Stroke Cases Research Articles

Relationship between longitudinal changes in lipid composition and ischemic stroke among hypertensive patients

BACKGROUND Dyslipidemia was strongly linked to stroke, however the relationship between dyslipidemia and its components and ischemic stroke remained unexplained. AIM To investigate the link between longitudinal changes in lipid profiles and dyslipidemia and ischemic stroke in a hypertensive population. METHODS Between 2013 and 2014, 6094 hypertension individuals were included in this, and ischemic stroke cases were documented to the end of 2018. Longitudinal changes of lipid were stratified into four groups: (1) Normal was transformed into normal group; (2) Abnormal was transformed into normal group; (3) Normal was transformed into abnormal group; and (4) Abnormal was transformed into abnormal group. To examine the link between longitudinal changes in dyslipidemia along with its components and the risk of ischemic stroke, we utilized multivariate Cox proportional hazards models with hazard ratio (HR) and 95%CI. RESULTS The average age of the participants was 62.32 years ± 13.00 years, with 329 women making up 54.0% of the sample. Over the course of a mean follow-up of 4.8 years, 143 ischemic strokes happened. When normal was transformed into normal group was used as a reference, after full adjustments, the HR for dyslipidemia and ischemic stroke among abnormal was transformed into normal group, normal was transformed into abnormal group and abnormal was transformed into abnormal group were 1.089 (95%CI: 0.598-1.982; P = 0.779), 2.369 (95%CI: 1.424-3.941; P < 0.001) and 1.448 (95%CI: 1.002-2.298; P = 0.047) (P for trend was 0.233), respectively. CONCLUSION In individuals with hypertension, longitudinal shifts from normal to abnormal in dyslipidemia-particularly in total and low-density lipoprotein cholesterol-were significantly associated with the risk of ischemic stroke.

Outcomes of surgical management for Kommerell's diverticulum associated with type b aortic dissection.

Kommerell's diverticulum presents a distinctive challenge in clinical management due to its rarity and diverse clinical manifestations, particularly when concurrent with type B aortic dissection. However, a consensus on the optimal treatment strategy has yet to be established. This study presents our experience with an open surgical approach to treating Kommerell's diverticulum associated with type B aortic dissection. This retrospective study evaluated 10 patients who underwent surgical repair for Kommerell's diverticulum with concurrent type B aortic dissection. Through median sternotomy, under cardiopulmonary bypass and deep hypothermic circulatory arrest + retrograde cerebral perfusion, a frozen elephant trunk stent graft was deployed in the descending thoracic aorta to address the type B aortic dissection and Kommerell's diverticulum. Aberrant subclavian arteries were reconstructed by bypassing the distal portion into the native ascending aorta or carotid artery, accompanied by proximal ligation of the aberrant artery. The median age of patient was 49 years (Interquartile range: 42.2-58.5). There were no in-hospital or 30-day post-operative deaths. All patients were discharged with a median hospital stay of 8.5 days (Interquartile range: 7.75-10.5). No cases of stroke or spinal cord ischaemia were observed. Follow-up was completed for all patients, with a mean duration of 27.4 (Standard deviation: 15.3) months, during which no adverse events occurred. This surgical approach for managing Kommerell's diverticulum with type B aortic dissection offers a safe and effective option, yielding favourable short-term outcomes. It may provide a durable alternative to traditional surgical methods and overcome limitations associated with endovascular surgeries.

The Burden of non-Communicable Diseases Attributable to Physical Inactivity in Türkiye

Physical inactivity is a major risk factor for non-communicable diseases (NCDs) globally. In Türkiye, the prevalence of physical inactivity is notably high, ranking third in Europe, with 44.4% of the population classified as physically inactive. This study aims to estimate the population attributable fractions (PAFs) of coronary heart disease, type 2 diabetes (DM), stroke, dementia, depression, and hypertension cases, deaths and disability-adjusted life-years (DALYs) due to physical inactivity in Türkiye. Data on physical inactivity prevalence and NCDs’ incidences, mortalities and DALYs were sourced from recent national surveys and Global Burden of Disease study. Relative risks (RRs) were obtained from global meta-analyses. PAFs were calculated using Levin’s equation. PAFs of physical inactivity were 16.7% for dementia, 11.6% for depression, 9.5% for stroke, 8.8% for CHD, 7.1% for type 2 diabetes and 3.1% for hypertension. Between 3.7% (for hypertension) and 17,5% (for dementia) of NCD deaths and 3.4% (for hypertension) and 17.1% (for dementia) of the DALYs due to NCDs examined in this study were attributable to insufficient physical activity. The burden was more significant among women and older ages.This study emphasizes the need for promoting physical activity and implement interventions focusing particularly on women and the elderly to reduce the burden of NCDs in Türkiye.

