Family History Of Vascular Disease Research Articles

PROFILE OF CHARACTERISTIC, RISK FACTOR, AND CLINICAL SEVERITY OF ISCHEMIC STROKE PATIENTS

Background: Ischemic strokes account for 87% of all strokes, making them the second leading cause of disability and one of the leading causes of mortality worldwide. Using the National Institutes of Health Stroke Scale (NIHSS), the clinical severity of an ischemic stroke can be assessed. Objective: The objective of this study is to ascertain the clinical severity, risk factors, and characteristics of patients with ischemic stroke at the neurology department of RSUD Dr. Soetomo Surabaya. Methods: The participants in this descriptive observational study comprise individuals who sought medical attention at the neurology department of RSUD Dr. Soetomo between January 2019 and December 2020 due to an ischemic stroke. The observed profile comprises the following factors: age, gender, obesity, smoking status, alcohol consumption, physical inactivity, family history of vascular disease, form of infarction, dyslipidemia, hypertension, cholesterol, and diabetes. Results: In the medical record data collection of 89 ischemic stroke patients, 36 patients were excluded when they first entered the hospital. So a total of 53 ischemic stroke patients were collected. 29 (54.72%) patients are male. The age range is dominated by 48 - 62 years from 29 (54.72%) patients. 44 (83.02%) patients are Javanese. 18 (33.96%) patients had a history of smoking, 1 (1.89%) patient consumed alcohol, and 1 (1.89%) patients were inactive physically. 13 (24.53%) patients have a family history of vascular disease, 45 (84.91%) patients have hypertension, 26 (49.06%) patients have dyslipidemia, and 19 (35.85%) patients have diabetes. 34 (64.15%) patients had moderate strokes, 15 (28.30%) patients had mild strokes, 2 (3.77%) patients had moderate-severe strokes, and 2 (3.77%) patients had severe strokes according to the results of the NIHSS assessment on the first admission. Conclusion: Ischemic stroke patients were mostly in the age range of 48 – 62 years. Comorbidities such as hypertension, dyslipidemia, hypertriglyceridemia, and diabetes are present in the majority of patients. The NIHSS scoring identified moderate stroke patients as having the most frequent outcomes, followed by patients with mild stroke.

Risk profile of patients with spontaneous cervical artery dissection.

Epidemiological data to characterize the individual risk profile of patients with spontaneous cervical artery dissection (sCeAD) are rather inconsistent. In the setting of the Italian Project on Stroke in Young Adults Cervical Artery Dissection (IPSYS CeAD), we compared the characteristics of 1,468 patients with sCeAD (mean age, 47.3±11.3; males, 56.7%) prospectively recruited at 39 Italian centres with those of 2 control groups, composed of 1) patients whose ischemic stroke was caused by mechanisms other than dissection (non-CeAD IS) selected from the prospective IPSYS registry and Brescia Stroke Registry and 2) stroke-free individuals selected from the staff members of participating hospitals, matched 1:1:1 by sex, age, and race. Compared to stroke-free subjects, sCeAD patients were more likely to be hypertensive (OR,1.65; 95%CI,1.37-1.98), to have personal history of migraine with aura (OR,2.45; 95%CI,1.74-3.34), without aura (OR,2.67; 95%CI,2.15-3.32) and family history of vascular disease in first-degree relatives (OR,1.69; 95%CI,1.39-2.05), and less likely to be diabetic (OR,0.65; 95%CI,0.47-0.91), hypercholesterolemic (OR,0.75; 95%CI,0.62-0.91), and obese (OR,0.41; 95%CI,0.31-0.54). Migraine without aura was also associated with sCeAD (OR,1.81; 95%CI,1.47-2.22) in comparison with patients with non-CeAD IS. In the subgroup of patients with migraine, sCeAD patients had higher frequency of migraine attacks and were less likely to take anti-migraine preventive medications, especially beta-blockers, compared with the other groups. The risk of sCeAD is influenced by migraine, especially migraine without aura, more than by other factors, increases with increasing frequency of attacks, and seems to be reduced by migraine preventive medications, namely beta-blockers. This article is protected by copyright. All rights reserved.

