tablet daily of placebo or B vitamins (2 mg folic acid, 25 mg vitamin B(6), and 500 μg vitamin B(12)) and followed up for a median 3·4 years (IQR 2·0-5·5) for the primary composite outcome of stroke, myocardial infarction, or death from vascular causes. In our post-hoc analysis of the interaction between antiplatelet therapy and the effects of treatment with B vitamins on the primary outcome, we used Cox proportional hazards regression before and after adjusting for imbalances in baseline prognostic factors in participants who were and were not taking antiplatelet drugs at baseline and in participants assigned to receive B vitamins or placebo. We also assessed the interaction in different subgroups of patients and different secondary outcomes. The VITATOPS trial is registered with ClinicalTrials.gov, number NCT00097669, and Current Controlled Trials, number ISRCTN74743444. At baseline, 6609 patients were taking antiplatelet therapy and 1463 were not. Patients not receiving antiplatelet therapy were more likely to be younger, east Asian, and disabled, to have a haemorrhagic stroke or cardioembolic ischaemic stroke, and to have a history of hypertension or atrial fibrillation. They were less likely to be smokers and to have a history of peripheral artery disease, hypercholesterolaemia, diabetes, ischaemic heart disease, and a

  17. Stroke

    Science.gov (United States)

    ... adjust your treatment as needed. Rehabilitation After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists. Language, ... may have trouble communicating after a stroke. You may not be able to find the ...

  18. Part 11: adult stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

    Science.gov (United States)

    Jauch, Edward C; Cucchiara, Brett; Adeoye, Opeolu; Meurer, William; Brice, Jane; Chan, Yvonne Yu-Feng; Gentile, Nina; Hazinski, Mary Fran

    2010-11-02

    Advances in stroke care will have the greatest effect on stroke outcome if care is delivered within a regional stroke system designed to improve both efficiency and effectiveness. The ultimate goal of stroke care is to minimize ongoing injury, emergently recanalize acute vascular occlusions, and begin secondary measures to maximize functional recovery. These efforts will provide stroke patients with the greatest opportunity for a return to previous quality of life and decrease the overall societal burden of stroke.

  19. Heart healthy and stroke free: successful business strategies to prevent cardiovascular disease.

    Science.gov (United States)

    Matson Koffman, Dyann M; Goetzel, Ron Z; Anwuri, Victoria V; Shore, Karen K; Orenstein, Diane; LaPier, Timothy

    2005-12-01

    Heart disease and stroke, the principal components of cardiovascular disease (CVD), are the first and third leading causes of death in the United States. In 2002, employers representing 88 companies in the United States paid an average of 18,618 dollars per employee for health and productivity-related costs. A sizable portion of these costs are related to CVD. Employers can yield a 3 dollar to 6 dollar return on investment for each dollar invested over a 2 to 5 year period and improve employee cardiovascular health by investing in comprehensive worksite health-promotion programs, and by choosing health plans that provide adequate coverage and support for essential preventive services. The most effective interventions in worksites are those that provide sustained individual follow-up risk factor education and counseling and other interventions within the context of a comprehensive health-promotion program: (1) screening, health risk assessments, and referrals; (2) environmental supports for behavior change (e.g., access to healthy food choices); (3) financial and other incentives; and (4) corporate policies that support healthy lifestyles (e.g., tobacco-free policies). The most effective practices in healthcare settings include systems that use (1) standardized treatment and prevention protocols consistent with national guidelines, (2) multidisciplinary clinical care teams to deliver quality patient care, (3) clinics that specialize in treating/preventing risk factors, (4) physician and patient reminders, and (5) electronic medical records. Comprehensive worksite health-promotion programs, health plans that cover preventive benefits, and effective healthcare systems will have the greatest impact on heart disease and stroke and are likely to reduce employers' health and productivity-related costs.

  20. Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED).

    Science.gov (United States)

    Towfighi, Amytis; Cheng, Eric M; Ayala-Rivera, Monica; McCreath, Heather; Sanossian, Nerses; Dutta, Tara; Mehta, Bijal; Bryg, Robert; Rao, Neal; Song, Shlee; Razmara, Ali; Ramirez, Magaly; Sivers-Teixeira, Theresa; Tran, Jamie; Mojarro-Huang, Elizabeth; Montoya, Ana; Corrales, Marilyn; Martinez, Beatrice; Willis, Phyllis; Macias, Mireya; Ibrahim, Nancy; Wu, Shinyi; Wacksman, Jeremy; Haber, Hilary; Richards, Adam; Barry, Frances; Hill, Valerie; Mittman, Brian; Cunningham, William; Liu, Honghu; Ganz, David A; Factor, Diane; Vickrey, Barbara G

    2017-02-06

    Recurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population. In this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP control of other vascular risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial

  1. Evaluation of heart attack by cardiac magnetic resonance and its association with collateral circulation

    International Nuclear Information System (INIS)

    Lluberas, N.; Mila, R.; Parma, G.; Florio, L.; Vignolo, G.; Trujillo, P.; Lluberas, R.

    2013-01-01

    Full text: It is known that infarct size depends on the magnitude of the area at risk (territory irrigation culprit vessel), ischemic time and presence of collateral circulation. MRI Heart (RMC) has high accuracy in estimating infarct area. To study the relationship between the presence of collateral circulation and infarct size assessed by RMC. 38 patients were included with STEMI reperfused medianteATC primary (34 above) those who had made an RMC in the acute phase (<30 days). Collateral circulation graduated as the classification Rentrop Quantification of delayed enhancement (mass of myocardial infarction and% relative to VI) He performed with software by manually tracing RT areas. Microvascular obstruction (OMV) was defined as areas of low signal intensity within the necrotic tissue. They were compared RMC parameters between two groups: group No Collateral (n = 30) [Rentrop 0-1] vs group Yes Collaterals (n = 8) [Rentrop 2-3]. The mean age was 57 ± 14 years, 68% were women. 87% of patients with circulation collateral event had previous angina vs 28% no collaterals (p = 0.004). The main results em is the table. According to the international literature, the group of patients with collateral circulation to the artery responsible for AMI showed a smaller infarct size assessed both by release Enzymatic as RMC and OMV lesser extent. These findings highlight the importance of circulation collateral and validates our methodology to quantify infarct size for future studies research

  2. Imaging recommendations for acute stroke and transient ischemic attack patients: a joint statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery.

    Science.gov (United States)

    Wintermark, Max; Sanelli, Pina C; Albers, Gregory W; Bello, Jacqueline A; Derdeyn, Colin P; Hetts, Steven W; Johnson, Michele H; Kidwell, Chelsea S; Lev, Michael H; Liebeskind, David S; Rowley, Howard A; Schaefer, Pamela W; Sunshine, Jeffrey L; Zaharchuk, Greg; Meltzer, Carolyn C

    2013-11-01

    In the article entitled "Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients: A Joint Statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery", we are proposing a simple, pragmatic approach that will allow the reader to develop an optimal imaging algorithm for stroke patients at their institution. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  3. Assessment of stroke and concomitant cerebrovascular disease with heart disease requires invasive treatment: analysis of 249 consecutive patients with heart disease.

    Science.gov (United States)

    Kim, Myeong Jin; Song, Hyun; Oh, Se-Yang; Choi, Jai Ho; Kim, Bum-Soo; Kang, Joonkyu; Shin, Yong Sam

    2014-06-01

    The aim of this study was to analyze the relationships of cerebrovascular disease (CVD), heart problems, and stroke in patients who required an invasive cardiac procedure. We enrolled 249 consecutive patients who required to or underwent invasive cardiac treatment and divided into a non-CVD group (n = 116) and a CVD group (n = 133). The latter group was divided into a coronary artery disease (CAD) group (n = 118) and a non-CAD group such as cardiac structural lesions (n = 15). No significant relationship with significant cerebrovascular stenosis was observed in either the CADs or non-CADs. The incidence of past stroke was significantly higher in the CVD group than that in the non-CVD group (12.8 vs. 3.4%; p = 0.017). Previous stroke event had increased odds of having significant cerebrovascular stenosis (odds ratio, 3.919, p = 0.006). In patients with both cardiac disease and the CVD, perioperative stroke was only one case (0.9%). The main source of stroke was cardiogenic in the immediate results and cerebrovascular lesions in the delayed results (1-12 months). The risk of perioperative stroke was very low in combined cardiac disease and the CVD. However, for preventing ischemic stroke due to the predetected cerebrovascular lesions, precautionary efforts could be needed for patients undergoing an invasive cardiac procedure, and concomitant cerebrovascular lesions should be considered as main source of delayed ischemic stroke. Georg Thieme Verlag KG Stuttgart · New York.

  4. Long-Term Follow-up of Participants with Heart Failure in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

    Science.gov (United States)

    Piller, Linda B.; Baraniuk, Sarah; Simpson, Lara M.; Cushman, William C.; Massie, Barry M.; Einhorn, Paula T.; Oparil, Suzanne; Ford, Charles E.; Graumlich, James F.; Dart, Richard A.; Parish, David C.; Retta, Tamrat M.; Cuyjet, Aloysius B.; Jafri, Syed Z.; Furberg, Curt D.; Saklayen, Mohammad G.; Thadani, Udho; Probstfield, Jeffrey L.; Davis, Barry R.

    2011-01-01

    Background In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind, practice-based, active-control, comparative effectiveness trial in high-risk hypertensive participants, risk of new-onset heart failure (HF) was higher in the amlodipine (2.5-10 mg/day) and lisinopril (10-40 mg/day) arms compared with the chlorthalidone (12.5-25 mg/day) arm . Similar to other studies, mortality rates following new-onset HF were very high (≥50% at 5 years), and were similar across randomized treatment arms. After the randomized phase of the trial ended in 2002, outcomes were determined from administrative databases. Methods and Results Using national databases, post-trial follow-up mortality through 2006 was obtained on participants who developed new-onset HF during the randomized (in-trial) phase of ALLHAT. Mean follow-up for the entire period was 8.9 years. Of 1761 participants with incident HF in-trial, 1348 died. Post-HF all-cause mortality was similar across treatment groups with adjusted hazard ratios (95% confidence intervals) of 0.95 (0.81-1.12) and 1.05 (0.89-1.25), respectively, for amlodipine and lisinopril compared with chlorthalidone, and 10-year adjusted rates of 86%, 87%, and 83%, respectively. All-cause mortality rates were also similar among those with reduced ejection fractions (84%) and preserved ejection fractions (81%) with no significant differences by randomized treatment arm. Conclusions Once HF develops, risk of death is high and consistent across randomized treatment groups. Measures to prevent the development of HF, especially blood pressure control, must be a priority if mortality associated with development of HF is to be addressed. PMID:21969009

  5. Protocol for Past BP: a randomised controlled trial of different blood pressure targets for people with a history of stroke of transient ischaemic attack (TIA in primary care

    Directory of Open Access Journals (Sweden)

    Greenfield Sheila

    2010-08-01

    Full Text Available Abstract Background Blood pressure (BP lowering in people who have had a stroke or transient ischaemic attack (TIA leads to reduced risk of further stroke. However, it is not clear what the target BP should be, since intensification of therapy may lead to additional adverse effects. PAST BP will determine whether more intensive BP targets can be achieved in a primary care setting, and whether more intensive therapy is associated with adverse effects on quality of life. Methods/Design This is a randomised controlled trial (RCT in patients with a past history of stroke or TIA. Patients will be randomised to two groups and will either have their blood pressure (BP lowered intensively to a target of 130 mmHg systolic, (or by 10 mmHg if the baseline systolic pressure is between 125 and 140 mmHg compared to a standard group where the BP will be reduced to a target of 140 mmHg systolic. Patients will be managed by their practice at 1-3 month intervals depending on level of BP and followed-up by the research team at six monthly intervals for 12 months. 610 patients will be recruited from approximately 50 general practices. The following exclusion criteria will be applied: systolic BP The primary outcome will be change in systolic BP over twelve months. Secondary outcomes include quality of life, adverse events and cardiovascular events. In-depth interviews with 30 patients and 20 health care practitioners will be undertaken to investigate patient and healthcare professionals understanding and views of BP management. Discussion The results of this trial will inform whether intensive blood pressure targets can be achieved in people who have had a stroke or TIA in primary care, and help determine whether or not further research is required before recommending such targets for this population. Trial Registration ISRCTN29062286

  6. Atorvastatin treatment and carotid plaque morphology in first-ever atherosclerotic transient ischemic attack/stroke: a case-control study.

    Science.gov (United States)

    Marchione, Pasquale; Vento, Claudio; Morreale, Manuela; Izzo, Chiara; Maugeri, Andrea; Manuppella, Federica; Romeo, Tommaso; Giacomini, Patrizia

    2015-01-01

    A relationship between echolucency of carotid plaques and the consequent risk of ipsilateral ischemic stroke has been observed. An aggressive lipid-lowering therapy may increase the echogenicity of carotid plaque in patients with elevated low-density lipoprotein cholesterol levels. The aim of this study is to prospectively evaluate the long-term effect of high-dose atorvastatin on carotid plaque morphology in patients with first-ever transient ischemic attack or stroke. All patients with symptomatic first ischemic atherosclerotic cerebrovascular event occurred within the previous 10 days were enrolled. Carotid Doppler ultrasound of the neck vessels with 7-11 MHz probe for the definition of the atherosclerotic carotid framework was performed. The analysis of the gray-scale median (GSM) of each plate was carried out with image processing software. A total of 240 symptomatic plaques were included and divided into 3 groups: 80 in group A (atorvastatin 80 mg), 80 in group B (atorvastatin 40 mg), and 80 to group C (no atorvastatin). GSM score increases significantly more extensive in group A than in group B (+48.65 vs. +39.46, P < .02) and group C (+48.65 vs. 19.3, P = .0002). An inverse association between reduction of low-density lipoprotein and the increase in the GSM score (r = -.456, P = .007) has been observed. Moreover, the reduction of high-sensitive C-reactive protein correlates inversely with the increase of the GSM (r = -.398, P = .021). Dose-dependent effect of atorvastatin on symptomatic carotid plaque morphology may suggest a specific role of this drug in the atherosclerotic stroke prevention. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Do-not-resuscitate orders in patients hospitalized with acute myocardial infarction: the Worcester Heart Attack Study.

    Science.gov (United States)

    Jackson, Elizabeth A; Yarzebski, Jorge L; Goldberg, Robert J; Wheeler, Brownell; Gurwitz, Jerry H; Lessard, Darleen M; Bedell, Susanna E; Gore, Joel M

    2004-04-12

    Coronary heart disease is the leading cause of death in Americans. Despite increased interest in end-of-life care, data regarding the use of do-not-resuscitate (DNR) orders in acutely ill cardiac patients remain extremely limited. The objectives of this study were to describe use of DNR orders, treatment approaches, and hospital outcomes in patients with acute myocardial infarction. The study sample consisted of 4621 residents hospitalized with acute myocardial infarction at all metropolitan Worcester, Mass, area hospitals in five 1-year periods from 1991 to 1999. Significant increases in the use of DNR orders were observed during the study decade (from 16% in 1991 to 25% in 1999). The elderly, women, and patients with previous diabetes mellitus or stroke were more likely to have DNR orders. Patients with DNR orders were significantly less likely to be treated with effective cardiac medications, even if the DNR order occurred late in the hospital stay. Less than 1% of patients were noted to have DNR orders before hospital admission. Patients with DNR orders were significantly more likely to die during hospitalization than patients without DNR orders (44% vs 5%). The results of this community-wide study suggest increased use of DNR orders in patients hospitalized with acute myocardial infarction during the past decade. Use of certain cardiac therapies and hospital outcomes are different between patients with and without DNR orders. Further efforts are needed to characterize the use of DNR orders in patients with acute coronary disease.

  8. Family history and body mass index predict perceived risks of diabetes and heart attack among community-dwelling Caucasian, Filipino, Korean, and Latino Americans—DiLH Survey

    Science.gov (United States)

    Fukuoka, Yoshimi; Choi, JiWon; Bender, Melinda S.; Gonzalez, Prisila; Arai, Shoshana

    2015-01-01

    Aim The purpose of the study was to explore the perceived risk for diabetes and heart attack and associated health status of Caucasian, Filipino, Korean, and Latino Americans without diabetes. Methods A cross-sectional survey was conducted with 904 urban adults (mean age 44.3 ± 16.1 years; 64.3% female) in English, Spanish or Korean between August and December 2013. Results Perceived risk for developing diabetes was indicated by 46.5% (n = 421), and 14.3% (n = 129) perceived themselves to be at risk for having a heart attack in their lifetime. Significant predictors of pessimistic diabetes risk perceptions: Filipino (adjusted odds ratio [AOR] = 1.7; 95% CI: 1.04–2.86) and Korean (AOR = 2.4; 1.33–4.48) ethnicity, family history of diabetes (AOR = 1.4; 1.00–1.84), female gender (AOR = 1.4; 1.04–1.96), high cholesterol (AOR= 1.6; 1.09–2.37) and higher body mass index (BMI) (AOR = 1.1; 1.08–1.15). Predictors of pessimistic heart attack risk perceptions were family history of an early heart attack (AOR = 2.9; 1.69–5.02), high blood pressure (AOR = 2.4; 1.45–3.84), and higher BMI (AOR = 1.1; 1.04–1.12) after controlling for socio-demographic factors. Older age, physical inactivity, smoking, and low HDL levels were not associated with risk perceptions. Conclusion Multiple risk factors were predictive of greater perceived diabetes risk, whereas, only family history of heart attack, high blood pressure and increases in BMI significantly contributed to perceived risk of heart attack among ethnically diverse at risk middle-aged adults. It is important that healthcare providers address the discordance between an individual’s risk perceptions and the presence of actual risk factors. PMID:25931282

  9. Efficacy and Safety of Vorapaxar With and Without a Thienopyridine for Secondary Prevention in Patients With Previous Myocardial Infarction and No History of Stroke or Transient Ischemic Attack: Results from TRA 2°P-TIMI 50.

    Science.gov (United States)

    Bohula, Erin A; Aylward, Philip E; Bonaca, Marc P; Corbalan, Ramon L; Kiss, Robert G; Murphy, Sabina A; Scirica, Benjamin M; White, Harvey; Braunwald, Eugene; Morrow, David A

    2015-11-17

    Vorapaxar antagonizes protease-activated receptor 1, the primary receptor for thrombin on human platelets, and reduces recurrent thrombotic events in stable patients with a previous myocardial infarction (MI). We wished to determine whether the efficacy and safety of antiplatelet therapy with vorapaxar was modified by concurrent thienopyridine use. The Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-Thrombolysis in Myocardial Infarction 50 (TRA 2°P-TIMI 50) was a randomized, double-blind, placebo-controlled trial of vorapaxar in 26,449 patients with previous atherothrombosis. This prespecified analysis included 16,897 patients who qualified with a MI in the preceding 2 weeks to 12 months and was restricted to patients without a history of stroke or transient ischemic attack given its contraindication in that population. Randomization was stratified on the basis of planned thienopyridine use. Thienopyridine was planned at randomization in 12,410 (73%). Vorapaxar significantly reduced the composite of cardiovascular death, MI, and stroke in comparison with placebo regardless of planned thienopyridine therapy (planned thienopyridine, hazard ratio, 0.80, 0.70-0.91, PGlobal Use of Strategies to Open Occluded Coronary Arteries (GUSTO) moderate or severe bleeding risk was increased with vorapaxar and was not significantly altered by planned thienopyridine (planned, hazard ratio, 1.50; 1.18-1.89, Phistory of previous MI, whether treated concomitantly with a thienopyridine or not. The relative risk of moderate or severe bleeding was similarly increased irrespective of thienopyridine use. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00526474. © 2015 American Heart Association, Inc.