A Checklist to Improve Acute Stroke Evaluation and Treatment in the Emergency Department.

Narrow therapeutic time windows and delays in assessing acute ischemic stroke patients limit the access to and effectiveness of reperfusion therapies. A 2-year quality improvement project codesigned and tested a checklist for quicker evaluation of suspected stroke cases in 2 emergency departments (EDs). Utility, feasibility, and implementation barriers were assessed through semistructured interviews. The impact on stroke quality metrics was analyzed using bivariate and multivariate regression models with data from the American Heart Association's Get With the Guidelines registry. Implementing the checklist was significantly associated with higher odds of receiving intravenous thrombolytics within 60 minutes of ED arrival (odds ratio: 6.4, 95% confidence interval: 1.1-68.7, P = 0.03). Users felt the checklist improved the standardization of stroke care and promoted teamwork, especially in a time of higher staff turnover. An ED-based stroke checklist resulted in timelier stroke care for acute ischemic stroke patients, meriting further testing in larger, more diverse settings.

Cerebrovascular accidents association between serum trace elements and toxic metals level, a case-control study.

Cerebrovascular accidents (CVAs) are among the most common complications of patients today. As the prevalence of ischemic CVAs rises, detecting related risk factors is crucial. Metal concentration has previously been considered a major risk factor in several neural complications, and in this study, we will investigate this. In this case-control study, 70 CVA (clinically approved ischemic stroke cases by imaging and NIH Stroke Scale (NIHSS)) and 70 individuals with no history of CVA controls were enrolled as the control group. The serum level of several metals, including Fe (Iron), Co (Cobalt), Ni (Nickel), Cu (copper), Zn (Zinc), Mn (Manganese), Pb (lead), Hg (Mercury), has been assessed using Inductively coupled plasma mass spectrometry (ICP-MS) method. Logistic regression (LR) has also been used to determine the association between metals' levels and CVA occurrence. As the mean age of the CVA group was 48.68 ± 15.25 years and for the non-CVA group was 47.89 ± 9.65 years, the result indicated that the serum level of Cu and Pb has been statically higher in the CVA group (respectively; P < 0.001 and P = 0.002) and Ni level was significantly lower (P = 0.003). Other measured metals' levels (Fe, Co, Ni, Mn, Hg) were not significantly different between CVA and non-CVA groups. In the LR model, all Cu, Pb, and Zn metals had a P value of 0.03 and an odd ratio (OR) and confidence interval (CI) of 1.34 (1.02-1.75), 1.19 (1.01-1.39) and 1.01 (1.001-1.02) respectively. Given that some metals are associated with a higher risk of CVA, researchers and physicians must better understand the risk factors and causes of the burden of CVA. However, further studies with a larger population and investigation of the exact pathogenesis of these metals are needed.

Forecasting stroke and stroke-driven dementia in a rapidly ageing population: a model-based analysis of alternative projection scenarios for Ireland

ObjectiveUnderstanding future population needs is key for informing stroke service planning. This study aims to evaluate scenarios for future trends in stroke age-specific incidence and case fatality, and estimate their impact on projected stroke and poststroke dementia prevalence in Ireland.DesignThis is an epidemiological modelling study based on a probabilistic Markov model. We extrapolated trends in age-specific stroke incidence and case fatality from 1990 to 2019 and applied these to 2016 to 2046. We defined trend scenarios based on stability and low and high decline, broadly based on the lower and upper bounds of evidence for trends to date. We also examined nonlinear trends involving decelerating decline over time and varying trends by age.Setting/participantsThe study is conducted on the Irish population aged 40–89 years in the period 2022–2046. We used multiple data sources, including systematic review and observational evidence.InterventionsNot applicable.Primary and secondary outcome measuresWe projected the incidence and prevalence of stroke (International Classification of Disease (ICD) codes I60–I61, I63–I64), poststroke dementia (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria) and poststroke disability (modified Rankin Scale 3–5).ResultsThe stable scenario indicated a projected 85 834 stroke survivors in 2046 (95% uncertainty interval (UI)=82 366–89 655), an increase of 45.7% from 2022. Assuming a high incidence decline and low case-fatality decline indicated a 5.4% increase in prevalence. Intermediate scenarios based on lower rates of decline, or decline rates slowing over time, implied an increase between 25.8% and 40.3%. Results did not differ substantially when we varied trends by age.In the stable scenario, we projected 16 978 poststroke dementia prevalent cases in 2046 (95% UI 14 958–19 157), an increase of 58.9% from 2022. In the high decline scenario, the increase would be 24.5%, with intermediate scenarios implying an increase between 41.3% and 56.3%.ConclusionsFuture stroke healthcare needs will vary substantially depending on epidemiological trends. There is an urgent need to both invest in prevention strategies and plan for likely increases in future stroke care needs.

