Prevalence Of Cerebrovascular Disease Research Articles

Prevalence and subtypes of radiological cerebrovascular disease in late-onset isolated seizures and epilepsy

BackgroundLate-onset epilepsy (LOE), onset over 60, is often attributed to cerebrovascular disease (CVD), and is associated with increased stroke risk. We investigated the radiological prevalence of CVD in LOE. MethodsWe undertook a retrospective case-control study of patients with LOE and age and sex-matched controls, also matched for imaging modality. Radiological CVD was recorded, with radiological findings by an experienced consultant neuroradiologist usi a structured proforma. Results105 cases and 105 controls were studied, comprising 61 (58.1%) males, mean (±SD) age (years) 72.7±7.48 (cases), 72.4±7.02 (controls). 9 cases had isolated seizures rather than LOE. Imaging modality (in cases and controls) was CT in 59 and MRI in 46. Radiological CVD was more prevalent amongst cases (65.7%) than controls (33.3%) (p<0.0001, Chi-square), odds ratio 3.83 (95% CI 2.16–6.79). Large vessel disease (LVD) (single or multiple cortical or subcortical infarcts>1.5cm) was present in 23 (21.9%) cases and 2 (1.9%) (p<0.001) controls, with small vessel disease (SVD) (periventricular or subcortical white matter lesions (WMLs), including leukoaraiosis (LA)) present in 52 (49.5%) cases (LA in 4) and 34 (32.3%) controls (LA in 0) (p<0.05). When WMLs were rated using a semiquantitative visual rating scale, a trend towards greater severity was observed amongst cases compared to controls. ConclusionsRadiological CVD is significantly more prevalent in patients with LOE than controls, including signs of both LVD and SVD. SVD also appears to be of greater severity. Further studies are needed in this area.

Body mass index correlates with ischemic heart disease and albuminuria in long-standing type 2 diabetes

AimsComprehensive data describing the effect of obesity on type 2 diabetes outcomes is lacking. We sought to address this by analyzing a tertiary hospital clinical database. MethodsWe extracted clinical and biochemical data for patients who attended a tertiary hospital diabetes clinic between 1998 and 2011 and were aged less than 65 years. Body mass index (BMI) was correlated with the prevalence of vascular complications and with cardiovascular risk factors. ResultsThe means of age and duration of diabetes for the 711 patients (392 men and 319 women) were 53 and 11 years respectively. BMI correlated with the prevalence of ischemic heart disease and, to a lesser degree, albuminuria, but not with the prevalence of cerebrovascular disease, neuropathy, retinopathy or renal function. BMI did not correlate with glycosylated hemoglobin, although obese patients used insulin both more frequently and at higher doses. ConclusionsIn people with long-standing type 2 diabetes who attend a tertiary hospital outpatient clinic, ischemic heart disease, in contrast to other vascular complications, correlates robustly with BMI. These findings indicate that clinical trials of weight loss in type 2 diabetes should use cardiac endpoints as their primary outcomes.

Cerebrovascular Disease and Stroke in Korean Male Adolescent

PurposeThis study aimed to estimate the prevalence and incidence of cerebrovascular disease (CVD) and stroke in Korean male adolescents.Materials and MethodsThe authors reviewed all medical certificates, medical records, and radiologic images from the examinations of Korean military conscription from January 2008 to May 2011.ResultsOf the 101156 examinees, 40 had CVD and stroke during adolescence. The overall prevalence and incidence of CVD and stroke was 39.54 cases per 100000 adolescents and 2.08 cases per 100000 adolescents per year, respectively and these were similar to the worldwide data. There were 3 cases of aneurysm, 3 cases of dural arteriovenous fistula, 11 cases of arteriovenous malformation, 4 cases of cavernous hemangioma, 4 cases of cerebrovascular infarction, 16 cases of Moyamoya disease, and 1 case of missing data. The incidence of arteriovenous malformation (0.57 cases per 100000 adolescents per year) was lower than the incidence for the worldwide general population. The incidence of Moyamoya disease was higher than that in any other country (15.82 cases per 100000 adolescents, vs. 0.83 cases per 100000 adolescents per year).ConclusionWe observed ischemic and hemorrhagic stroke, each accounting for approximately half of cases, and high incidence of Moyamoya disease with low incidence of arteriovenous malformation in Korean male adolescents.