PROFILE OF CHARACTERISTIC, RISK FACTOR, AND STROKE SEVERITY ON INFARCTION STROKE PATIENTS

Background: Stroke is the second leading cause of death and the third leading cause of morbidity. Therefore, it is important to know which risk factor that most patients have. Stroke can be divided according to its severity using NIHSS, NIHSS itself has strong ability to predict outcomes after stroke Objective: This study’s aim to learn about profile of characteristic, risk factor, and stroke severity on infarction stroke patients in ward Seruni A RSUD Dr. Soetomo from July 2018 – June 2019. Methods: This descriptive observational study’s samples are patients with infarction stroke in ward Seruni A RSUD Dr. Soetomo from July 2018 – June 2019. The observed profile include age, sex, ethnic, family history of vascular disease, history of hypertension, diabetes, heart disease, dyslipidemia, obesity, smoking, alcohol consumption, physical inactivity, and stroke severity. Results: From 200 patiens, 55% (110) are 56-70 years old. 61% (122) patients are male. 81 out of 96 are Javanese. 25 out of 135 have family history of vascular disease, 140 out of 194 have hypertension, 69 out of 190 have diabetes, 27 out of 183 have heart disease, 101 out of 174 have dyslipidemia, 62 out of 162 have obesity, 33 out of 82 smoke, 4 out of 63 consume alcohol, and 50 out of 55 are inactive physically. On admission, out of 60 patients, 27 have moderate stroke, 25 minor, and 8 moderate to severe. On discharge, out of 49 patients, 23 have moderate stroke, 20 minor, 3 moderate to severe, and 3 severe. Conclusion: Infarction stroke patients were mostly male and the peak incidence occur between 56-70 years old. Most patients have histories of hypertension, dyslipidemia, and diabetes. On admission and discharge, most patients have moderate stroke, followed by mild stroke.

Fatal hemorrhage after tonsillectomy

AbstractThis is the first report of a segmental mediolysis occurring in arterioles, affecting the neck/tonsillar region and leading to a fatal hemorrhage after a tonsillectomy in a 20-year-old woman. Arteriolar mediolysis could be observed in tissue layers about 2 cm distant from the tonsillectomy region. Reparative changes were observed in the carotid and small neck arteries as well as in only one intramyocardial arteriole; however, no other vascular regions typically reported in segmental mediolysis arteriopathy were affected and aneurysm formation was not observed. No family history of vascular disease or hypertension was known. Pathophysiologically, previously reported reasons for post-tonsillectomy bleeding could be excluded. Segmental mediolysis may represent a wider spectrum of affected arteriolar vessels besides the reported small and medium sized arteries leading to aneurysms, which impedes radiographic diagnosis.

Coronary artery disease severity and risk factors in diabetic patients

Traditional cardiovascular risk factors CVRF's are well recognised for their association with atherosclerotic CAD. However the relationship between CVRF's and severity of atherosclerotic burden in diabetic patients assessed angiographically is not well established. This study aimed to assess the relationship between cardiovascular risk factors and the severity of coronary artery disease (CAD) in diabetic patients. We prospectively enrolled 220 diabetic patients who underwent coronary angiography. Disease severity was determined from the results of coronary angiography based on the presence or absence of multiple (two or three) diseased vessels and the SYNTAX score which allocates a numerical value for the degree of coronary stenosis severity. In the studied population (135 men and 85 women, mean age 64.7 ± 12.4 years). dyslipidaemia, hypertension and abdominal obesity were the most frequent modifiable cardiovascular risk factor, present in 40.9, 55.8 and 33.7% of patients, respectively. Multiple logistic regression analysis showed that glycated hemoglobin HBA1c level, ratio of total to HDL cholesterol and abdominal obesity significantly increased the risk of multivessel CAD: odds ratios (ORs) of 2.19 (1.15–2.35; P = 0.039), 1.82 (1.13–1.99; P = 0.032) and 1.76 (1.23–2.67; P = 0.009), respectively. In contrast other traditional CRFs (hypertension, age and family history of vascular disease) were not associated with CAD severity. A significant linear correlation was also noted between HBA1c level and the syntax score.(p:0.001, r:0.541) Among diabetic patients underwent coronary angiography; HBA1c, abdominal obesity and dyslipidemia are significantly associated with the severity of CAD.