The Predictive Value of Circulating Gal-3 for New Stroke Events in Paroxysmal Atrial Fibrillation Patients Despite Oral Anticoagulation Medications.

CHA2DS2-VASc is used to assess the risk of stroke in patients with atrial fibrillation (AF) and guide anticoagulant treatment decisions, but it has limitations in accurately predicting stroke risk in individual patients. The objective of this study is to conduct a cohort study by assessing preoperative levels of Gal-3 in paroxysmal AF patients, aiming to observe its correlation with the subsequent incidence of stroke events. This study enrolled 197 patients with nonvalvular paroxysmal AF. Blood samples were taken to test Gal-3 levels. All patients were followed up for 4 years after admission. Compared to the nonstroke cases, serum levels of Gal-3 were markedly elevated in stroke cases (7.08 [IQR, 4.60-10.96] vs. 17.34 [IQR, 8.28-20.31], p < 0.001). Gal-3 yields a superior AUC (0.748, with a 95%CI of 0.681-0.807) compared to other classical stroke indices, such as BNP, CHA2DS2-Vas score, and TNI. Remarkably, the Gal-3 index exhibited a superior predictive capacity, yielding a significant incremental predictive value that surpassed the conventional risk factors (CHA2DS2-VASc score) for stroke events, as evidenced by an IDI of 16.4% (p < 0.001) and an NRI of 34.7% (p = 0.002). The presence of Gal-3 is an independent risk factor for stroke in patients with AF. Elevated levels of Gal-3 have the potential to serve as a valuable biomarker for identifying incident strokes in AF patients. Furthermore, incorporating the assessment of Gal-3 levels into the conventional CHA2DS2-VASc score could significantly enhance its predictive accuracy for stroke in AF patients.

Abstract WP98: Temporal Trends and Predictors of Door-in-Door-out Times for Interhospital Stroke Transfers in the Greater Cincinnati Northern Kentucky Stroke Study

Introduction: Acute treatment for stroke often requires emergent interhospital transfer for access to advanced therapies not available at the initial hospital. Prolonged transfer times have been associated with worse outcomes. Door-in-door-out time (DIDO: the amount of time a patient spends in the transferring emergency department [ED]) is an important quality metric in acute stroke care, with current recommendations for DIDO times ≤ 120 minutes. We sought to characterize trends and predictors of DIDO times for interhospital stroke transfers using the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS). Methods: We utilized data from the GCNKSS, a population-based epidemiologic stroke study, from the following time points: 1999, 2005, 2010, 2015, and 2020. Patients ≥18 years with acute ischemic stroke (AIS) or hemorrhagic stroke (HS) who presented to an initial ED and were not admitted but were transferred to another hospital were included. The primary outcome was DIDO time. Temporal trends in DIDO time were tested using the Mann-Kendall trend test. Generalized linear mixed effects models with hospital-specific random intercepts were constructed to evaluate the associations between patient- and hospital-level covariates and DIDO time. Results: Of 13,678 stroke cases over the time periods studied, 1574 patients met inclusion criteria for the overall stroke group (mean age 64.7 [SD: 15.6], 51.6% female), with 851 (54.1%) having AIS and 723 (45.9%) HS. Over the time periods examined, the median DIDO time for the overall stroke group was 213 minutes (IQR 142-305), and DIDO times significantly increased over time (Figure 1; P&lt;.0001). In the overall stroke group, hospital-level factors explained 4.0% of the variation in DIDO time. In the multiple regression model, factors associated with increased DIDO time included: history of prior stroke (+33.6 minutes; P&lt;.0001) and receipt of MRI prior to transfer (+165.7 minutes; P&lt;.0001); whereas EMS transport (-30.0 minutes; P&lt;.001) and increasing NIHSS score (P&lt;.0001) were associated with decreased DIDO time. Results were similar for AIS and HS subgroups (Table 2). Conclusions: In this population-based epidemiologic study, DIDO times exceeded recommended time targets and increased over time. Hospital-level factors accounted for only a minor proportion of the overall variation in DIDO times, suggesting that future quality improvement efforts should target modifiable clinical and systems factors to improve DIDO times.

