Common Risk Factors For Stroke Research Articles

Association between smoking and intracranial artery dissection in patients aged less than 50 years: A propensity score-matched analysis.

Smoking is a common risk factor for stroke in the young population. Intracranial artery dissection (ICAD) is a major cause of stroke in this population. However, the association between smoking and ICAD in young patients is not well characterized. We aimed to evaluate the association between smoking and ICAD in young individuals using propensity score-matched analysis. We conducted a retrospective study of consecutive patients aged <50 years with ICAD who were admitted to Beijing Tiantan Hospital between January 2016 and December 2020. Patients with other non-atherosclerotic/non-aneurysmal cerebrovascular diseases were selected as controls. Propensity score matching was based on age and sex. Smoking and other vascular risk factors were compared between the two groups. The ICAD and control group included 120 and 197 patients, respectively. Propensity score matching resulted in 70 matched pairs. Smoking was the only significant factor association with ICAD in the matched cohort (p=0.031). In this propensity score-matched analysis, smoking showed a positive association with ICAD in young patients with common cerebrovascular diseases that were neither atherosclerotic nor aneurysmal. Further studies are required to investigate the predictive role of smoking for ICAD in the young population.

P491 YOUNG AND MIDDLE–AGED PATIENTS PRESENTING WITH ACUTE CORONARY SYNDROME: THE ROLE OF LIPOPROTEIN(A)

Abstract Background Lipoprotein(a) [Lp(a)] is a liver–derived lipoprotein with genetically determined concentrations. High level of lipoprotein(a) is a common risk factor for cardiovascular disease and stroke. Higher plasma Lp(a) concentrations are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD), through mechanisms associated with increased atherogenesis, inflammation, and thrombosis. Methods The study enrolled patients ≤ 55 years of age referred to Cardiology Department of Policlinico Casilino with acute coronary syndrome (ACS). In order to identify patients with high cardiovascular risk, we measured, according to current guidelines, Lp(a) value. Results A total of 73 patients (84% males, mean age 47±7 years old) were enrolled from July 2020 to March 2022. Mean Lp(a) level was 50.9± 46.7 mg/dL. High Lp(a) &amp;gt; 50 mg/dL was documented in 31.5 % of patients, while the interim grey zone of elevated Lp (a) (30–50 mg/dL) in 27.4%. Conclusion In our experience, elevated levels of Lp(a) was documented in more than half of patients, presenting with ACS at a relatively young age. This support recent guidelines recommendation to measure Lp (a) at least once in adults, preferably in the first lipid profile, to identify patients with high cardiovascular risk of recurrence. This result focus on the potential use in clinical practice of efficacious Lp(a)–lowering drugs.

Impaired pulmonary function mediates the impact of preterm birth on later-life stroke: a 2-step, multivariable Mendelian randomization study.

Observational studies have suggested an association between preterm birth and stroke in late adulthood, but it remains unclear whether the association is causal. The purpose of this study was to evaluate the causal effects of gestational age on stroke and to determine the pathophysiological mechanisms underlying the causal associations. Two-sample Mendelian randomization (MR) was performed to assess the causal effects of fetal gestational duration, early preterm birth (EPB), preterm birth, or postterm birth on stroke and its subtypes. Two-step Mendelian randomization (TSMR) and multivariable Mendelian randomization (MVMR) were additionally used to determine the role of common stroke risk factors, including cardiovascular diseases, hypertension, pulmonary impairment, inflammation, and metabolic diseases, in mediating the causal associations between gestational age and stroke and its subtypes. Genetically predicted EPB increased the risk of cardioembolic stroke (CES; odds ratio [OR], 1.115; 95% confidence interval [CI], 1.036 to 1.200; p=0.004) and large artery stroke (LAS; OR, 1.131; 95% CI, 1.031 to 1.241; p=0.009). The TSMR results showed that EPB was associated with a lower forced expiratory volume in the first second and forced vital capacity ratio (FEV1/FVC) (β=-0.020; 95% CI, -0.035 to -0.005; p=0.009), which increased the risk of CES and LAS. Further MVMR analysis showed that the associations between EPB and stroke disappeared after adjustment for FEV1/FVC. Our data demonstrate that EPB is causally associated with an elevated risk of CES and LAS, and that pulmonary dysfunction mediates the causal impact of EPB on CES and LAS.