How Well do the Framingham Risk Factors Correlate With Diagnoses of Ischemic Heart Disease and Cerebrovascular Disease in a Military Beneficiary Cohort?

We sought to determine how well the Framingham prediction rules correlate with ischemic heart disease and cerebrovascular disease in a military beneficiary cohort by examining demographic and International Classification of Diseases, Ninth Revision codes from electronic medical records between 2001 and 2008. This sample (n = 163,627) included people averaged at 52 years of age (range 18-108); slightly more than half were male (55%), 21% were African-American, and 59% were Caucasian. Fifteen percent of beneficiaries had ischemic heart disease and 3.4% had cerebrovascular disease. The Framingham model fits our data well; all Framingham risk factors were associated with increased likelihood of ischemic heart disease and all Framingham risk factors except gender increased cerebrovascular disease prevalence. Age was the strongest correlate for both ischemic heart disease and cerebrovascular disease (> 60 years old; ischemic heart disease relative risk, 3.9; 95% confidence interval, 3.7-4.0; cardiovascular disease relative risk, 3.9; 95% confidence interval, 3.6-4.2) followed by hyperlipidemia and hypertension. We conclude that military clinicians can risk stratify military beneficiaries using the Framingham risk model.

Epworth Sleepiness Scale may be an indicator for blood pressure profile and prevalence of coronary artery disease and cerebrovascular disease in patients with obstructive sleep apnea

This study seeks to determine whether scores of a short questionnaire assessing subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]) are associated with blood pressure (BP) level, BP profile, and prevalence of related coronary artery disease (CAD) and cerebrovascular disease (CVD) in obstructive sleep apnea (OSA) patients diagnosed by polysomnography (PSG). Twenty university hospital sleep centers in China mainland were organized by the Chinese Medical Association to participate in this study. Between January 2004 and April 2006, 2,297 consecutive patients (aged 18-85 years; 1,981 males and 316 females) referred to these centers were recruited. BP assessments were evaluated at four time points (daytime, evening, nighttime, and morning) under standardized conditions. Anthropometric measurements, medical history of hypertension, CAD, and CVD were collected. ESS score was calculated for each participant and at the night of BP assessment, nocturnal PSG was performed and subjects were classified into four groups based on the apnea-hypopnea index (AHI) from PSG as follows: control group (control, n = 213) with AHI < 5; mild sleep apnea (mild, n = 420) with AHI ≥ 5 and <15; moderate sleep apnea (moderate, n = 460) with AHI ≥ 15 and <30; and severe sleep apnea (severe, n = 1,204) with AHI ≥ 30. SPSS 11.5 software package was used for the relationships between ESS and BP profile and prevalence of CAD and CVD. ESS is correlated positively with average daytime, nighttime, evening, and morning BP before and even after controlling for confounding effects of age, sex, BMI, AHI, and nadir nocturnal oxygen saturation (before--r = 0.182, 0.326, 0.245, and 0.329, respectively, all P values < 0.001; after--r = 0.069, 0.212, 0.137, and 0.208, respectively, all P values < 0.001). In the severe group, nighttime, evening, morning average BPs (ABPs), the ratio of nighttime/daytime average BP (ratio of nighttime average BP to daytime average BP), and prevalence of hypertension, drug-resistant hypertension (R-HTN), isolated nighttime hypertension (IN-HTN), CAD, and CVD in excessive daytime sleepiness (EDS, ESS ≥ 11) subjects are higher than those in non-EDS (ESS 0-10; t/χ(2) = -8.388, -6.207, -8.607, -5.901, 12.742, 38.980, 16.343, 59.113, and 67.113, respectively; all P values < 0.05). For EDS subjects in the moderate group but not in the control and mild group, nighttime ABP and the ratio of nighttime/daytime average BP are higher (t = -2.086 and -3.815, respectively, all P values < 0.05). Linear fitting with ESS and the ratio of nighttime/daytime average BP shows a positive correlation (r(2) = 0.049, P < 0.001). In severe OSA patients with comparable AHI, EDS may identify a subset of individuals with OSA at higher risk of hypertension, R-HTN, IN-HTN, CAD, and CVD. Overall, nighttime ABP seems to be more sensitive to be influenced by EDS than other ABP parameters. Future studies should investigate the potential dose-effect relationship between EDS and hypertension and the possibility that diagnosis and treatment of EDS could aid in BP reduction and ultimately in decreased morbidity and mortality from cardiovascular and cerebrovascular complications (TMUIRB20010002 at www.clinicaltrials.gov ).