Isolated abdominal aortic dissection in a young female patient

A 43-year-old woman presented with acute lower abdominal pain radiating to both sides of the groin. She had no history of smoking, drug abuse, surgeries, trauma, or any chronic diseases. There was no family history of vascular disease. On the admission physical examination, she was normotensive, had normal pulses on four limbs, and presented tenderness and pain on abdominal aortic palpation and in her lower abdomen. Contrastenhanced abdominal and thoracic computed tomography showed a distal infrarenal abdominal aortic dissection compromising both common iliac arteries (A) and a saccular dilation of the left common iliac dissected artery (B and C). The patient had partial remission of pain with opioids and elected to undergo an endovascular treatment. A coil embolization of the left internal iliac artery (the level at which the dissection ended) was performed, and then a unibody bifurcated endoluminal graft was deployed, covering most of the infrarenal aorta and both common iliac arteries. The patient recovered uneventfully, with total pain remission. The patient did not meet diagnostic criteria for Takayasu disease and had neither Marfan nor Ehlers-Danlos syndrome; her serologic inflammatory and infectious markers were negative, and she had no other radiologic signs of arterial disease of the aorta or its major branches. At 1-month follow-up, computed tomography angiography showed total thrombosis of the dissection’s false lumen as well as of the saccular dilation and patency of the infrarenal aorta and iliac arteries (D). Isolated abdominal aortic dissection, an extremely rare entity, is estimated to occur in 0.4% to 2% of all aortic dissections. It may be classified on the basis of etiology as iatrogenic, traumatic, or spontaneous. Most patients with spontaneous abdominal aortic dissections present with dissection of the infrarenal aortic segment, extending or not to the iliac arteries. Although there is no consensus in the literature on the treatment indications, most authors advocate treatment of all symptomatic patients and of those asymptomatic with radiologic evidence of aneurysmal dilation. There is no standardized technique, and although the endovascular approach used in this case was successfully undertaken, long-term follow-up is warranted to see how the device behaves in a young patient with small-caliber arteries.

Distribution of coronary artery disease severity and risk factors in Afro-Caribbeans

Traditional risk factors are strong predictors of the incidence of coronary artery disease (CAD), but their association with disease severity remains controversial and could differ across ethnic groups. In this study, we assessed the prevalence of cardiovascular risk factors (CRFs) in Afro-Caribbean patients with documented CAD, and sought to identify which of these factors are related to disease severity. We retrospectively studied 420 consecutive patients with CAD. Disease severity was determined from the results of invasive coronary angiography, based on the presence or absence of multiple (two or three) diseased vessels and the myocardial jeopardy (MJ) score. In the studied population (mean age 64.7 ± 12.4 years), hypertension, diabetes and dyslipidaemia were the most frequent modifiable CRFs, present in 75.9, 47.8 and 37.8% of patients, respectively. Multiple logistic regression analysis showed that diabetes, male sex and personal cardiovascular history significantly increased the risk of multivessel CAD: odds ratios (ORs) of 1.53 (1.01-2.33; P=0.048), 1.61 (1.02-2.55; P=0.043) and 1.68 (1.11-2.56; P=0.015), respectively. Obesity was an independent negative predictor, with an OR of 0.48 (0.29-0.79; P=0.004). Other traditional CRFs (hypertension, dyslipidaemia, smoking, age and family history of vascular disease) were not associated with CAD severity. For high-risk lesions (MJ score ≥8), both diabetes and hypertension were independent predictors of disease severity, whereas obesity was no longer a protective factor. Diabetes emerged as the strongest modifiable risk factor predictor of multivessel disease in Afro-Caribbean patients, whereas obesity was an independent protective factor. The underlying mechanisms of these associations should be relevant to disease prevention.