  10. Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Cruz-Flores, Salvador; Rabinstein, Alejandro; Biller, Jose; Elkind, Mitchell S V; Griffith, Patrick; Gorelick, Philip B; Howard, George; Leira, Enrique C; Morgenstern, Lewis B; Ovbiagele, Bruce; Peterson, Eric; Rosamond, Wayne; Trimble, Brian; Valderrama, Amy L

    2011-07-01

    Our goal is to describe the effect of race and ethnicity on stroke epidemiology, personal beliefs, access to care, response to treatment, and participation in clinical research. In addition, we seek to determine the state of knowledge on the main factors that may explain disparities in stroke care, with the goal of identifying gaps in knowledge to guide future research. The intended audience includes physicians, nurses, other healthcare professionals, and policy makers. Members of the writing group were appointed by the American Heart Association Stroke Council Scientific Statement Oversight Committee and represent different areas of expertise in relation to racial-ethnic disparities in stroke care. The writing group reviewed the relevant literature, with an emphasis on reports published since 1972. The statement was approved by the writing group; the statement underwent peer review, then was approved by the American Heart Association Science Advisory and Coordinating Committee. There are limitations in the definitions of racial and ethnic categories currently in use. For the purpose of this statement, we used the racial categories defined by the US federal government: white, black or African American, Asian, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander. There are 2 ethnic categories: people of Hispanic/Latino origin or not of Hispanic/Latino origin. There are differences in the distribution of the burden of risk factors, stroke incidence and prevalence, and stroke mortality among different racial and ethnic groups. In addition, there are disparities in stroke care between minority groups compared with whites. These disparities include lack of awareness of stroke symptoms and signs and lack of knowledge about the need for urgent treatment and the causal role of risk factors. There are also differences in attitudes, beliefs, and compliance among minorities compared with whites. Differences in socioeconomic status and insurance coverage

  11. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Towfighi, Amytis; Ovbiagele, Bruce; El Husseini, Nada; Hackett, Maree L; Jorge, Ricardo E; Kissela, Brett M; Mitchell, Pamela H; Skolarus, Lesli E; Whooley, Mary A; Williams, Linda S

    2017-02-01

    Poststroke depression (PSD) is common, affecting approximately one third of stroke survivors at any one time after stroke. Individuals with PSD are at a higher risk for suboptimal recovery, recurrent vascular events, poor quality of life, and mortality. Although PSD is prevalent, uncertainty remains regarding predisposing risk factors and optimal strategies for prevention and treatment. This is the first scientific statement from the American Heart Association on the topic of PSD. Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion. This multispecialty statement provides a comprehensive review of the current evidence and gaps in current knowledge of the epidemiology, pathophysiology, outcomes, management, and prevention of PSD, and provides implications for clinical practice. © 2016 American Heart Association, Inc.

  12. Performance of short ECG recordings twice daily to detect paroxysmal atrial fibrillation in stroke and transient ischemic attack patients

    DEFF Research Database (Denmark)

    Poulsen, Mai Bang; Binici, Zeynep; Domínguez, Helena

    2017-01-01

    Aims Prolonged cardiac monitoring after stroke is recommended though there is no consensus on optimal methods. Short-term ECG recordings with a "thumb-ECG" device have shown promising preliminary results regarding effectiveness and cost benefit. We aimed to examine the performance of thumb-ECG an...

  13. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Winstein, Carolee J; Stein, Joel; Arena, Ross; Bates, Barbara; Cherney, Leora R; Cramer, Steven C; Deruyter, Frank; Eng, Janice J; Fisher, Beth; Harvey, Richard L; Lang, Catherine E; MacKay-Lyons, Marilyn; Ottenbacher, Kenneth J; Pugh, Sue; Reeves, Mathew J; Richards, Lorie G; Stiers, William; Zorowitz, Richard D

    2016-06-01

    The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from

  14. 'I was in control of it from the start': A qualitative study of men's experiences of positive adjustment following a heart attack.

    Science.gov (United States)

    Smith, Fran; Banwell, Elizabeth; Rakhit, Roby

    2017-09-01

    A qualitative design was used to explore the experience of positive adjustment following a heart attack. Ten men attending a cardiac rehabilitation programme completed in-depth semi-structured interviews. An overarching theme: 'I was in control of it from the start' emerged with six subthemes, relating to intrapersonal and interpersonal factors and processes. The subthemes reflected the importance of identifying controllable versus non-controllable factors and employing adaptive coping strategies.

  15. Usefulness of left ventricular speckle tracking echocardiography and novel measures of left atrial structure and function in diagnosing paroxysmal atrial fibrillation in ischemic stroke and transient ischemic attack patients

    DEFF Research Database (Denmark)

    Skaarup, Kristoffer Grundtvig; Christensen, Hanne; Host, Nis

    2017-01-01

    Asymptomatic paroxysmal atrial fibrillation (PAF) is often assumed to be the cause of cryptogenic ischemic strokes (IS) and transient ischemic attacks (TIA). We examined the usefulness of measures obtained by 2D speckle tracking echocardiography and novel left atrial measurements, in the diagnosi...

  16. C-reactive protein, waist circumference, and family history of heart attack are independent predictors of body iron stores in apparently healthy premenopausal women.

    Science.gov (United States)

    Suárez-Ortegón, M F; Arbeláez, A; Mosquera, M; Méndez, F; Aguilar-de Plata, C

    2012-08-01

    Ferritin levels have been associated with metabolic syndrome and insulin resistance. The aim of the present study was to evaluate the prediction of ferritin levels by variables related to cardiometabolic disease risk in a multivariate analysis. For this aim, 123 healthy women (72 premenopausal and 51 posmenopausal) were recruited. Data were collected through procedures of anthropometric measurements, questionnaires for personal/familial antecedents, and dietary intake (24-h recall), and biochemical determinations (ferritin, C reactive protein (CRP), glucose, insulin, and lipid profile) in blood serum samples obtained. Multiple linear regression analysis was used and variables with no normal distribution were log-transformed for this analysis. In premenopausal women, a model to explain log-ferritin levels was found with log-CRP levels, heart attack familial history, and waist circumference as independent predictors. Ferritin behaves as other cardiovascular markers in terms of prediction of its levels by documented predictors of cardiometabolic disease and related disorders. This is the first report of a relationship between heart attack familial history and ferritin levels. Further research is required to evaluate the mechanism to explain the relationship of central body fat and heart attack familial history with body iron stores values.

  17. Depressive symptoms following stroke and transient ischemic attack: is it time for a more intensive treatment approach? results from the TABASCO cohort study.

    Science.gov (United States)

    Tene, Oren; Shenhar-Tsarfaty, Shani; Korczyn, Amos D; Kliper, Efrat; Hallevi, Hen; Shopin, Ludmila; Auriel, Eitan; Mike, Anat; Bornstein, Natan M; Assayag, Einor Ben

    2016-05-01

    To examine whether depressive symptoms after a stroke or a transient ischemic attack (TIA) increase the risk of cognitive impairment and functional deterioration at 2-year follow-up. Participants were survivors of first-ever, mild-to-moderate ischemic stroke or TIA from the TABASCO prospective cohort study who underwent 3T magnetic resonance imaging and were examined by a multiprofessional team 6, 12, and 24 months after the event using direct interviews, depression scales, and neurologic, neuropsychological, and functional evaluations. The main outcome was the development of cognitive impairment, either mild cognitive impairment (MCI) or dementia. MCI was diagnosed by a decline on at least 1 cognitive domain (≥ 1.5 SD) of the Montreal Cognitive Assessment score and/or on the computerized neuropsychological battery, as compared with age- and education-matched published norms. Dementia was diagnosed by a consensus forum that included senior neurologists specializing in memory disorders and a neuropsychologist. Data were obtained from 306 consecutive eligible patients (mean age: 67.1 ± 10.0 years) who were admitted to the department of emergency medicine at the Tel Aviv Medical Center from April 1, 2008, to December 1, 2011, within 72 hours from onset of symptoms of TIA or stroke. Of these patients, 51 (16.7%) developed cognitive impairment during a 2-year follow-up. Multivariate regression analysis showed that a Geriatric Depression Scale (GDS) score ≥ 6 at admission and at 6 months after the event was a significant independent marker of cognitive impairment 2 years after the stroke/TIA (OR = 3.62, 95% CI, 1.01-13.00; OR = 3.68, 95% CI, 1.03-13.21, respectively). A higher GDS score at 6 months was also related to a worse functional outcome (P depression screening among stroke and TIA survivors as a tool to identify patients who are prone to have a worse cognitive and functional outcome. These patients may benefit from closer medical surveillance and a more

  18. Nurse-led intervention to improve knowledge of medications in survivors of stroke or transient ischemic attack: a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Muideen Olaiya

    2016-11-01

    Full Text Available Introduction: Limited evidence exists on effective interventions to improve knowledge of preventive medications in patients with chronic diseases, such as stroke. We investigated the effectiveness of a nurse-led intervention, where a component was to improve knowledge of prevention medications, in patients with stroke or transient ischemic attack (TIA.Methods: Prospective sub-study of the Shared Team Approach between Nurses and Doctors For Improved Risk Factor Management (STAND FIRM, a randomized controlled trial of risk factor management. We recruited patients aged ≥18 years and hospitalized for stroke/TIA. The intervention comprised an individualized management program, involving nurse-led education, and management plan with medical specialist oversight. The outcome, participants’ knowledge of secondary prevention medications at 12 months, was assessed using questionnaires. A score of ≥5 was considered as good knowledge. Effectiveness of the intervention on knowledge of medications was determined using logistic regression. Results: Between May 2014 and January 2015, 142 consecutive participants from the main trial were included in this sub-study, 64 to usual care and 78 to the intervention (median age 68.9 years, 68% male, and 79% ischemic stroke. In multivariable analyses, we found no significant difference between intervention groups in knowledge of medications. Factors independently associated with good knowledge (score ≥5 at 12 months included higher socio-economic position (OR 4.79, 95% CI 1.76, 13.07, greater functional ability (OR 1.69, 95% CI 1.17, 2.45, being married/living with a partner (OR 3.12, 95% CI 1.10, 8.87, and using instructions on pill bottle/package as an administration aid (OR 4.82, 95% CI 1.76, 13.22. Being aged ≥65 years was associated with poorer knowledge of medications (OR 0.24, 95% CI 0.08, 0.71, while knowledge was worse among those taking three medications (OR 0.15, 95% CI 0.03, 0.66 or ≥4 medications

  19. Health care in patients 1 year post-stroke in general practice: research on the utilisation of the Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident.

    Science.gov (United States)

    de Weerd, L; Rutgers, A W F; Groenier, K H; van der Meer, K

    2012-01-01

    This study evaluates the kind of aftercare that ischaemic stroke patients receive and the extent that aftercare fulfils the criteria of the 'Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident'. Fifty-seven patients were interviewed 1 year post-stroke about secondary prevention and aftercare. Forty general practitioners (GPs) completed a questionnaire about guidance and secondary prevention (concerning medication and lifestyle advice). Most patients would like to see their GP more regularly. More aftercare was required than was planned. The use of aspirin remained the same, fewer patients used statins and more used antihypertensives. Of the 40 GPs who participated, 12% did not apply prevention. Blood pressure, glucose and cholesterol were measured in 84%, 28% and 40% of patients. All of these measures were often elevated, but treatment was not given. Lifestyle advice was offered to one-quarter of patients. Considering all of the advice given in the Dutch Protocol, several aspects can be improved in relation to secondary prevention. Too little attention is paid to giving lifestyle advice, stricter medical checkups by GPs are necessary and there is a decrease in use of preventive medication, partly because GPs monitors use of medication inadequately. The use of the Dutch Protocol in aftercare can be improved by a more detailed description of advice.

  20. The performance of blood pressure and other cardiovascular risk factors as screening tests for ischaemic heart disease and stroke.

    Science.gov (United States)

    Law, M R; Wald, N J; Morris, J K

    2004-01-01

    This paper summarises the main evidence and conclusions relating to using blood pressure measurement as a screening test to identify people who will develop ischaemic heart disease (IHD) or stroke, as recently published in a Health Technology Assessment report. While blood pressure is recognised as an important cause of stroke and IHD, and lowering blood pressure can substantially lower the risk of these diseases, the measurement of blood pressure is a poor screening test. It is not good in distinguishing those who will and will not develop these diseases. The poor screening performance is illustrated by the findings that in the largest cohort study, persons in the top 10% of the distribution of systolic blood pressure experienced only 21% of all IHD events and 28% of all strokes at a given age. Using several cardiovascular risk factors in combination does not add materially to the poor screening performance of blood pressure alone. Among persons in a specified age group, the 5% at highest risk experience 17% of all heart disease deaths with risk computation based on blood pressure alone, 22% when based on blood pressure and apolipoprotein B (or LDL cholesterol) in combination, and only 28% using these two, smoking and three other cardiovascular risk factors all in combination. Identifying patients at the time of hospital discharge following myocardial infarction or stroke is the most effective screening test to identify those who will die of cardiovascular disease. In patients with a history of myocardial infarction or stroke the cardiovascular death rate in the absence of treatment is about 5% per year, a risk that persists for at least 15 years. In the absence of treatment, about half of all deaths from heart disease in a population occur after hospital discharge following the first infarct. Among persons with no history of cardiovascular disease, age is a better screening test than the reversible risk factors, and the best policy is to offer treatment to all

  1. The difference between acute coronary heart disease and ischaemic stroke risk with regard to gender and age in Finnish and Swedish populations.

    Science.gov (United States)

    Hyvärinen, Marjukka; Qiao, Qing; Tuomilehto, Jaakko; Söderberg, Stefan; Eliasson, Mats; Stehouwer, Coen D A

    2010-06-01

    We studied the age and gender difference between acute coronary heart disease and ischaemic stroke risk and examined the extent to which such a difference may be explained by known risk factors. Data from Finnish and Swedish population-based cohorts including 9278 individuals were collaboratively analysed. Hazards ratios (95% confidence intervals) for coronary heart disease and stroke incidence were estimated using the Cox-proportional hazards model. The incidence of coronary heart disease and stroke was higher in all age groups in men than in women, and the gender difference was more marked for coronary heart disease than for ischaemic stroke. There was a 10-year lag in the development of coronary heart disease and stroke in women compared with men. The multivariable adjusted hazard ratios for the incidence of coronary heart disease in men and women were 3.87 (2.49-6.02) and 1.71 (1.07-2.74) at age 50-59 years, and 7.22 (4.59-11.36) and 3.49 (2.18-5.57) at age 60-69 years compared with women aged 40-49 years. For ischaemic stroke, they were 2.64 (1.45-4.82) and 2.17 (1.18-3.97) at age 50-59 years, and 5.19 (2.81-9.58) and 4.89 (2.67-8.97) at age 60-69 years, respectively. Acute coronary heart disease and ischaemic stroke events appeared approximately 10 years earlier in men than in women, and these rates remained higher in men than in women in all age groups. The gender difference was more marked for coronary heart disease than for ischaemic stroke. This may be taken into account when developing interventions and treatment strategies.

  2. Dietary choline and betaine; associations with subclinical markers of cardiovascular disease risk and incidence of CVD, coronary heart disease and stroke: the Jackson Heart Study.

    Science.gov (United States)

    Millard, Heather R; Musani, Solomon K; Dibaba, Daniel T; Talegawkar, Sameera A; Taylor, Herman A; Tucker, Katherine L; Bidulescu, Aurelian

    2018-02-01

    Several mechanisms have been described through which dietary intake of choline and its derivative betaine may be associated in both directions with subclinical atherosclerosis. We assessed the association of dietary intake of choline and betaine with cardiovascular risk and markers of subclinical cardiovascular disease. Data from 3924 Jackson Heart Study (JHS) African-American participants with complete food frequency questionnaire at baseline and follow-up measurements of heart disease measures were used. Multivariable linear regression models were employed to assess associations between choline and betaine intake with carotid intima-media thickness, coronary artery calcium, abdominal aortic calcium and left ventricular mass. Cox proportional hazards regression models were used to estimate associations with time to incident coronary heart disease (CHD), ischemic stroke and cardiovascular disease (CVD). During an average nine years of follow-up, 124 incident CHD events, 75 incident stroke events and 153 incident CVD events were documented. In women, greater choline intake was associated with lower left ventricular mass (p = 0.0006 for trend across choline quartiles) and with abdominal aortic calcium score. Among all JHS participants, there was a statistically significant inverse association between dietary choline intake and incident stroke, β = -0.33 (p = 0.04). Betaine intake was associated with greater risk of incident CHD when comparing the third quartile of intake with the lowest quartile of intake (HR 1.89, 95 % CI 1.14, 3.15). Among our African-American participants, higher dietary choline intake was associated with a lower risk of incident ischemic stroke, and thus putative dietary benefits. Higher dietary betaine intake was associated with a nonlinear higher risk of incident CHD.

  3. Incidence and Risk Factors of Stroke or Systemic Embolism in Patients With Atrial Fibrillation and Heart Failure

    DEFF Research Database (Denmark)

    Iguchi, Moritake; Tezuka, Yuji; Ogawa, Hisashi

    2018-01-01

    BACKGROUND: Heart failure (HF) is a heterogeneous syndrome, but the effect of the type and severity of HF on the incidence of stroke or systemic embolism (SE) in atrial fibrillation (AF) patients is unclear.Methods and Results:The Fushimi AF Registry is a community-based prospective survey of AF ...... of HF in patients with AF. The incidence of stroke/SE was markedly increased in the 30 days after admission for HF, but compensated 'stable' HF did not appear to confer an independent risk.......BACKGROUND: Heart failure (HF) is a heterogeneous syndrome, but the effect of the type and severity of HF on the incidence of stroke or systemic embolism (SE) in atrial fibrillation (AF) patients is unclear.Methods and Results:The Fushimi AF Registry is a community-based prospective survey of AF....... On multivariate analysis, the incidence of stroke/SE was not associated with pre-existing HF (hazard ratio (HR), 1.24; 95% confidence interval (CI), 0.92-1.64) or each criterion for the definition of pre-existing HF, but was associated with high B-type natriuretic peptide (BNP) or N-terminal proBNP levels (above...

  4. Recurrent Hemorrhagic Conversion of Ischemic Stroke in a Patient with Mechanical Heart Valve: A Case Report and Literature Review

    OpenAIRE

    Micheal Jace Tarver; Tyler Schmidt; Michael T. Koltz

    2018-01-01

    The authors present a unique case of recurrent stroke, discovered to be secondary to hemorrhagic conversion of microemboli from a mechanical aortic valve despite anticoagulation with Coumadin. The complexity of this case was magnified by the patient’s young age, a mechanical heart valve (MHV), and a need for anticoagulation to maintain MHV patency in a setting of potentially life-threatening intracranial hemorrhage. Anticoagulant and antiplatelet therapy are risk factors for hemorrhagic conve...

  5. Long-term physical activity in leisure time and mortality from coronary heart disease, stroke, respiratory diseases, and cancer. The Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Schnohr, Peter; Lange, Peter; Scharling, Henrik

    2006-01-01

    BACKGROUND: The purpose of this study was to describe the associations between different levels of long-term physical activity in leisure time and subsequent causes of deaths. DESIGN: The Copenhagen City Heart Study is a prospective cardiovascular population study of 19 329 men and women aged 20-...... was in both sexes associated with significantly lower mortality from coronary heart disease, cancer and all-causes. The same tendency was found for stroke and respiratory diseases, but the associations did not reach statistical significance......., total-cholesterol, high-density lipoprotein-cholesterol, systolic blood pressure, diabetes mellitus, alcohol consumption, body mass index, education, income, and forced expiratory volume in 10.78 (% predicted). RESULTS: Adjusted relative risks (95% confidence interval) for coronary heart disease were...

  6. CDC Vital Signs-Heart Age

    Centers for Disease Control (CDC) Podcasts

    2015-09-01

    This podcast is based on the September 2015 CDC Vital Signs report. Your heart age is the age of your heart and blood vessels as a result of your risk factors for heart attack and stroke. If you smoke or have high blood pressure, your heart age will be much higher than your actual age. Learn what you can do to lower your heart age and keep it low.  Created: 9/1/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 9/1/2015.

  7. Heart Attack and Women

    Science.gov (United States)

    ... Carpal tunnel syndrome Depression Irritable bowel syndrome Migraine Thyroid disease Urinary tract infections All A-Z health topics ... Carpal tunnel syndrome Depression Irritable bowel syndrome Migraine Thyroid disease Urinary tract infections All A-Z health topics ...

  8. Successful Heart Transplantation Following Decompressive Craniectomy in a Patient with Restrictive Cardiomyopathy and Extensive Stroke in the Region of the Right Middle Cerebral Artery

    Directory of Open Access Journals (Sweden)

    Salih Gulsen

    2014-09-01

    Full Text Available Restrictive cardiomyopathy (RCM in children is associated with a greater risk of embolic stroke than are other congenital heart diseases. After diagnosis, 50% of children with RCM die within 2 years without heart transplantation. As such, all RCM patients are placed on the heart transplantation list and must wait for an appropriate heart for transplantation. Every type of embolic stroke can occur while waiting for a donor heart; therefore, the cardiovascular team must initiate antithrombotic therapy at time RCM is diagnosed. Some pediatric RCM patients experience embolic stroke (50% are the cerebral type despite antithrombotic therapy, including acetylsalicylic acid, warfarin, and heparine. Neurosurgeons working in hospitals that perform organ transplantation expect to see RCM cases with restrictive large cerebral infarct. We think that decompressive craniectomy should be performed as soon as possible after determining the clinical condition of any patient with RCM and a large right middle cerebral artery (MCA infarct.

