Cases Of First Stroke Research Articles

Vitamin E and risk of first stroke in general hypertensive patients: a nested case–control study

Background: Epidemiological studies on the association between levels of plasma vitamin E and first stroke risk are inconclusive. Methods: A nested, case–control study was conducted utilizing data on 115,337 hypertensive patients from the H-type Hypertension and Stroke Prevention and Control Project. The current analysis comprised 2193 cases of first stroke and 2193 controls matched for age, sex, and study site. Results: The mean plasma concentration of vitamin E was 12.37 (3.61) μg/mL. The smoothing curve showed a linear correlation between plasma vitamin E levels and the risk of the first stroke. Hypertensive patients with plasma vitamin E levels ≥14.1 μg/mL (Q4) had an increased risk of first stroke (adjusted odds ratios [OR]: 1.18; 95% confidence interval [CI]: 1.01, 1.37) compared with those with plasma vitamin E < 14.1 μg/mL (Q1–Q3). Sub-group analysis revealed that the relationship between plasma vitamin E (≥14.1.1 vs. P interaction = 0.035). Conclusions: This study suggests that higher levels of plasma vitamin E are associated with an elevated risk of first stroke among Chinese hypertensive patients.

Utility of single versus sequential measurements of risk factors for prediction of stroke in Chinese adults

Absolute risks of stroke are typically estimated using measurements of cardiovascular disease risk factors recorded at a single visit. However, the comparative utility of single versus sequential risk factor measurements for stroke prediction is unclear. Risk factors were recorded on three separate visits on 13,753 individuals in the prospective China Kadoorie Biobank. All participants were stroke-free at baseline (2004–2008), first resurvey (2008), and second resurvey (2013–2014), and were followed-up for incident cases of first stroke in the 3 years following the second resurvey. To reflect the models currently used in clinical practice, sex-specific Cox models were developed to estimate 3-year risks of stroke using single measurements recorded at second resurvey and were retrospectively applied to risk factor data from previous visits. Temporal trends in the Cox-generated risk estimates from 2004 to 2014 were analyzed using linear mixed effects models. To assess the value of more flexible machine learning approaches and the incorporation of longitudinal data, we developed gradient boosted tree (GBT) models for 3-year prediction of stroke using both single measurements and sequential measurements of risk factor inputs. Overall, Cox-generated estimates for 3-year stroke risk increased by 0.3% per annum in men and 0.2% per annum in women, but varied substantially between individuals. The risk estimates at second resurvey were highly correlated with the annual increase of risk for each individual (men: r = 0.91, women: r = 0.89), and performance of the longitudinal GBT models was comparable with both Cox and GBT models that considered measurements from only a single visit (AUCs: 0.779–0.811 in men, 0.724–0.756 in women). These results provide support for current clinical guidelines, which recommend using risk factor measurements recorded at a single visit for stroke prediction.

Long-term exposure to ambient source-specific particulate matter and its components and incidence of cardiovascular events – The Heinz Nixdorf Recall study

BackgroundFew studies have examined the risk of long-term exposure to source-specific airborne pollutants on incidence of cerebrovascular and cardiovascular events. ObjectivesWe aimed to estimate the effect of long-term exposure to source-specific air pollution and particulate matter (PM) components on incidence of stroke, coronary heart disease (CHD), and total cardiovascular events (CVE) in the population-based Heinz Nixdorf Recall study (HNR). MethodsWe used baseline (2000–2003) and 14-year follow-up data of the HNR Study, an ongoing population-based prospective cohort study in Western Germany. Participants’ residential mean exposures to NO2 and total and source-specific PM10, PM2.5, accumulation mode particle number concentration (PNAM), and PM components were modelled using a dispersion and chemical transport model. We used Cox regression to evaluate the effect of pollutants (per 1 μg/m3 increase and per interquartile range – IQR) on risk of stroke and CHD, adjusting for socio-demographic characteristics, lifestyle risk factors and nighttime traffic noise exposure. ResultsIn 4,105 included participants (aged 45–76 at baseline, 52.5% women), we observed 118 cases of first stroke and 373 cases of first CHD during 46,748 person-years under risk. The median survival time within the cohort was 13.3 years. No effect of exposure to ambient air pollution on risk of CHD was observed, but distinct effects were observed for stroke. Ambient traffic-specific PM showed a stronger effect on stroke than industry-specific PM: hazard ratios (95% confidence interval) for total, traffic-specific, and industry-specific PM2.5 were 1.16 (1.02–1.34), 2.53 (1.07–5.97), and 1.27 (1.03–1.56) per 1 μg/m3 increase, respectively. PM components showed no substantially different effects from those of total PM per IQR, but higher associations were observed for NH4 and SO4 per 1 μg/m3. However, the exposure contrast of ammonium and sulfate components was very low. ConclusionTraffic-specific PM exhibited stronger effects than total and industry-specific PM on risk of stroke. Among components, NH4 and SO4 showed higher effects. No effect was observed for PM and CHD.