Abstract TP202: Sex-specific Differences In Risk Profiles For Cancer Among 19702 Japanese Patients With Ischemic Stroke: The Biobank Japan Project

Background: There is limited data on sex-specific differences in subtypes and risk profiles of cancer among ischemic stroke patients. Methods: Among the subjects registered in the BioBank Japan database, 19702 ischemic stroke patients (n= 12241 male and n= 7261 female, median age 71 years old) were analyzed. We compared the prevalence of 20 cancer types between men and women. The multivariate logistic analysis was used to explore the association between risk factors and cancer by sex. Results: Any cancer was present in 1656 (8.4%) subsets of the overall cohort. The prevalence was highest for colorectal cancer (1.9%) followed by gastric cancer (1.6%), prostate cancer (1.2%), breast cancer (0.8%), and lung cancer (0.5%). Incidence was significantly higher in men than women for any (8.7% vs. 7.8%, P=0.029), colorectal (2.1% vs. 1.5%, P=0.003), gastric (2.0% vs. 1.0%, P&lt;0.001), lung (0.6% vs. 0.4%, P=0.013), bladder (0.7% vs. 0.2%, P&lt;0.001), pharyngeal/laryngeal (0.4% vs. 0.1%, P&lt;0.001), and kidney (0.4% vs. 0.1%, P&lt;0.001) cancer. By contrast, sex-specific cancer was more frequently observed in women than men (3.0% vs. 1.8%, P&lt;0.001). In men, older age (ORs 1.80, 95%CIs 1.67-1.94, P&lt;0.001], chronic renal failure (ORs 1.74, 95%CIs 1.24-2.46, P=0.002), atrial fibrillation or flutter (ORs 1.37, 95%CIs 1.07-1.76, P=0.014), and smoking (ORs 1.27, 95%CIs 1.09-1.48, P=0.002) were independently associated with cancer. In women, older age was the only independent factor associated with cancer (ORs 1.15, 95%CIs 1.05-1.25, P=0.002). Conclusion: Men have a higher prevalence of cancer including shared 6 anatomic sites, while sex-specific cancer was more common in women. Male predominance is largely explained by risk profiles including older age, chronic renal failure, atrial fibrillation or flutter, and smoking. These results indicate that cancer among stroke patients shares common risk factors for stroke or cardiovascular disease in men but not women.

Risk factors for multiple recurrent ischemic strokes.

Cardiovascular diseases, hypertension, diabetes mellitus, dyslipidemia, and atrial fibrillation are the most common modifiable risk factors for recurrent ischemic stroke. In this study, we aimed to find the risk factors associated with more than two recurrent ischemic strokes after the first-ever stroke. We collected the ischemic stroke patients in our stroke registry data bank, and the eligible patients were followed for recurrent ischemic stroke after 2008. Our study consisted of 927 patients who were followed up for 9 years after the first-ever stroke. We found that 185 (20%) patients had a recurrent ischemic stroke, and another 32 (3.5%) patients had more than one recurrence after the first-ever ischemic stroke. The mean time for the first stroke recurrence was 1 year, and the mean time for the multiple stroke recurrences was 3 years. Significant risk factors for multiple recurrences were congestive heart disease (P < 0.015) and diabetes mellitus (P < 0.006). We concluded that even with the appropriate treatments, patients with congestive heart disease and diabetes mellitus have a higher rate of multiple recurrences for ischemic stroke after the first-ever ischemic stroke, indicating that more attention should be paid to this issue.