  9. Heart-type Fatty Acid-Binding Protein (H-FABP as a Biochemical Marker to Differentiate Ischemic and Hemorrhagic Stroke

    Directory of Open Access Journals (Sweden)

    Eli Halimah

    2017-03-01

    Full Text Available Stroke is an acute neurological syndrome that occurs due to a decrease in blood flow caused by blocked or rupture of blood vessels of the brain (cerebrovascular that causes damage to brain tissue. Based on the pathogenesis, there are two types of stroke, the ischemic and hemorrhagic stroke, in which the handling of treatment in both types of stroke are very different, so the differential diagnosis is required to distinguish the two types of stroke. The purpose of this study is to determine whether Heart-type Fatty Acid-Binding Protein (H-FABP can be used as a parameter of biochemical marker to distinguish between ischemic and hemorrhagic stroke. H-FABP assay is performed using blood serum and analyzed by Enzyme Linked Immunosorbent Assay (ELISA sandwich method, each using H-FABP test kit. Blood serum taken from 20 patients with ischemic strokes and 18 hemorrhagic stroke patients from one of a hospital in Jakarta. The results showed that the average H-FABP concentration in ischemic stroke‑patients is 9,07 ng/mL and hemorrhagic stroke‑patients is 18,54 ng/mL; statistically there are significant difference between H-FABP concentration in ischemic stroke‑patients and hemorrhagic stroke-patients (α=0.05. Thus Heart-type Fatty Acid-Binding Protein (H-FABP can be used as one of the parameters of biochemical markers to distinguish between ischemic and hemorrhagic stroke.

  10. Comparing the decline in coronary heart disease and stroke mortality in neighbouring countries with different healthcare systems.

    LENUS (Irish Health Repository)

    Bennett, K

    2013-06-04

    OBJECTIVE: To examine age and gender specific trends in coronary heart disease (CHD) and stroke mortality in two neighbouring countries, the Republic of Ireland (ROI) and Northern Ireland (NI). DESIGN: Epidemiological study of time trends in CHD and stroke mortality. SETTING\\/PATIENTS: The populations of the ROI and NI, 1985-2010. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Directly age standardised CHD and stroke mortality rates were calculated and analysed using joinpoint regression to identify years where the slope of the linear trend changed significantly. This was performed separately for specific age groups (25-54, 55-64, 65-74 and 75-84 years) and by gender. Annual percentage change (APC) and 95% CIs are presented. RESULTS: There was a striking similarity between the two countries, with percentage change between 1985 and 1989 and between 2006 and 2010 of 67% and 69% in CHD mortality, and 64% and 62% in stroke mortality for the ROI and NI, respectively. However, joinpoint analysis identified differences in the pace of change between the two countries. There was an accelerated pace of decline (negative APC) in mortality for both CHD and stroke in both countries from the mid-1990s (APC ROI -8% (95% CI -9.5 to 6.5) and NI -6.6% (-6.9 to -6.3)), but the accelerated decrease started later for CHD mortality in the ROI. In recent years, a levelling off in CHD mortality was observed in the 25-54 year age group in NI and in stroke mortality for men and women in the ROI. CONCLUSIONS: While differences in the pace of change in mortality were observed at different time points, similar, substantial decreases in CHD and stroke mortality were achieved between 1985 and 1989 and between 2006 and 2010 in the ROI and NI despite important differences in health service structures. There is evidence of a levelling in mortality rates in some groups in recent years.

  11. A Mediterranean diet and risk of myocardial infarction, heart failure and stroke: A population-based cohort study.

    Science.gov (United States)

    Tektonidis, Thanasis G; Åkesson, Agneta; Gigante, Bruna; Wolk, Alicja; Larsson, Susanna C

    2015-11-01

    The Mediterranean diet, which is palatable and easily achievable, has been associated with lower all-cause and cardiovascular disease (CVD) incidence and mortality. Data on heart failure (HF) and stroke types are lacking. The aim was to examine a Mediterranean diet in relation to incidence of myocardial infarction (MI), HF and stroke types in a Swedish prospective cohort. In a population-based cohort of 32,921 women, diet was assessed through a self-administered questionnaire. The modified Mediterranean diet (mMED) score was created based on high consumption of vegetables, fruits, legumes, nuts, whole grains, fermented dairy products, fish and monounsaturated fat, moderate intakes of alcohol and low consumption of red meat, on a 0-8 scale. Relative risks (RR) with 95% confidence intervals (CI), adjusted for potential confounders, were estimated by Cox proportional hazards regression models. During 10 y of follow-up (1998-2008), 1109 MIs, 1648 HFs, 1270 ischemic strokes and 262 total hemorrhagic strokes were ascertained. A high adherence to the mMED score (6-8), compared to low, was associated with a lower risk of MI (RR: 0.74, 95% CI: 0.61-0.90, p = 0.003), HF (RR: 0.79, 95% CI: 0.68-0.93, p = 0.004) and ischemic stroke (RR: 0.78, 95% CI: 0.65-0.93, p = 0.007), but not hemorrhagic stroke (RR: 0.88, 95% CI: 0.61-1.29, p = 0.53). Better adherence to a Mediterranean diet was associated with lower risk of MI, HF and ischemic stroke. The Mediterranean diet is most likely to be beneficial in primary prevention of all major types of atherosclerosis-related CVD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Polyphenols and Oxidative Stress in Atherosclerosis-Related Ischemic Heart Disease and Stroke.

    Science.gov (United States)

    Cheng, Yu-Chen; Sheen, Jer-Ming; Hu, Wen Long; Hung, Yu-Chiang

    2017-01-01

    Good nutrition could maintain health and life. Polyphenols are common nutrient mainly derived from fruits, vegetables, tea, coffee, cocoa, mushrooms, beverages, and traditional medicinal herbs. They are potential substances against oxidative-related diseases, for example, cardiovascular disease, specifically, atherosclerosis-related ischemic heart disease and stroke, which are health and economic problems recognized worldwide. In this study, we reviewed the risk factors for atherosclerosis, including hypertension, diabetes mellitus, hyperlipidemia, obesity, and cigarette smoking as well as the antioxidative activity of polyphenols, which could prevent the pathology of atherosclerosis, including endothelial dysfunction, low-density lipoprotein oxidation, vascular smooth muscle cell proliferation, inflammatory process by monocytes, macrophages or T lymphocytes, and platelet aggregation. The strong radical-scavenging properties of polyphenols would exhibit antioxidative and anti-inflammation effects. Polyphenols reduce ROS production by inhibiting oxidases, reducing the production of superoxide, inhibiting OxLDL formation, suppressing VSMC proliferation and migration, reducing platelet aggregation, and improving mitochondrial oxidative stress. Polyphenol consumption also inhibits the development of hypertension, diabetes mellitus, hyperlipidemia, and obesity. Despite the numerous in vivo and in vitro studies, more advanced clinical trials are necessary to confirm the efficacy of polyphenols in the treatment of atherosclerosis-related vascular diseases.

  13. Polyphenols and Oxidative Stress in Atherosclerosis-Related Ischemic Heart Disease and Stroke

    Directory of Open Access Journals (Sweden)

    Yu-Chen Cheng

    2017-01-01

    Full Text Available Good nutrition could maintain health and life. Polyphenols are common nutrient mainly derived from fruits, vegetables, tea, coffee, cocoa, mushrooms, beverages, and traditional medicinal herbs. They are potential substances against oxidative-related diseases, for example, cardiovascular disease, specifically, atherosclerosis-related ischemic heart disease and stroke, which are health and economic problems recognized worldwide. In this study, we reviewed the risk factors for atherosclerosis, including hypertension, diabetes mellitus, hyperlipidemia, obesity, and cigarette smoking as well as the antioxidative activity of polyphenols, which could prevent the pathology of atherosclerosis, including endothelial dysfunction, low-density lipoprotein oxidation, vascular smooth muscle cell proliferation, inflammatory process by monocytes, macrophages or T lymphocytes, and platelet aggregation. The strong radical-scavenging properties of polyphenols would exhibit antioxidative and anti-inflammation effects. Polyphenols reduce ROS production by inhibiting oxidases, reducing the production of superoxide, inhibiting OxLDL formation, suppressing VSMC proliferation and migration, reducing platelet aggregation, and improving mitochondrial oxidative stress. Polyphenol consumption also inhibits the development of hypertension, diabetes mellitus, hyperlipidemia, and obesity. Despite the numerous in vivo and in vitro studies, more advanced clinical trials are necessary to confirm the efficacy of polyphenols in the treatment of atherosclerosis-related vascular diseases.

  14. Addition of 24-Hour Heart Rate Variability Parameters to the Cardiovascular Health Study Stroke Risk Score and Prediction of Incident Stroke: The Cardiovascular Health Study

    Science.gov (United States)

    Bodapati, Rohan K.; Kizer, Jorge R.; Kop, Willem J.; Kamel, Hooman; Stein, Phyllis K.

    2018-01-01

    Background Heart rate variability (HRV) characterizes cardiac autonomic functioning. The association of HRV with stroke is uncertain. We examined whether 24-hour HRV added predictive value to the Cardiovascular Health Study clinical stroke risk score (CHS-SCORE), previously developed at the baseline examination. Methods and Results N=884 stroke-free CHS participants (age 75.3 ± 4.6), with 24-hour Holters adequate for HRV analysis at the 1994–1995 examination, had 68 strokes over ≤8 year follow-up (median 7.3 [interquartile range 7.1–7.6] years). The value of adding HRV to the CHS-SCORE was assessed with stepwise Cox regression analysis. The CHS-SCORE predicted incident stroke (HR=1.06 per unit increment, P=0.005). Two HRV parameters, decreased coefficient of variance of NN intervals (CV%, P=0.031) and decreased power law slope (SLOPE, P=0.033) also entered the model, but these did not significantly improve the c-statistic (P=0.47). In a secondary analysis, dichotomization of CV% (LOWCV% ≤12.8%) was found to maximally stratify higher-risk participants after adjustment for CHS-SCORE. Similarly, dichotomizing SLOPE (LOWSLOPE <− 1.4) maximally stratified higher-risk participants. When these HRV categories were combined (eg, HIGHCV% with HIGHSLOPE), the c-statistic for the model with the CHS-SCORE and combined HRV categories was 0.68, significantly higher than 0.61 for the CHS-SCORE alone (P=0.02). Conclusions In this sample of older adults, 2 HRV parameters, CV% and power law slope, emerged as significantly associated with incident stroke when added to a validated clinical risk score. After each parameter was dichotomized based on its optimal cut point in this sample, their composite significantly improved prediction of incident stroke during ≤8-year follow-up. These findings will require validation in separate, larger cohorts. PMID:28396041

  15. [Mortality rate of acute heart attack in Zalaegerszeg micro-region. Results of the first Hungarian 24-hour acute ST-elevation myocardial infarction intervention care unit].

    Science.gov (United States)

    Lupkovics, Géza; Motyovszki, Akos; Németh, Zoltán; Takács, István; Kenéz, András; Burkali, Bernadett; Menyhárt, Ildikó

    2010-04-04

    Morbidity and mortality rates of acute heart attack emphasize the significance of this patient group worldwide. The prompt and exact diagnosis and the timing of adequate therapy is crucial for this patients. Modern supply of acute heart attack includes invasive cardiology intervention, primer percutaneous coronary intervention. In year 1999, American and European recommendations suggested primer percutaneous coronary intervention only as an alternative possibility instead of thrombolysis, or in case of cardiogenic shock. 24 hour intervention unit for patients with acute heart attack was first organized in Hungary in Zala County Hospital's Cardiology Department, in year 1998. Our present study confirms, that since the intervention treatment has been introduced, average mortality rate has been reduced considerably in our area comparing to the national average. Mortality rates in West Transdanubian region and in Zalaegerszeg's micro-region were studied and compared for the period between 1997-2004, according to the data of National Public Health and Medical Officer Service. These data were then compared with the national average mortality data of Hungarian Central Statistical Office. With the help of our own computerized database we examined this period and compared the number of the completed invasive interventions to the mortality statistics. In the first full year, in 1998, we completed 82 primer and 283 elective PCIs; these number increased to 318 and 1265 by year 2005. At the same time, significant decrease of acute infarction related mortality was detectable among men of the Zalaegerszeg micro-region, comparing to the national average (pheart attack intervention care improved the area's mortality statistics significantly, comparing to the national average. The skilled work of the experienced team means an important advantage to the patients in Zalaegerszeg micro-region.

  16. The thick left ventricular wall of the giraffe heart normalises wall tension, but limits stroke volume and cardiac output.

    Science.gov (United States)

    Smerup, Morten; Damkjær, Mads; Brøndum, Emil; Baandrup, Ulrik T; Kristiansen, Steen Buus; Nygaard, Hans; Funder, Jonas; Aalkjær, Christian; Sauer, Cathrine; Buchanan, Rasmus; Bertelsen, Mads Frost; Østergaard, Kristine; Grøndahl, Carsten; Candy, Geoffrey; Hasenkam, J Michael; Secher, Niels H; Bie, Peter; Wang, Tobias

    2016-02-01

    Giraffes--the tallest extant animals on Earth--are renowned for their high central arterial blood pressure, which is necessary to secure brain perfusion. Arterial pressure may exceed 300 mmHg and has historically been attributed to an exceptionally large heart. Recently, this has been refuted by several studies demonstrating that the mass of giraffe heart is similar to that of other mammals when expressed relative to body mass. It thus remains unexplained how the normal-sized giraffe heart generates such massive arterial pressures. We hypothesized that giraffe hearts have a small intraventricular cavity and a relatively thick ventricular wall, allowing for generation of high arterial pressures at normal left ventricular wall tension. In nine anaesthetized giraffes (495±38 kg), we determined in vivo ventricular dimensions using echocardiography along with intraventricular and aortic pressures to calculate left ventricular wall stress. Cardiac output was also determined by inert gas rebreathing to provide an additional and independent estimate of stroke volume. Echocardiography and inert gas-rebreathing yielded similar cardiac outputs of 16.1±2.5 and 16.4±1.4 l min(-1), respectively. End-diastolic and end-systolic volumes were 521±61 ml and 228±42 ml, respectively, yielding an ejection fraction of 56±4% and a stroke volume of 0.59 ml kg(-1). Left ventricular circumferential wall stress was 7.83±1.76 kPa. We conclude that, relative to body mass, a small left ventricular cavity and a low stroke volume characterizes the giraffe heart. The adaptations result in typical mammalian left ventricular wall tensions, but produce a lowered cardiac output. © 2016. Published by The Company of Biologists Ltd.

  17. Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis.

    Science.gov (United States)

    Zhang, Dongfeng; Wang, Weijing; Li, Fang

    2016-10-18

    Resting heart rate is linked to risk of coronary artery disease, stroke, sudden death and noncardiovascular diseases. We conducted a meta-analysis to assess these associations in general populations and in populations of patients with hypertension or diabetes mellitus. We searched PubMed, Embase and MEDLINE from inception to Mar. 5, 2016. We used a random-effects model to combine study-specific relative risks (RRs). We used restricted cubic splines to assess the dose-response relation. We included 45 nonrandomized prospective cohort studies in the meta-analysis. The multivariable adjusted RR with an increment of 10 beats/min in resting heart rate was 1.12 (95% confidence interval [CI] 1.09-1.14) for coronary artery disease, 1.05 (95% CI 1.01-1.08) for stroke, 1.12 (95% CI 1.02-1.24) for sudden death, 1.16 (95% CI 1.12-1.21) for noncardiovascular diseases, 1.09 (95% CI 1.06-1.12) for all types of cancer and 1.25 (95% CI 1.17-1.34) for noncardiovascular diseases excluding cancer. All of these relations were linear. In an analysis by category of resting heart rate ( 80 beats/min), the RRs were 0.99 (95% CI 0.93-1.04), 1.08 (95% CI 1.01-1.16) and 1.30 (95% CI 1.19-1.43), respectively, for coronary artery disease; 1.08 (95% CI 0.98-1.19), 1.11 (95% CI 0.98-1.25) and 1.08 (95% CI 0.93-1.25), respectively, for stroke; and 1.17 (95% CI 0.94-1.46), 1.31 (95% CI 1.12-1.54) and 1.57 (95% CI 1.39-1.77), respectively, for noncardiovascular diseases. After excluding studies involving patients with hypertension or diabetes, we obtained similar results for coronary artery disease, stroke and noncardiovascular diseases, but found no association with sudden death. Resting heart rate was an independent predictor of coronary artery disease, stroke, sudden death and noncardiovascular diseases over all of the studies combined. When the analysis included only studies concerning general populations, resting heart rate was not associated with sudden death. © 2016 Canadian Medical

  18. Special Operations Soldier With Cardiac Family History: Use of CCTA and Protein Biomarker Testing to Detect Risk of Heart Attack From Noncalcified Plaque.

    Science.gov (United States)

    Singh, Millee; Kroman, Anne; Singh, Juile; Tariq, Hassan; Amin, Shetal; Morales-Pablon, Cesar Alberto; Cahill, Kristina Vanessa; Harrison, Eric Edward

    2015-01-01

    We sought to characterize the risk of a heart attack in a 48-year-old asymptomatic US Special Operations Command (SOCOM) Soldier without known coronary artery disease (CAD). CAD continues to be a leading cause of morbidity and mortality among most age groups in the United States. Much research is dedicated to establishing new techniques to predict myocardial infarction (MI). Coronary computed tomography (CT) angiography, also known as CCTA, along with 7-protein serum biomarker risk assessment was performed for risk evaluation. A 48-year-old SOCOM Soldier with a family history of heart disease had skeletal chest pain from war injuries and a 5-fold higher risk of heart attack over the next 5 years on the basis of protein markers. A nonobstructive left anterior descending coronary artery (LAD) plaque with a lipid-rich core and a thin fibrous cap (i.e., vulnerable plaque) was detected by CCTA. The patient was warned about his risk and prescribed four cardiac medications and scheduled for angioplasty even though he fell outside the guidelines by not having a severe obstructive blockage. Four days later, unfortunately, he had a heart attack before starting his medications and before angioplasty. CCTA with biomarker testing may have an important role in predicating acute coronary syndrome (ACS) in Special Operations Forces (SOF) Soldiers with at least one risk factor. Conventional stress testing and nuclear scanning would not detect non-flow-limiting vulnerable plaques in vulnerable patients. In order to collect more data, the PROTECT Registry has been started to evaluate asymptomatic Soldiers with at least one risk factor referred to the clinic by military physicians. 2015.

  19. Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Wechsler, Lawrence R; Demaerschalk, Bart M; Schwamm, Lee H; Adeoye, Opeolu M; Audebert, Heinrich J; Fanale, Christopher V; Hess, David C; Majersik, Jennifer J; Nystrom, Karin V; Reeves, Mathew J; Rosamond, Wayne D; Switzer, Jeffrey A

    2017-01-01

    Telestroke is one of the most frequently used and rapidly expanding applications of telemedicine, delivering much-needed stroke expertise to hospitals and patients. This document reviews the current status of telestroke and suggests measures for ongoing quality and outcome monitoring to improve performance and to enhance delivery of care. A literature search was undertaken to examine the current status of telestroke and relevant quality indicators. The members of the writing committee contributed to the review of specific quality and outcome measures with specific suggestions for metrics in telestroke networks. The drafts were circulated and revised by all committee members, and suggestions were discussed for consensus. Models of telestroke and the role of telestroke in stroke systems of care are reviewed. A brief description of the science of quality monitoring and prior experience in quality measures for stroke is provided. Process measures, outcomes, tissue-type plasminogen activator use, patient and provider satisfaction, and telestroke technology are reviewed, and suggestions are provided for quality metrics. Additional topics include licensing, credentialing, training, and documentation. © 2016 American Heart Association, Inc.