Abstract DP9: Enhancing Nursing Education to Improve Stroke Patient Education and Outcomes

Background: Stroke is the fifth leading cause of death in Minnesota and in the United States. Stroke is a leading cause of long-term disabilities and is largely preventable (80%). Evidence indicates that patients receiving care from stroke specialized nurses, including nurse-led stroke prevention, show better outcomes. Stroke program leaders at a Primary Stroke Center identified this as an opportunity to improve stroke program education, quality of nursing care, and stroke patient outcomes. Purpose: The primary focus area was improving stroke-patient education to include individualized stroke risk factors. As our project progressed, the initial goal remained. The secondary focus was to see if the effect of in-person, hands-on (escape room) nurse education would improve individualized stroke-patient education compliance compared to eLearning and poster board education. Methods: All stroke cases from June 2023 - June 2024 were audited for documentation of individualized stroke-patient education. Utilizing stroke guidelines and scientific statements, a standardized practice of individualizing stroke-patient education was developed. Staff learning modules were developed including eLearning, unit poster board, and in-person learning (escape room). Throughout the project, completion rates of individualized stroke-patient education were compared. A nursing survey was conducted to evaluate confidence and knowledge post multimodality learning modules. Results: Prior to initiation of nursing learning modules, 24 hospitalized stroke-patient charts from June and July 2023 were audited for individualized stroke education (40%). After initiation of nursing learning modules, 183 hospitalized stroke-patient charts from August 2023 to June 2024 were audited for individualized stroke education (poster board 44%, eLearning 45%, escape room 75%). The post nursing learning module survey responses demonstrated improved learners’ knowledge for the interactive escape room (poster board average-good 77%, eLearning average-good 83%, escape room good-excellent 89%). Conclusion: By identifying educational gaps, we were able to enhance nursing education; which improved stroke-patient education and outcomes. In conclusion, nursing confidence and knowledge increased with the in-person escape room education. This suggests engaging in-person learning could be more effective in developing nursing knowledge, improving patient care, and positive patient outcomes.

Larger Perfusion Mismatch Volume Is Associated With Longer Hospital Length of Stay in Medium Vessel Occlusion Stroke.

Prolonged length of stay (LOS) following a stroke is associated with unfavorable clinical outcomes. Factors predicting LOS in medium vessel occlusion (MeVO), impacting up to 40% of acute ischemic stroke (AIS) cases, remain underexplored. This study aims to investigate the predictors of LOS in AIS-MeVO. We conducted a retrospective analysis of prospectively maintained stroke databases, comprising AIS cases with MeVO in the anterior circulation, assessed by adequate CT perfusion (CTP). Baseline and clinical data were obtained from electronic health records. Alberta Stroke Program Early CT Scores (ASPECTS) were calculated from non-contrast head CT. The perfusion mismatch volume (time to maximum > 6 s minus relative cerebral blood flow <30%) volume was reported from CTP. Multiple regression was employed to examine the relationship between baseline parameters and hospital LOS. A total of 133 patients (median age 71 [interquartile range 63-80] years, 59.4% females) were included in the study cohort. The perfusion mismatch volume significantly positively correlated with LOS (r = 0.264, p = 0.004). After adjusting for age, sex, hypertension, diabetes, prior stroke or transient ischemic attack, admission NIHSS, ASPECTS, Tan score, intravenous thrombolysis, mechanical thrombectomy (MT), and hemorrhagic transformation, a larger mismatch volume remained independently associated with longer hospital stays (β = 0.209, 95% confidence interval [CI] 0.006-0.412, p = 0.045). Additional significant determinants of longer hospital stay included admission NIHSS (β = 0.250, 95% CI: 0.060-0.440, p = 0.010) and MT (β = 0.208, 95% CI: 0.006-0.410, p = 0.044). Among patients who underwent MT (n = 83), multiple regression analysis incorporating both perfusion mismatch volume and admission NIHSS revealed that perfusion mismatch volume remained independently associated with LOS (β = 0.248, 95% CI: 0.019-0.471, p = 0.033), while admission NIHSS did not retain significance (β = 0.208, 95% CI: 0.019-0.433, p = 0.071). In our cohort of AIS patients with MeVO in the anterior circulation, and particularly in those who underwent MT, the perfusion mismatch volume serves as an independent predictor of LOS. These findings offer critical valuable insights in clinical assessments and decision-making protocols of MT in AIS-MeVO.

