Common Risk Factors For Stroke Research Articles

Ten Recommendations for Accelerating Hypertension and Diabetes Control to Reduce Stroke, Heart, and Renal Disease with the Aim to Save Lives in Cameroon Through Partnerships and Collaborations.

Hypertension and diabetes are currently the most common, treatable, and controllable cardiovascular and metabolic risk factors for stroke, heart, and renal diseases in Cameroon. Hypertension affects 30% of adults aged≥20years with 90% as uncontrolled cases, while type 2 diabetes affects 6% of the same population, with 70% remaining underdiagnosed. Despite publication of the first Roadmap on raised blood pressure by the World Heart Federation in 2015, the Pan African Society of Cardiology Roadmap in 2017, andthe technical package for cardiovascular disease management in primary health care (WHO-HEARTS) in 2020, very little progress has been made in improving the diagnosis, treatment, and control of cardiovascular risk factors and diseases in Cameroon. The Cameroon Cardiac Society and a dozen Cameroon non-communicable diseases societies, national organizations from the community and the civil society, along with researchers and members of academia and the health sector, came together under the patronage of representatives of the government to propose new strategies to improve hypertension and diabetes control and save lives in Cameroon. Two simple and practical algorithms for the management of hypertension and diabetes were developed. The ten recommendations tailored to be efficiently implemented in our country were summarized under the acronym 'A SMART VIEW' (Awareness, Screening, Manufacture, Activity, Research, Task-shifting, HIV/AIDS, Insurance, Education, and WHO-HEARTS). It is our hope that all stakeholders will further collaborate to remove barriers and enhance facilitators to deploy the proposed actions and reduce the burden of uncontrolled hypertension and untreated diabetes in Cameroon.

Characteristics of stroke inpatients in a single- center in Kunming: A multi-ethnic settlement with a northern sub-tropical low-latitude plateau mountain monsoon climate

Objective: This study aimed to evaluate the characteristics of stroke inpatients in Kunming in southwest China. Methods: Basic demographic information and risk factors of stroke inpatients admitted to a first-rate tertiary referral hospital in Kunming from January 1, 2015, to September 15, 2022, were retrospectively analysed. In total, 7,108 stroke inpatients with ischemic stroke (IS), primary intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) were included. Results: IS was the most common type of stroke (75.97%), followed by ICH (13.45%) and SAH (10.58%). There were significant differences among the three groups in sex, age, ethnic, residence, occupation, and medical expenses (P<0.05). There was also a statistically significant difference in the proportion of inpatients between the four seasons (P<0.05). Hypertension, dyslipidemia, and diabetes were common risk factors for stroke. There were significant differences in the incidence of smoking, alcohol use, hypertension, dyslipidemia, diabetes, atrial fibrillation, and pulmonary infection among the three stroke subtypes (P<0.05). Conclusion: Demographic information and risk factors were different among the three stroke subtypes. The number of hospitalized patients from all three groups varied slightly in different seasons in Kunming. Different types of cerebrovascular disease patients in the region have different characteristics from demographic information to risk factors.

A Comprehensive Review of Cryptogenic Stroke and Atrial Fibrillation: Real-World Insights Into the Role of Insertable Cardiac Monitors.

Cryptogenic stroke, a subtype of ischemic stroke with no identifiable cause after comprehensive evaluation, presents a unique challenge in stroke prevention. Atrial fibrillation (AF), a common risk factor for ischemic stroke, is often underdiagnosed in these patients due to its intermittent, asymptomatic nature. Early detection of AF is critical, as anticoagulation therapy significantly reduces the risk of recurrent stroke in AF patients. However, traditional short-term monitoring methods frequently fail to identify paroxysmal AF. Insertable cardiac monitors (ICMs) offer a novel solution by providing continuous, long-term heart rhythm monitoring, which has proven effective in detecting occult AF. Real-world data further support the clinical value of ICMs in guiding the initiation of anticoagulation therapy, ultimately improving stroke prevention strategies. Despite some limitations, such as false positives and the invasive nature of the device, ICMs have emerged as a critical tool in modern stroke management. As technology evolves, future advancements may further enhance AF detection by integrating artificial intelligence and wearable devices. This review provides a comprehensive overview of the role of AF in cryptogenic stroke, the importance of early detection, and the growing significance of ICMs in clinical practice.