Association of Psychosocial Stress With Risk of Acute Stroke

Psychosocial stress is considered a modifiable risk factor for stroke. Given the prevalence of chronic and acute exposure to stress, it represents a potentially attractive target for population-health interventions. To determine the association of psychosocial stress with the risk of acute stroke and explore factors that might modify the association of stress with risk of acute stroke in a large international population. INTERSTROKE is an international retrospective case-control study of risk factors for first acute stroke in 32 countries in Asia, North and South America, Europe, Australia, the Middle East, and Africa. A total of 13 462 patients with stroke and 13 488 matched controls were recruited between January 11, 2007, and August 8, 2015. The present analyses were performed from June 1 to 30, 2021, and included 13 350 cases and 13 462 controls with available data on psychosocial stress. Psychosocial stress and occurrence of stressful life events within the preceding year were measured using a standardized questionnaire of self-reported stress at home and work. The association of stress with acute stroke and its subtypes was examined using multivariable conditional logistic regression and factors that might modify the association, particularly self-reported locus of control. Among 26 812 participants included in the analysis, the mean (SD) age of cases was 62.2 (13.6) years; that of controls, 61.3 (13.3) years; 7960 cases (59.6%) and 8017 controls (59.6%) were men. Several periods of stress and permanent stress were reported for 2745 cases (20.5%) and 1933 controls (14.4%), with marked regional variation in prevalence, with the lowest in China (201 of 3981 [5.0%] among controls and 364 of 3980 [9.1%] among cases) and highest in South East Asia (233 of 855 [26.1%] among controls and 241 of 782 [30.8%] among cases). Increased stress at home (odds ratio [OR], 1.95 [95% CI, 1.77-2.15]) and at work (OR, 2.70 [95% CI, 2.25-3.23]) and recent stressful life events (OR, 1.31 [95% CI, 1.19-1.43]) were associated with an increased risk of acute stroke on multivariable analyses (vs no self-reported stress). Higher locus of control at home was associated with a reduced odds of all stroke (OR, 0.73 [95% CI, 0.68-0.79]), and higher locus of control both at work and at home were associated with a lower odds of acute stroke and significantly diminished the association with stress at work (OR, 2.20 [95% CI, 1.88-2.58]; P = .008 for interaction) and home (OR, 1.69 [95% CI, 1.44-1.98]; P < .001 for interaction) for acute stroke. Psychosocial stress is a common risk factor for acute stroke. The findings of this case-control study suggest that higher locus of control is associated with lower risk of stroke and may be an important effect modifier of the risk associated with psychosocial stress.

Knowledge regarding risk factors, warning signs, and immediate response to stroke among patients attending general outpatient department in a selected multispeciality hospital

Background: The stroke burden in India is very high, and its incidence has been rising over the past few decades. Acute stroke is a time-sensitive emergency and requires identifying warning signs and seeking medical attention to prevent mortality and morbidity. Knowing its risk factors, accurately identifying warning signs, and seeking medical attention within a timeline is challenging to avoid secondary complications. Objective: To assess the knowledge of risk factors, warning signs, and immediate response to stroke among patients attending the general outpatient department (OPD) and find out the relationship of knowledge with selected socio-demographic and clinical variables of the patients. Material and Methods: A hospital-based cross-sectional study was conducted on 200 patients attending the general outpatient department (OPD) recruited consecutively after meeting the inclusion and exclusion criteria. Demographic profile, clinical profile, and knowledge questionnaire on risk factors, warning signs, and response to stroke were used to gather the data. Consent was taken from the patient after obtaining the ethical clearance. Results: Nearly half of the patients (43.5%) had very good knowledge, and almost the same number (43%) had good knowledge about stroke risk factors. The participants identified the most common risk factors for stroke: hypertension (77%) and excessive alcohol consumption (73%). Most patients (92.5%) have poor knowledge about warning signs, and only 7% had adequate knowledge. The most common stroke warning sign described by participants was 'confusion and slurred speech' identified by 17%. All patients were aware of seeking medical attention within 72 hours. Still, none of them knew about the golden timeline (3 hours), its importance, and thrombolytic therapy as a selective stroke treatment during the golden timeline. There is no association between participants' knowledge of stroke risk factors and warning signs and socioeconomic, clinical, and source of information variables (p&lt;.05). Conclusion: Most patients have better knowledge about risk factors but lack warning signs and immediate response to stroke irrespective of their socioeconomic, clinical, and source of receiving stroke-related information. Hospitals must galvanize the efforts to disseminate stroke-related information involving nursing staff to organize different educational strategies in OPDs.