Midday napping duration and risk of stroke: A prospective study in China.

Evidence on the potential effects of midday napping on risk of stroke in Chinese populations remains limited. We aimed to prospectively investigate the association between midday napping and risk of subsequent stroke and stroke subtypes in the Kailuan study. Midday napping duration was obtained from a self-reported questionnaire. Incident stroke cases from baseline (2014) to December 31, 2020 were confirmed by review of medical records. The association of midday napping duration with risk of incident stroke and subtypes was examined using a Cox regression model, adjusting for potential confounders. We further investigated the joint effects of nocturnal sleep duration and midday napping on the risk of stroke. A total of 96,899 individuals (21.0% women; 51.9±14.0 years) were included. During an average follow-up of 5.62±0.69 years, 2539 incident stroke cases were documented. After adjusting for potential confounders, we found that participants with a midday napping duration of >60min/day had higher risk of incident stroke (adjusted HR: 1.23; 95% CI: 1.07, 1.42), compared with those without midday napping. Furthermore, significant joint effects were found in both nocturnal sleep duration (P-interaction=0.04) and snoring status (P-interaction= 0.005) on the association between midday napping duration and the risk of incident stroke, especially for participants who napped >60min/day and slept ≤7h/night compared with those who slept 7-8h/night and did not take a nap, or those who napped >60min/day and snored compared with those who did not take a nap and snore. We found that prolonged midday napping (>60min/day) was associated with higher risk of stroke and the association was stronger among those with shorter nocturnal sleep duration or those who snored.

Abstract DP42: A Stroke Case Management Program To Improve Hospital Readmission Rates After Index Stroke

Abstract DP42: A Stroke Case Management Program To Improve Hospital Readmission Rates After Index Stroke

Clinical effectiveness and cost-effectiveness of first-line early combination of dipeptidyl peptidase 4 inhibitors and metformin in patients with type 2 diabetes in Taiwan: A modelling study.

Early dipeptidyl peptidase-4 inhibitors and metformin (DPP4i-Met) combination has been shown to extend the time to treatment failure and provide better glycaemic control for newly diagnosed type 2 diabetes (T2D) patients; however, the long-term clinical and economic outcomes of early DPP4i-Met combination remain unknown. We seek to assess the comparative long-term clinical and cost-effectiveness of DPP4i-Met versus Met for treatment-naïve T2D patients with inadequately controlled HbA1c (i.e., ≥8.5%). The IQVIA CORE Diabetes Model was used to simulate the quality-adjusted life years (QALYs) and healthcare costs over a lifetime from Taiwan's National Health Insurance Administration's perspective, with both QALYs and costs discounted at 3% annually. Model inputs were taken from the analyses of Taiwanese or Asian populations. Primary outcomes included the number needed to treat (NNT) to prevent one case of a clinical event and the incremental cost-effectiveness ratios (ICERs). Costs are presented in 2023 US dollars. Over 40 years of projection, Met-DPP4i-treated patients had fewer complications than those using Met alone (e.g., lowering the incidence of stroke by 2.21% [2.68, 1.74]). The NNT using DPP4i-Met versus Met alone to prevent one case of stroke, microalbuminuria, neuropathy and background retinopathy was 45, 135, 65 and 182, respectively. Such long-term benefits in reducing costly complications offset the higher treatment cost of DDP4i-Met versus Met ($5796 vs. $5484/person). As a result, using DPP4i-Met versus Met yielded 0.086 QALYs gained and savings of $489 for overall treatment-naïve T2D patients and 0.064 QALYs gained and savings of $714 for young-onset T2D patients. Early DPP4i-Met provides long-term clinical and economic benefits compared to Met alone for newly diagnosed T2D patients, including those with young-onset T2D.

Sequential Epidemiological Analyses of Real-World Data: A Tool for Prospective Drug Safety Surveillance from the Rofecoxib Example.