Prevalence and Risk Factors of Stroke in Inpatients with Type 2 Diabetes Mellitus in China.

The prevalence and the cluster characteristics of risk factors of stroke were assessed in a Chinese diabetic population. Clinical data of 30 693 inpatients who were diagnosed with type 2 diabetes mellitus (T2DM) and admitted between 2013 and 2018 were retrospectively analyzed. The age-standardized prevalence of stroke was estimated using the 2010 Chinese population census data, and risk factors were analyzed by multiple imputation and regression. The crude and standardized prevalence rates of stroke in patients with T2DM were 34.4% and 21.5%, respectively, and 85.2% of the stroke patients had ischemic stroke. Nearly half of the patients who experienced stroke had clusters of more than 4 risk factors. Compared with no-risk-factor clustering, the risk of stroke significantly increased 3-4 times in the presence of more than 4 risk-factor clusters (P<0.001). Hypertension was the most common major risk factor for ischemic stroke [odds ratio (OR), 2.34; 95% confidence interval (CI), 2.18-2.50] and hemorrhagic stroke (OR, 3.68; 95% CI 2.95-4.59; P<0.001). Moreover, a 1-standard-deviation increase in fasting blood glucose (FBG) was significantly negatively correlated with ischemic stroke risk, and the same change in FBG was significantly associated with an 8% increased risk of hemorrhagic stroke. The prevalence of stroke in patients with T2DM is rather high, and the clustering of risk factors is associated with the development of stroke in T2DM patients. Risk factors differ in different stroke subtypes. Identifying risk factors for a specific high-risk group is necessary.

The predictive value of CHA2DS2-VASc score on the prognosis of patients with atrial fibrillation based on a prospective cohort study.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia encountered in clinical practice, and it is associated with an increased risk of mortality, stroke, and peripheral embolism. The risk of stroke in AF is heterogeneous and dependent on underlying clinical conditions included in current risk stratification schemes. Recently, the CHA2DS2-VASc score has been incorporated into guidelines to encompass common stroke risk factors observed in routine clinical practice. The aim of this study was to study the predictive value of CHA2DS2-VASc score on the prognosis of patients with AF to determine the correlation of major complications including cerebral infarction and intracranial hemorrhage in patients with AF with oral anticoagulant and antiplatelet aggregation drugs and to identify the risk factors for all-cause mortality. A prospective study was conducted on 181 patients with AF who underwent physical examinations at Hai'an Qutang Central Hospital from January 2020 to December 2020. The patient's general condition, chronic disease history, CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 years, and sex category (female)] score, left ventricular ejection fraction (LVEF), lipid metabolism, and oral anticoagulant and antiplatelet aggregation medication during physical examination were recorded. By using telephone meetings to complete the follow-up, we tracked the patient's cerebral infarction, intracranial hemorrhage, and survival status within 2 years of follow-up, statistically analyzed the relationship between AF complications and medication, and grouped patients with AF based on the CHA2DS2-VASc score to evaluate its predictive ability for mortality outcomes in these patients. The patients were divided into four groups according to the medication situation, and the incidence of cerebral infarction in the combination group was significantly lower than that in the non-medication group (0.0% vs. 19.2%; P<0.01). The incidence of intracranial hemorrhage in the combination group was significantly higher than that in the non-drug group (13.8% vs. 0.0%; P<0.01). The logistic regression model indicated that patients with a history of cerebral infarction had an increased risk of death compared to those without a history of cerebral infarction [odds ratio (OR) =7.404; 95% confidence interval (CI): 2.255-24.309]. After grouping according to the CHA2DS2-VASc score, we found that there was a significant difference in the 2-year survival rate between patients with CHA2DS2-VASc score <5 and those with a score ≥5 (P<0.01). The characteristic curve analysis of the participants showed that the CHA2DS2-VASc score had good predictive ability for all-cause mortality in patients with AF (area under the curve =0.754), with a cutoff value of 4, a sensitivity of 62.50%, a specificity of 86.06%, and a 95% CI of 0.684-0.815. The CHA2DS2-VASc score demonstrated high predictive value for all-cause mortality in patients with AF.