"EMMA Study: a Brazilian community-based cohort study of stroke mortality and morbidity".

Stroke has a high burden of disability and mortality. The aim here was to evaluate epidemiology, risk factors and prognosis for stroke in the EMMA Study (Study of Stroke Mortality and Morbidity). Prospective community-based cohort carried out in Hospital Universitário, University of São Paulo, 2006-2014. Stroke data based on fatal and non-fatal events were assessed, including sociodemographic data, mortality and predictors, which were evaluated by means of logistic regression and survival analyses. Stroke subtype was better defined in the hospital setting than in the local community. In the hospital phase, around 70% were first events and the ischemic subtype. Among cerebrovascular risk factors, the frequency of alcohol intake was higher in hemorrhagic stroke (HS) than in ischemic stroke (IS) cases (35.4% versus 12.3%, P < 0.001). Low education was associated with higher risk of death, particularly after six months among IS cases (odds ratio, OR, 4.31; 95% confidence interval, CI, 1.34-13.91). The risk of death due to hemorrhagic stroke was greater than for ischemic stroke and reached its maximum 10 days after the event (OR: 3.31; 95% CI: 1.55-7.05). Four-year survival analysis on 665 cases of first stroke (82.6% ischemic and 17.4% hemorrhagic) showed an overall survival rate of 48%. At four years, the highest risks of death were in relation to ischemic stroke and illiteracy (hazard ratio, HR: 1.83; 95% CI: 1.26-2.68) and diabetes (HR: 1.45; 95% CI: 1.07-1.97). Major depression presented worse one-year survival (HR: 4.60; 95% CI: 1.36-15.55). Over the long term, the EMMA database will provide additional information for planning resources destined for the public healthcare system.

Influence of health education based on the transtheoretical model on controllable behavior factors of stroke patients

Objective To explore the effect of health education based on the transtheoretical model on controllable behavior factors of stroke patients. Methods A total of 124 cases of first stroke were randomly divided into experimental group and control group with 62 cases in each.Health education based on the transtheoretical mode was applied in the experimental group, while the control group was given routine health education in department of internal medicine.After hospital discharge 6 months and 12 months, the awareness rate of stroke rehabilitation knowledge, secondary prevention behavior, knowledge of risk factors of stroke success rate and cerebral events were compared. Results The scores of stroke rehabilitation knowledge, secondary prevention behavior and risk factors of stroke compliance rate were higher than those of control group(P<0.01 and P<0.05). Conclusions Compared with the neurological department of internal medicine routine health education, health education based on the transtheoretical model can significantly improve stroke patients controllable behavior. Key words: Stroke; Controllable behavior factors; Quality of life; Health education

Black tea consumption and risk of stroke in women and men

PurposeOur aim was examine the association between black tea consumption and risk of total stroke and stroke types in a prospective study. MethodsA total of 74,961 Swedish women and men who were free of cardiovascular disease and cancer at baseline in 1997 were followed up through December 2008. Tea consumption was assessed with a questionnaire at baseline. Stroke cases were ascertained from the Swedish Hospital Discharge Registry. ResultsDuring a mean follow-up of 10.2 years, we ascertained 4089 cases of first stroke, including 3159 cerebral infarctions, 435 intracerebral hemorrhages, 148 subarachnoid hemorrhages, and 347 unspecified strokes. After adjustment for other risk factors, high tea consumption was associated with a significantly lower risk of total stroke; however, there was no dose–response relation (P for trend = .36). Compared with no tea consumption, the multivariable relative risk for four or more cups per day (median, 5) was 0.79 (95% confidence interval [CI], 0.62–0.998). The corresponding relative risks were 0.80 (95% CI, 0.61–1.04) for cerebral infarction and 0.68 (95% CI, 0.35–1.30) for hemorrhagic stroke. ConclusionsThese findings suggest that daily consumption of four or more cups of black tea is inversely associated with risk of stroke.