Large administrative healthcare databases can be used for near real-time sequential safety surveillance of drugs as an alternative approach to traditional reporting-based pharmacovigilance. The study aims to build and empirically test a prospective drug safety monitoring setup and perform a sequential safety monitoring of rofecoxib use and risk of cardiovascular outcomes. We used Danish population-based health registers and performed sequential analysis of rofecoxib use and cardiovascular outcomes using case-time-control and cohort study designs from January 2000 to September 2004. Each monitoring period added 6 months of data until the end ofthe study period. In the case-time-control study, incident cases of myocardial infarction (MI) and ischemic stroke were identified and matched with up to five time controls on age, sex, and calendar time. Exposure status on the date of diagnosis was assessed using a 60-day focal window, with reference windows 120, 180, and 240 days prior to the diagnoses. In the cohort study, incident users of rofecoxib were matched up to 1:4 with ibuprofen users (active comparators) using high-dimensional disease risk scores and were followed for 60 days. The earliest association between rofecoxib use and therisk of MI was seen in study period 2 for case-time-control design (OR 1.42, 95% CI 1.04-1.93) and instudy period 7 for the cohort study design (RR 1.22; 95% CI 1.02-1.47). Our prospective drug safety monitoring setup showed that the risk of MI could have been detected 3.5 years before theultimate market withdrawal of rofecoxib. However, further research is needed to validate this approach.

Association Between Liver Fibrosis and Risk of Incident Stroke and Mortality: ALarge Prospective Cohort Study.

There is a well-established relationship between liver conditions and cardiovascular diseases. However, uncertainty persists regarding the contribution of liver fibrosis to major stroke types including ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage at the population level. In this large prospective cohort study, participants without previous stroke or coronary heart disease at baseline from the UK Biobank were included. We identified participants at high probability of advanced liver fibrosis using the Fibrosis-4 index >2.67 or aspartate aminotransferase to platelet ratio index ≥1.0. Multivariable Cox proportional hazard regression analyses were conducted to estimate hazard ratios (HRs) for liver fibrosis with the incidence of major stroke types, stroke-related death, and all-cause death. Among 379 953 participants (mean age, 56.2 [SD, 8.1] years; 44.6% men), 7396 (1.9%) had a Fibrosis-4 index >2.67 at baseline. During a median follow-up of 12.75 (interquartile range, 12.03-13.48) years, 7143 (1.9%) incident stroke cases were documented. Advanced liver fibrosis assessed by the Fibrosis-4 index was associated with an increased risk of ischemic stroke (HR, 1.94 [95% CI, 1.70-2.22]), intracerebral hemorrhage (HR, 2.14 [95% CI, 1.63-2.81]), subarachnoid hemorrhage (HR, 1.90 [95% CI, 1.27-2.84), stroke-related death (HR, 2.20 [95% CI, 1.73-2.80]), and all-cause death (HR, 2.59 [95% CI, 2.46-2.73]). Using the aspartate aminotransferase to platelet ratio index as an alternative score, liver fibrosis was correlated with magnified risk of intracerebral hemorrhage (HR, 3.76 [95% CI, 2.38-5.93]) and subarachnoid hemorrhage (HR, 3.05 [95% CI, 1.51-6.13]) compared with ischemic stroke (HR, 1.58 [95% CI, 1.17-2.14]). Restricted cubic spline analysis showed nonlinear associations of the Fibrosis-4 index and aspartate aminotransferase to platelet ratio index with stroke incidence and all-cause death. Liver fibrosis is associated with increased risk of incident stroke and death among people without previous stroke or cardiovascular events, with particularly greater risk of intracerebral hemorrhage and subarachnoid hemorrhage. Noninvasive indices of liver fibrosis may serve as an easily accessible marker to detect individuals facing elevated risk of stroke and death in the primary prevention settings.

Epilepsy Stands Nearby: A Pilot CT Perfusion Study on Post-Stroke Non-Convulsive Status Epilepticus.

To investigate the relevance of hyperperfusion on computerised perfusion imaging (CTP) in the emergency setting in people with non-convulsive status epilepticus (NCSE) and previous stroke, to derive relevant aspects on the epileptogenic focus and the network recruited for NCSE propagation. We enrolled consecutive adult patients with acute-onset NCSE and a previous stroke at a single institution undergoing CTP and EEG during symptoms. All patients underwent standard imaging including CT, CTP, CT angiograms and standard EEG within 30 min from hospital arrival. Age-/sex-matched NCSE without previous stroke cases and recurrent ischaemic stroke cases were included to test for accuracy of hyperperfusion rates. Overall, 15 patients had a previous stroke and developed NCSE (mean age 78 years, 46.7% female). All patients had hyperperfusion on CTP imaging (mean onset-to-CTP 184 min). Only one case showed hyperperfusion limited to the previous stroke lesion, and one had a combination of lesional and peri-lesional hyperperfusion. All remaining cases (n = 13) had exclusive extra-lesional involvement. Five cases had multiple separated hyperperfused areas, and five had ipsilateral intra-thalamic hyperperfusion. No correlation emerged between onset-to-CTP timing and hyperperfusion (p value for CTP = 0.66, CBV = 0.28, MTT = 0.28, reverse Tmax = 0.66). Hyperperfusion was present in NCSE cases only and in none of age-/sex-matched ischaemic stroke cases (n = 18). Hyperperfusion involves cortical areas external to the previous lesion site during NCSE, supporting the relevance of networks for the spatial evolution of epileptic activity and limited relevance of the lesion site for the propagation of the epileptiform activity.