Abstract P425: Frequency of Nut Consumption is Associated with Reduced Prevalence of Peripheral Arterial Disease in a Very Large Community Cohort

Introduction: Consumption of nuts may improve lipids, insulin resistance and markers of inflammation, and increased nut intake has been associated with lower risk of coronary and cerebrovascular disease. However, an association between nut intake and peripheral artery disease (PAD) is less certain. The purpose of this analysis was to investigate the association between dietary nut consumption and presence of PAD defined by ankle-brachial index (ABI) <0.9 in a large community cohort. Methods: Over 3.5 million self-referred participants from 2003-2008 at >20,000 US sites who completed a medical and lifestyle questionnaire were evaluated by screening ankle brachial indices <0.9 for PAD. Subjects were asked about frequency of consumption of a serving of nuts (<1x/month, 1x/month - 1x/week, 2-3x/week, 4-5x/week, and daily). Multivariate logistic regression analysis was used to estimate odds of PAD in different nut consumption categories. Results: Among 3,503,770 individuals, mean age was 63.6 ±10.6 years and 63% were female. The consumption of nuts ranged from 20% with <1x/month consumption to 15% daily consumption (Figure). After adjustment for age, gender, race/ethnicity, smoking, physical activity, diabetes, hypertension, hyperlipidemia and family history of vascular disease, there was a step-wise inverse association of nut intake with PAD (Figure). Compared to subjects with consumption of nuts <1x/month, daily nut consumption was associated with a 23% lower odds of PAD (OR 0.774, 95% CI 0.761 - 0.787). Conclusions: We present data from a very large community cohort, in which nut consumption exhibited an inverse step-wise relationship with PAD prevalence after correction for established risk factors for atherosclerosis. These observations suggest the need for more rigorous testing for a role for nuts in PAD prevention.

Maternal Flow-Mediated Dilation and Nitrite Concentration During Third Trimester of Pregnancy and Postpartum Period

Objectives. To compare maternal flow-mediated dilation (FMD) of the brachial artery and nitrite concentration between third trimester of pregnancy (3rdT) and postpartum (PP) period. Additionally, we will evaluate whether FMD correlates with nitrite concentration in both periods. Methods. Eligibility criteria was healthy women with singleton pregnancy, gestational age >28 weeks, nonsmokers, and no personal or family history of vascular disease. Each women was examined during 3rdT and between 8 and 12 weeks PP to evaluate FMD and nitrite concentration in whole blood. Women not examined in both periods were excluded. Values between both periods were compared using paired t tests. Correlation between FMD and nitrite was examined by Pearson correlation coefficient. Significance level set as p < 0.05. Results. We invited 42 pregnant women. Among them, 35 were eligible and 7 of them were excluded for not attending the PP evaluation resulting in 28 participants analyzed. We found no significant change in FMD (10.39 ± 5.57% vs. 8.42 ± 4.21%; p = 0.11; 3rdT vs. PP, respectively) and no significant change in nitrite concentration (257.41 ± 122.95 nmol/L vs. 237.16 ± 90.01 nmol/L; p = 0.28). Baseline brachial artery diameter had a significant reduction (3.11 ± 0.30 to 2.75 ± 0.34 mm; p < 0.01). No significant correlation between FMD and nitrite during 3rdT (r = −0.13; p = 0.50) or PP (r = 0.14; p = 0.48) was found. Conclusions. We did not observe significant changes in both FMD and nitrite concentration between third trimester and the PP period. FMD did not correlate with nitrite in both periods. More studies are needed to confirm our findings.

Retrograde iliac artery dissection

A 42-year-old man presented with acute abdominal pain. He was normotensive and had no history of smoking, diabetes, surgeries, or trauma, but had hypertension controlled with one drug. There was no family history of vascular disease. The physical examination revealed hypersensibility in the lower abdomen, without any palpable mass. Femoral and distal pulses were normal. Ultrasound imaging revealed ectasia of the right common iliac artery (RCIA) and wall hematoma but no free fluid in the abdominal cavity. Computed tomography angiography (CTA) showed a slightly dilated RCIA and dissection from the RCIA to the distal abdominal aorta (retrograde dissection; A/Cover). The patient was placed under general anesthesia, and a transperitoneal approach was initiated. An extensive hematoma and inflammatory reaction were seen next to the anterior wall of the aorta and the RCIA. The site of the RCIA dissection was the iliac bifurcation extending to the distal abdominal aorta. The arterial wall was extremely thin and fragile and was reconstructed using a bifurcated polytetrafluoroethylene graft (B). Histology revealed myxoid degeneration and fragmentation of the elastic fibers of the RCIA. Control CTA imaging on postoperative day 6 did not reveal any problems (C), and the patient was discharged on postoperative day 7 without complications. At 50 days postoperatively, the patient was doing well.