  20. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Yaghi, Shadi; Willey, Joshua Z; Cucchiara, Brett; Goldstein, Joshua N; Gonzales, Nicole R; Khatri, Pooja; Kim, Louis J; Mayer, Stephan A; Sheth, Kevin N; Schwamm, Lee H

    2017-12-01

    Symptomatic intracranial hemorrhage (sICH) is the most feared complication of intravenous thrombolytic therapy in acute ischemic stroke. Treatment of sICH is based on expert opinion and small case series, with the efficacy of such treatments not well established. This document aims to provide an overview of sICH with a focus on pathophysiology and treatment. A literature review was performed for randomized trials, prospective and retrospective studies, opinion papers, case series, and case reports on the definitions, epidemiology, risk factors, pathophysiology, treatment, and outcome of sICH. The document sections were divided among writing group members who performed the literature review, summarized the literature, and provided suggestions on the diagnosis and treatment of patients with sICH caused by systemic thrombolysis with alteplase. Several drafts were circulated among writing group members until a consensus was achieved. sICH is an uncommon but severe complication of systemic thrombolysis in acute ischemic stroke. Prompt diagnosis and early correction of the coagulopathy after alteplase have remained the mainstay of treatment. Further research is required to establish treatments aimed at maintaining integrity of the blood-brain barrier in acute ischemic stroke based on inhibition of the underlying biochemical processes. © 2017 American Heart Association, Inc.

  1. Carotid Atherosclerotic Plaque Characteristics on Magnetic Resonance Imaging Relate With History of Stroke and Coronary Heart Disease.

    Science.gov (United States)

    Selwaness, Mariana; Bos, Daniel; van den Bouwhuijsen, Quirijn; Portegies, Marileen L P; Ikram, M Arfan; Hofman, Albert; Franco, Oscar H; van der Lugt, Aad; Wentzel, Jolanda J; Vernooij, Meike W

    2016-06-01

    Because atherosclerosis is a systemic disease, presence and composition on 1 location may relate to ischemic events in distant locations. We examined whether carotid atherosclerotic wall thickness, stenosis, and plaque composition are related to history of ischemic stroke and coronary heart disease (CHD). From the population-based Rotterdam Study, 1731 asymptomatic participants (mean age, 72.4±9.1 years; 55% males) underwent magnetic resonance imaging of both carotid arteries. We assessed carotid wall thickness, stenosis and plaque composition, that is presence of intraplaque hemorrhage, lipid, and calcification. History of ischemic stroke and CHD was assessed until date of magnetic resonance imaging. The study was approved by the institutional review board, and all participants gave informed consent. Logistic regression analyses adjusted for age and traditional cardiovascular risk factors were used to study sex-specific associations between plaque characteristics and clinical events. We found that both carotid stenosis and intraplaque hemorrhage were associated with ischemic stroke in men but not in women (men: odds ratio [OR] for stenosis [per 10% increase]: 1.17 [95% CI, 1.06-1.30] and for intraplaque hemorrhage 2.39 [95% CI, 1.32-4.35]). In both men and women, carotid stenosis was associated with CHD (men: OR per 10% increase 1.12 [95% CI, 1.04-1.21] and women: OR, 1.17 [95% CI, 1.03-1.34]) and carotid wall thickness was associated with CHD (men: OR, 1.20 [95% CI, 1.03-1.39] and women: OR, 1.21 [95% CI, 0.88-1.65]). None of the plaque components was associated with CHD. Whereas carotid plaque thickness and stenosis are associated with the history of ischemic stroke and CHD, carotid intraplaque hemorrhage is associated with ischemic stroke, but not with CHD, providing novel insights into the pathogenesis of cardiovascular events. © 2016 American Heart Association, Inc.

  2. Right ventricular longitudinal strain correlates well with right ventricular stroke work index in patients with advanced heart failure referred for heart transplantation.

    Science.gov (United States)

    Cameli, Matteo; Lisi, Matteo; Righini, Francesca Maria; Tsioulpas, Charilaos; Bernazzali, Sonia; Maccherini, Massimo; Sani, Guido; Ballo, Piercarlo; Galderisi, Maurizio; Mondillo, Sergio

    2012-03-01

    Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and success of using left ventricular assist devices (LVADs) in patients with refractory heart failure. Tissue Doppler and M-mode measurements of tricuspid systolic motion (tricuspid S' and tricuspid annular plane systolic excursion [TAPSE]) are the most currently used methods for the quantification of RV longitudinal function; RV deformation analysis by speckle-tracking echocardiography (STE) has recently allowed the analysis of global RV longitudinal function. Using cardiac catheterization as the reference standard, this study aimed at exploring the correlation between RV longitudinal function by STE and RV stroke work index (RVSWI) in patients referred for cardiac transplantation. Right-side heart catheterization and transthoracic echo Doppler were simultaneously performed in 41 patients referred for cardiac transplantation evaluation for advanced systolic heart failure. Thermodilution RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. RV longitudinal strain (RVLS) by STE was assessed averaging all segments in apical 4-chamber view (global RVLS) and by averaging RV free-wall segments (free-wall RVLS). Tricuspid S' and TAPSE were also calculated. No significant correlations were found for TAPSE or tricuspid S' with RVSWI (r = 0.14; r = 0.06; respectively). Close negative correlations between global RVLS and free-wall RVLS with the RVSWI were found (r = -0.75; r = -0.82; respectively; both P rights reserved.

  3. Acute ischemic stroke update.

    Science.gov (United States)

    Baldwin, Kathleen; Orr, Sean; Briand, Mary; Piazza, Carolyn; Veydt, Annita; McCoy, Stacey

    2010-05-01

    Stroke is the third most common cause of death in the United States and is the number one cause of long-term disability. Legislative mandates, largely the result of the American Heart Association, American Stroke Association, and Brain Attack Coalition working cooperatively, have resulted in nationwide standardization of care for patients who experience a stroke. Transport to a skilled facility that can provide optimal care, including immediate treatment to halt or reverse the damage caused by stroke, must occur swiftly. Admission to a certified stroke center is recommended for improving outcomes. Most strokes are ischemic in nature. Acute ischemic stroke is a heterogeneous group of vascular diseases, which makes targeted treatment challenging. To provide a thorough review of the literature since the 2007 acute ischemic stroke guidelines were developed, we performed a search of the MEDLINE database (January 1, 2004-July 1, 2009) for relevant English-language studies. Results (through July 1, 2009) from clinical trials included in the Internet Stroke Center registry were also accessed. Results from several pivotal studies have contributed to our knowledge of stroke. Additional data support the efficacy and safety of intravenous alteplase, the standard of care for acute ischemic stroke since 1995. Due to these study results, the American Stroke Association changed its recommendation to extend the time window for administration of intravenous alteplase from within 3 hours to 4.5 hours of symptom onset; this recommendation enables many more patients to receive the drug. Other findings included clinically useful biomarkers, the role of inflammation and infection, an expanded role for placement of intracranial stents, a reduced role for urgent carotid endarterectomy, alternative treatments for large-vessel disease, identification of nontraditional risk factors, including risk factors for women, and newly published pediatric stroke guidelines. In addition, new devices for

  4. Platelet function testing in transient ischaemic attack and ischaemic stroke: A comprehensive systematic review of the literature.

    Science.gov (United States)

    Lim, Soon Tjin; Coughlan, Catherine A; Murphy, Stephen J X; Fernandez-Cadenas, Israel; Montaner, Joan; Thijs, Vincent; Marquardt, Lars; McCabe, Dominick J H

    2015-01-01

    The majority of patients with ischaemic cerebrovascular disease (CVD) are not protected from further vascular events with antiplatelet therapy. Measurement of inhibition of platelet function ex vivo on antiplatelet therapy, using laboratory tests that correlate with the clinical effectiveness of these agents, would potentially enable physicians to tailor antiplatelet therapy to suit individuals. A systematic review of the literature was performed to collate all available data on ex vivo platelet function/reactivity in CVD patients, especially those treated with aspirin, dipyridamole or clopidogrel. Particular emphasis was paid to information from commonly available whole blood platelet function analysers (PFA-100®, VerifyNow® and Multiplate®). Data on pharmacogenetic mechanisms potentially influencing high on-treatment platelet reactivity (HTPR) on antiplatelet therapy in CVD were reviewed. Two-hundred forty-nine potentially relevant articles were identified; 93 manuscripts met criteria for inclusion. The prevalence of ex vivo HTPR in CVD varies between 3-62% with aspirin monotherapy, 8-61% with clopidogrel monotherapy and 56-59% when dipyridamole is added to aspirin in the early, subacute or late phases after TIA/stroke onset. The prevalence of HTPR on aspirin was higher on the PFA-100 than on the VerifyNow in one study (p stroke (p = 0.003; 1 study). Studies assessing the influence of genetic polymorphisms on HTPR in CVD patients are limited, and need validation in large multicentre studies. Available data illustrate that an important proportion of CVD patients have ex vivo HTPR on their prescribed antiplatelet regimen, and that the prevalence varies depending on the definition and assay used. Large, adequately-sized, prospective multicentre collaborative studies are urgently needed to determine whether comprehensive assessment of HTPR at high and low shear stress with a range of user-friendly whole blood platelet function testing platforms, in conjunction

  5. Contemporary trends in cardiogenic shock: Incidence, intra-aortic balloon pump utilisation and outcomes from the London Heart Attack Group.

    Science.gov (United States)

    Rathod, Krishnaraj S; Koganti, Sudheer; Iqbal, M Bilal; Jain, Ajay K; Kalra, Sundeep S; Astroulakis, Zoe; Lim, Pitt; Rakhit, Roby; Dalby, Miles C; Lockie, Tim; Malik, Iqbal S; Knight, Charles J; Whitbread, Mark; Mathur, Anthony; Redwood, Simon; MacCarthy, Philip A; Sirker, Alexander; O'Mahony, Constantinos; Wragg, Andrew; Jones, Daniel A

    2018-02-01

    Cardiogenic shock remains a major cause of morbidity and mortality in patients with ST-segment elevation myocardial infarction. We aimed to assess the current trends in cardiogenic shock management, looking specifically at the incidence, use of intra-aortic balloon pump therapy and outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. We undertook an observational cohort study of 21,210 ST-segment elevation myocardial infarction patients treated between 2005-2015 at the eight Heart Attack Centres in London, UK. Patients' details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society percutaneous coronary intervention dataset. There were 1890 patients who presented with cardiogenic shock. The primary outcome was all-cause mortality at a median follow-up of 4.1 years (interquartile range: 2.2-5.8 years). Increasing rates of cardiogenic shock were seen over the course of the study with consistently high mortality rates of 45-70%. A total of 685 patients underwent intra-aortic balloon pump insertion during primary percutaneous coronary intervention for cardiogenic shock with decreasing rates over time. Those patients undergoing intra-aortic balloon pump therapy were younger, more likely to have poor left ventricular function and less likely to have had previous percutaneous coronary intervention compared to the control group. Procedural success rates were similar (86.0% vs 87.1%, p=0.292) although crude, in-hospital major adverse cardiac event rates were higher (43.8% vs 33.7%, p<0.0001) in patients undergoing intra-aortic balloon pump therapy. Kaplan-Meier analysis demonstrated significantly higher mortality rates in patients receiving intra-aortic balloon pump therapy (50.9% intra-aortic balloon pump vs 39.9% control, p<0.0001) during the follow-up period. After multivariate Cox analysis (hazard ratio 1.04, 95% confidence interval 0

  6. Patent Foramen Ovale and Cryptogenic Strokes in the Stroke in Young Fabry Patients Study.

    Science.gov (United States)

    Huber, Roman; Grittner, Ulrike; Weidemann, Frank; Thijs, Vincent; Tanislav, Christian; Enzinger, Christian; Fazekas, Franz; Wolf, Markus; Hennerici, Michael G; McCabe, Dominick J H; Putaala, Jukaa; Tatlisumak, Turgut; Kessler, Christoph; von Sarnowski, Bettina; Martus, Peter; Kolodny, Edwin; Norrving, Bo; Rolfs, Arndt

    2017-01-01

    A patent foramen ovale (PFO) is disproportionately prevalent in patients with cryptogenic stroke. Without alternative explanations, it is frequently considered to be causative. A detailed stratification of these patients may improve the identification of incidental PFO. We investigated the PFO prevalence in 3497 transient ischemic attack and ischemic stroke patients aged 18 to 55 years in the prospective multicenter SIFAP1 study (Stroke in Young Fabry Patients 1) using the ASCO classification. Patients without an obvious cause for transient ischemic attack/stroke (ASCO 0) were divided into subgroups with and without vascular risk factors (ASCO 0+ and 0-). In addition, we looked for PFO-related magnetic resonance imaging lesion patterns. PFO was identified in 25% of patients. Twenty percent of patients with a definite or probable cause of transient ischemic attack/stroke (≥1 grade 1 or 2 ASCO criterion; n=1769) had a PFO compared with 29% of cryptogenic stroke patients (ASCO 0 and 3; n=1728; Pstrokes revealed a PFO in 24% of 978 ASCO 3 patients (n.s. versus ASCO 1 and 2) and a higher prevalence of 36% in 750 ASCO 0 cases (Pstroke patients demonstrate a heterogeneous PFO prevalence. Even in case of less conclusive diseases like nonstenotic arteriosclerosis, patients should preferentially be considered to have a non-PFO-mediated stroke. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2016 American Heart Association, Inc.

  7. Semi-automatic software based detection of atrial fibrillation in acute ischaemic stroke and transient ischaemic attack

    DEFF Research Database (Denmark)

    Nickelsen, M N; Snoer, A; Ali, A M

    2017-01-01

    continuous cardiac rhythm monitoring. Extended monitoring detects more PAF but is limited by costs due to manual analysis. Interpretive software might be a reasonable screening tool. The aim was to validate the performance and utility of Pathfinder SL software compared to manual analysis. METHODS: In all......, 135 ischaemic stroke patients with no prior history of PAF or atrial fibrillation and who had done a 7-day continuous electrocardiogram monitoring (Holter) were included. Manual analysis was compared with Pathfinder SL software including a systematic control of registered events. RESULTS: Seventeen...... (12.6%) patients were diagnosed with PAF (atrial fibrillation > 30 s). Pathfinder SL software including a systematic control of events registered 16 (94.1%) patients with PAF. Manually 15 (88.2%) patients were detected with PAF. Pathfinder SL had a negative predictive value of 99% and sensitivity...

  8. Haemodynamics and oxygen metabolism in patients after reversible ischaemic attack or minor ischaemic stroke assessed with positron emission tomography

    International Nuclear Information System (INIS)

    Itoh, M.; Hatazawa, J.; Abe, Y.; Fujiwara, T.; Kubota, K.; Yamaguchi, K.; Sato, T.; Matsuzawa, T.; Fukuda, H.; Ido, T.; Pozzilli, C.

    1987-01-01

    Regional cerebral blood flow (CBF), blood volume (CBV) and oxygen metabolic rate (CMRO2) were evaluated and compared among normals, patients with recent reversible ischaemic attacks (RIAs) and patients with chronic minor infarction using positron emission tomography. Average CBF together with CMRO2 significantly decreased in the infarction group in the middle cerebral artery territory of the affected hemisphere while the mean values for RIAs were intermediate between the other two groups. CBV also reduced, however it was more preserved compared to flow as seen in decreased CBF/CBV values. Significant interhemispheric difference was found in CBF/CBV ratio, but it did not clearly correlate with OEF changes. Higher OEF was noted only in the restricted brain regions of RIAs where CBF showed large hemispheric asymmetry. However, in other regions, the coupled decline of blood flow and metabolism was found which suggests tissue damage or neuronal cell loss in the brain with previous RIA symptoms. (orig.)

  9. DAILY CHANGES OF CENTRAL HEMODYNAMICS IN PATIENTS WITH CHRONIC HEART FAILURE WITH NIGHT-TIME DYSPNOEA ATTACK

    Directory of Open Access Journals (Sweden)

    S. A. Dovgolis

    2006-01-01

    Full Text Available Aim. To study daily changes of central hemodynamics (CHD in patients with chronic heart failure (CHF and the effects of therapy. Materials and methods. 22 patients with ischemic heart disease and CHF of III-IV functional class (FC by NYHA, age 60,5±10,5 were observed. Patients were suffering from night-time dyspnoea attacks and had pulmonary artery occlusion pressure (PAOP 15-20 mm Hg. CHD was monitored invasively before the treatment and after 4 weeks of CHF treatment. Results. According to the cardiac index (CI at admission patients were split into two groups. 9 patients of group-I had CI ≤2,15 l\\min\\m2, and 13 patients of group-II had CI >2,15 l\\min\\m2. In patients of group-I CI increased in 4 weeks of treatment. The treatment caused considerable clinical improvement in all patients. The CHD indexes also improved. Initially evening-night-time peaks of PAOP (р≤0,002, systolic (SBP (р≤0,003, diastolic (DBP (р=0,002 and average (BPa (р=0,0007 blood pressure (BP as well as double multiplication (DM (р≤0,008 were registered in patients of group-I. At the end of treatment only evening-night increase in DBP (р=0,002 and BPa (р≤0,006 were noted. In patients of group-II after 4 weeks of treatment CI decreased or didn’t change. Towards 28-th day of treatment 10 patients had clinical improvements. Only one patient’s FC NYHA increased. At the end of treatment the normalization of CHD was registered totally in group. Initially evening-night-time peaks of PAOP (р≤0,002, SBP (р≤0, 0001, CI (р=0,057 and DM (р=0,084 were registered in patients of group-II. At the end of treatment evening-night-time peaks of PAOP (р≤0,015, SBP (р≤0,044, CI (р≤0,005 and DM (р≤0,044 still remained. Besides, evening-night-time peaks of cardiac output (р≤0,01 and systolic index (р≤0, 06 have added. Conclusion. In patients with CHF with initial CI ≤2,15 l\\min\\m2 treatment results in the normalization of CHD and its daily

  10. A Targeted Self-Management Approach for Reducing Stroke Risk Factors in African American Men Who Have Had a Stroke or Transient Ischemic Attack.

    Science.gov (United States)

    Sajatovic, Martha; Tatsuoka, Curtis; Welter, Elisabeth; Colon-Zimmermann, Kari; Blixen, Carol; Perzynski, Adam T; Amato, Shelly; Cage, Jamie; Sams, Johnny; Moore, Shirley M; Pundik, Svetlana; Sundararajan, Sophia; Modlin, Charles; Sila, Cathy

    2018-02-01

    This study compared a novel self-management (TargetEd MAnageMent Intervention [TEAM]) versus treatment as usual (TAU) to reduce stroke risk in African American (AA) men. Six-month prospective randomized controlled trial with outcomes evaluated at baseline, 3 months, and 6 months. Academic health center. Thirty-eight (age 60 were randomly assigned to TEAM (n = 19) or TAU (n = 19). Self-management training, delivered in 1 individual and 4 group sessions (over 3 months). Blood pressure, glycosylated hemoglobin (HbA 1c ), lipids, medication adherence, weight, and standardized measures of health behaviors (diet, exercise, smoking, substances), depression, and quality of life. Qualitative assessments evaluated the perspectives of TEAM participants. T tests for paired differences and nonparametric tests. Thematic content qualitative analysis. Mean age was 52.1 (standard deviation [SD] = 7.4) and mean body mass index was 31.4 (SD = 7.4). Compared to TAU, TEAM participants had significantly lower mean systolic blood pressure by 24 weeks, and there was also improvement in HbA 1c and high-density lipoprotein cholesterol ( P = .03). Other biomarker and health behaviors were similar between groups. Qualitative results suggested improved awareness of risk factors as well as positive effects of group support.