Risk-factor profile, drug usage and cardiovascular events within a year in patients with and at high risk of atherothrombosis recruited from Asia as compared with those recruited from non-Asian regions: a substudy of the REduction of Atherothrombosis for Continued Health (REACH) registry

ObjectiveTo clarify the differences in the baseline characteristics, prevalence and incidence of atherothrombosis in patients recruited from Asia versus non-Asian regions.DesignInternational Prospective Cohort Study.SettingRegion focused substudy.PatientsThe Reduction of Atherothrombosis for...

Prognosis of Atrial Fibrillation in Patients with Symptomatic Peripheral Arterial Disease: Data from the REduction of Atherothrombosis for Continued Health (REACH) Registry

Background Atrial fibrillation (AF) is a significant risk factor for cardiovascular (CV) mortality. This study aims to evaluate the prognostic implication of AF in patients with peripheral arterial disease (PAD). Methods The International Reduction of Atherothrombosis for Continued Health (REACH) Registry included 23,542 outpatients in Europe with established coronary artery disease, cerebrovascular disease (CVD), PAD and/or ≥3 risk factors. Of these, 3753 patients had symptomatic PAD. CV risk factors were determined at baseline. Study end point was a combination of cardiac death, non-fatal myocardial infarction (MI) and stroke (CV events) during 2 years of follow-up. Cox regression analysis adjusted for age, gender and other risk factors (i.e., congestive heart failure, coronary artery re-vascularisation, coronary artery bypass grafting (CABG), MI, hypertension, stroke, current smoking and diabetes) was used. Results Of 3753 PAD patients, 392 (10%) were known to have AF. Patients with AF were older and had a higher prevalence of CVD, diabetes and hypertension. Long-term CV mortality occurred in 5.6% of patients with AF and in 1.6% of those without AF ( p < 0.001). Multivariable analyses showed that AF was an independent predictor of late CV events (hazard ratio (HR): 1.5; 95% confidence interval (CI): 1.09–2.0). Conclusion AF is common in European patients with symptomatic PAD and is independently associated with a worse 2-year CV outcome.

Parkinson disease and comorbid cerebrovascular disease

Optimal management of chronic diseases not only requires tackling of the primary disease processes, but also necessitates timely recognition and treatment of comorbid conditions. In this article, we illustrate this two-pronged approach for two common age-related disorders: Parkinson disease (PD) and cerebrovascular disease (CVD). We first discuss the pathophysiological mechanisms that could provide a link between PD and CVD. Patients with PD have a series of risk factors that could promote development of CVD, but also have several protective factors. We then review the available clinical, radiological and neuropathological evidence to support an association between these two conditions. We conclude by discussing the potential implications for clinical practice, highlighting how comorbid CVD could alter the clinical presentation of PD and reviewing the possibilities for prevention and secondary prophylaxis. Additional research will be needed to fully evaluate the prevalence and clinical relevance of comorbid CVD in PD. Pending further evidence, we recommend that cerebral neuroimaging should be considered if patients with initially uncomplicated PD develop-either acutely or chronically-prominent and/or treatment-resistant gait impairment, postural instability, depression, cognitive decline, or urinary incontinence. Finding comorbid CVD in such patients could have prognostic implications, and could necessitate treatment to arrest further progression of CVD.

Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes

The presence of peripheral arterial disease (PAD) or cerebrovascular disease (CVD) is associated with higher likelihood of significant coronary artery disease (CAD). We sought to assess the prevalence of PAD, CVD, prior CAD, or pre-existent disease in multiple arterial territories ('polyvascular' disease) in patients presenting with non-ST-segment elevation acute coronary syndrome and its impact on adverse events. Data from 95 749 patients enrolled from February 2003 to September 2006 at 484 sites in the CRUSADE registry were analysed. Patients were categorized as having prior 0, 1, 2, or 3 affected arterial beds. The rates of in-hospital mortality, myocardial infarction, stroke, and congestive heart failure were analysed, as were the rates of non-bypass surgery-related red blood cell transfusion and major bleeding. On presentation, 11,345 (11.9%) patients had established PAD, 9973 (10.4%) had documented CVD, and 41,404 (43.2%) had prior CAD. In this cohort, 0, 1, 2, and 3 arterial bed disease before presentation was present in 46 814 (48.9%, 95% CI 48.6-49.2%), 36 704 (38.3%, 95% CI 37.8-39.0%), 10 675 (11.2%, 95% CI 10.9-11.9%), and 1556 (1.6%, 95% CI 1.5-1.8%) patients, respectively. The rates of ischaemic events increased with the number of affected vascular beds. The adjusted odds ratio for the composite of in-hospital ischaemic events for pre-existent disease in 1, 2, or 3 arterial beds (compared with 0 arterial bed involvement) increased from 1.07 to 1.26 to 1.31 (P < 0.001). Similarly, the adjusted odds ratio for transfusion increased with greater disease burden from 1.11 to 1.28 to 1.30 (P < 0.001), although the adjusted rates of protocol-defined non-bypass surgery-related major bleeding did not. Prior polyvascular disease increases the risk of in-hospital adverse events, including mortality. Identification of these patients in clinical trial and real world populations may provide an opportunity to reduce their excess risk with intensive secondary prevention efforts.

Fatal and Nonfatal Cardiovascular Disease and the Use of Therapies for Secondary Prevention in a Rural Region of India

The rate of cardiovascular disease is widely considered to be increasing throughout India. Precise and reliable data on fatal and nonfatal cardiovascular disease, however, are few, and little is known about the use of preventive therapies. This is particularly true for rural regions. Data were collected from 53 villages in the Godavari region of Andhra Pradesh. Mortality data were obtained from a verbal autopsy-based mortality surveillance system during a 12-month period in 2003 to 2004. The prevalence of nonfatal cardiovascular disease and the use of preventive therapies were estimated from a stratified random sample of 4535 adults (> or =30 years of age) in 2005. Cardiovascular disease was the leading cause of mortality, accounting for at least 32% of all deaths. The average age at cardiovascular death was 65 years, and 51% of all cardiovascular deaths occurred in patients <70 years of age. Among adults, the prevalence of coronary heart disease was estimated to be 4.8% (95% CI, 4.1 to 5.5), and the prevalence of cerebrovascular disease was estimated at 2.0% (95% CI, 1.5 to 2.4). Among individuals with either diagnosis, 14% (95% CI, 10 to 18) reported taking aspirin, 41% (95% CI, 36 to 47) took a blood pressure-lowering medication, and 5% (95% CI, 3 to 7) reported using a cholesterol-lowering medication. This region has a large disease burden attributable to cardiovascular disease with significant underuse of proven, low-cost preventive medications.

The postmodern everyday life and the incidence of stroke in young adults: a descriptive-exploratory study

We sought to understand the everyday life of people who had suffered from Stroke, relating it with the contemporary nuances, in younger than 45 years, in a public hospital from Florianopolis, Brazil. This is a qualitative, exploratory-descriptive study. Data were collected through recorded interviews, that were transcripted and analyzed according to Bardin’s method. The following categories emerged: Way of Life; Meaning Life; Rethinking Before, Here-and-Now, and Afterwards. The results pointed-out that the contemporary way of life contributes for the prevalence of cerebrovascular diseases in younger ages. It was noticed that the majority of causes of Stroke in young adults is prevented, emphasizing the importance of measures for health promotion and prevention of illnesses. We stand out for the necessity of rethinking how nursing can contribute for the prevention of health aggravations due to contemporary way of life, promoting a more healthful life