Inflammation in ischemic stroke patients with type 2 diabetes – Part II: Potential therapeutic targets

Stroke is the leading cause of disability and the second leading cause of death worldwide. Diabetes mellitus is an important independent cardiovascular risk factor in patients, regardless of age, smoking habit, and hypertension. Approximately one-third of first-time ischemic stroke patients have diabetes. Inflammation is among the most important pathological mechanisms in atheroma formation, the damage cascades of the acute phase, as well as during the subacute and chronic phases after stroke. Diabetes, as a common risk factor for stroke, is often present for a long time before a stroke occurs, causing low-grade inflammation, and disrupting the proper functioning of the neurovascular units. These proinflammatory processes and maladaptive immune mechanisms are further accelerated after cerebral ischemia and worsen the stroke outcome in diabetic patients. Clinical treatments for ischemic stroke are currently focused on restoring cerebral blood flow (reperfusion) in the acute phase, including thrombolysis and mechanical thrombectomy, which are not applicable to patients that fall outside of the treatment window and/or without large-vessel occlusion. There are few approved treatments targeting cellular injury caused by inflammation. There are even fewer data on effective treatment for diabetic stroke targeting inflammation. This paper presents the second part of a review focusing on the potential therapeutic targets in stroke patients with type 2 diabetes.

Inflammation in ischemic stroke patients with type 2 diabetes – Part I: Atherosclerosis formation, acute ischemia, post-stroke infection, and long-term sequelae

Stroke is the leading cause of disability and the second leading cause of death worldwide. Diabetes mellitus is a critical independent cardiovascular risk factor in patients, irrespective of age, smoking, and hypertension. Approximately one-third of first-time ischemic stroke patients have diabetes. Inflammation is among the most important pathological mechanisms in atheroma formation, the damage cascades of the acute phase, as well as during the subacute and chronic phases after stroke. Diabetes, as a common risk factor for stroke, is often present for a long time before a stroke occurs, causing low-grade inflammation, and disrupting the proper functioning of the neurovascular units. These proinflammatory processes and maladaptive immune mechanisms are further accelerated after cerebral ischemia and worsen the stroke outcome in diabetic patients. Clinical treatments for ischemic stroke are currently focused on restoring cerebral blood flow (reperfusion) in the acute phase, including thrombolysis and mechanical thrombectomy, which are not applicable to patients that fall outside of the treatment window and/or without large-vessel occlusion. There are few approved treatments targeting cellular injury caused by inflammation. There are even fewer data on effective treatment for diabetic stroke targeting inflammation. This paper presents the first part of a review focusing on the temporospatial aspects of inflammation in ischemic stroke pathophysiology in stroke patients with type 2 diabetes.

Biomarkers for predicting atrial fibrillation: An explorative sub-analysis of the randomised SCREEN-AF trial