Abstract 9495: Deep Learning Algorithm for Predicting Atrial Fibrillation Based on Chest Radiography

Introduction: Atrial fibrillation (AF) is a common risk factor for stroke and heart failure, with gradually increasing prevalence. AF is usually diagnosed on the basis of electrocardiography. Chest radiography is commonly performed as a screening test among patients with cardiac diseases but cannot be used to detect AF because of its unclear radiographical findings.Hypothesis: We hypothesize that deep learning methods, particularly convolutional neural networks (CNN), can be used to detect AF on chest radiographs. Methods: Chest radiographs used for training were obtained from Yongin Severance Hospital, South Korea. A total of 11,044 images acquired from patients with normal sinus rhythm or AF were used, whereas images from patients with other rhythms, such as paced rhythm or left bundle branch block, were excluded. The training, validation, and test datasets were split 8:1:1, and Resnet was applied as a model architecture. The accuracy, area under the receiver operating characteristic (ROC) curve, area under the precision-recall curve (PRC), precision, and recall were calculated. Gradient-weighted class activation mapping (Grad-CAM) was used to determine the area focused on by the model to predict AF. Results: AF was detected from chest radiographs with an accuracy, AUC, and PRC of 0.95, 0.81 and 0.39 in the validation set, respectively, and 0.94, 0.76, and 0.35 in the test set, respectively (Figure 1-A, B). Grad-CAM showed that the highest predictive value images from each dataset focused on the heart and its border, while the lowest predictive value images focused on the ribs (Figure 1-C, D, E, F). Conclusions: Deep learning algorithms can be used to detect AF on chest radiographs, which can be used as a screening tool for AF patients.

Prehospital stroke care in Africa: The reality and potential solutions.

Prehospital stroke care in Africa: The reality and potential solutions.

Etiological Risk Factors Profile of Arterial Ischemic Stroke in Children at A Tertiary Care Children's Hospital

Objective: To determine the etiological risk factors of arterial ischemic stroke (AIS) in children. Study Design: An observational cohort study. Place and Duration of the Study: Neurology department of “The Children's Hospital and Institute of Child Health, Multan”, from January 2020 to December 2020. Methods: Children in the age group from one month of age to 12 years with a history of acute onset of focal neurological deficit of upper motor nerve and positive findings on neuroimaging were included in the study. The workup included baseline lab testing, neuroimaging, cardiac evaluation, and cerebro-spinal fluid (CSF) laboratory testing. We used predesigned proforma for recording the patient's details and the possible etiology of the stroke. Results: In a total of 84 children, 28 (33.3%) were male and 56 (66.7%) were female. Age ranged from 4 months to 11 years with a mean age of 3.4±2.2 years. Etiological risk factors identified in 62 (73.8%) patients and were remained undetermined in 22 (26.2%) patients. The risk factors identified were central nervous system infection arteriopathy in 22 (26.2%), iron deficiency anemia 20 (23.8%), cardiac disorders 11 (13.1%), moyamoya disease in 5 (6.0%), and mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes in 4 (4.8%) patients. Practical Implications: It is essential to know the etiology of risk factors responsible for AIS as the management and prognosis are directly influenced by them. Conclusion: Infection-associated arteriopathy was the most common etiological risk factor for arterial ischemic stroke in our study population. Keywords: Anemia, arterial ischemic stroke, central nervous system, moamoya

Why Would a Child Have a Stroke?

Identifying the etiology of childhood arterial ischemic stroke helps prevent stroke recurrence. In addition, stroke may herald a serious underlying condition requiring treatment, such as acquired heart disease, malignancy, or autoimmune disorder. Evidence-based guidelines exist for adults to identify and treat common risk factors for primary and secondary stroke, including hypertension, diabetes, elevated lipids, atrial fibrillation, and sleep apnea, which are rarely relevant in children. However, guidelines do not exist in pediatrics. Identifying the cause of childhood stroke may be straightforward or may require extensive clinical and neuroimaging expertise, serial evaluations, and reassessment based on the evolving clinical picture. Risk factors may be present but not necessarily causative, or not causative until a triggering event such as infection or anemia occurs. Herein, we describe strategies to determine stroke etiology, including challenges and potential pitfalls.

The outcomes of mechanical thrombectomy in patients with acute stroke with and without intravenous injection of tissue plasminogen activator