Chocolate consumption and risk of stroke

To investigate the association between chocolate consumption and risk of stroke in men and conduct a meta-analysis to summarize available evidence from prospective studies of chocolate consumption and stroke. We prospectively followed 37,103 men in the Cohort of Swedish Men. Chocolate consumption was assessed at baseline using a food-frequency questionnaire. Cases of first stroke were ascertained from the Swedish Hospital Discharge Registry. For the meta-analysis, pertinent studies were identified by searching the PubMed and EMBASE databases through January 13, 2012. Study-specific results were combined using a random-effects model. During 10.2 years of follow-up, we ascertained 1,995 incident stroke cases, including 1,511 cerebral infarctions, 321 hemorrhagic strokes, and 163 unspecified strokes. High chocolate consumption was associated with a lower risk of stroke. The multivariable relative risk of stroke comparing the highest quartile of chocolate consumption (median 62.9 g/week) with the lowest quartile (median 0 g/week) was 0.83 (95 % CI 0.70-0.99). The association did not differ by stroke subtypes. In a meta-analysis of 5 studies, with a total of 4,260 stroke cases, the overall relative risk of stroke for the highest vs lowest category of chocolate consumption was 0.81 (95% CI 0.73-0.90), without heterogeneity among studies (p = 0.47). These findings suggest that moderate chocolate consumption may lower the risk of stroke.

The SMART Rehabilitation System for Stroke Self-management: Issues and Challenges for Evidence-based Health Technology Research

Background and Purpose. Stroke is one of the major causes of disability in the UK with over 100,000 cases of first stroke and 3,000 cases of further stroke every year. In the USA, it is the third leading cause of death and serious long-term disability. The benefit of telehealth technologies is now recognized and a range of telehealth systems have already been successfully developed to assist people to self-manage the medical aspects of long term conditions. This paper presents the rationale for the use of technology for the remote rehabilitation of stroke survivors and describes the research findings used to inform the design, development and deployment of the SMART device for upper limb self-managed rehabilitation. Case Description. Case studies involving 4 stroke survivors with a mean age of 61.5 (SD27.5), 2 male and 2 female, were used in the final stages of prototype deployment for the SMART system. Chang es in functional activity were analyzed through predeployment and postdeployment measurement. Descriptive statistics were used to calculate where there was an observed improvement, maintenance, or deterioration in the TELER indicators, the Timed Up and Go (TUG) values and the Motor Assessment Scale (MAS).. Outcomes. Functional improvements were observed in 50% of items measured with 40% unchanged and 10% deterioration. Discussion. The Randomized Controlled Trial may not be the most appropriate research method to be used in the early design, development and prototype deployment of telerehabilitation systems because of the complexity of the development process, the interaction processes, the clinical requirement, and the individual needs of the stroke survivor. An evaluation framework is suggested that can provide observations and information essential in the development of health technologies.

Stroke risk and antihypertensive drug treatment in the general population: the Japan arteriosclerosis longitudinal study

To evaluate the association between stroke risk and blood pressure (BP) levels with regard to the usage of antihypertensive medications. From the Japan arteriosclerosis longitudinal study, 11,371 participants from the four population-based cohort studies (aged 40-89) were followed up for a mean of 9.5 years. A Poisson regression model, adjusting for possible confounding factors, was used to investigate the risk of first stroke among six BP-based categories (BP defined according to recent guidelines), in relation to the use of antihypertensive medications. There were 324 incident cases of first stroke. Among untreated groups, the relative hazard increased linearly with the elevation of BP grade (trend P = 0.0001). The untreated group with normal BP had a significantly higher stroke risk [relative hazard 2.09, 95% confidence interval 1.09-4.01] than the untreated group with optimal BP. There was no stepwise increase in stroke risk observed among treated groups (trend P = 0.1). The stroke risk among treated groups, even among those with optimal BP (relative hazard 4.10, 95% confidence interval 1.17-14.4), was significantly higher than that in the untreated groups with the same BP level. Treated individuals with optimal BP had a higher stroke risk than untreated ones with optimal BP. Healthcare providers need to be vigilant for residual cardiovascular risks in treated hypertensive patients.