Background Atrial fibrillation (AF) is a common treatable risk factor for stroke. Screening for paroxysmal AF in general practice is difficult, but biomarkers might help improve screening strategies. Objectives We investigated six blood biomarkers for predicting paroxysmal AF in general practice. Methods This was a pre-specified sub-study of the SCREEN-AF RCT done in Germany. Between 12/2017-03/2019, we enrolled ambulatory individuals aged 75 years or older with a history of hypertension but without known AF. Participants in the intervention group received active AF screening with a wearable patch, continuous ECG monitoring for 2x2 weeks and usual care in the control group. The primary endpoint was ECG-confirmed AF within six months after randomisation. High-sensitive Troponin I (hsTnI), brain natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-pro BNP), N-terminal pro atrial natriuretic peptide (NT-ANP), mid-regional pro atrial natriuretic peptide (MR-pro ANP) and C-reactive protein (CRP) plasma levels were investigated at randomisation for predicting AF within six months after randomisation. Results Blood samples were available for 291 of 301 (96.7%) participants, including 8 with AF (3%). Five biomarkers showed higher median results in AF-patients: BNP 78 vs. 41 ng/L (p = 0.012), NT-pro BNP 273 vs. 186 ng/L (p = 0.029), NT-proANP 4.4 vs. 3.5 nmol/L (p = 0.027), MR-pro ANP 164 vs. 125 pmol/L (p = 0.016) and hsTnI 7.4 vs. 3.9 ng/L (p = 0.012). CRP levels were not different between groups (2.8 vs 1.9 mg/L, p = 0.1706). Conclusion Natriuretic peptide levels and hsTnI are higher in patients with AF than without and may help select patients for AF screening, but larger trials are needed.

Abstract TP271: A Retrospective Analysis of Demographic and Clinical Variables Within a Single Center Young Stroke Cohort

Introduction: Despite significant efforts to increase public awareness of cerebrovascular disease, the incidence of stroke and transient ischemic attack (TIA) in young adults has remained elevated, representing a major public health concern. We sought to better characterize our young stroke population in order to gain insight as to where targeted interventions could be beneficial in community outreach and support of affected patients. Methods: We conducted a retrospective study evaluating young adults (under 50 years of age) presenting to a single urban academic medical center with acute ischemic stroke or TIA between 2013 and 2022. Demographic information and clinical variables (including past medical history, Trial of Org 10172 in Acute Stroke Treatment [TOAST] classification of stroke etiology, and discharge disposition) were extracted from the electronic medical record and descriptive statistics were calculated. Results: A total of 408 patients were reviewed. Within this study population, the median age was 43 years (IQR 38-47 years) and 235 (57.6%) were men. The median initial National Institutes of Health Stroke Scale upon presentation was 3 (IQR 1-7). The most common stroke risk factors were tobacco use (44.6%), pre-existing cardiovascular disease (26.2%), and other substance use (23.8%). The most common TOAST classification upon discharge was Stroke of Undetermined Etiology (32.9%). Most patients (244, 59.8%) were discharged directly to home from the hospital, although 140 (34.3%) were transitioned to another facility, including acute rehabilitation facilities (95, 23.3%), skilled nursing facilities (22, 5.4%), and long-term acute care hospitals (11, 2.7%). Conclusion: Our study highlights that the continued high incidence of stroke in the young may be at least partially attributable to a high prevalence of traditional cardiovascular risk factors, thus emphasizing the importance of smoking cessation counseling and early treatment of hypertension in the primary care setting. In addition, while most young patients will present with minor stroke symptoms, a significant portion are unable to return directly to home upon discharge from the hospital.

Comparison of Recurrent Stroke in Patients with First Stroke Ischemic and Hemorrhagic in Soetomo General Academic Hospital Surabaya