Background: Stroke is a major health problem and leading cause of mortality worldwide. This study aimed to evaluate the consequences of intravascular interventions in patients with acute ischemic stroke with and without intravenous tissue plasminogen activator (tPA) injection. Methods: This prospective cohort study was conducted on 120 patients with acute ischemic stroke. Patients were divided into three groups based on the type of disease treatment: angiography, tPA, and combined therapy (angiography + tPA). Patients in the tPA group were treated with a standard dose of intravenous alteplase (0.9 mg/kg). The severity of acute ischemic stroke was calculated on days 0, 14, and 90 after the interventions using the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) questionnaires. Results: All three groups were homogeneous regarding age, gender, location, job status, education, and body mass index (BMI) distribution. Coronary disease was the most common risk factor for stroke in 38.33% of patients. There was no significant difference in mean NIHSS and mRS scores between the groups on days 0, 14, and 90 after intervention (p &gt; 0.05). Mean NIHSS and mRS scores significantly decreased from the first time point (day 0), 10 days until 90 days after treatment in all three groups (p &lt; 0.001); however, there was no significant difference in treatment effect between the three groups at these time points (p &gt; 0.05). Conclusion: Treatment with angiography and tPA alone or with combined therapy significantly decreased the severity of acute ischemic stroke. A significant decrease was observed in the mean NIHSS and mRS scores in all therapy groups, indicating that these treatments were effective in mitigating acute ischemic stroke and improving functional independence in these patients. The eligibility criteria by which patients with acute ischemic stroke are selected for each specific therapy are essential to achieving better clinical outcomes.

Knowledge of Stroke among Hypertensive Patients in Dhulikhel

Background More than 50% of patients with stroke have hypertension, a common modifiable risk factor for stroke. Studies reported that 90% of diagnosed hypertensive patients do not seek for treatment in Nepal and the reason for this remains unexplored. There is a possibility that lack of knowledge of stroke and its potential causes may be the reason.&#x0D; Objective To assess the knowledge of stroke in a group of patients with hypertension in suburban Nepal.&#x0D; Method Hypertensive patients visiting a tertiary care hospital in Nepal were approached and were included if they were 18 years or older. We used the Nepali version of ‘Awareness of Stroke, Risk Factors, and Treatment’ questionnaire to assess the knowledge of stroke. Descriptive statistics were used to analyze the results.&#x0D; Result A total of 273 patients were included with the mean age of 56 years. Almost half (48%) of the patients were uneducated. We found that only 24% of the patients identified brain as an organ affected by stroke, only 32% were aware about more than one warning signs of stroke, 64% reported that they were unaware of the treatment options for stroke and only 5% reported control of blood pressure as a part of stroke management. The commonest reported identifiable risk factor for hypertension was high blood pressure (44%).&#x0D; Conclusion There are significant knowledge gaps regarding stroke in hypertensive patients. Although most patients recognized hypertension as a risk factor for stroke, they were unaware of treatment options. Increasing awareness of hypertension as a risk factor for stroke may help to prevent the stroke burden in Nepal.

Association of intermittent versus continuous hemodialysis modalities with mortality in the setting of acute stroke among patients with end-stage renal disease

Patients with end-stage renal disease (ESRD) are 8–10 times more likely to suffer from a stroke compared with the general public. Despite this risk, there are minimal data elucidating which...

Aging Microbiota-Gut-Brain Axis in Stroke Risk and Outcome.

The microbiota-gut-brain-axis (MGBA) is a bidirectional communication network between gut microbes and their host. Many environmental and host-related factors affect the gut microbiota. Dysbiosis is defined as compositional and functional alterations of the gut microbiota that contribute to the pathogenesis, progression and treatment responses to disease. Dysbiosis occurs when perturbations of microbiota composition and function exceed the ability of microbiota and its host to restore a symbiotic state. Dysbiosis leads to dysfunctional signaling of the MGBA, which regulates the development and the function of the host's immune, metabolic, and nervous systems. Dysbiosis-induced dysfunction of the MGBA is seen with aging and stroke, and is linked to the development of common stroke risk factors such as obesity, diabetes, and atherosclerosis. Changes in the gut microbiota are also seen in response to stroke, and may impair recovery after injury. This review will begin with an overview of the tools used to study the MGBA with a discussion on limitations and potential experimental confounders. Relevant MGBA components are introduced and summarized for a better understanding of age-related changes in MGBA signaling and its dysfunction after stroke. We will then focus on the relationship between the MGBA and aging, highlighting that all components of the MGBA undergo age-related alterations that can be influenced by or even driven by the gut microbiota. In the final section, the current clinical and preclinical evidence for the role of MGBA signaling in the development of stroke risk factors such as obesity, diabetes, hypertension, and frailty are summarized, as well as microbiota changes with stroke in experimental and clinical populations. We conclude by describing the current understanding of microbiota-based therapies for stroke including the use of pre-/pro-biotics and supplementations with bacterial metabolites. Ongoing progress in this new frontier of biomedical sciences will lead to an improved understanding of the MGBA's impact on human health and disease.