  11. Quantifying the risk of heart disease following acute ischaemic stroke: a meta-analysis of over 50 000 participants

    Science.gov (United States)

    Gunnoo, Trishna; Hasan, Nazeeha; Khan, Muhammad Saleem; Slark, Julia; Bentley, Paul; Sharma, Pankaj

    2016-01-01

    Objective Following an acute stroke, there is a high risk of recurrence. However, the leading cause of mortality following a stroke is due to coronary artery disease (CAD) and myocardial infarction (MI) but that risk has not been robustly quantified. We sought to reliably quantify the risk of ischaemic heart disease (IHD) in patients presenting with acute ischaemic stroke (AIS) in the absence of a known cardiac history. Setting A meta-analysis study. PubMed, MEDLINE, EMBASE and Google Scholar were searched for potential studies up to October 2015. Included studies reported an acute cerebral ischaemic event and followed for CAD or MI within 1 year in patients without known IHD. Using arcsine transformed proportions for meta-analysis, studies were combined using a generic inverse variance random-effects model to calculate the pooled standardised mean difference and 95% CIs. These were interpreted as the percentage prevalence of CAD or incidence of MI following AIS. Results 17 studies with 4869 patients with AIS demonstrated a mean average of asymptomatic CAD in 52%. Anatomical methods of CAD detection revealed a prevalence of asymptomatic ≥50% coronary stenosis in 32% (95% CI 19% to 47%; pischaemic stroke revealed an overall risk of MI in the year following stroke of 3% (95% CI 1% to 5%; pischaemic stroke with no cardiac history have more than 50% coronary stenosis and 3% are at risk of developing MI within a year. Our findings provide a reliable quantitative measure of the risk of IHD following AIS in patients with no cardiac history. PMID:26792217

  12. Quantifying the risk of heart disease following acute ischaemic stroke: a meta-analysis of over 50,000 participants.

    Science.gov (United States)

    Gunnoo, Trishna; Hasan, Nazeeha; Khan, Muhammad Saleem; Slark, Julia; Bentley, Paul; Sharma, Pankaj

    2016-01-20

    Following an acute stroke, there is a high risk of recurrence. However, the leading cause of mortality following a stroke is due to coronary artery disease (CAD) and myocardial infarction (MI) but that risk has not been robustly quantified. We sought to reliably quantify the risk of ischaemic heart disease (IHD) in patients presenting with acute ischaemic stroke (AIS) in the absence of a known cardiac history. A meta-analysis study. PubMed, MEDLINE, EMBASE and Google Scholar were searched for potential studies up to October 2015. Included studies reported an acute cerebral ischaemic event and followed for CAD or MI within 1 year in patients without known IHD. Using arcsine transformed proportions for meta-analysis, studies were combined using a generic inverse variance random-effects model to calculate the pooled standardised mean difference and 95% CIs. These were interpreted as the percentage prevalence of CAD or incidence of MI following AIS. 17 studies with 4869 patients with AIS demonstrated a mean average of asymptomatic CAD in 52%. Anatomical methods of CAD detection revealed a prevalence of asymptomatic ≥ 50% coronary stenosis in 32% (95% CI 19% to 47%; pischaemic stroke revealed an overall risk of MI in the year following stroke of 3% (95% CI 1% to 5%; pischaemic stroke with no cardiac history have more than 50% coronary stenosis and 3% are at risk of developing MI within a year. Our findings provide a reliable quantitative measure of the risk of IHD following AIS in patients with no cardiac history. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis

    DEFF Research Database (Denmark)

    Kaptoge, Stephen; Di Angelantonio, Emanuele; Lowe, Gordon

    2010-01-01

    .18-1.49) for ischaemic stroke; 1.34 (1.18-1.52) for vascular mortality; and 1.34 (1.20-1.50) for non-vascular mortality. INTERPRETATION: CRP concentration has continuous associations with the risk of coronary heart disease, ischaemic stroke, vascular mortality, and death from several cancers and lung disease......-person variation in risk factor levels. RESULTS: Log(e) CRP concentration was linearly associated with several conventional risk factors and inflammatory markers, and nearly log-linearly with the risk of ischaemic vascular disease and non-vascular mortality. Risk ratios (RRs) for coronary heart disease per 1-SD...... higher log(e) CRP concentration (three-fold higher) were 1.63 (95% CI 1.51-1.76) when initially adjusted for age and sex only, and 1.37 (1.27-1.48) when adjusted further for conventional risk factors; 1.44 (1.32-1.57) and 1.27 (1.15-1.40) for ischaemic stroke; 1.71 (1.53-1.91) and 1.55 (1...

  14. Should heart age calculators be used alongside absolute cardiovascular disease risk assessment?

    OpenAIRE

    Bonner, Carissa; Bell, Katy; Jansen, Jesse; Glasziou, Paul; Irwig, Les; Doust, Jenny; McCaffery, Kirsten

    2018-01-01

    Background National estimates of ‘heart age’ by government health organisations in the US, UK and China show most people have an older heart age than current age. While most heart age calculators are promoted as a communication tool for lifestyle change, they may also be used to justify medication when clinical guidelines advocate their use alongside absolute risk assessment. However, only those at high absolute risk of a heart attack or stroke are likely to benefit from medication, and it is...

  15. Platelet degranulation and monocyte-platelet complex formation are increased in the acute and convalescent phases after ischaemic stroke or transient ischaemic attack.

    LENUS (Irish Health Repository)

    McCabe, Dominick J H

    2004-06-01

    Flow cytometric studies suggest that platelets are activated in ischaemic stroke or transient ischaemic attack (TIA). However, few studies have measured circulating leucocyte-platelet complexes in this patient population. Whole blood flow cytometry was used to quantify the expression of CD62P-, CD63-, and PAC1-binding, and the percentages of leucocyte-platelet complexes in acute (1-27 d, n = 79) and convalescent (79-725 d, n = 70) ischaemic cerebrovascular disease (CVD) patients compared with controls without CVD (n = 27). We performed a full blood count, and measured plasma levels of soluble P-selectin, soluble E-selectin, and von Willebrand factor antigen (VWF:Ag) as additional markers of platelet and\\/or endothelial cell activation. The median percentage CD62P expression and the median percentage monocyte-platelet complexes were higher in both acute and convalescent CVD patients than controls (P <\\/= 0.02). The mean white cell count and mean VWF:Ag levels were significantly elevated in the acute and convalescent phases after ischaemic stroke or TIA (P <\\/= 0.02). Otherwise, there was no significant increase in any other marker of platelet or endothelial activation in CVD patients. There was a positive correlation between the percentage expression of CD62P and the percentages of both neutrophil-platelet and monocyte-platelet complexes in the acute phase, and the percentages of all leucocyte-platelet complexes in the convalescent phase after ischaemic CVD. This study provides evidence for ongoing excessive platelet and\\/or endothelial activation in ischaemic CVD patients despite treatment with antithrombotic therapy.

  16. Ischemic Stroke: MedlinePlus Health Topic

    Science.gov (United States)

    ... Clots) (American Stroke Association) Let's Talk about Ischemic Stroke (American Heart Association) Also in Spanish Prevention and Risk Factors Carotid Endarterectomy (National Heart, Lung, and Blood Institute) ...

  17. Program of rehabilitative exercise and education to avert vascular events after non-disabling stroke or transient ischemic attack (PREVENT Trial: a multi-centred, randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Thompson Kara

    2010-12-01

    Full Text Available Abstract Background Despite lack of outward signs, most individuals after non-disabling stroke (NDS and transient ischemic attack (TIA have significant cardiovascular and cerebrovascular disease and are at high risk of a major stroke, hospitalization for other vascular events, or death. Most have multiple modifiable risk factors (e.g., hypertension, physical inactivity, hyperlipidaemia, diabetes, tobacco consumption, psychological stress. In addition, accelerated rates of depression, cognitive decline, and poor quality of sleep have been reported following TIA, which correlate with poor functional outcomes and reduced quality of life. Thus, NSD and TIA are important warning signs that should not be overlooked. The challenge is not unlike that facing other 'silent' conditions - to identify a model of care that is effective in changing people's current behaviors in order to avert further morbidity. Methods/Design A single blind, randomized controlled trial will be conducted at two sites to compare the effectiveness of a program of rehabilitative exercise and education versus usual care in modifying vascular risk factors in adults after NDS/TIA. 250 adults within 90 days of being diagnosed with NDS/TIA will be randomly allocated to a 12-week program of exercise and education (PREVENT or to an outpatient clinic assessment and discussion of secondary prevention recommendations with return clinic visits as indicated (USUAL CARE. Primary outcome measures will include blood pressure, waist circumference, 12-hour fasting lipid profile, and 12-hour fasting glucose/hemoglobin A1c. Secondary measures will include exercise capacity, walking endurance, physical activity, cognitive function, depression, goal attainment and health-related quality of life. Outcome assessment will be conducted at baseline, post-intervention, and 6- and 12-month follow-ups. Direct health care costs incurred over one year by PREVENT versus USUAL CARE participants will also be

  18. Childhood intelligence in relation to adult coronary heart disease and stroke risk: evidence from a Danish birth cohort study

    DEFF Research Database (Denmark)

    Batty, G. David; Mortensen, Erik Lykke; Andersen, Anne-Marie Nybo

    2005-01-01

    While recent studies have reported an inverse relation between childhood intelligence test scores and all-cause mortality in later life, the link with disease-specific outcomes has been rarely examined. Furthermore, the potential confounding effect of birthweight and childhood social circumstances...... is unknown. We investigated the relation of childhood intelligence with coronary heart disease (CHD) and stroke risk in a cohort of 6910 men born in 1953 in the Copenhagen area of Denmark. Events were ascertained from 1978 to 2000 using a cause-of-death register and hospital discharge records. There were 150...... CHD (19 fatal; 131 non-fatal) and 93 stroke (4 fatal; 89 non-fatal) events during follow-up into mid-life. Childhood intelligence was inversely related to CHD with the highest rate apparent in adults with low childhood test scores (HR(lowest vs. highest quartile), 2.70; 95% confidence interval: 1...

  19. What causes disability after transient ischemic attack and minor stroke?: Results from the CT and MRI in the Triage of TIA and minor Cerebrovascular Events to Identify High Risk Patients (CATCH) Study.

    Science.gov (United States)

    Coutts, Shelagh B; Modi, Jayesh; Patel, Shiel K; Aram, Heidi; Demchuk, Andrew M; Goyal, Mayank; Hill, Michael D

    2012-11-01

    Minor stroke and transient ischemic attack portend a significant risk of disability. Three possible mechanisms for this include disability not captured by the National Institutes of Health Stroke Scale, symptom progression, or recurrent stroke. We sought to assess the relative impact of these mechanisms on disability in a population of patients with transient ischemic attack and minor stroke. Five hundred ten consecutive minor stroke (National Institutes of Health Stroke Scalefour of 499 (15%; 95% CI, 12%-18%) patients had a disabled outcome. Baseline factors predicting disability were: age≥60 years, diabetes mellitus, premorbid modified Rankin Scale 1, ongoing symptoms, baseline National Institutes of Health Stroke Scale, CT/CT angiography-positive metric, and diffusion-weighted imaging positivity. In the multivariable analysis ongoing symptoms (OR, 2.4; 95% CI, 1.3-4.4; P=0.004), diabetes mellitus (OR, 2.3; 95% CI, 1.2-4.3; P=0.009), female sex (OR, 1.8; 95% CI, 1.1-3; P=0.025), and CT/CT angiography-positive metric (OR, 2.4; 95% CI, 1.4-4; P=0.001) predicted disability. Of the 463 patients who did not have a recurrent event, 55 were disabled (12%). By contrast 19 of 36 (53%) patients were disabled after a recurrent event (risk ratio, 4.4; 95% CI, 3-6.6; Pstroke become disabled. In terms of absolute numbers, most patients have disability as a result of their presenting event; however, recurrent events have the largest relative impact on outcome.

  20. Atrial fibrillation detected by external loop recording for seven days or two-day simultaneous Holter recording: A comparison in patients with ischemic stroke or transient ischemic attack.

    Science.gov (United States)

    Sejr, Michala Herskind; Nielsen, Jens Cosedis; Damgaard, Dorte; Sandal, Birgitte Forsom; May, Ole

    Atrial fibrillation (AF) is the most common cardiac cause of ischemic stroke and transient ischemic attack (IS/TIA). To compare the diagnostic value of seven-day external loop recording (ELR) and two-day Holter recording for detecting AF after IS/TIA. 191 IS/TIA patients without AF history. Endpoint was AF >30s. We started two-day Holter recording and seven-day ELR simultaneously. Seven-day ELR and two-day Holter recording detected the same three AF patients. ELR detected another six patients with AF adjudicated by cardiologists, four detections after Holter (3 vs. 7, p=0.125) and two false-positive detections during Holter. Seven-day ELR automatically classified 50/191 patients (26%) with AF, but only 7/50 (14%) were confirmed as AF by cardiologists. Seven-day ELR did not detect significantly more patients with AF than two-day Holter recording. 86% of patients with ELR-classified AF were false positives, indicating a poor performance of the automatic AF detection algorithm used. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Heart Disease Risk Factors

    Science.gov (United States)

    ... About CDC.gov . Home About Heart Disease Coronary Artery Disease Heart Attack Heart Attack Signs and Symptoms ... Privacy FOIA No Fear Act OIG 1600 Clifton Road Atlanta , GA 30329-4027 USA 800-CDC-INFO ( ...

  2. Empowered to gain a new foothold in life--A study of the meaning of participating in cardiac rehabilitation to patients afflicted by a minor heart attack.

    Science.gov (United States)

    Simonÿ, Charlotte P; Dreyer, Pia; Pedersen, Birthe D; Birkelund, Regner

    2015-01-01

    This study aimed to investigate what it means to patients afflicted by a minor heart attack to participate in cardiac rehabilitation (CR). CR is well-established internationally to support patients towards moving forward in satisfying, healthy, and well-functioning lives. Studies indicate that patients achieve improvement in quality of life when participating in CR. However, knowledge of how patients are supported during CR is sparse. Moreover, knowledge of what participating in CR means to patients afflicted by a minor heart attack is lacking. In-depth knowledge in this area is crucial in order to understand these patients' particular gains and needs. In a phenomenological-hermeneutic frame field observations, focus group interviews, and individual interviews were conducted among 11 patients during and after their participation in CR. Field notes and transcribed interviews underwent three-phased interpretation. It was found that patients were supported to gain renewed balance in their lives during CR. Three themes were identified: (1) receiving a helpful but limited caring hand, (2) being supported to find new values in life, and (3) developing responsibility for the remaining time. The patients were carefully guided through a difficult time and supported to continue in healthy everyday lives. They were given hope which enabled them to find themselves a new foothold in life with respect to their own sense of well-being. This guidance and a sense of hopefulness were provided by heart specialists and more seasoned heart patients. In conclusion, patients were empowered to achieve a healthier lifestyle and improve their personal well-being during CR. However, structural barriers in the programme prevented adequate support regarding the patients' total needs. Knowledge of the benefits of CR emphasizes the significance of the programme and highlights the importance of high inclusion. Efforts should be made to develop more flexible and longer lasting programmes and

  3. Empowered to gain a new foothold in life—A study of the meaning of participating in cardiac rehabilitation to patients afflicted by a minor heart attack

    Directory of Open Access Journals (Sweden)

    Charlotte P. Simonÿ

    2015-12-01

    Full Text Available This study aimed to investigate what it means to patients afflicted by a minor heart attack to participate in cardiac rehabilitation (CR. CR is well-established internationally to support patients towards moving forward in satisfying, healthy, and well-functioning lives. Studies indicate that patients achieve improvement in quality of life when participating in CR. However, knowledge of how patients are supported during CR is sparse. Moreover, knowledge of what participating in CR means to patients afflicted by a minor heart attack is lacking. In-depth knowledge in this area is crucial in order to understand these patients’ particular gains and needs. In a phenomenological-hermeneutic frame field observations, focus group interviews, and individual interviews were conducted among 11 patients during and after their participation in CR. Field notes and transcribed interviews underwent three-phased interpretation. It was found that patients were supported to gain renewed balance in their lives during CR. Three themes were identified: (1 receiving a helpful but limited caring hand, (2 being supported to find new values in life, and (3 developing responsibility for the remaining time. The patients were carefully guided through a difficult time and supported to continue in healthy everyday lives. They were given hope which enabled them to find themselves a new foothold in life with respect to their own sense of well-being. This guidance and a sense of hopefulness were provided by heart specialists and more seasoned heart patients. In conclusion, patients were empowered to achieve a healthier lifestyle and improve their personal well-being during CR. However, structural barriers in the programme prevented adequate support regarding the patients’ total needs. Knowledge of the benefits of CR emphasizes the significance of the programme and highlights the importance of high inclusion. Efforts should be made to develop more flexible and longer lasting

  4. Cost-effectiveness analysis of different systolic blood pressure targets for people with a history of stroke or transient ischaemic attack: Economic analysis of the PAST-BP study.

    Science.gov (United States)

    Penaloza-Ramos, Maria Cristina; Jowett, Sue; Barton, Pelham; Roalfe, Andrea; Fletcher, Kate; Taylor, Clare J; Hobbs, Fd Richard; McManus, Richard J; Mant, Jonathan

    2016-10-01

    The PAST-BP trial found that using a lower systolic blood pressure target (disease was associated with a small additional reduction in blood pressure (2.9 mmHg). To determine the cost effectiveness of an intensive systolic blood pressure target (stroke or transient ischaemic attack on general practice stroke/transient ischaemic attack registers in England. A Markov model with a one-year time cycle and a 30-year time horizon was used to estimate the cost per quality-adjusted life year of an intensive target versus a standard target. Individual patient level data were used from the PAST-BP trial with regard to change in blood pressure and numbers of primary care consultations over a 12-month period. Published sources were used to estimate life expectancy and risks of cardiovascular events and their associated costs and utilities. In the base-case results, aiming for an intensive blood pressure target was dominant, with the incremental lifetime costs being £169 lower per patient than for the standard blood pressure target with a 0.08 quality-adjusted life year gain. This was robust to sensitivity analyses, unless intensive blood pressure lowering reduced quality of life by 2% or more. Aiming for a systolic blood pressure target of stroke/transient ischaemic attack in the community, but it is difficult to separate out the impact of the lower target from the impact of more active management of blood pressure. © The European Society of Cardiology 2016.

  5. Survival of resuscitated cardiac arrest patients with ST-elevation myocardial infarction (STEMI) conveyed directly to a Heart Attack Centre by ambulance clinicians.

    Science.gov (United States)

    Fothergill, Rachael T; Watson, Lynne R; Virdi, Gurkamal K; Moore, Fionna P; Whitbread, Mark

    2014-01-01

    This study reports survival outcomes for patients resuscitated from out-of-hospital cardiac arrest (OHCA) subsequent to ST-elevation myocardial infarction (STEMI), and who were conveyed directly by ambulance clinicians to a specialist Heart Attack Centre for expert cardiology assessment, angiography and possible percutaneous coronary intervention (PCI). This is a retrospective descriptive review of data sourced from the London Ambulance Service's OHCA registry over a one-year period. We observed excellent survival rates for our cohort of patients with 66% of patients surviving to be discharged from hospital, the majority of whom were still alive after one year. Those who survived tended to be younger, to have had a witnessed arrest in a public place with an initial cardiac rhythm of VF/VT, and to have been transported to the specialist centre more quickly than those who did not. A system allowing ambulance clinicians to autonomously convey OHCA STEMI patients who achieve a return of spontaneous circulation directly to a Heart Attack Centre is highly effective and yields excellent survival outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Social media for health promotion: What messages are women receiving about cardiovascular disease risk by the Canadian Heart and Stroke Foundation?

    Science.gov (United States)

    Gonsalves, Christine A; McGannon, Kerry R; Schinke, Robert J

    2017-11-01

    The aim of this study was to explore the meanings of women's cardiovascular disease constructed within the Canadian Heart and Stroke Foundation Facebook page. Posts from Heart and Stroke Foundation and public user comments surrounding the launch of the Heart and Stroke Foundation re-branding were of interest. Ethnographic content analysis was employed to analyse text ( n = 40), images ( n = 32), videos ( n = 6), user comments and replies ( n = 42) from November 2016 to March 2017. Constructions (re)presented on Facebook of 'typical' women at risk and risk reduction were problematic as women most at risk were excluded through the use of consumerist, medicalized identities which also excluded promotion of healthy behaviour changes.

  7. It is not just a Minor Thing - A Phenomenological-Hermeneutic Study of Patients' Experiences when afflicted by a Minor Heart Attack and Participating in Cardiac Rehabilitation.

    Science.gov (United States)

    Simonÿ, Charlotte P; Dreyer, Pia; Pedersen, Birthe D; Birkelund, Regner

    2017-06-01

    To improve cardiac care, especially cardiac rehabilitation, patients' perspectives should be better addressed. In Denmark, patients afflicted by a minor heart attack in terms of unstable angina pectoris or non-ST-elevation myocardial infarction are treated in fast-track programmes with subacute treatment in hospital, early discharge and follow-up specialised outpatient cardiac rehabilitation. Knowledge of these patients' experiences of their life situation is essential to develop sufficient care protocols. To gain in-depth understanding of how patients afflicted by a minor heart attack experience their life situation when following cardiac rehabilitation. Focus group interviews and individual interviews were conducted with 11 patients enrolled in the cardiac rehabilitation programme. Data consisted of text in the form of transcribed interviews. A three-phased interpretation inspired by Paul Ricoeur's theory of interpretation was applied. As an overall concept, the patients experienced being forced into a demanding life shaking journey. Three themes emerged: Difficulty accepting the disease: facing the disease is a difficult challenge for the patients, leading to vulnerability and helplessness; Understanding that life has become frail: patients feel shaken as they realise that the disease is chronic and life-threatening; and An altered life: patients must adjust to new limitations in their everyday lives. Patients experience an overall demanding transition when they are afflicted by a minor heat attack, whereby their lives are sweepingly changed. Supporting patients' integrity, which becomes vulnerable during the various stages of transitions, is essential to ensure a healthy outcome. Being together with fellow patients during cardiac rehabilitation is a facilitating factor in the course of transition. © 2016 Nordic College of Caring Science.