Highlight: The incidence of recurrent stroke in patients with the first stroke of ischemic type was 2.5-fold higher than that of hemorrhagic type, with the majority of recurrent strokes being the same type as the first stroke. Hypertension is the most common modifiable stroke risk factor in both stroke types, and in 5% of cases, secondary prevention is still not optimal. The average length of hospital stay for patients with the first stroke of hemorrhagic type was 3 days longer, along with a higher average NIHSS score on presentation than patients with ischemic stroke. ABSTRACT Introduction: Stroke is the leading cause of mortality and disability in Indonesia, as well as being the major cause of death and disability-adjusted life years (DALY) lost worldwide. Recurrent stroke is one of the most common complications of stroke after discharge, despite being highly preventable. Objective: This study aimed to compare the differences in recurrent stroke profiles between patients with first stroke ischemic and hemorrhagic strokes. Methods: The study was done by collecting secondary data from medical records and the stroke registry at Dr. Seotomo General Academic Hospital over a period of six months (January–July 2020). Result: This study examined 36 samples that met the inclusion criteria. The results revealed that patients who experienced their first stroke of the ischemic type had a 2.5-fold higher incidence of recurrent stroke than those who suffered a hemorrhagic type. Except for one case, the majority of patients had the same type of stroke as the first. The most frequent modifiable risk factors seen in these two types of strokes are hypertension and physical inactivity. It was found that there were still 5% of the risk factors for which secondary prevention had not been carried out optimally with antidyslipidemic, antidiabetic, or antihypertensive drugs. The most common acute treatment for ischemic stroke is antiplatelet therapy, either single or dual therapy. Up to 90% of hemorrhagic strokes were treated conservatively, and in one patient, extraventricular drainage was performed. Conclusion: There were more stroke patients with a first stroke of hemorrhagic type that presented with NIHSS scores in the severe to very severe range, and the average length of hospitalization in this group was longer.

Clinical and Epidemiological Profile of Intracranial and Extracranial Arterial Stenosis of Stroke Patients in the Southwestern Region of Saudi Arabia

Abstract Background: Stroke is a significant contributor to global morbidity and mortality, affecting populations worldwide, including the southwestern region of Saudi Arabia. Intracranial arterial stenosis and extracranial arterial stenosis are recognized as common risk factors for stroke. The main aim of this study was to investigate the prevalence of intracranial and extracranial arterial stenosis among stroke patients residing in the southwestern region of Saudi Arabia. Materials and Methods: This descriptive cross-sectional study was conducted in the southwestern region of Saudi Arabia from January 2022 to December 2022. Ethical approval was obtained from the Institutional Review Committee. Data were collected through a comprehensive review of medical records, capturing demographic information, risk factors, stroke subtype, severity, comorbidities, and results of magnetic resonance imaging, magnetic resonance angiography, and transcranial Doppler examinations. Data were analyzed using SPSS. Results: In this study, 201 stroke patients were analyzed, with 113 (56.2%) males and 88 (43.8%) females. The prevalence of stenosis in stroke patients was 57.21%, with 63 patients having intracranial stenosis, 30 patients having extracranial stenosis, and 22 patients having both types of stenosis. Most intracranial stenosis cases exhibited 50%–69% stenosis, while extracranial stenosis cases were evenly distributed between 50%–69% and 100% stenosis. The presence of diabetes, dyslipidemia, metabolic syndrome, and cardiovascular disease was significantly associated with stenosis (P values of 0.029, 0.005, 0.043, and 0.012, respectively). High glycated hemoglobin (HbA1c) levels and elevated triglyceride levels were also strongly correlated with stenosis (P values of 0.003 and 0.021, respectively). Conclusion: This study reveals a high prevalence (57.21%) of arterial stenosis in stroke patients in the southwestern region of Saudi Arabia, with diabetes, dyslipidemia, metabolic syndrome, and cardiovascular disease significantly associated with stenosis. Elevated HbA1c and triglyceride levels were strongly correlated with stenosis, emphasizing the importance of comprehensive risk factor management and targeted interventions to reduce stroke burden.

The role of the tongue in post-stroke dysphagia and obstructive sleep apnea: Correlation with sonography measurement