Association between the hemoglobin A1c/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in China

BackgroundStroke has emerged as an escalating public health challenge among middle-aged and older individuals in China, closely linked to glycolipid metabolic abnormalities. The Hemoglobin A1c/High-Density Lipoprotein Cholesterol (HbA1c/HDL-C) ratio, an integrated marker of glycolipid homeostasis, may serve as a novel predictor of stroke risk.MethodsOur investigation utilized data from the China Health and Retirement Longitudinal Study cohort (2011–2018). Stroke cases were identified based on self-reported, physician-confirmed diagnoses. Logistic regression models were established to determine the correlation between HbA1c/HDL-C and stroke prevalence (2011) as well as between cumulative mean HbA1c/HDL-C (2011–2015) and new stroke incidence (2015–2018). Additionally, smoothed curve fitting, subgroup analyses, and interaction tests were conducted to ensure the robustness of the findings.ResultsIn the cross-sectional analysis, 8,502 participants were enrolled, of whom 189 had a history of stroke. Our findings revealed a significant positive linear relationship between HbA1c/HDL-C and stroke prevalence after adjusting for covariates (OR: 1.26, 95% CI: 1.09–1.45). When HbA1c/HDL-C was categorized into tertiles, only the highest tertile (T3) showed a significant correlation with stroke prevalence compared to the lowest tertile (T1) (OR:1.71, 95% CI: 1.05–2.77). In the longitudinal analysis of 5,165 participants, 336 cases of new-onset stroke were identified over a follow-up period of 7 years. Adjusting for confounders, individuals with higher cumulative mean HbA1c/HDL-C exhibited an increased likelihood of new stroke incidence (OR: 1.14, 95% CI: 1.01–1.29). Using the T1 of cumulative mean HbA1c/HDL-C as a reference, the fully adjusted OR for stroke was 1.65 (95% CI: 1.21–2.24) in T2 and 1.54 (95% CI: 1.08–2.19) in T3. The predictive value of the HbA1c/HDL-C in stroke risk assessment have been significantly improved compared to the traditional HDL-C and HbA1c. Consistent associations were observed across most stratified subgroups.ConclusionsElevated baseline and cumulative mean HbA1c/HDL-C levels are significantly associated with an increased risk of stroke among middle-aged and older individuals in China, underscoring the potential of HbA1c/HDL-C as a clinical marker for long-term stroke risk assessment and prevention strategies.

Arterial stiffness mediates insulin resistance-related risk of atherosclerotic cardiovascular disease: a real-life, prospective cohort study.

The precise pathways connecting insulin resistance (IR) to atherosclerotic cardiovascular disease (ASCVD) remain undefined. The present study aimed to examine the mediating role of arterial stiffness in the association between IR and ASCVD, providing epidemiology insights into the potential mechanisms driving IR to incident ASCVD. A total of 59,777 participants from the Kailuan Study Arterial Stiffness Subcohort who were free of ASCVD at baseline were enrolled in the present study. Arterial stiffness was assessed using baPWV and IR was assessed by triglyceride glucose index (TyG) or metabolic score for insulin resistance (METS-IR). Mediation analysis was adopted to explore the mediating effects of baPWV on the associations between IR and ASCVD and its subtypes. Over a median follow-up of 5.97 years, a total of 2073 cases of ASCVD were identified, with 478 cases of coronary heart disease (CHD) and 1636 cases of ischemic stroke. Mediation analyses revealed that 11.1% of the total association (HR 1.23; 95% CI 1.17 to 1.30) between the TyG index and ASCVD was mediated through baPWV. Specifically, 6.58% and 14.0% of the total associations of the TyG index with CHD and ischemic stroke, respectively, were mediated through baPWV. Similar patterns were observed for METS-IR. These results remained consistent when assessed through causal mediation analysis, time-lagged mediation analysis, and various sensitivity analyses. The association between IR indices and ASCVD was found to be partly mediated by baPWV, indicating a pathway connecting IR to ASCVD outcomes and the potential for interventions targeting arterial stiffness for ASCVD prevention.