  8. Increasing Area Deprivation and Socioeconomic Inequalities in Heart Disease, Stroke, and Cardiovascular Disease Mortality Among Working Age Populations, United States, 1969-2011

    Directory of Open Access Journals (Sweden)

    Gopal K. Singh, PhD

    2015-04-01

    Full Text Available Objectives: We examined the extent to which area- and individual-level socioeconomic inequalities in cardiovascular-disease (CVD, heart disease, and stroke mortality among United States men and women aged 25-64 years changed between 1969 and 2011. Methods: National vital statistics data and the National Longitudinal Mortality Study were used to estimate area- and individual-level socioeconomic gradients in mortality over time. Rate ratios and log-linear and Cox regression were used to model mortality trends and differentials. Results: Area socioeconomic gradients in mortality from CVD, heart disease, and stroke increased substantially during the study period. Compared to those in the most affluent group, individuals in the most deprived area group had, respectively 35%, 29%, and 73% higher CVD, heart disease, and stroke mortality in 1969, but 120-121% higher mortality in 2007-2011. Gradients were steeper for women than for men. Education, income, and occupation were inversely associated with CVD, heart disease, and stroke mortality, with individual-level socioeconomic gradients being steeper during 1990-2002 than in 1979-1989. Individuals with low education and incomes had 2.7 to 3.7 times higher CVD, heart disease, and stroke mortality risks than their counterparts with high education and income levels. Conclusions and Global Health Implications: Although mortality declined for all US groups during 1969-2011, socioeconomic disparities in mortality from CVD, heart disease and stroke remained marked and increased over time because of faster declines in mortality among higher socioeconomic groups. Widening disparities in mortality may reflect increasing temporal areal inequalities in living conditions, behavioral risk factors such as smoking, obesity and physical inactivity, and access to and use of health services. With social inequalities and prevalence of smoking, obesity, and physical inactivity on the rise, most segments of the working

  9. Increasing Area Deprivation and Socioeconomic Inequalities in Heart Disease, Stroke, and Cardiovascular Disease Mortality Among Working Age Populations, United States, 1969-2011.

    Science.gov (United States)

    Singh, Gopal K; Siahpush, Mohammad; Azuine, Romuladus E; Williams, Shanita D

    2015-01-01

    We examined the extent to which area- and individual-level socioeconomic inequalities in cardiovascular-disease (CVD), heart disease, and stroke mortality among United States men and women aged 25-64 years changed between 1969 and 2011. National vital statistics data and the National Longitudinal Mortality Study were used to estimate area- and individual-level socioeconomic gradients in mortality over time. Rate ratios and log-linear and Cox regression were used to model mortality trends and differentials. Area socioeconomic gradients in mortality from CVD, heart disease, and stroke increased substantially during the study period. Compared to those in the most affluent group, individuals in the most deprived area group had, respectively 35%, 29%, and 73% higher CVD, heart disease, and stroke mortality in 1969, but 120-121% higher mortality in 2007-2011. Gradients were steeper for women than for men. Education, income, and occupation were inversely associated with CVD, heart disease, and stroke mortality, with individual-level socioeconomic gradients being steeper during 1990-2002 than in 1979-1989. Individuals with low education and incomes had 2.7 to 3.7 times higher CVD, heart disease, and stroke mortality risks than their counterparts with high education and income levels. Although mortality declined for all US groups during 1969-2011, socioeconomic disparities in mortality from CVD, heart disease and stroke remained marked and increased over time because of faster declines in mortality among higher socioeconomic groups. Widening disparities in mortality may reflect increasing temporal areal inequalities in living conditions, behavioral risk factors such as smoking, obesity and physical inactivity, and access to and use of health services. With social inequalities and prevalence of smoking, obesity, and physical inactivity on the rise, most segments of the working-age population in low- and middle-income countries will likely experience increased cardiovascular

  10. Snoring and risk of stroke and ischaemic heart disease in a 70 year old population. A 6-year follow-up study

    DEFF Research Database (Denmark)

    Jennum, P; Schultz-Larsen, K; Davidsen, Michael

    1994-01-01

    heart disease (IHD) and stroke while controlling for the potential influence of major cardio- and cerebrovascular risk factors. METHODS. In all, 804 70 year old males and females were classified according to snoring habits. Alcohol and tobacco consumption, blood pressure, body mass index, social group......, plasma lipids (triglycerides, cholesterol, high density lipoprotein), fasting blood glucose, plasma epinephrine and norepinephrine were determined at baseline. RESULTS. Over a 6-year period (1984-1990) 88 suffered an IHD episode, 60 had a stroke and 180 died. A slightly higher stroke incidence was found...

  11. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Derdeyn, Colin P; Zipfel, Gregory J; Albuquerque, Felipe C; Cooke, Daniel L; Feldmann, Edward; Sheehan, Jason P; Torner, James C

    2017-08-01

    The aim of this statement is to review the current data and to make suggestions for the diagnosis and management of both ruptured and unruptured brain arteriovenous malformations. The writing group met in person and by teleconference to establish search terms and to discuss narrative text and suggestions. Authors performed their own literature searches of PubMed, Medline, or Embase, specific to their allocated section, through the end of January 2015. Prerelease review of the draft statement was performed by expert peer reviewers and by the members of the Stroke Council Scientific Oversight Committee and Stroke Council Leadership Committee. The focus of the scientific statement was subdivided into epidemiology; diagnosis; natural history; treatment, including the roles of surgery, stereotactic radiosurgery, and embolization; and management of ruptured and unruptured brain arteriovenous malformations. Areas requiring more evidence were identified. Brain arteriovenous malformations are a relatively uncommon but important cause of hemorrhagic stroke, especially in young adults. This statement describes the current knowledge of the natural history and treatment of patients with ruptured and unruptured brain arteriovenous malformations, suggestions for management, and implications for future research. © 2017 American Heart Association, Inc.

  12. Recurrent Hemorrhagic Conversion of Ischemic Stroke in a Patient with Mechanical Heart Valve: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Micheal Jace Tarver

    2018-01-01

    Full Text Available The authors present a unique case of recurrent stroke, discovered to be secondary to hemorrhagic conversion of microemboli from a mechanical aortic valve despite anticoagulation with Coumadin. The complexity of this case was magnified by the patient’s young age, a mechanical heart valve (MHV, and a need for anticoagulation to maintain MHV patency in a setting of potentially life-threatening intracranial hemorrhage. Anticoagulant and antiplatelet therapy are risk factors for hemorrhagic conversion post-cerebral ischemia; however, the pathophysiology underlying endothelial cell dysfunction causing red blood cell extravasation is an active area of basic and clinical research. The need for randomized clinical trials to aid in the creation of standardized treatment protocol continues to go unmet. Consequently, there is marked variation in therapeutic approaches to treating intracranial hemorrhage in patients with an MHV. Unfortunately, patients with an MHV are considered at high thromboembolic (TE risk, and these patients are often excluded from clinical trials of acute stroke due to their increased TE potential. The authors feel this case represents an example of endothelial dysfunction secondary to microthrombotic events originating from an MHV, which caused ischemic stroke with hemorrhagic conversion complicated by the need for anticoagulation for an MHV. This case offers a definitive treatment algorithm for a complex clinical dilemma.

  13. Homocysteine, Ischemic Stroke, and Coronary Heart Disease in Hypertensive Patients: A Population-Based, Prospective Cohort Study.

    Science.gov (United States)

    Han, Liyuan; Wu, Qunhong; Wang, Changyi; Hao, Yanhua; Zhao, Jinshun; Zhang, Lina; Fan, Rui; Liu, Yanfen; Li, Runhua; Chen, Zhongwei; Zhang, Tao; Chen, Sihan; Ma, Jianping; Liu, Shengyuan; Peng, Xiaolin; Duan, Shiwei

    2015-07-01

    Total homocysteine level (tHcy) is a risk factor of ischemic stroke (IS) and coronary heart disease. However, the results are conflicting and mainly focused on healthy individuals in developed countries. A prospective, population-based cohort study was conducted among 5935 participants from 60 communities in the city of Shenzhen, China. A Cox regression analysis was applied to evaluate the contribution of tHcy to the risk of IS and coronary heart disease. The effect of folic acid supplementation on tHcy levels was also evaluated among 501 patients with essential hypertension, who received an average of 2.5 years of folic acid supplementation. After adjustment for confounding factors, the hazard ratios (95% confidence intervals) of IS caused by hyperhomocysteinemia were 2.18 (1.65-2.89), 2.40 (1.56-3.67), and 2.73 (1.83-4.08) in the total, male, and female participants, respectively. Compared with normal levels of tHcy (disease. The 2.5 years of folic acid supplementation reduced tHcy levels by 6.7 μmol/L (27.92%) in patients with essential hypertension. Hyperhomocysteinemia in Chinese hypertensive patients is significantly associated with IS risk but not coronary heart disease susceptibility, and folic acid supplementation can efficiently reduce tHcy levels. © 2015 American Heart Association, Inc.

  14. Prediction of Major Vascular Events after Stroke

    DEFF Research Database (Denmark)

    Ovbiagele, Bruce; Goldstein, Larry B.; Amarenco, Pierre

    2014-01-01

    BACKGROUND: Identifying patients with recent stroke or transient ischemic attack (TIA) at high risk of major vascular events (MVEs; stroke, myocardial infarction, or vascular death) may help optimize the intensity of secondary preventive interventions. We evaluated the relationships between...... were analyzed. Hazard ratios (HRs) from Cox regression models were used to determine the risk of subsequent MVEs based on the FCRS predicting 20% or more 10-year coronary heart disease risk. The novel risk model was derived based on multivariable modeling with backward selection. Model discrimination...

  15. Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Gorelick, Philip B; Furie, Karen L; Iadecola, Costantino; Smith, Eric E; Waddy, Salina P; Lloyd-Jones, Donald M; Bae, Hee-Joon; Bauman, Mary Ann; Dichgans, Martin; Duncan, Pamela W; Girgus, Meighan; Howard, Virginia J; Lazar, Ronald M; Seshadri, Sudha; Testai, Fernando D; van Gaal, Stephen; Yaffe, Kristine; Wasiak, Hank; Zerna, Charlotte

    2017-10-01

    Cognitive function is an important component of aging and predicts quality of life, functional independence, and risk of institutionalization. Advances in our understanding of the role of cardiovascular risks have shown them to be closely associated with cognitive impairment and dementia. Because many cardiovascular risks are modifiable, it may be possible to maintain brain health and to prevent dementia in later life. The purpose of this American Heart Association (AHA)/American Stroke Association presidential advisory is to provide an initial definition of optimal brain health in adults and guidance on how to maintain brain health. We identify metrics to define optimal brain health in adults based on inclusion of factors that could be measured, monitored, and modified. From these practical considerations, we identified 7 metrics to define optimal brain health in adults that originated from AHA's Life's Simple 7: 4 ideal health behaviors (nonsmoking, physical activity at goal levels, healthy diet consistent with current guideline levels, and body mass index brain health but recognize that the truly ideal circumstance may be uncommon because there is a continuum of brain health as demonstrated by AHA's Life's Simple 7. Therefore, there is opportunity to improve brain health through primordial prevention and other interventions. Furthermore, although cardiovascular risks align well with brain health, we acknowledge that other factors differing from those related to cardiovascular health may drive cognitive health. Defining optimal brain health in adults and its maintenance is consistent with the AHA's Strategic Impact Goal to improve cardiovascular health of all Americans by 20% and to reduce deaths resulting from cardiovascular disease and stroke by 20% by the year 2020. This work in defining optimal brain health in adults serves to provide the AHA/American Stroke Association with a foundation for a new strategic direction going forward in cardiovascular health

  16. Chocolate Consumption and Risk of Coronary Heart Disease, Stroke, and Diabetes: A Meta-Analysis of Prospective Studies.

    Science.gov (United States)

    Yuan, Sheng; Li, Xia; Jin, Yalei; Lu, Jinping

    2017-07-02

    Although epidemiological studies have examined the role of chocolate in preventing cardiometabolic disease, the results remain inconsistent. Herein, we conducted a meta-analysis of prospective studies to determine the association between chocolate intake and risk of coronary heart disease (CHD), stroke, and diabetes. A systematical search in PubMed and Embase through March 2017, together with reference scrutiny of relevant literatures, was performed to identify eligible studies. Relative risks (RRs) and 95% confidence intervals (CIs) were pooled using random effect models. Fourteen prospective studies of primary prevention with 508,705 participants were finally included, with follow-up durations ranging from 5 to 16 years. The summary RRs for the highest versus lowest chocolate consumption were 0.90 (95% CI: 0.82-0.97; n = 6) for CHD, 0.84 (95% CI: 0.78-0.90; n = 7) for stroke, and 0.82 (95% CI: 0.70-0.96; n = 5) for diabetes. Dose-response meta-analysis suggested a nonlinear association of chocolate consumption with all outcomes. For both CHD and stroke, there was little additional risk reduction when consuming chocolate ≥3 servings/week (one serving was defined as 30 g of chocolate). For diabetes, the peak protective effect of chocolate emerged at 2 servings/week (RR: 0.75, 95% CI: 0.63-0.89), with no benefit observed when increasing consumption above 6 servings/week. In conclusion, chocolate intake is associated with decreased risks of CHD, stroke, and diabetes. Consuming chocolate in moderation (≤6 servings/week) may be optimal for preventing these disorders.

  17. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Demaerschalk, Bart M; Kleindorfer, Dawn O; Adeoye, Opeolu M; Demchuk, Andrew M; Fugate, Jennifer E; Grotta, James C; Khalessi, Alexander A; Levy, Elad I; Palesch, Yuko Y; Prabhakaran, Shyam; Saposnik, Gustavo; Saver, Jeffrey L; Smith, Eric E

    2016-02-01

    To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke. Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. After a review of the current literature, it was clearly evident that the levels of evidence supporting individual exclusion criteria for intravenous alteplase vary widely. Several exclusionary criteria have already undergone

  18. Similarities and differences between coronary heart disease and stroke in the associations with cardiovascular risk factors: The Japan Collaborative Cohort Study.

    Science.gov (United States)

    Matsunaga, Masaaki; Yatsuya, Hiroshi; Iso, Hiroyasu; Yamashita, Kentaro; Li, Yuanying; Yamagishi, Kazumasa; Tanabe, Naohito; Wada, Yasuhiko; Wang, Chaochen; Ota, Atsuhiko; Tamakoshi, Koji; Tamakoshi, Akiko

    2017-06-01

    Coronary heart disease (CHD) and stroke have common risk factors, but some of these differ in the magnitude or direction of associations between CHD and stroke. We assessed whether the impact of each risk factor differed between CHD and stroke mortality in Asians. In total, 104 910 subjects aged 40-79 years without histories of cancer, CHD and stroke at baseline were followed between 1988 and 2009. Competing-risks analysis was used to test for differences in the associations of each risk factor with two endpoints (CHD and stroke). Population attributable fractions (PAFs) were also calculated for these endpoints to estimate the population impact of each risk factor. During a median 19.1-year follow-up, 1554 died from CHD and 3163 from stroke. The association of hypertension with CHD was similar to that with stroke in terms of the magnitude and direction (multivariable-adjusted hazard ratio for CHD: 1.63 vs. stroke: 1.73 in men and 1.70 vs. 1.66 in women). Conversely, the magnitude of these associations differed for smoking (CHD: 1.95 vs. stroke: 1.23 in men and 2.45 vs. 1.35 in women) and diabetes (1.49 vs. 1.09 in men and 2.08 vs. 1.39 in women). The highest PAF for CHD was caused by smoking in men and by hypertension in women; that for stroke was caused by hypertension in both sexes. Hypertension associations and PAFs were consistent between CHD and stroke, but not for other risk factors. These findings may be useful to optimize public health intervention strategies. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Effect of B vitamins and lowering homocysteine on cognitive impairment in patients with previous stroke or transient ischemic attack: a prespecified secondary analysis of a randomized, placebo-controlled trial and meta-analysis.

    Science.gov (United States)

    Hankey, Graeme J; Ford, Andrew H; Yi, Qilong; Eikelboom, John W; Lees, Kennedy R; Chen, Christopher; Xavier, Denis; Navarro, Jose C; Ranawaka, Udaya K; Uddin, Wasim; Ricci, Stefano; Gommans, John; Schmidt, Reinhold; Almeida, Osvaldo P; van Bockxmeer, Frank M

    2013-08-01

    High plasma total homocysteine (tHcy) has been associated with cognitive impairment but lowering tHcy with B-vitamins has produced equivocal results. We aimed to determine whether B-vitamin supplementation would reduce tHcy and the incidence of new cognitive impairment among individuals with stroke or transient ischemic attack≥6 months previously. A total of 8164 patients with stroke or transient ischemic attack were randomly allocated to double-blind treatment with one tablet daily of B-vitamins (folic acid, 2 mg; vitamin B6, 25 mg; vitamin B12, 500 μg) or placebo and followed up for 3.4 years (median) in the VITAmins TO Prevent Stroke (VITATOPS) trial. For this prespecified secondary analysis of VITATOPS, the primary outcome was a new diagnosis of cognitive impairment, defined as a Mini-Mental State Examination (MMSE) score6 months after the qualifying stroke; 2608 participants were cognitively unimpaired (MMSE≥24), of whom 2214 participants (1110 B-vitamins versus 1104 placebo) had follow-up MMSEs during 2.8 years (median). At final follow-up, allocation to B-vitamins, compared with placebo, was associated with a reduction in mean tHcy (10.2 μmol/L versus 14.2 μmol/L; Pvitamin B6, and vitamin B12 to a self-selected clinical trial cohort of cognitively unimpaired patients with previous stroke or transient ischemic attack lowered mean tHcy but had no effect on the incidence of cognitive impairment or cognitive decline, as measured by the MMSE, during a median of 2.8 years. URL: http://www.controlled-trials.com. Unique identifier: ISRCTN74743444; URL: http://www.clinicaltrials.gov. Unique identifier: NCT00097669.

  20. All-Cause Mortality up to and After Coronary Heart Disease and Stroke Events in European Middle-Aged Men: The PRIME Study.

    Science.gov (United States)

    Majed, Bilal; Montaye, Michèle; Wagner, Aline; Arveiler, Dominique; Ducimetiere, Pierre; Tafflet, Muriel; Ferrieres, Jean; Ruidavets, Jean-Bernard; Kee, Frank; Evans, Alun; Amouyel, Philippe; Prugger, Christof; Empana, Jean-Philippe

    2015-05-01

    The aim was to investigate prospectively the all-cause mortality risk up to and after coronary heart disease (CHD) and stroke events in European middle-aged men. The study population comprised 10 424 men 50 to 59 years of age recruited between 1991 and 1994 in France (N=7855) and Northern Ireland (N=2747) within the Prospective Epidemiological Study of Myocardial Infarction. Incident CHD and stroke events and deaths from all causes were prospectively registered during the 10-year follow-up. In Cox's proportional hazards regression analysis, CHD and stroke events during follow-up were used as time-dependent covariates. A total of 769 CHD and 132 stroke events were adjudicated, and 569 deaths up to and 66 after CHD or stroke occurred during follow-up. After adjustment for study country and cardiovascular risk factors, the hazard ratios of all-cause mortality were 1.58 (95% confidence interval 1.18-2.12) after CHD and 3.13 (95% confidence interval 1.98-4.92) after stroke. These findings support continuous efforts to promote both primary and secondary prevention of cardiovascular disease. © 2015 American Heart Association, Inc.