ObjectiveObstructive sleep apnea (OSA) is a common risk factor for stroke, and dysphagia and pneumonia are both well-known complications of stroke. The development of these conditions is related to the oropharyngeal structures. We investigated whether specific structural features of the tongue may lead to the development of these complications. MethodsPatients with ischemic stroke who required admission and community-dwelling elderly controls were enrolled. The participants underwent tongue measurements by received hand-held ultrasound, and received questionnaires to evaluate sleep quality and daytime sleepiness. The patient group also underwent objective sleep measurement by actigraphy and the 3-Step Swallowing Test (3-SSS). Sleep parameters and outcomes were analyzed. ResultsPatient with ischemic stroke had significantly thicker tongue than controls (6.53 cm v. 6.05 cm, p = 0.002). Multiple logistic regression analysis revealed that the anatomical parameters of the tongue in patients with stroke were significantly correlated with parameters of OSA, and the thickness of the tongue was positively correlated with the development of OSA (p = 0.024) and pneumonia (p = 0.048). ConclusionsA thicker-than average tongue may be a risk factor for OSA and pneumonia in patient with stroke. Hand-held ultrasound can be used to identify these anatomical features. Further studies are warranted to clarify the role of the tongue in these post-stroke complications.

Qualitative Study on Knowledge of Non-Pharmacological Interventions as Management Strategies for Hypertension Among Middle-Aged Adults in Rural Areas of Anambra State

Recent World Health Organization records show that hypertension is more common in Africa than in other parts of the world, and remains a major common risk factor for cardiovascular diseases, stroke, renal diseases, and death. However, little is known about hypertension management strategies among people in rural areas. Therefore, this phenomenological study aimed to investigate knowledge of hypertension management strategies among middle-aged adults in rural areas of Anambra state. Focus group discussions were used to collect data from 40 middle-aged adults (20 males and 20 females). The data were analysed thematically. Results showed that the participants were all aware of hypertension but lacked in-depth knowledge of disease management strategies. Most of the participants did not believe that engaging in regular physical exercise/activity, and other factors like reduction in salt and alcohol intake could help in controlling high blood pressure. Social workers who are also social service providers are needed to raise awareness among middle-aged people in rural areas about hypertension management strategies. This can be done through the provision of social services like education, health services, and transport services, as this will go a long way in helping rural dwellers gain more knowledge of hypertension management strategies. With the provision of health services, the rural population will not only know management strategies for hypertension but will also be able to check their blood pressure regularly, while transport services will make it possible for the rural population who do not have health centres in their community and means of transporting themselves to the neighbouring community for treatment to do so. Future research should focus on the importance of welfare/home visits as an avenue for awareness creation on hypertension management strategies, as this will be an avenue for the provision of better social services for people in rural areas and an improvement in social service research.

Epidemiology of Common Stroke Risk Factors: Implications Report

Epidemiology of Common Stroke Risk Factors: Implications Report

Instantaneous stroke risk assessment of adults in Enugu, South East Nigeria: results from a random point survey

Stroke remains a major cause of morbidity, death, and disability around the world, most especially in black Africans. Understanding the magnitude and appreciation of stroke risk in susceptible populations remains a key strategy in reducing stroke burden. This study examined and compared 5-year stroke risk in an adult population in Enugu, Southeast Nigeria. A point cross-sectional survey assessing stroke risk in adults was done in October 2019 in the city of Enugu as part of the World Stroke Day commemoration using the Stroke Riskometer app, and the data was analyzed. Ethical approval was obtained. The total number of participants in this survey was 117 traders in a market in the Enugu metropolis, Enugu State, Nigeria. More males, 63%, than females, 37%, participated in this study. The total mean age was 47.50 years, with a total mean 5-year stroke risk of 3.93. Stroke risk was noted to be higher in females 4.56 than in males 3.56. Elevated blood pressure was present in 35% of the participants, and elevated blood glucose was seen in 5% of the total population. The World Stroke Organization’s Stroke Riskometer app is a valuable tool in assessing stroke risks especially in resource poor settings. This app also serves as a cost-effective method of conducting epidemiological research in stroke and other non-communicable diseases internationally. Hypertension remains the most common risk factor for stroke globally. Higher stroke risk in females likely associated with higher mean age.