PP070. Maternal flow-mediated dilation and nitrite concentration during third trimester of pregnancy and postpartum period

The vascular endothelium is thought to be responsible for cardiovascular adaptations in gestation, such as the decrease in peripheral vascular resistance and the decrease in arterial pressure. There is an increase of nitric oxide (NO) serum levels in normal gestation due to an increment in the activity of the enzyme endothelial nitric oxide synthase (eNOS). To compare maternal flow-mediated dilation of the brachial artery (FMD) and the nitrite concentration between the third trimester of pregnancy and postpartum period. Additionally we want to evaluate whether FMD correlates with nitrite concentration. Eligibility criteria were healthy pregnant women with single fetus, gestational age greater than 28 weeks, nonsmokers, and without personal or family history of vascular disease. Each pregnant woman was examined in the third trimester of pregnancy (3(rd)T) and between 8 and 12 weeks postpartum (PP) to evaluate FMD and nitrite concentrations in the whole blood. We excluded women who were not examined in both periods. We compared the values between the two periods using paired t tests. The correlation between FMD and nitrite concentration was examined by Pearson correlation coefficient. Significance level was set at p<0.05. 42 pregnant women were invited for the study. 35 healthy women were elected and 7 of them were excluded for not attending the postpartum evaluation. We found a trend of decreased FMD in the PP period (10.39±5.57 % vs. 8.42±4.21 %, p=0.11; 3(rd)T vs. PP respectively). No significant change was observed in the nitrite concentration (257.41±122.95nmol/L vs.237.16±90.01nmol/L, p=0.28). We did not observe significant correlation between FMD and nitrite during 3(rd)T (r=-0.13, p=0.50) or PP (r=0.14, p=0.48). Although our sample size did not permit sufficient precision, FMD seems to decrease between the third trimester and postpartum period. Nitrite concentration did not change between the third trimester of pregnancy and the postpartum period, and it was not correlated to FMD. Studies evaluating larger samples are necessary to confirm these findings.

Age- and Gender-Specific Prevalence of Risk Factors in Patients with First-Ever Ischemic Stroke in China

Background. Evidences are accumulating that age and gender have great impact on the distribution of stroke risk factors. Such data are lacking in Chinese population. Methods. 1027 patients with first-ever ischemic stroke (IS) were recruited and divided into young adult (<50 years), middle-aged (50∼80 years), and very old (>80 years) groups according to stroke onset ages. Vascular risk factors were collected and compared among groups. Results. Female patients were globally older than male patients at stroke onset and having higher prevalence of diabetes mellitus (DM), heart diseases, and atrial fibrillation (AF). However, females were less likely to drink heavily or smoke than males. Young patients had a much higher proportion of smoking and drinking than middle-aged and very old patients and the highest family history of hypertension, while very old patients had the highest prevalence of heart diseases and AF but lowest proportion of positive family history of vascular diseases. Hypertension and DM were equally frequent among three groups. Conclusion. Our study showed that vascular risk factors had a specific age and gender distribution pattern in Chinese IS patients. Secondary prevention strategy should emphasize on the control of different risk factors based on patient's age and gender.