Nationwide incidence of first stroke and TIA in the Netherlands

Information on incidence of stroke is important for developing and maintaining public health strategies in primary and secondary prevention. Nationwide data on the incidence of stroke are scarce and absent for the Netherlands. New cases of first stroke and stroke subtypes in the Dutch population in 2000 were identified through linkage of national registers and included hospitalized patients for first stroke and out-of-hospital deaths from first stroke. The number of non-fatal, non-hospitalized stroke patients was estimated based on data from the Rotterdam study, a population based cohort. We identified 26,556 patients with a first stroke (20,798 hospitalized patients, 5758 out-of-hospital deaths). The number of non-fatal, non-hospitalized first stroke patients was estimated to be 12,255. Extrapolation of the data to the total Dutch population led to an overall estimate of approximately 41,000 patients with a first stroke. Stroke incidence increased with age and was higher in men than in women, except in the lowest (< 45 years) and highest age group (> 85 years). The present study provides for the first time incidence estimates of first stroke (hospitalized patients, out-of hospital deaths and non-fatal, non-hospitalized patients) based upon virtually the entire Dutch population.

Predictors of Early Seizures after Stroke

Prevalence and Predictors of Early Seizure and Status Epilepticus after First StrokeLabovitz DL, Allen Hauser W, Sacco RLNeurology 2001;57:200–206BackgroundEarly seizure (ES) has been reported in 2 to 6% of strokes and is a predictor of recurrent seizures. Acute stroke has been reported to cause 22% of all cases of status epilepticus (SE) in adults. The determinants of ES and SE after stroke, however, are not well understood.MethodsAn incidence study was conducted to identify all cases of first stroke in adult residents of northern Manhattan. Cases of ES and SE within 7 days of stroke were identified through medical record review. Statistical analyses were performed by using univariate and multivariate logistic regression models.ResultsThe cohort consisted of 904 patients; ES occurred in 37 (4.1%). The frequency of ES by stroke subtype and location was deep infarct in two (0.6%) of 356, lobar infarct in 20 (5.9%) of 341, deep intracerebral hemorrhage (ICH) in four (4.0%) of 101, lobar ICH in seven (14.3%)...

Predictors of Early Seizures after Stroke

Prevalence and Predictors of Early Seizure and Status Epilepticus after First Stroke Labovitz DL, Allen Hauser W, Sacco RL Neurology 2001;57:200–206 Background Early seizure (ES) has been reported in 2 to 6% of strokes and is a predictor of recurrent seizures. Acute stroke has been reported to cause 22% of all cases of status epilepticus (SE) in adults. The determinants of ES and SE after stroke, however, are not well understood. Methods An incidence study was conducted to identify all cases of first stroke in adult residents of northern Manhattan. Cases of ES and SE within 7 days of stroke were identified through medical record review. Statistical analyses were performed by using univariate and multivariate logistic regression models. Results The cohort consisted of 904 patients; ES occurred in 37 (4.1%). The frequency of ES by stroke subtype and location was deep infarct in two (0.6%) of 356, lobar infarct in 20 (5.9%) of 341, deep intracerebral hemorrhage (ICH) in four (4.0%) of 101, lobar ICH in seven (14.3%) of 49, and subarachnoid hemorrhage in four (8.0%) of 50. SE occurred in 10 (1.1%) patients, representing 27.0% of patients with ES. Diabetes, hypertension, current smoking, alcohol use, age, gender, and race/ethnicity were not significant determinants of ES. In a subgroup of patients who had a National Institutes of Health (NIH) stroke scale (NIHSS) score recorded, NIHSS score was not an independent predictor of ES in multivariate analysis. After accounting for stroke severity, ES was not a predictor of 30-day case fatality. Conclusions Lesion location and stroke subtype are strong determinants of ES risk, even after adjusting for stroke severity. ES does not predict 30-day mortality. SE occurs in more than one fourth of patients with ES.