A Focused Group Perspective of Risk Factors for Hypertension Among Middle-Aged Adults in Rural Areas of Anambra State, Nigeria

ABSTRACT Purpose Recent records by the World Health Organization show that hypertension is more prevalent in Africa than in other parts of the world, and remains the foremost common risk factor for cardiovascular-related diseases, stroke, renal diseases, and death. However, little is known about the risk factors for hypertension by people from rural areas, especially among middle-aged adults. Therefore, the study examined the knowledge of the risk factors for hypertension among middle-aged adults in rural areas of Anambra state, Nigeria. Materials, and method Focus group discussions were used to collect data from 40 middle-aged adults (20 males and 20 females). Two key themes stood out from the data collection guides. These are “awareness of hypertension and its’ symptoms” and “knowledge of risk factors of hypertension”. Results The findings showed that the participants were aware of hypertension but lacked in-depth knowledge of the risk factors for the disease. Most participants did not believe that intake of certain foods like starchy foods and excess alcohol consumption could lead to one being hypertensive. Discussion and conclusion There is a need for social workers to sensitize and enlighten the middle-aged adults in the study area on the risk factors for the disease.

Demographic and Clinical Characteristics of a Sample of Egyptian Stroke Patients Admitted to the Stroke Unit of a University Hospital

Background Stroke is a catastrophic life-changing event which influences not only stroke patients but also their families and care givers. The recommended treatments for ischemic stroke that are guideline include systematic supportive care in a stroke unit or stroke center is still deficient. Aim of the Work To present the demographic profile, and clinical characteristics of a sample of Egyptian patients, with acute ischemic stroke, admitted to stroke unit in Ain Shams University Hospital, and compare to other ethnic groups reported in other studies. Subjects and Methods This is a retrospective study, derived from the database of stroke patients admitted to the stroke unit in Ain Shams University Hospital and Ain shams specialized hospital in the period from (the first of January 2016 to 30th of March 2020). Results A favorable early outcome (mRS≤2) showed high significant correlation with male gender, younger age and less prevalence of AF, and a significant correlation with less prevalence of hypertension and dyslipidemia. Conclusion The burden of stroke and high prevalence of stroke risk factors in Egypt are alarming. Research is critically needed to fully evaluate the burden of stroke in Egypt, and organization of stroke care locally and nationally requires coordinated efforts by multiple stakeholders. The most common risk factor for stroke was hypertension followed by dyslipidemia and then smoking with higher incidence of rheumatic heart diseases due to lowered living conditions.

Pulmonary hypertension: An unexplored risk factor for stroke in patients with atrial fibrillation

BackgroundAtrial fibrillation (Afib) is one of the most common and significant risk factors for stroke, with the CHADsVAsc score used as the tool for stroke risk assessment. Pulmonary hypertension (PH) has not been studied as an independent risk factor for stroke in individuals with Afib. MethodsIn this retrospective case-control study, National Inpatient Sample Database was used to sample individuals with atrial fibrillation, and baseline demographics and comorbidities were collected using ICD-10 codes. Patients with missing data, age under 18, history of thromboembolic diseases, or stroke were excluded. Greedy propensity matching using R was performed to match patients with and without PH on age, race, gender, and 19 other comorbidities, including anticoagulation use. Binary logistic regression was performed after matching to assess whether PH was an independent risk factor for stroke. A p-value of <0.05 was considered statistically significant. ResultsOf the 2,421,545 patients included in the study, 158,545 (6.5%) had PH. PH patients were more likely to be elderly, females, and smokers. Comorbidities were more common in the PH group. Patients with PH were more likely to have an ischemic stroke (3.6% vs. 2.9%, p<0.001), hemorrhagic stroke (2.2% vs. 0.7%, p<0.001), and transient ischemic attack (TIA) (2.3% vs. 0.7%, p<0.001). After matching, the presence of PH was associated with increased ischemic stroke (OR: 1.2 [1.1-1.2]; p<0.001), hemorrhagic stroke (OR: 2.4 [2.1-2.6]; p<0.001) and TIA (OR: 2.2 [2.0-2.4]; p<0.001). PH patients also had increased length of stay (β = 0.8; p<0.001) mortality (OR: 1.1 [1.0-1.2]; p<0.001). ConclusionApart from demonstrating the deleterious effect of PH on mortality and length of hospital stay, this study is the first to report on such a large scale that PH independently increases the incidence of all types of strokes in patients with Afib.