Stroke Risk Factors of Stroke Patients in China: A Nationwide Community-Based Cross-Sectional Study.

Background: Stroke is the leading cause of death in China, and its burdens are rapidly increasing. The prevalence and control of stroke risk factors among stroke patients in China are unknown. Objective: We investigated the stroke risk factors of stroke patients in China. Design: We examined stroke risk factors in 6580 stroke patients aged 18 years or older in the China National Chronic Diseases and Nutrition Surveillance of Adults (2015–2017). With regard to the basic characteristics of the study participants, categorical variables were described as frequency (percent). The chi-square test was used to analyze the difference between men and women. The multivariate logistic regression model was used in the multivariate analysis. Results: Among the 6580 stroke patients, hypertension was the most common stroke risk factor identified in most cases (78.51%), followed by overweight or obesity (61.58%), dyslipidemia (54.38%), smoking (24.04%), diabetes (21.75%), family history of stroke (17.43%), lack of exercise (16.35%), and atrial fibrillation (4.47%). Drinking stroke patients had a lower rate of hypertension, diabetes, and dyslipidemia. Patients with hyperuricemia had a higher rate of hypertension and dyslipidemia than no-hyperuricemia patients. The hypertension awareness, treatment, and control rates among hypertension stroke patients were 73.62%, 70.19%, and 17.79%, respectively. The diabetes awareness, treatment, and control rates among diabetes patients were 69.74%, 65.83%, and 34.59%, respectively. The dyslipidemia awareness, treatment, and control rates among dyslipidemia patients were 42.37%, 29.4%, and 20.07%, respectively. Among treated hypertension patients, the rates of taking medicine as medically advised, controlled diet, increased exercise, and blood pressure monitoring were 91.31%, 58.88%, 45.78%, and 73.99%, respectively. Among treated diabetes patients, the rates of oral antidiabetic medications, insulin injection, diet control, and blood glucose monitoring were 78.24%, 34.71%, 85.77%, and 78.24%, respectively. Among treated dyslipidemic patients, the rate of taking medicine as medical advice, controlled diet, increased exercise, and regular blood lipid monitoring was 80.61%, 77.57%, 56.46%, and 40.3%, respectively. Conclusions: The most common risk factors for community stroke patients in China are hypertension, dyslipidemia, and overweight or obesity. The stroke community patients’ suboptimal awareness and treatment of hypertension, and suboptimal awareness, treatment, and control of diabetes, and dyslipidemia are significant problems in China.

Risk of Stroke With Mitral Stenosis: The Underlying Mechanism, Treatment, and Prevention.

Mitral stenosis (MS), a valvular heart disease, is defined by the narrowing of the mitral valve orifice. The common risk factors for stroke include mitral annular calcification (MAC), diabetes mellitus (DM), male gender, hypertension (HTN), hyperlipidemia, and obesity. Endothelial damage, hypercoagulability, and blood stasis in the left atrium promote the development of the thrombus. Among all the risk factors described, MAC is the independent predictor of stroke. The complicated mechanisms responsible for thromboembolism, predisposing factors for thromboembolism, the risk of cerebrovascular accident (CVA) in MS patients, advanced standardized assessment models for identifying those at risk for stroke, and the possible advantages and disadvantages of available therapies have all been discussed in this review article. We have also discussed newer oral anticoagulants (NOACs) like dabigatran, edoxaban, apixaban, and rivaroxaban. Non-pharmacological therapies are also highlighted such as left atrial appendage ligation and occlusion devices. We also conducted a thorough review of the literature on the efficacy and safety of various NOACs in reducing the risk of stroke.

Age Specific Models to Capture the Change in Risk Factor Contribution by Age to Short Term Primary Ischemic Stroke Risk.

Age is one of the most important risk factors when it comes to stroke risk prediction. However, including age as a risk factor in a stroke prediction model can give rise to a number of difficulties. Age often dominates the risk score, and also not all risk factors contribute proportionally to stroke risk by age. In this study we investigate a number of common stroke risk factors, using Framingham heart study data from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center to determine if they appear to contribute proportionally by age to a stroke risk score. As we find evidence that there is some non-proportionality by age, we then create a set of logistic regression risk models that each predict the 5 year stroke risk for a different age group. The age group models are shown to be better calibrated when compared to a model for all ages that includes age as a risk factor. This suggests that to get better predictions for stroke risk it may be necessary to consider alternative methods for including age in stroke risk prediction models that account for the non-proportionality of the other risk factors as age changes.