Prevalence and predictors of early seizure and status epilepticus after first stroke.

Early seizure (ES) has been reported in 2% to 6% of strokes and is a predictor of recurrent seizures. Acute stroke has been reported to cause 22% of all cases of status epilepticus in adults. The determinants of ES and status epilepticus (SE) after stroke, however, are not well understood. An incidence study was conducted to identify all cases of first stroke in adult residents of northern Manhattan. Cases of ES and SE within 7 days of stroke were identified through medical record review. Statistical analyses were performed using univariate and multivariate logistic regression models. The cohort consisted of 904 patients; ES occurred in 37 (4.1%). The frequency of ES by stroke subtype and location was deep infarct 0.6% (2/356), lobar infarct 5.9% (20/341), deep intracerebral hemorrhage (ICH) 4.0% (4/101), lobar ICH 14.3% (7/49), and subarachnoid hemorrhage 8.0% (4/50). SE occurred in 10 patients (1.1%), representing 27.0% of patients with ES. Diabetes, hypertension, current smoking, alcohol use, age, gender, and race/ethnicity were not significant determinants of ES. In a subgroup of patients who had an NIH stroke scale (NIHSS) score recorded, NIHSS score was not an independent predictor of ES in multivariate analysis. After accounting for stroke severity, ES was not a predictor of 30-day case fatality. Lesion location and stroke subtype are strong determinants of ES risk, even after adjusting for stroke severity. ES does not predict 30-day mortality. SE occurs in more than one-quarter of patients with ES.

Stroke-attributable nursing home use: a population-based study.

To estimate 1) among patients with stroke, nursing home use attributable to stroke, and 2) the savings in nursing home use, assuming strokes were prevented. All confirmed cases of first stroke among Rochester, Minnesota, residents from 1987 through 1989 (n = 290) and one nonstroke control of same gender and similar age for each patient were followed up in provider-linked medical records and State of Minnesota nursing home files until emigration, death, or December 31, 1994. Data included disability and place of residence at baseline (i.e., date of stroke for each patient and their corresponding control), length of follow-up, cumulative incidence of nursing home admission, proportion of follow-up spent in a nursing home, and number of nursing home days. Before baseline, patients and controls were similar in the level of disability (mean Rankin = 1.7 for patients and 1.6 for controls) and the proportion in a nursing home (11% for both groups). Among those not in the nursing home at baseline, 5-year cumulative incidence of first admission was 48% for cases versus 20% for controls. Survival was significantly shorter for cases than for controls; the proportion of follow-up spent in the nursing home was 20% for cases versus 11% for controls. When controlling for survival, cases experienced an average of 110 (95% CI, 63 to 156) more nursing home days per person than controls in the first five years. When nursing home use during differential survival was included, the difference in nursing home days between cases and controls was no longer significant (p = 0.16). Stroke prevention would result in fewer cases admitted to the nursing home, older age at first admission, and a smaller proportion of remaining life spent in the nursing home, but stroke prevention would not result in fewer nursing home days.

Hormone Replacement Therapy and the Risk of Stroke

Falkeborn, Margareta; Persson, Ingemar; Terént, Andreas; Adami, Hans-Olov; Lithell, Hans; Bergström, Reinhold Author Information

Hormone Replacement Therapy and the Risk of Stroke

The protective effect of postmenopausal estrogen replacement therapy on coronary heart disease has been shown in several studies. However, the effect on stroke is more controversial, and data on estrogen-progestin combinations are sparse. A total of 23,088 women living in the Uppsala (Sweden) Health Care Region were identified from pharmacy records as having been prescribed noncontraceptive estrogens during 1977 through 1980. They were followed up from 1977 to 1983 for admissions to the hospital because of a first stroke (International Classification of Diseases, Eighth Revision, codes 430 through 438 and 344). The mean observation time was 5.8 years. The expected number was based on person-years in the cohort and incidence rates in the population of the region. Overall, 361 cases of first stroke were observed in the cohort, as compared with 403.2 expected (relative risk [RR], 0.90; 95% confidence limits, 0.81, 0.99). The RR for acute stroke (International Classification of Diseases, Eighth Revision, codes 431 through 436) was 0.85 (0.75, 0.97). In women younger than 60 years at entry who were prescribed estradiol compounds (1 to 2 mg) or conjugated equine estrogens (0.625 to 1.25 mg), the risk of any stroke was reduced by almost 30% (RR, 0.72; 0.58, 0.88) and the risk of acute stroke was reduced by 40% (RR, 0.61; 0.46, 0.79). Women prescribed a combined estradiol-levonorgestrel brand also had a lowered risk of stroke (RR, 0.61; 0.40, 0.88). Weak compounds (mainly estriol) showed no stroke-protective effect, nor was there any relationship between hormone replacement and risk of subarachnoid hemorrhage. Hormone replacement therapy with potent estrogens alone or cyclically combined with progestins can, particularly when started shortly after menopause, reduce the risk of stroke.