Prevalence and cognitive impact of cerebrovascular findings in Alzheimer’s disease: a retrospective, naturalistic study

Cerebrovascular disease (CVD) is a major risk factor for cognitive decline associated with progression to Alzheimer's disease (AD) and dementia. The objective of this study was to retrospectively assess the prevalence of CVD and its cognitive impact in patients with AD in everyday clinical practice. Medical notes were retrospectively reviewed for all individuals who presented at East Sussex Memory Clinic (2004-2008) for investigation of cognitive impairment and had brain magnetic resonance imaging (MRI) as part of their clinical work-up. Global cognitive status was assessed with Mini-Mental State Examination (MMSE) and Cambridge Cognitive Examination. The extent of cerebrovascular abnormalities was qualitatively evaluated with MRI. Notes were reviewed for 232 patients (109 males, 123 females), mean age 76 years (range 62-93), who underwent MRI. Of these, 167 (72%) patients were diagnosed with AD. CVD was present in 89% of AD patients and 47% of patients had moderate to severe cerebrovascular abnormalities. The majority of patients (57%) had MMSE scores in the 21-26 range, indicative of mild AD. There was a trend towards worse cognitive status in patients with more severe CVD, which did not reach significance. Hachinski Ischaemic score indicated these patients did not have vascular dementia (VaD) (mean +/- standard deviation 1.1 +/- 1.3). These findings, based on qualitative MRI, indicate that cerebrovascular pathology is a very common associated feature in patients with mild to moderate AD, without VaD. Although the study suggests that CVD does not contribute to cognitive decline, and is not associated with the development of VaD, a non-significant trend was observed towards worsening cognitive status with increasing severity of CVD. The finding of this trend suggests a need for additional research, especially a prospective quantitative method of assessing CVD, to improve our understanding of how CVD contributes to cognitive impairment in AD.

Systemic Antiphospholipid Syndrome and Atherosclerosis

Atherosclerosis (AT) is a metabolic, systemic inflammatory/immune disease characterized by lipoproteins metabolism alteration that leads to immune/inflammatory system activation with the consequent proliferation of smooth-muscle cells, narrowing arteries and atheroma formation. Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by thrombophilic state and circulating antiphospholipid antibodies (aPL) including anti beta2-GPI. Experimental studies and human observations suggest that APS is associated with AT. In fact, innate and adaptive immune responses participate in the pathogenesis of both diseases. Anti-oxLDL, anti-aPL, anti beta2GPI, anti-HSP antibodies, among others, has been found in patients with APS and AT. Endothelial dysfunctions, oxidative stress, increase of cell adhesion molecules, active platelets, are common findings in both diseases. Macrophages, dendritic cells, T-cell activation, CD40-CD40 ligand interaction, are considered as pathogenic mechanism of AT and APS. Premature AT may be the first symptom of APS. Thrombophilia, aPL antibodies, and APS may be present in patients with premature AT. An association between AT and venous thrombosis (a clinical hallmark of APS) has been proposed in unselected patients with deep venous thrombosis of the legs without symptomatic AT. Asymptomatic AT, defined in terms of carotid intima media thickness and lumen diameter decrease, was observed in patients with APS. Premenopausal female patients with PAPS have a higher prevalence of cerebrovascular disease in comparison with male patients. Accelerated AT and hormones could be the explanation of these findings. High levels of aCLs, significantly predict the risk of future ischemic stroke in women but not in men. AT is one of the main features of systemic APS and offer opportunities for new treatment strategies.