  1. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions

    Science.gov (United States)

    Shams, Tanzila; Zaidat, Osama; Yavagal, Dileep; Xavier, Andrew; Jovin, Tudor; Janardhan, Vallabh

    2016-01-01

    Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interventional Laboratory Consensus (SILC) criteria using a 7M management approach for the development and standardization of each stroke interventional laboratory within stroke centers. The SILC criteria include: (1) manpower: personnel including roles of medical and administrative directors, attending physicians, fellows, physician extenders, and all the key stakeholders in the stroke chain of survival; (2) machines: resources needed in terms of physical facilities, and angiography equipment; (3) materials: medical device inventory, medications, and angiography supplies; (4) methods: standardized protocols for stroke workflow optimization; (5) metrics (volume): existing credentialing criteria for facilities and stroke interventionalists; (6) metrics (quality): benchmarks for quality assurance; (7) metrics (safety): radiation and procedural safety practices. PMID:27610118

  2. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions.

    Science.gov (United States)

    Shams, Tanzila; Zaidat, Osama; Yavagal, Dileep; Xavier, Andrew; Jovin, Tudor; Janardhan, Vallabh

    2016-06-01

    Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interventional Laboratory Consensus (SILC) criteria using a 7M management approach for the development and standardization of each stroke interventional laboratory within stroke centers. The SILC criteria include: (1) manpower: personnel including roles of medical and administrative directors, attending physicians, fellows, physician extenders, and all the key stakeholders in the stroke chain of survival; (2) machines: resources needed in terms of physical facilities, and angiography equipment; (3) materials: medical device inventory, medications, and angiography supplies; (4) methods: standardized protocols for stroke workflow optimization; (5) metrics (volume): existing credentialing criteria for facilities and stroke interventionalists; (6) metrics (quality): benchmarks for quality assurance; (7) metrics (safety): radiation and procedural safety practices.

  3. Relationship between tap water hardness, magnesium, and calcium concentration and mortality due to ischemic heart disease or stroke in the Netherlands

    NARCIS (Netherlands)

    Leurs, L.J.; Schouten, L.J.; Mons, M.N.; Goldbohm, R.A.; Brandt, P.A. van den

    2010-01-01

    BACKGROUND: Conflicting results on the relationship between the hardness of drinking water and mortality related to ischemic heart disease (IHD) or stroke have been reported. OBJECTIVES: We investigated the possible association between tap water calcium or magnesium concentration and total hardness

  4. Alpha-Linolenic Acid Intake and 10-Year Incidence of Coronary Heart Disease and Stroke in 20,000 Middle-Aged Men and Women in The Netherlands

    NARCIS (Netherlands)

    Goede, de J.; Verschuren, W.M.M.; Boer, J.M.A.; Kromhout, D.; Geleijnse, J.M.

    2011-01-01

    Background - Whether intake of alpha-linolenic acid (ALA), the plant-derived n-3 polyunsaturated fatty acid (PUFA), could prevent cardiovascular diseases is not yet clear. We examined the associations of ALA intake with 10-year incidence of coronary heart disease (CHD) and stroke in the Netherlands.

  5. Comparison of the impact of atrial fibrillation on the risk of stroke and cardiovascular death in women versus men (The Copenhagen City Heart Study)

    DEFF Research Database (Denmark)

    Friberg, Jens; Scharling, Henrik; Gadsbøll, Niels

    2004-01-01

    The Copenhagen City Heart Study is a population-based cohort study. Using baseline data from 3 cohort examinations (1976 to 1978, 1981 to 1983, and 1991 to 1994), we analyzed the gender-specific effect of atrial fibrillation (AF) on the risk of stroke and cardiovascular death during 5 years of fo...

  6. Lung function and risk of fatal and non-fatal stroke. The Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Truelsen, T; Prescott, E; Lange, P

    2001-01-01

    adjustment for potential confounders: sex, age, smoking, inhalation, body mass index, systolic blood pressure, triglycerides, physical activity in leisure time, education, diabetes mellitus, and antihypertensive treatment. RESULTS: We found an inverse association between FEV1 and risk of first-time stroke...

  7. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women.

    Science.gov (United States)

    Fung, Teresa T; Chiuve, Stephanie E; McCullough, Marjorie L; Rexrode, Kathryn M; Logroscino, Giancarlo; Hu, Frank B

    2008-04-14

    The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to lower blood pressure, but little is known about its long-term effect on cardiovascular end points. Our objective was to assess the association between a DASH-style diet adherence score and risk of coronary heart disease (CHD) and stroke in women. In this prospective cohort study, diet was assessed 7 times during 24 years of follow-up (1980-2004) with validated food frequency questionnaires. A DASH score based on 8 food and nutrient components (fruits, vegetables, whole grains, nuts and legumes, low-fat dairy, red and processed meats, sweetened beverages, and sodium) was calculated. Lifestyle and medical information was collected biennially with a questionnaire. The Cox proportional hazard model was used to adjust for potential confounders. The study population comprised 88,517 female nurses aged 34 to 59 years without a history of cardiovascular disease or diabetes in 1980. The main outcome measures were the numbers of confirmed incident cases of nonfatal myocardial infarction, CHD death, and stroke. We documented 2129 cases of incident nonfatal myocardial infarction, 976 CHD deaths, and 2317 [corrected] cases of stroke. After adjustment for age, smoking, and other cardiovascular risk factors, the relative risks of CHD across quintiles of the DASH score were 1.0, 0.99, 0.86, 0.87, and 0.76 (95% confidence interval, 0.67-0.85) (PDASH score was also significantly associated with lower risk of stroke (multivariate relative risks across quintiles of the DASH score were 1.0, 0.92, 0.91, 0.89, and 0.82) (P=.002 for trend). Cross-sectional analysis in a subgroup of women with blood samples showed that the DASH score was significantly associated with lower plasma levels of C-reactive protein (P=.008 for trend) and interleukin 6 (P=.04 for trend). Adherence to the DASH-style diet is associated with a lower risk of CHD and stroke among middle-aged women during 24 years of follow-up.

  8. National data on stroke outcomes in Thailand.

    Science.gov (United States)

    Kongbunkiat, Kannikar; Kasemsap, Narongrit; Thepsuthammarat, Kaewjai; Tiamkao, Somsak; Sawanyawisuth, Kittisak

    2015-03-01

    Stroke is a major public health problem worldwide. There are limited data on national stroke prevalence and outcomes after the beginning of the thrombolytic therapy era in Thailand. This study aimed to investigate the prevalence and factors associated with mortality in stroke patients in Thailand using the national reimbursement databases. Clinical data retrieved included individuals under the universal coverage, social security, and civil servant benefit systems between 1 October 2009 and 30 September 2010. The stroke diagnosis code was based on the International Classification of Diseases 10th revision system including G45 (transient cerebral ischemic attacks and related syndromes), I61 (intracerebral hemorrhage), and I63 (cerebral infarction). The prevalence and stroke outcomes were calculated from these coded data. Factors associated with death were evaluated by multivariable logistic regression analysis. We found that the most frequent stroke subtype was cerebral infarction with a prevalence of 122 patients per 100,000 of population, an average length of hospital stay of 6.8 days, an average hospital charge of 20,740 baht (∼$USD 691), a mortality rate of 7%, and thrombolytic prescriptions of 1%. The significant factors associated with stroke mortality were septicemia, pulmonary embolism, pneumonia, myocardial infarction, status epilepticus, and heart failure. In conclusion, the prevalence and outcomes of stroke in Thailand were comparable with other countries. The era of thrombolytic therapy has just begun in Thailand. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Effects of early age at natural menopause on coronary heart disease and stroke in Chinese women.

    Science.gov (United States)

    Shen, Lijun; Song, Lulu; Liu, Bingqing; Li, Hui; Zheng, Xiaoxuan; Zhang, Lina; Yuan, Jing; Liang, Yuan; Wang, Youjie

    2017-08-15

    Menopause is identified as a risk factor for cardiovascular disease because of the change of estrogen. The objective of the study was to explore the associations between early age at natural menopause (menopause at an age≤45years) and the presence of CHD and stroke. The study subjects were from the first follow-up survey of the Dongfeng-Tongji cohort study. A total of 16,515 postmenopausal women were included for the analysis. Logistic regression models were used to examine the associations between age at natural menopause (≤45, 45-52, >52years) and the presence of CHD and stroke adjusted for sociodemographic characteristics, lifestyle, reproductive history and metabolic factors. In the fully adjusted model, for each 1-year delay in menopausal age, the prevalence of CHD and stroke was reduced by 3% (OR, 0.97; 95% CI, 0.95-0.98) and 5% (OR, 0.95; 95% CI, 0.92-0.98), respectively. Women with early menopause (≤45years) had a higher prevalence of CHD (OR, 1.33; 95% CI, 1.13-1.57) compared with those with menopause at ages 45-52years. Similarly, women with early menopause (≤45years) was associated with higher prevalence of stroke (OR, 1.69; 95% CI, 1.25-2.30) compared with those with menopause at ages 45-52years. Early age at natural menopause is significantly associated with the presence of CHD and stroke among Chinese women. Copyright © 2017. Published by Elsevier B.V.

  10. Bowel Movement Frequency, Laxative Use, and Mortality From Coronary Heart Disease and Stroke Among Japanese Men and Women: The Japan Collaborative Cohort (JACC) Study.

    Science.gov (United States)

    Kubota, Yasuhiko; Iso, Hiroyasu; Tamakoshi, Akiko

    2016-05-05

    The associations of bowel movement frequency and laxative use with cardiovascular disease (CVD) are unclear. A total of 72 014 subjects (29 668 men and 42 346 women) aged 40 to 79 years, without a history of CVD or cancer, completed a lifestyle questionnaire at baseline between 1988 and 1990 that included information on bowel movement frequency (daily, every 2-3 days, or once every 4 or more days) and laxative use (yes or no), and were followed-up until 2009. During the subjects' 1 165 569 person-years of follow-up, we documented 977 deaths from coronary heart disease (561 men and 416 women), 2024 from total stroke (1028 men and 996 women), 1127 from ischemic stroke (606 men and 521 women), and 828 from hemorrhagic stroke (388 men and 440 women). The prevalence of CVD risk factors, such as diabetes, stress, depression, and physical inactivity, was higher in laxative users and in those with a lower frequency of bowel movements. The multivariable HRs (95% confidence intervals [CIs]) of laxative users were as follows: 1.56 (95% CI, 1.21-2.03) for coronary heart disease and 1.37 (95% CI, 1.07-1.76) for ischemic stroke in men, and 1.27 (95% CI, 1.08-1.49) for total stroke, and 1.45 (95% CI, 1.17-1.79) for ischemic stroke in women. Similar results were observed even after the exclusion of deaths that occurred early in the follow-up period. A significant association between bowel movement frequency and mortality from CVD was not observed. Constipation could be a marker of exposure to CVD risk factors, and laxative use could be a risk factor for mortality from coronary heart disease and ischemic stroke.

  11. Bowel Movement Frequency, Laxative Use, and Mortality From Coronary Heart Disease and Stroke Among Japanese Men and Women: The Japan Collaborative Cohort (JACC Study

    Directory of Open Access Journals (Sweden)

    Yasuhiko Kubota

    2016-05-01

    Full Text Available Background: The associations of bowel movement frequency and laxative use with cardiovascular disease (CVD are unclear. Methods: A total of 72 014 subjects (29 668 men and 42 346 women aged 40 to 79 years, without a history of CVD or cancer, completed a lifestyle questionnaire at baseline between 1988 and 1990 that included information on bowel movement frequency (daily, every 2–3 days, or once every 4 or more days and laxative use (yes or no, and were followed-up until 2009. Results: During the subjects’ 1 165 569 person-years of follow-up, we documented 977 deaths from coronary heart disease (561 men and 416 women, 2024 from total stroke (1028 men and 996 women, 1127 from ischemic stroke (606 men and 521 women, and 828 from hemorrhagic stroke (388 men and 440 women. The prevalence of CVD risk factors, such as diabetes, stress, depression, and physical inactivity, was higher in laxative users and in those with a lower frequency of bowel movements. The multivariable HRs (95% confidence intervals [CIs] of laxative users were as follows: 1.56 (95% CI, 1.21–2.03 for coronary heart disease and 1.37 (95% CI, 1.07–1.76 for ischemic stroke in men, and 1.27 (95% CI, 1.08–1.49 for total stroke, and 1.45 (95% CI, 1.17–1.79 for ischemic stroke in women. Similar results were observed even after the exclusion of deaths that occurred early in the follow-up period. A significant association between bowel movement frequency and mortality from CVD was not observed. Conclusions: Constipation could be a marker of exposure to CVD risk factors, and laxative use could be a risk factor for mortality from coronary heart disease and ischemic stroke.

  12. Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: a subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial.

    Science.gov (United States)

    Amarenco, Pierre; Albers, Gregory W; Denison, Hans; Easton, J Donald; Evans, Scott R; Held, Peter; Hill, Michael D; Jonasson, Jenny; Kasner, Scott E; Ladenvall, Per; Minematsu, Kazuo; Molina, Carlos A; Wang, Yongjun; Wong, K S Lawrence; Johnston, S Claiborne

    2017-04-01

    Ticagrelor is an effective antiplatelet therapy for patients with coronary atherosclerotic disease and might be more effective than aspirin in preventing recurrent stroke and cardiovascular events in patients with acute cerebral ischaemia of atherosclerotic origin. Our aim was to test for a treatment-by-ipsilateral atherosclerotic stenosis interaction in a subgroup analysis of patients in the Acute Stroke or Transient Ischaemic Attack Treated with Aspirin or Ticagrelor and Patient Outcomes (SOCRATES) trial. SOCRATES was a randomised, double-blind, controlled trial of ticagrelor versus aspirin in patients aged 40 years or older with a non-cardioembolic, non-severe acute ischaemic stroke, or high-risk transient ischaemic attack from 674 hospitals in 33 countries. We randomly allocated patients (1:1) to ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2-90, given orally) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2-90, given orally) within 24 h of symptom onset. Investigators classified all patients into atherosclerotic and non-atherosclerotic groups for the prespecified, exploratory analysis reported in this study. The primary endpoint was the time to occurrence of stroke, myocardial infarction, or death within 90 days. Efficacy analysis was by intention to treat. The SOCRATES trial is registered with ClinicalTrials.gov, number NCT01994720. Between Jan 7, 2014, and Oct 29, 2015, we randomly allocated 13 199 patients (6589 [50%] to ticagrelor and 6610 [50%] to aspirin). Potentially symptomatic ipsilateral atherosclerotic stenosis was reported in 3081 (23%) of 13 199 patients. We found a treatment-by-atherosclerotic stenosis interaction (p=0·017). 103 (6·7%) of 1542 patients with ipsilateral stenosis in the ticagrelor group and 147 (9·6%) of 1539 patients with ipsilateral stenosis in the aspirin group had an occurrence of stroke, myocardial infarction, or death within 90 days (hazard ratio 0·68 [95% CI 0·53-0

  13. Gender Differences in Risks of Coronary Heart Disease and Stroke in Patients with Type 2 Diabetes Mellitus and Their Association with Metabolic Syndrome in China

    Directory of Open Access Journals (Sweden)

    Mei-Fang Yao

    2016-01-01

    Full Text Available Coronary heart disease (CHD and stroke are common complications of type 2 diabetes mellitus (T2DM. We aimed to explore the differences in the risks of CHD and stroke between Chinese women and men with T2DM and their association with metabolic syndrome (MS. This study included 1514 patients with T2DM. The Asian Guidelines of ATPIII (2005 were used for MS diagnosis, and the UKPDS risk engine was used to evaluate the 10-year CHD and stroke risks. Women had lower CHD risk (15.3% versus 26.3%, fatal CHD risk (11.8% versus 19.0%, stroke risk (8.4% versus 10.3%, and fatal stroke risk (1.4% versus 1.6% compared with men with T2DM (p<0.05–0.001. The CHD risk (28.4% versus 22.6%, p<0.001 was significantly higher in men with MS than in those without MS. The CHD (16.2% versus 11.0%, p<0.001 and stroke risks (8.9% versus 5.8%, p<0.001 were higher in women with MS than in those without MS. In conclusion, our findings indicated that Chinese women with T2DM are less susceptible to CHD and stroke than men. Further, MS increases the risk of both these events, highlighting the need for comprehensive metabolic control in T2DM.

  14. Baseline blood pressure, low- and high-density lipoproteins, and triglycerides and the risk of vascular events in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

    DEFF Research Database (Denmark)

    Amarenco, Pierre; Goldstein, Larry B; Callahan, Alfred

    2009-01-01

    AND RESULTS: The SPARCL trial randomized 4731 patients with recent stroke or transient ischemic attack (TIA) and no known coronary heart disease and LDL-C between 100 and 190 mg/dL to either atorvastatin 80 mg/d or placebo. Baseline assessment included SBP, DBP and measurements of low-density lipoprotein....... There were no interactions between any of these baseline variables and the effect of treatment on outcome strokes. CONCLUSIONS: In patients with recent stroke or TIA and no coronary heart disease, only lower baseline HDL-C predicted the risk of recurrent stroke with HDL-C, triglycerides, and LDL/HDL ratio...

  15. Low stroke rate and few thrombo-embolic events after HeartMate II implantation under mild anticoagulation.

    Science.gov (United States)

    Menon, Ares K; Götzenich, Andreas; Sassmannshausen, Helena; Haushofer, Marcus; Autschbach, Rüdiger; Spillner, Jan W

    2012-08-01

    Bleeding and thrombo-embolism are two of the most threatening adverse events associated with the use of continuous flow left ventricular assist devices (LVADs) in the treatment of severe heart failure. We analysed our LVAD patients treated with the HeartMate II (HM II) device by following a low anticoagulation regimen. Between 2008 and February 2011, we implanted 40 HM II LVADs in our institution. Intention to treat was bridge to transplant in 25, destination therapy in 9, bridge to candidacy in 5 cases and bridge to recovery in 1 case. Heparin was started only after 24 h postoperatively, and Phenprocumon (Phen) was started after removal of all chest drains. International normalized ratio (INR) target in the years 2008-2009 was 2.5, and 2.0-2.5 since 2010. Acetyl salicylic acid (ASA) was prescribed 50-100 mg/day only in patients <55 years or in case of severe atherosclerotic disease of the right coronary artery. All data were analysed consecutively concerning thrombo-embolic and bleeding events. Fifty-two percent of the patients were in INTERMACS level 1 or 2 at the time of implantation. The mean age was 58 ± 11 years, and the mean days under LVAD was 241 days (maximum: 1052 days). The survival rate was 87.5% after 30 years and 75% in the long term. Early postoperatively, no strokes or thrombo-embolic events occurred. In the long term, two patients suffered from ischaemic strokes, but recovered well. In both of these index events, the INR was lasting below 1.4. One of these two patients developed pump thrombosis additionally. Only three patients (ASA + Phen) developed gastrointestinal bleeding (7.5%). Two patients were withdrawn from Phen + ASA because of multiple angiodysplasia. Compared with the literature, even a mild anticoagulation protocol does not increase the risk of thrombotic events, but reduces bleeding events in the use of an HM II LVAD.

  16. ESRD After Heart Failure, Myocardial Infarction, or Stroke in Type 2 Diabetic Patients With CKD.

    Science.gov (United States)

    Charytan, David M; Solomon, Scott D; Ivanovich, Peter; Remuzzi, Giuseppe; Cooper, Mark E; McGill, Janet B; Parving, Hans-Henrik; Parfrey, Patrick; Singh, Ajay K; Burdmann, Emmanuel A; Levey, Andrew S; de Zeeuw, Dick; Eckardt, Kai-Uwe; McMurray, John J V; Claggett, Brian; Lewis, Eldrin F; Pfeffer, Marc A

    2017-10-01

    How cardiovascular (CV) events affect progression to end-stage renal disease (ESRD), particularly in the setting of type 2 diabetes, remains uncertain. Observational study. 4,022 patients with type 2 diabetes, anemia, and chronic kidney disease from the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). Postrandomization CV events. ESRD (defined as initiation of dialysis for >30 days, kidney transplantation, or refusal or nonavailability of renal replacement therapy) and post-ESRD mortality within 30 days and during overall follow-up after an intercurrent CV event. Population limited to clinical trial participants with diabetes and anemia. 155 of 652 (23.8%) ESRD cases occurred after an intercurrent CV event; 110 (16.9%) cases followed heart failure, 28 (4.3%) followed myocardial infarction, 12 (1.84%) followed stroke, and 5 (0.77%) followed multiple CV events. ESRD rate was higher within 30 days in individuals with an intercurrent CV event compared with those without an intercurrent event (HR, 22.2; 95% CI, 17.0-29.0). Compared to no intercurrent CV events, relative risks for ESRD were higher after the occurrence of heart failure overall (HR, 3.4; 95% CI, 2.7-4.2) and at 30 days (HR, 20.1; 95% CI, 14.5-27.9) than after myocardial infarction or stroke (Pfailure, are strongly associated with risk for ESRD. These findings underscore the need for kidney-specific therapies in addition to treatment of CV risk factors to lower ESRD incidence in diabetes. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  17. Aetiological blood biomarkers of ischaemic stroke.