Recurrence Risk after Noncardioembolic Mild Ischemic Stroke in a Japanese Population

Background and Purpose: This study aimed to identify the recurrence rate and risk factors or clinical variables predictive of vascular events after mild ischemic stroke (IS). Methods: From December 2006 to September 2007, patients with acute IS with a modified Rankin Scale of 0∼1 were consecutively enrolled in this study. Variables including sex, family history of vascular disease, age, height, weight, stroke subtype, blood pressure, lipid profile, fasting glucose, HbA1c, smoking, alcohol consumption, exercise habits, waist circumference, ankle-brachial pressure index, salt intake and physical activity were assessed. The primary outcome was stroke recurrence or other vascular events such as myocardial infarction, angina pectoris, and peripheral artery disease. Survival curves were calculated by Kaplan-Meier survival analysis, and hazard ratios for recurrence were determined by univariate and multivariate Cox proportional hazards regression models. Results: A total of 102 mild IS patients (78 men and 24 women, mean age 64 years) were successfully followed for 3 years. Of those 102 patients, 25 (24.5%) had stroke recurrence, and 4 (3.9%) had a coronary event. Among the variables studied, abnormal ankle-brachial pressure index, metabolic syndrome, stroke subtypes, salt intake and poor lifestyle management were significant independent predictors of stroke recurrence or cardiovascular events. Conclusions: In mild IS patients within 3 years after onset, not only pathophysiological factors but also lifestyle factors can aid in the identification of patients at high risk for recurrence.

Risk Factors Associated with Acute Coronary Syndromes in South African Asian Indian Patients [The AIR Study

Aims: To examine the association between traditional risk factors and acute coronary syndrome [ACS] in the South Asian Indian population in KwaZulu Natal, South Africa. Methods and Results: The study population comprised 4418 patients with a mean age of 54.6 ± 10.9 years, of whom 67% were males. The majority presented with STEMI [75%], 16% had NSTEMI, and 9% unstable angina. Visceral obesity [82%, mean waist circumference 101.43 ± 10.34 cm] was the most commonly observed risk factor, while 78% had hypercholesterolaemia [mean 5.97 ± 1.11 mmol/L] and 74% a family history of vascular disease. More males compared to females were smokers [p 65 years, n = 742] groups, whilst older patients were more likely to have diabetes [59 %, p = 0.001], and hypertension [68 %, p = <0.0001]. Conclusion: Asian Indians in South African have multiple risk factors for ACS, possibly contributing to the increased incidence of coronary heart disease at a young age. This study further confirms that a family history of vascular disease is strongly associated with the presence of ACS, and should be incorporated in future risk factor analyses.

Clinical assessment incorporating a personal genome

The cost of genomic information has fallen steeply, but the clinical translation of genetic risk estimates remains unclear. We aimed to undertake an integrated analysis of a complete human genome in a clinical context. We assessed a patient with a family history of vascular disease and early sudden death. Clinical assessment included analysis of this patient's full genome sequence, risk prediction for coronary artery disease, screening for causes of sudden cardiac death, and genetic counselling. Genetic analysis included the development of novel methods for the integration of whole genome and clinical risk. Disease and risk analysis focused on prediction of genetic risk of variants associated with mendelian disease, recognised drug responses, and pathogenicity for novel variants. We queried disease-specific mutation databases and pharmacogenomics databases to identify genes and mutations with known associations with disease and drug response. We estimated post-test probabilities of disease by applying likelihood ratios derived from integration of multiple common variants to age-appropriate and sex-appropriate pre-test probabilities. We also accounted for gene-environment interactions and conditionally dependent risks. Analysis of 2.6 million single nucleotide polymorphisms and 752 copy number variations showed increased genetic risk for myocardial infarction, type 2 diabetes, and some cancers. We discovered rare variants in three genes that are clinically associated with sudden cardiac death-TMEM43, DSP, and MYBPC3. A variant in LPA was consistent with a family history of coronary artery disease. The patient had a heterozygous null mutation in CYP2C19 suggesting probable clopidogrel resistance, several variants associated with a positive response to lipid-lowering therapy, and variants in CYP4F2 and VKORC1 that suggest he might have a low initial dosing requirement for warfarin. Many variants of uncertain importance were reported. Although challenges remain, our results suggest that whole-genome sequencing can yield useful and clinically relevant information for individual patients. National Institute of General Medical Sciences; National Heart, Lung And Blood Institute; National Human Genome Research Institute; Howard Hughes Medical Institute; National Library of Medicine, Lucile Packard Foundation for Children's Health; Hewlett Packard Foundation; Breetwor Family Foundation.