Prevalencia de la enfermedad cerebrovascular en la comunidad rural de Salamá, Honduras, utilizando el método epidemiológico de captura-recaptura

Cerebrovascular disease (CVD) is one of the leading causes of mortality and disability in Honduras. In 2001 the first epidemiological study conducted into stroke or CVD in the urban district of Colonia Kennedy in Tegucigalpa, Honduras, was published; the prevalence rate was found to be 5.7 x 1000 inhabitants. To date few epidemiological studies have been carried out on CVD in rural areas of Central America. To determine the prevalence of CVD in the rural community of Salama, Olancho, Honduras, using the epidemiological method known as capture-recapture. The capture-recapture technique includes three sources of data: door-to-door interviews, research of medical records and interviews held with community leaders. All the residents in the rural community of Salama, Olancho, in north-western Honduras, were evaluated and the prevalence day was 5th May, 2005. The World Health Organisation's definition of CVD and the recommendations of the 'Global stroke initiative' were used. A total of 1121 households were visited, which involved a total population of 5608 inhabitants. The prevalence for CVD was found to be 3.6 x 1000 inhabitants. The prevalence rate for CVD in the rural community of Salama, Honduras, is similar to that reported for other rural regions of Latin America. The capture-recapture technique is recommended for conducting studies into the prevalence of stroke in rural areas.

Idiopathic normal-pressure hydrocephalus: clinical comorbidity correlated with cerebral biopsy findings and outcome of cerebrospinal fluid shunting

Objectives: To elucidate the importance of clinically diagnosed cerebral comorbidity in idiopathic normal-pressure hydrocephalus (INPH) and its effect on improvement after shunt surgery as well as concordance with parenchymal pathological...

Target organ damage in hypertensive patients of different ethnic groups

Background Hypertension is associated with involvement of target organs which varies among the different ethnic groups. The multiplicity of the population in Israel offers an opportunity for evaluating target organ damage in hypertensive patients of different ethnic origins. Methods and results Data were collected from the computerized medical files of hypertensive patients in primary care clinics. The analysis was done on 576 hypertensive patients: 138 Bedouins (Arab residents), 141 Sephardic Jews (immigrants from North Africa and the Middle East), 152 Asian-Indian Jews (immigrants from India) and 145 Ashkenazi Jews (immigrants from Europe and North and South America). In multivariable logistic regressions adjusted for known risk factors and ethnicity, the prevalence of cerebrovascular disease was the highest among the Asian-Indian Jews (OR = 3.09, p value = 0.009). Renal damage was highest among the Bedouins (OR = 4.54, p value < 0.0001) and Asian-Indian Jews (OR = 2.88, p value = 0.005). The differences in the prevalence of renal damage among the various ethnic groups were even more pronounced among patients without diabetes (OR = 8.31, p value < 0.0001 in Bedouins and OR = 7.46, p value = 0.001 in Asian-Indian Jews). The prevalence of ischemic heart disease did not differ significantly among the four ethnic groups. Conclusions The prevalence of cerebrovascular and renal diseases are both significantly associated with ethnic origin of Asian-Indian Jews and Bedouins. However, the multivariate analysis shows that the prevalence of ischemic heart disease is not associated with ethnicity.

Which Model of Stroke Unit Is Better for Stroke Patient Management?

The increasing prevalence of cerebrovascular diseases has made urgent the need to develop timely and effective treatment strategies to tackle this health problem. Stroke units (SUs) appear to be the ideal setting where the management of acute stroke patients, including specific treatments as thrombolysis, may be optimized. Which model of SU gives the best results is still an unsettled issue. The more intensive and timely multidisciplinary approach to the acute phase of stroke, the management of medical complications, and the earlier and more focused rehabilitation, are likely the most qualifying aspects of our Neurovascular treatment unit.

Geographical variation of cerebrovascular disease in New York State: the correlation with income