    Science.gov (United States)

    Sonderer, Julian; Katan Kahles, Mira

    2015-01-01

    Each year, over 5 million people die worldwide from stroke, and at least every sixth patient who survives will experience another stroke within five years [1]. We are therefore eager to advance early and rapid diagnosis, prognosis and optimal risk stratification, as well as secondary prevention. In this context, blood biomarkers may improve patient care, as they have already done in other fields in the past, for example, troponin T/I in patients with heart attacks, natriuretic peptides in patients with heart failure or PCT (procalcitonin) [2] in patients with pneumonia. In the setting of acute stroke, a blood biomarker can be any quantifiable entity that reflects the manifestation of a stroke-related process. The most fruitful implementation of stroke biomarkers is in areas where information from traditional clinical sources is limited. There may be markers, for example, to guide risk stratification, reveal stroke aetiology, identify patients who may benefit most from interventions, monitor treatment efficacy, and recognise the risk of short-term complications or unfavourable long-term outcomes. For this review we focus on blood biomarkers that could help distinguish the underlying aetiology of an ischaemic stroke. Stroke tends to be a much more heterogeneous condition than ischaemic heart disease, which is caused by atherosclerosis in the vast majority of cases. Causes of stroke include small and large vessel disease, cardioembolism, dissections, and rare vasculo- and coagulopathies, among others. Because of this heterogeneity among stroke patients, it is clear that a monolithic approach to stroke prevention or secondary prevention is not warranted. Aetiological classification is important specifically because prognosis, risk of recurrence and management options differ greatly between aetiological subtypes. Considering that today up to 30% of stroke patients still cannot be classified into a specific subtype [3], the ability to improve aetiological classification

  18. Mortality, stroke, and heart failure in atrial fibrillation cohorts after ablation versus propensity-matched cohorts

    OpenAIRE

    Jarman, Julian WE; Hunter, Tina D; Hussain, Wajid; March, Jamie L; Wong, Tom; Markides, Vias

    2017-01-01

    Julian WE Jarman,1 Tina D Hunter,2 Wajid Hussain,1 Jamie L March,3 Tom Wong,1 Vias Markides1 1Cardiology & Electrophysiology, Heart Rhythm Centre, NIHR Cardiovascular Research Unit, The Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College, London, UK; 2Health Outcomes Research, CTI Clinical Trial and Consulting Services, Inc., Cincinnati, OH, 3Health Economics and Market Access, Biosense Webster, Inc., Diamond Bar, CA, USA Background: We sought to determine...

  19. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Thompson, B Gregory; Brown, Robert D; Amin-Hanjani, Sepideh; Broderick, Joseph P; Cockroft, Kevin M; Connolly, E Sander; Duckwiler, Gary R; Harris, Catherine C; Howard, Virginia J; Johnston, S Claiborne Clay; Meyers, Philip M; Molyneux, Andrew; Ogilvy, Christopher S; Ringer, Andrew J; Torner, James

    2015-08-01

    The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment. © 2015 American Heart Association, Inc.

  20. Clinical predictive value of the ABCD2 score for early risk of stroke in patients who have had transient ischaemic attack and who present to an Australian tertiary hospital.

    Science.gov (United States)

    Sanders, Lauren M; Srikanth, Velandai K; Psihogios, Helen; Wong, Kitty K; Ramsay, David; Phan, Thanh G

    2011-02-07

    To determine the predictive value of the ABCD(2) score for early risk of stroke in Australian patients who have had transient ischaemic attack (TIA). Cohort study of 512 consecutive patients with suspected TIA referred by the emergency department to the acute stroke unit (in accordance with the TIA pathway) of an urban tertiary hospital in Melbourne, Victoria, between 1 June 2004 and 30 November 2007. Overall accuracy, estimated by the area under the curve (AUC) of receiver operating characteristic plots (of true positive rate v false positive rate), and sensitivity, specificity, predictive values and likelihood ratios at prespecified cut-off ABCD(2) scores for stroke within 2, 7 and 90 days. 24 patients were excluded because their symptoms lasted more than 24 hours. All included patients were reviewed by a stroke physician; TIA was confirmed in 301/488 (61.7%). Most (289/301; 96.0%) had complete follow-up. Stroke occurred in 4/292 patients (1.37%; 95% CI, 0.37%-3.47%) within 2 days and 7/289 (2.42%; 95% CI, 0.98%-4.93%) within 90 days; no patient had a stroke between 2 and 7 days. The AUCs for stroke in patients with confirmed TIA were 0.80 (95% CI, 0.68-0.91) and 0.62 (95% CI, 0.40-0.83) for stroke within 2 days and 90 days, respectively. At a cut-off of ≥ 5, the ABCD(2) score had modest specificity for stroke within 2 days (0.58) and 90 days (0.58), but positive predictive values (2 days, 0.03; 90 days, 0.04) and positive likelihood ratios (2 days, 2.40; 90 days, 1.71) were both poor. The score performed similarly poorly at other prespecified cut-off scores. Given its poor predictive value, the use of the ABCD(2) score alone may not be dependable for guiding clinical treatment decisions or service organisation in an Australian tertiary setting. Validation in other Australian settings is recommended before it can be applied with confidence.

  1. Low vitamin B6 but not homocyst(e)ine is associated with increased risk of stroke and transient ischemic attack in the era of folic acid grain fortification.

    Science.gov (United States)

    Kelly, Peter J; Shih, Vivian E; Kistler, J Philip; Barron, Megan; Lee, Hang; Mandell, Roseann; Furie, Karen L

    2003-06-01

    The introduction of cereal grain folic acid fortification in 1998 has reduced homocyst(e)ine (tHcy) concentrations in the US population. We performed a case-control study to determine the risk of stroke and transient ischemic attack (TIA) associated with tHcy and low vitamin status in a postfortification US sample. Consecutive cases with new ischemic stroke/TIA were compared with matched controls. Fasting tHcy, folate, pyridoxal 5'-phosphate (PLP), B12, and MTHFR 677C-->T genotype were measured. Mean PLP was significantly lower in cases than controls (39.97 versus 84.1 nmol/L, P<0.0001). After stroke risk factors were controlled for, a strong independent association was present between stroke/TIA and low PLP (adjusted odds ratio [OR], 4.6; 95% CI, 1.4 to 15.1; P<0.001) but not elevated tHcy (OR, 0.92; 95% CI, 0.4 to 2.1). Low B6 but not tHcy was strongly associated with cerebrovascular disease in this postfortification, folate-replete sample.

  2. Preventable risk factors for coronary heart disease and stroke amongst ethnic groups in London.

    Science.gov (United States)

    Lemic-Stojcevic, N; Dundas, R; Jenkins, S; Rudd, A; Wolfe, C

    2001-05-01

    People of African Caribbean descent have higher mortality rates from stroke than other ethnic groups. However, little is known about the prevalence of stroke risk factors in UK ethnic minority groups. We investigated the prevalence of these risk factors amongst African Caribbeans, black Africans and whites. A random sample of patients aged 45-74 registered with 16 general practices in south London was surveyed in 1995. Main outcome measures were: prevalence of hypertension, mean serum cholesterol, serum fibrinogen and glycosylated haemoglobin AIC. Logistic and linear regressions were used to determine ethnic differences in these measures. Hypertension was more prevalent in black Caribbeans (79.4%) and black Africans (71.6%) than in whites (54.3%) (p Africans had similar rates to black Caribbeans for these risk factors apart from lower triglvceride levels. These differences in risk factors may partially explain the high stroke mortality rates in black Caribbeans and black Africans compared to whites. There was little difference in prevalence of these risk factors between black Caribbean and black African groups. Specific strategies targeted to each ethnic group need to be developed to reduce risk factors.

  3. Association between arterial calcifications and nonlacunar and lacunar ischemic strokes.

    Science.gov (United States)

    van Dijk, Anouk C; Fonville, Susanne; Zadi, Taihra; van Hattem, Antonius M G; Saiedie, Ghesrouw; Koudstaal, Peter J; van der Lugt, Aad

    2014-03-01

    Nonlacunar cerebral infarcts are presumed to be caused by thromboembolism from the heart or extracranial arteries, whereas lacunar infarcts are thought to be caused by small vessel disease. We investigated to what extent arterial calcifications differ between nonlacunar and lacunar ischemic strokes. We studied 820 consecutive patients with transient ischemic attack or ischemic stroke in the anterior circulation who underwent multidetector computed tomography angiography and had no rare cause of stroke. The presence of likely cardioembolic pathogenesis was determined according to the Trial of Org 10172 in Acute Stroke Treatment criteria. The remaining 708 patients were categorized as nonlacunar or lacunar strokes, either transient ischemic attacks or strokes, based on clinical symptoms corrected by brain imaging results. We measured volume of calcifications in the aortic arch, symptomatic extracranial and intracranial carotid artery using multidetector computed tomography angiography. The difference in calcifications between nonlacunar and lacunar strokes was assessed with a multivariable logistic regression analysis. We adjusted for degree of symptomatic carotid artery stenosis and cardiovascular risk factors. We found an independent association between volume of aortic arch calcifications and nonlacunar ischemic strokes (adjusted odds ratio [95% confidence interval], 1.11 [1.02-1.21]). No independent associations between extracranial and intracranial carotid artery calcifications and nonlacunar strokes were present. The only difference we found between nonlacunar and lacunar strokes was a higher calcification volume in the aortic arch in nonlacunar strokes. Our findings only partially confirm the notion of distinct etiologies and suggest that the potential role of other plaque components, plaque morphology, and aortic arch calcifications in ischemic stroke subtypes awaits further evaluation.

  4. Test Your Stroke Knowledge

    Science.gov (United States)

    ... 9-1-1. Which of the following are risk factors for stroke? High blood pressure Heart disease Smoking High cholesterol Diabetes Show Answer All of these are risk factors for stroke. If you smoke - quit. If you have high ...

  5. Copeptin Levels in Patients With Acute Ischemic Stroke and Stroke Mimics.

    Science.gov (United States)

    Wendt, Matthias; Ebinger, Martin; Kunz, Alexander; Rozanski, Michal; Waldschmidt, Carolin; Weber, Joachim E; Winter, Benjamin; Koch, Peter M; Nolte, Christian H; Hertel, Sabine; Ziera, Tim; Audebert, Heinrich J

    2015-09-01

    Copeptin levels are increased in patients diagnosed with stroke and other vascular diseases. Copeptin elevation is associated with adverse outcome, predicts re-events in patients with transient ischemic attack and is used in ruling-out acute myocardial infarction. We evaluated whether copeptin can also be used as a diagnostic marker in the prehospital stroke setting. We prospectively examined patients with suspected stroke on the Stroke Emergency Mobile-an ambulance that is equipped with computed tomography and point-of-care laboratory. A blood sample was taken from patients immediately after arrival. We analyzed copeptin levels in patients with final hospital-based diagnosis of stroke or stroke mimics as well as in vascular or nonvascular patients. In addition, we examined the associations of symptom onset with copeptin levels and the prognostic value of copeptin in patients with stroke. Blood samples of 561 patients were analyzed. No significant differences were seen neither between cerebrovascular (n=383) and other neurological (stroke mimic; n=90) patients (P=0.15) nor between vascular (n=391) and nonvascular patients (n=170; P=0.57). We could not detect a relationship between copeptin levels and time from onset to blood draw. Three-month survival status was available in 159 patients with ischemic stroke. Copeptin levels in nonsurviving patients (n=8: median [interquartile range], 27.4 [20.2-54.7] pmol/L) were significantly higher than in surviving patients (n=151: median [interquartile range], 11.7 [5.2-30.9] pmol/L; P=0.024). In the prehospital setting, copeptin is neither appropriate to discriminate between stroke and stroke mimic patients nor between vascular and nonvascular patients. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01382862. The Pre-Hospital Acute Neurological Therapy and Optimization of Medical Care in Stroke Patients study (PHANTOM-S) was registered (NCT01382862). This sub-study was observational and not registered separately

  6. A cross-sectional study of individuals seeking information on transient ischemic attack and stroke symptoms online: a target for intervention?

    Directory of Open Access Journals (Sweden)

    Anthony S Kim

    Full Text Available BACKGROUND: Individuals with TIA/stroke symptoms often do not seek urgent medical attention. We assessed the feasibility of identifying individuals searching for information on TIA/stroke symptoms online as a target for future interventions to encourage urgent evaluation and we evaluated the performance of a self-reported risk score to identify subjects with true TIA or stroke. METHODOLOGY/PRINCIPAL FINDINGS: We placed online advertisements to target English-speaking adults in the United States searching for TIA/stroke-related keywords. After completing an online questionnaire, participants were telephoned by a vascular neurologist to assess the likelihood of TIA/stroke. We used logistic regression and the c-statistic to assess associations and model discrimination respectively. Over 122 days, 251 (1% of 25,292 website visitors completed the online questionnaire and 175 were reached by telephone (mean age 58.5 years; 63% women for follow-up. Of these participants, 37 (21% had symptoms within 24 hours, 60 (34% had not had a medical evaluation yet, and 68 (39% had TIA/stroke. Applying a modified ABCD(2 score yielded a c-statistic of 0.66, but 2 of 12 with a zero score had a TIA/stroke. Those with new symptoms were more likely to have TIA/stroke (OR 4.90, 95% CI 2.56-9.09. CONCLUSIONS/SIGNIFICANCE: Individuals with TIA/stroke that are seeking real-time information on symptoms online can be readily identified, in some cases before they have sought formal medical evaluation. Although a simple self-reported risk score was unable to identify a low-risk population in this selected group, this population may still present an attractive target for future interventions designed to encourage urgent medical evaluation.

  7. The validity of the Finnish Diabetes Risk Score for the prediction of the incidence of coronary heart disease and stroke, and total mortality.

    Science.gov (United States)

    Silventoinen, Karri; Pankow, James; Lindström, Jaana; Jousilahti, Pekka; Hu, Gang; Tuomilehto, Jaakko

    2005-10-01

    Cardiovascular disease shares several risk factors with type 2 diabetes. We tested whether the Finnish Diabetes Risk Score (FINDRISC), recently developed in a Finnish population to estimate the future risk of diabetes, would also identify individuals at high risk of coronary heart disease (CHD) and stroke, and total mortality in this same population. Independent risk factor surveys were conducted in 1987, 1992, and 1997 in Finland, comprising 8268 men and 9457 women aged 25-64 years and free of CHD and stroke at baseline. During the follow-up until the end of 2001, 699 incident acute CHD events, 324 acute stroke events, and 765 deaths occurred. The data were analysed by using receiver operating characteristic (ROC) curves and the Cox-regression model. The areas under the ROC curves (AUC) were 71% for CHD, 73% for stroke, and 68% for total mortality in men and 78, 68, and 72% in women, respectively. The addition of systolic and diastolic blood pressures, total and high-density lipoprotein cholesterol, and smoking increased the AUC values modestly (the change of the absolute values from 2.6 to 6.5%), but the additional use of plasma glucose had only a slight effect on the AUC values for CHD and stroke. The FINDRISC is a reasonably good predictor of CHD, stroke and total mortality.

  8. [Strokes caused by infection in the tropics].

    Science.gov (United States)

    Carod-Artal, F J

    Almost three out of every four people in the world who suffer a fatal stroke live in developing countries. A number of different tropical diseases may appear in Europe in the coming years as a consequence of the demographic change that is being brought about by migratory flows. We review the main infectious causes of strokes in the tropics. There are estimated to be 500 million cases of malaria every year. Cerebral malaria can cause cerebral oedema, diffuse or focal compromise of the subcortical white matter and cortical, cerebellar and pontine infarctions. Chagas disease is an independent risk factor for stroke in South America. At least 20 million people have the chronic form of Chagas disease. The main prognostic factors for Chagas-related stroke are the presence of apical aneurysms, arrhythmia and heart failure. Vascular complications of neurocysticercosis include transient ischemic attacks, ischemic strokes due to angiitis and intracranial haemorrhages. The frequency of cerebral infarction associated with neurocysticercosis varies between 2% and 12%. Gnathostomiasis is a cause of subarachnoid haemorrhage in south-east Asia. Other less common causes of stroke are viral haemorrhagic fevers due to arenavirus and flavivirus. Several diseases that are endemic in the tropics can be responsible for up to 10% of the cases of strokes in adults.

  9. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals.

    Science.gov (United States)

    Kivimäki, Mika; Jokela, Markus; Nyberg, Solja T; Singh-Manoux, Archana; Fransson, Eleonor I; Alfredsson, Lars; Bjorner, Jakob B; Borritz, Marianne; Burr, Hermann; Casini, Annalisa; Clays, Els; De Bacquer, Dirk; Dragano, Nico; Erbel, Raimund; Geuskens, Goedele A; Hamer, Mark; Hooftman, Wendela E; Houtman, Irene L; Jöckel, Karl-Heinz; Kittel, France; Knutsson, Anders; Koskenvuo, Markku; Lunau, Thorsten; Madsen, Ida E H; Nielsen, Martin L; Nordin, Maria; Oksanen, Tuula; Pejtersen, Jan H; Pentti, Jaana; Rugulies, Reiner; Salo, Paula; Shipley, Martin J; Siegrist, Johannes; Steptoe, Andrew; Suominen, Sakari B; Theorell, Töres; Vahtera, Jussi; Westerholm, Peter J M; Westerlund, Hugo; O'Reilly, Dermot; Kumari, Meena; Batty, G David; Ferrie, Jane E; Virtanen, Marianna

    2015-10-31

    Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603,838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528,908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p

  10. Patients' understanding of their heart attack and the impact of exposure to a media campaign on pre-hospital time.

    Science.gov (United States)

    Tummala, Shrikar R; Farshid, Ahmad

    2015-01-01

    Patients with acute myocardial infarction (AMI) have a limited understanding of AMI symptoms and risk factors. This can lead to delays in the recognition of an AMI and hospital presentation. We aimed to assess patients' understanding of their AMI symptoms and risk factors and also assess the impact of exposure to a media campaign on their pre-hospital time. We surveyed 100 AMI patients admitted to the Canberra Hospital. We asked them about their AMI symptoms and risk factors and the impact of the National Heart Foundation (NHF) advertisements on their AMI experience. Only 26% of patients recognised that they were having an AMI. In 34% of cases, an ambulance was called. There was no significant difference in the median pre-hospital time between patients who encountered the NHF advertisements and those who had not (133 minutes vs. 137 minutes, p=0.809). Only 22% of patients could identify all of their personal AMI risk factors. Most AMI patients do not initially recognise their condition nor do they call for an ambulance. Exposure to the NHF advertisements had no significant influence on reducing pre-hospital time in this cohort. Most patients have a limited understanding of AMI risk factors and causes. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  11. The impact of health-related quality of life on the incidence of ischaemic heart disease and stroke; a cohort study in an Iranian population.

    Science.gov (United States)

    Dadjou, Yahya; Kermani-Alghoraishi, Mohammad; Sadeghi, Masoumeh; Talaei, Mohammad; Yousefy, Alireza; Oveisgharan, Shahram; Roohafza, Hamidreza; Rabiei, Katayoun; Sarrafzadegan, Nizal

    2016-04-01

    The aim of study was to evaluate the impact of health-related quality of life (QoL) on the occurrence of ischaemic heart disease (IHD) and stroke using a validated questionnaire. We followed the 3,283 subjects, aged ≥ 35 years and without history of cardiovascular events (CVE) over four years from 2007 to 2011 from the Isfahan cohort study. The World Health Organization QoL questionnaire (WHOQOL-BREF), which contains four separate domains, was used to assess QoL. Incidence rates of IHD and stroke were recorded during follow-up. Socioeconomic demographic data including marital state, educational level, occupation, income and place of living and metabolic risk factors such as diabetes mellitus (DM), hypertension (HTN), dyslipidaemia, body mass index and smoking were also recorded. More IHD (42%) and stroke (57%) patients were illiterate; while the educational status was significantly different only in the IHD group (P = 0.000). Differences in income and occupation were notable in patients with stroke and IHD, respectively, compared to subjects without them (P stroke patients in comparison with subjects without CVE (P = 0.000). Two-way multivariate analyses of covariance test after age, educational status and metabolic risk factors adjustment showed that subject