Incidence of First-ever Stroke, Stroke Events, and Early Case Fatality Rate in China: Results from a National Population-based Survey.

In recent years, stroke has become the leading cause of death in the Chinese population，and the burden of stroke is huge. The aim of this study is to describe the epidemiological characteristics of population-based stroke incidence and case fatality rates in China, which are nationally representative. In 2013, a nationally representative household survey was conducted at 155 survey sites in 31 provinces. All stroke cases occurring within 1 year before the start of the survey period, including first-ever and recurrent strokes, were considered event cases. According to computed tomography, magnetic resonance imaging, and autopsy results, stroke was classified as ischemic, hemorrhagic, subarachnoid hemorrhagic, or difficult-to-classify stroke. The 7- and 30-day case fatality rates after stroke onset were investigated. A total of 595,711 people were surveyed, with 2164 diagnosed stroke events and 1645 first-ever strokes. The age-standardized incidence of first-ever stroke and stroke event incidence in the Chinese population were 229.5 and 300.61 per 100,000 person-years, respectively. The world population age-standardized incidence of first-ever stroke and stroke events by the World Health Organization were 188.5 and 246.3 per 100,000 person-years, respectively. Among the 31 provinces, the top five incidence rates of first-ever stroke were recorded in Shannxi, Heilongjiang, Ningxia, Henan, and Tianjin (518.0, 400.8, 389.5, 366.6, and 344.0 per 100,000 person-years, respectively). The top five incidence rates of stroke events were documented in Heilongjiang, Shannxi, Henan, Tianjin, and Ningxia (672.7, 603.1, 580.2, 469.0, and 456.2 per 100,000 person-years, respectively). The 7- and 30-day case fatality rates were 14.3% and 17.8% for patients with first-ever stroke, respectively. Significant differences in the 30-day mortality rate of different stroke subtypes were recorded: 8.3% (95% CI, 8.2-8.5) for ischemic stroke, 44.4% (95% CI, 42.2-46.5) for cerebral hemorrhage, and 3.1% (95% CI, 3.0-3.3) for subarachnoid hemorrhage (P < 0.0001). Compared with the area of residence, the 30-day mortality rate of first-ever stroke in rural areas was 19.8% (95% CI, 19.3-20.3), which was higher than that in urban areas (14.9% [95% CI, 14.5-15.3]) (P = 0.011). In China, the incidences of first-ever stroke and stroke events are increasing, whereas the early case fatality rate is declining, which will inevitably lead to a higher stroke prevalence and a greater stroke burden. Therefore, the primary and secondary prevention strategies should be strengthened to reduce the incidence and burden of stroke.

Association between cumulative loneliness and risk of cardiovascular diseases in middle-aged and older adults: A longitudinal study.

Previous longitudinal studies have investigated the association between baseline loneliness and the risk of developing cardiovascular diseases (CVD). Nevertheless, the cumulative effect of loneliness on CVD remains uncertain. The objective of this study is to assess the relationship between the cumulative duration of loneliness and the risk of CVD in middle-aged and older adults. Prospective cohort study. The study utilized data from a sample of 8353 adults aged 45 years and older who participated in the China Health and Retirement Longitudinal Study (CHARLS). Loneliness was assessed biennially between 2011 and 2015, and categorized into four groups: never, one time point, two time points, and three time points. The Cox Proportional Hazards Regression Model was employed to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Following a mean follow-up period of 4.7 years (standard deviation: 0.7 years), a total of 1314 cases of CVD were identified, including 913 cases of heart disease and 504 cases of stroke. After adjusting for potential confounding factors, individuals who experienced loneliness at one time point (HR, 1.21; 95% CI: 1.06, 1.38), two time points (HR, 1.23; 95% CI: 1.03, 1.45), and three time points (HR, 1.50; 95% CI: 1.19, 1.89) had a significantly higher risk of developing CVD compared to those who never experienced loneliness. Cumulative loneliness was associated with increased risk of CVD in middle-age and older adults. Additional research is warranted to delve into the underlying mechanisms, while it is advisable to contemplate social interventions aimed at addressing loneliness.