BackgroundIncome is known to be associated with cerebrovascular disease; however, little is known about the more detailed relationship between cerebrovascular disease and income. We examined the hypothesis that the geographical distribution of cerebrovascular disease in New York State may be predicted by a nonlinear model using income as a surrogate socioeconomic risk factor.ResultsWe used spatial clustering methods to identify areas with high and low prevalence of cerebrovascular disease at the ZIP code level after smoothing rates and correcting for edge effects; geographic locations of high and low clusters of cerebrovascular disease in New York State were identified with and without income adjustment. To examine effects of income, we calculated the excess number of cases using a non-linear regression with cerebrovascular disease rates taken as the dependent variable and income and income squared taken as independent variables. The resulting regression equation was: excess rate = 32.075 - 1.22*10-4(income) + 8.068*10-10(income2), and both income and income squared variables were significant at the 0.01 level. When income was included as a covariate in the non-linear regression, the number and size of clusters of high cerebrovascular disease prevalence decreased. Some 87 ZIP codes exceeded the critical value of the local statistic yielding a relative risk of 1.2. The majority of low cerebrovascular disease prevalence geographic clusters disappeared when the non-linear income effect was included. For linear regression, the excess rate of cerebrovascular disease falls with income; each $10,000 increase in median income of each ZIP code resulted in an average reduction of 3.83 observed cases. The significant nonlinear effect indicates a lessening of this income effect with increasing income.ConclusionIncome is a non-linear predictor of excess cerebrovascular disease rates, with both low and high observed cerebrovascular disease rate areas associated with higher income. Income alone explains a significant amount of the geographical variance in cerebrovascular disease across New York State since both high and low clusters of cerebrovascular disease dissipate or disappear with income adjustment. Geographical modeling, including non-linear effects of income, may allow for better identification of other non-traditional risk factors.

Different Strokes

Cerebrovascular disease (CD) is a leading cause of disability and death in British Columbia, as in much of the developed world. Provision of care for stroke-affected persons depends upon accurate estimates of prevalence, but also on a clearer understanding of the specific characteristics and needs of this population. Data are drawn from the Canadian Community Health Survey, Cycle 1.1, 2000 - 2001. Bivariate analysis examines older populations age 55+ living in BC to determine how stroke-affected persons differ from non-stroke-affected persons according to sociodemographic factors, health, co-morbid conditions, need for help, and service use. Multivariate logistic regression was used to assess the impact of stroke status on need for help with regular and instrumental activities of daily living. Risk of stroke rises every decade after age 55. The prevalence of CD in British Columbia is 3.7% among those age 55+ and 5.2% among those age 65+. Stroke survivors use more acute care services (i.e., they spend more nights in hospital and consult physicians more often on an annual basis). Being older and female, as well as having lower income and poor health are characteristics of stroke survivors. Even after controlling for these variables, the odds of needing help with regular tasks of daily living are still higher for stroke-affected persons because of the high level of disability associated with stroke. Ultimately, while it is appropriate to target acute care resources to treat stroke and to minimize negative stroke outcomes, these data support the need to develop a clearer understanding of the needs and service utilization patterns of community-dwelling stroke survivors to ensure access to a full continuum of care.

Heritable Connective Tissue Disorders and Stroke

Stroke is a heterogeneous syndrome caused by multiple etiologies. Heritable defects in connective tissue cause a small fraction of ischemic and hemorrhagic stroke. They are the consequence of mutations in genes encoding extracellular matrix constituents such as collagens and proteoglycans. Ehlers–Danlos syndrome, Marfan’s syndrome, osteogenesis imperfecta, and pseudoxantoma elasticum are the most common disorders responsible for cerebrovascular manifestations. Neurofibromatosis and polycystic kidney disease, although not connective tissue disorders, are hereditary diseases with a high prevalence of vascular complications. Ehlers–Danlos syndrome type IV is the most frequent and most life-threatening form due to the presence of intracranial aneurysms, carotid-cavernous fistulas, and arterial dissections. Marfan’s syndrome has a typical phenotype associated with arterial dissections and intracranial aneurysms. Osteogenesis imperfecta, although infrequent, can present with aneurysms, dissections, fistulas, and stenosis of cerebral vessels. Pseudoxanthoma elasticum is commonly associated with occlusive disease of small vessels and other complications such as aneurysms or arteriovenous malformations. Autosomal–dominant polycystic kidney disease is a common cause of multiple intracranial aneurysms. Neurofibromatosis type 1 is characterized by multiple neurofibromas; it is responsible for stenosis or occlusions of intracranial arteries and vascular malformations. These vasculopathies are associated with a relatively high prevalence of cerebrovascular disease; their early recognition should help in the investigation of asymptomatic carriers, and to provide genetic counseling. The growing knowledge of molecular biology could help in the understanding of the underlying mechanism of these complex disorders as well as identify future therapeutic interventions.