Abstract TP82: Gaps In Clinical History And Diagnostic Evaluation For Young Women With Ischemic Stroke - We Need An Updated Approach

Introduction: Young women with stroke represent a unique patient population. There are a variety of sex-specific etiologies that warrant a different approach to evaluation and secondary prevention in young women. Secondary prevention begins during the acute hospitalization, thus, certain aspects of the history and evaluations may be indicated early after stroke. We describe our center’s experience with young women presenting with stroke over a 2.5-year period. Methods: We performed a retrospective review of women between 18-45 years, identified from our stroke registry (1/2015 to 5/2018). An assessment of key variables regarding common stroke risk factors (RFs), sex-specific RFs, (pregnancy history, estrogen use, migraine, autoimmune conditions) and workup (pregnancy test, hypercoagulable states, substance use) was conducted. Results: Of 198 women with acute ischemic stroke in our study period, medical RFs of hypertension, diabetes, hyperlipidemia, and atrial fibrillation were each ascertained for more than 98% of women. Lifestyle RFs of tobacco use and alcohol use were reported for 85.9% and 87.6%, respectively and urine drug screens were performed in 67%. Obstetric history (gravida/para) was obtained in only 19.7%, pregnancy tests were conducted in 69.2%, and hypertensive disorders of pregnancy were only reported in patients who were pregnant (2%) or post-partum (5.6%). Oral contraceptive (OCP) or hormone replacement (HRT) was reported in 6.6% and migraine with or without aura in 12.6%. Among 76 patients (38.4%) with cryptogenic stroke, obstetric history was reported in only 25%, OCP/HRT use in 5.3%, and antiphospholipid antibody syndrome was assessed in 64%. Conclusion: The acute stroke hospitalization is a critical period for identification of stroke etiology and assessment of cardiovascular risk. There are known sex disparities in standard evaluation and management of stroke. In pre-menopausal women, gaps in care may be even greater if the history and assessment are not completed with sex-specific variables in mind. We suggest a standard approach to the history and assessment of young women. We plan to implement this approach in our patient population while tracking the impact on care.

Abstract TP206: Vascular Risk Factors And Stimulant Use Among Stroke Patients

Background: In 2019, an estimated 7.3 US million adults had used stimulants in the past year. Stimulant use is associated with increased stroke risk, yet the prevalence of common stroke risk factors (RFs) in patients who use stimulants is not well described. We sought to examine the association between stimulant use and the presence of stroke risk factors (RFs) in stroke patients. Methods: We conducted an IRB approved retrospective review of ischemic and hemorrhagic stroke patients admitted 9/2019 through 9/2020. Inclusion criteria were age ≥18 and completion of a urine drug screen (UDS) on admission. Logistic regression was used to model the association of RFs (hypertension, type 2 diabetes (DMII), hyperlipidemia, atrial fibrillation, and coronary disease) to acute stimulant use, adjusting for socio-demographic characteristics. Results: Among 1878 patients screened, 814 (43.3%) had a UDS. UDS was more common in younger (median age 60 vs 67), male (60.4% vs 47.6%) and Black (35.6% vs 27.5%) and Hispanic (22.0% vs 21.6%) patients. Of those with UDS, 72(8.84%) had cocaine and/or amphetamine detected and 660 (81.08%) were UDS negative. After controlling for age, sex, race, and insurance status, hypertension (OR 2.28, 95%CI 1.17-4.41) was positively associated with stimulant use while DMII was negatively associated (OR 0.39, 95%CI 0.19-0.81). Other RFs were not associated with stimulant use. Conclusion: Despite being younger, stroke patients with stimulant-positive UDS had a higher prevalence of hypertension, a leading risk factor for recurrent stroke, than UDS-negative patients. This group may represent a high-risk population that may benefit from targeted interventions for secondary stroke prevention. Differences in screening by sex, race, and age may lead to missed opportunities for assessment of recurrent stroke risk. A standard approach to drug screening may eliminate these biases.