Incidence and prognosis of stroke in the Valle d'Aosta, Italy. First-year results of a community-based study.

We sought to determine the incidence rate, risk factors, and prognosis of stroke in Valle d'Aosta, Italy, to provide information for planning regional health-care facilities. We undertook a prospective study of all new cases of stroke in the geographically defined population of 114,325 residents of Valle d'Aosta in northern Italy. In the first year of the study (January 1-December 31, 1989), 254 cases of first stroke were registered. The crude annual incidence rate was 2.23/1,000, 1.98/1,000 for men and 2.46/1,000 for women. After adjustment to the 1988 Italian population, the incidence rate for first stroke was 2.15/1,000 per year, 2.48/1,000 per year for men and 1.99/1,000 per year for women. The pathological diagnosis was cerebral infarction in 67%, intracranial hemorrhage in 15%, and unknown in 18%. The overall 30-day case-fatality rate was 31%. In survivors, Barthel Index Score recorded at 30 days from stroke onset showed that 100 patients (62%) were dependent in activities of daily living. Our results do not differ significantly from those reported in Umbria, the only similar study performed in Italy, and support non-Italian data as to risk factors in stroke.

Epidemiology of stroke in Lund-Orup, Sweden, 1983-85. Incidence of first stroke and age-related changes in subtypes.

The incidence of stroke in the hospital district of Lund-Orup (total population 200,191), the local uptake area of the University Hospital, Lund, was studied. Between January 1, 1983 and December 31, 1985, there were 1054 cases of first stroke. Age adjusted (to Swedish Dec 1983 population) incidence rates were 221.2 for males, 195.8 for females, and 208.3 for total population (per 100,000 and year). Case-fatality ratio by 30 days was 17.5%. Atherothrombotic infarction was the most common subtype (58.4%), followed in frequency by cardiac embolism (30.6%), intracerebral hemorrhage (8.3%) and subarachnoid hemorrhage (2.7%). The most important change in the distribution of subtypes with age was an increase in the proportion of cardiac embolism from 13% in the youngest to 44% in the oldest age groups. The present study underscores the importance of careful determination of subtypes of stroke in future epidemiological studies.

Incidence of stroke in young adults in Florence, Italy.

A population-based study specifically addressing stroke in young adults (aged 15-44 years) was conducted in Florence, Italy, from 1983 to 1985. We identified 47 cases of first stroke by means of a daily check of the medical facilities of the city and nearby towns and a review of death certificates. Patients were assessed by a neurologist shortly after the onset of the stroke, and computed tomography or autopsy was performed in 96%. The average annual incidence rate for all stroke (cases per 100,000 population per year) was 9.0 (95% confidence interval 5.8-13.4) for males and 8.7 (95% confidence interval 5.5-13.0) for females. The average annual incidence rates for the pathologic types of stroke were 3.4 for cerebral infarction, 3.2 for subarachnoid hemorrhage, and 1.9 for intracerebral hemorrhage. The case-fatality ratio was 23.4% at 1 month. Among patients with ischemic strokes, atherosclerosis and cardiac disease accounted for 50% of the cases. Based on angiography or autopsy findings, aneurysm or arteriovenous malformation were demonstrated in 88% of the patients with subarachnoid hemorrhage. In 50% of the patients with intracerebral hemorrhage, no cause of bleeding was detected. Our study may supply information about stroke pathologic types in an unselected series of young adults.