Stroke in mitral valve prolapse: risk factors and left atrial function in cryptogenic versus non-cryptogenic ischemic subtypes.

Mitral valve prolapse (MVP) has been associated with an increased risk of ischemic stroke. Older age, thicker mitral leaflets, and significant mitral regurgitation (MR) leading to atrial fibrillation have been traditionally considered risk factors for ischemic stroke in MVP. However, specific risk factors for MVP-stroke subtypes are not well defined. The aim of this study is to evaluate clinical and echocardiographic parameters, including left atrial (LA) function, in MVP with cryptogenic (C) vs. non-cryptogenic (NC) stroke. In this case-control matched study, MVPs were identified in consecutive echocardiograms obtained after a stroke from January 2013 to December2016 at the University of California, San Francisco. MVP was defined as leaflet displacement ≥2 mm in the parasternal long-axis view at end-systole. Age/gender matched MVPs without stroke and healthy controls without MVP were also identified. We analyzed LA end-systolic/diastolic volume index, emptying fraction (LAEF), function index (LAFI), and global longitudinal strain in all MVPs and controls. We also measured left ventricular (LV) volume indexes, mass index, ejection fraction (EF), degree of MR and leaflet thickness. We identified a total of 30 MVPs (age 70 ± 12, 50% females) with stroke (11 with C- and 19 with NC-stroke), 20 age/gender matched MVPs without a stroke and 16 controls. MVPs without stroke had lower BMI, less hypertension but more MR (≥moderate in 45% vs. 17%), more abnormal LA function (lower LAEF, LAFI) and larger LV volumes/mass (all p < 0.05) when compared to MVPs with stroke. Leaflet thickness was overall mild (<3 mm) and similar in the 2 groups. Within the MVP stroke group, NC-stroke had higher BMI, more hypertension and more atrial fibrillation compared to C-stroke. In the variables tested, patients with C-stroke did not differ from controls. MVP-related MR may be protective against stroke despite abnormal LA function. Risk of NC-stroke in MVP is related to common stroke risk factors rather than mitral valve leaflet thickness. The etiology of C-stroke in MVP warrants further studies.

Demographic and Clinical Characteristics of Stroke Cases in Murtala Muhammed Specialist Hospital, Kano, Nigeria: A retrospective study

Stroke is a cerebrovascular disease that disturbs or damages the blood supply to the brain. This study aimed to evaluate the demographic and clinical characteristics of stroke cases in Murtala Muhammed Specialist Hospital, Kano, Nigeria. Five years of records of three hundred (300) stroke patients comprised of biodata and clinical data were collected. The data were expressed as mean±SD, while simple percentage and Chi-square (χ2) tests were used to determine the incidence and association between the variables respectively using Minitab 17.0 software. The results showed an incidence of 182 (61%) males and 118 (39%) females, 265 (78%) and 65 (22%) for the above and below 40 years age groups respectively. The Hausa, Yoruba and Igbo ethnic groups have an incidence of 258 (86%), 24 (8%), and 18 (6%) respectively. The yearly incidence was 40 (13%), 50 (17%), 20 (7%), 56 (17%), and 134 (45%) for 2017 through 2021, respectively. The incidence of hemorrhagic, ischaemic, and transient ischaemic attack strokes were, 222 (74%), 63 (21%), and 15 (5%), while that of left, right, and both sides impairments were 144 (48%), 138 (46%), and 18 (6%), respectively. The common risk factors were hypertension (50%) and hypotension (20%), diabetes mellitus 54 (18%), and others 12 (4%) and 3 (1%) respectively. No association between sex and stroke types (P = 0.553). Conclusively, although intracerebral hemorrhagic stroke, right-side impairment, and hypertension were the most common stroke types, disabilities, and risk factors, respectively there was no association obtained between sex and the incidence of stroke type.