Ethnic South Asian ischaemic stroke patients have a higher prevalence of a family history of vascular disease compared to age, gender and diabetes-matched ethnic Chinese subjects

Family history is a known non-modifiable risk factor of stroke. We aimed to compare the frequency of a family history of vascular disease between ethnic South Asian and Chinese stroke patients. We studied consecutive ethnic South Asian and Chinese ischaemic stroke patients matched for age, gender and presence of diabetes. Among the 152 matched pairs, ethnic South Asian ischaemic stroke patients had a higher frequency of vascular family history (IHD OR 3.465 p < 0.001; CVD OR 1.754 p = 0.059; and either IHD or CVD OR 2.169 p = 0.003) compared to matched ethnic Chinese patients, independent of past IHD history and stroke subtype. In the ethnic South Asian cohort, patients ≤ 60 years old had a higher frequency of a family history of IHD (37% vs 13%, p < 0.001), CVD (34% vs 15%, p = 0.005) and either IHD or CVD (52% vs 25%, p < 0.001) compared to those > 60 years. Family history of vascular disease is common among ethnic South Asian ischaemic stroke patients, particularly among those ≤ 60 years old. We postulate that the higher frequency of a vascular family history among ethnic South Asians compared to ethnic Chinese may be explained by genetic, environmental and lifestyle influences, or interactions between these factors.

Reducing the impact of vascular disease: the proposed Vascular Risk Programme for risk assessment and management

increases with age, progresses faster in men than women, in those with a family history of vascular disease, in certain ethnic groups such as south Asians and people from socioeconomically deprived backgrounds. Nevertheless, the rate at which vascular disease progresses is determined by a number of modifiable factors such as smoking, diet, physical inactivity, hypertension, hyperlipidaemia, dysglycaemia and obesity. This common set of risk factors underlie all types of vascular disease – heart disease, stroke, diabetes and renal disease, supporting a shared vascular risk screening programme for preventing and managing risk in all of these conditions (Figure 1). The Department of Health has examined how a comprehensive vascular risk assessment and management programme could work in practice, including modelling of clinical and cost-effectiveness of implementation of the programme. The Introduction V ascular disease (which includes coronary heart disease, stroke, diabetes and chronic kidney disease) currently affects more than four million people in England. It causes 170,000 deaths a year in England (36% of all deaths), is responsible for one-fifth of all hospital admissions and is the largest single cause of long-term ill health and disability. In view of its high prevalence and costs, in April 2008 the Department of Health announced plans to introduce a comprehensive vascular risk assessment and management programme, based on recommendations by the National Screening Committee, for all people aged 40 to 74 years. The programme is set for a rollout in 2009–2010, is estimated to cost around £250 million per year and aims to shift the emphasis to primary prevention of vascular disease. What will it mean for general practice? Since the implementation of the National Service Frameworks there have already been significant improvements with a 40% reduction in cardiovascular deaths in people under 75 years since 1996. The reasons for this decline are complex but include improvements in diet, smoking cessation and secondary prevention strategies. However, most cardiovascular events are caused by low grades of stenosis. The risk factors for vascular disease are well documented. Having one vascular condition increases the likelihood of an individual suffering others, and they often coexist. The prevalence of vascular disease TOPICAL REVIEW

373: Can pregnancy associated complications predict primary atherothrombotic occlusive vascular events in premenopausal women?

THROMBOTIC OCCLUSIVE VASCULAR EVENTS IN PREMENOPAUSAL WOMEN? GALIA ORON, YARIV YOGEV, SHLOMIT BEN-AMI, AVI BEN-HAROUSH, MOSHE HOD, JACOB BAR, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tiqwa, and Sackler Faculty of Medicine, Tel Aviv University, Obstetrics and Gynecology, Tel Aviv, Israel OBJECTIVE: Scarcity of data exists concerning the potential association between pregnancy complications as early risk factor for atherothrombotic event. The aim of this study was to determine if adverse pregnancy outcomes can be added to the list of classical risk factors for atherothrombotic occlusive vascular disease (AOVD), in young women. STUDY DESIGN: A retrospective questionnaire/case-control study. Study group included women aged 50 years with an ICD-9 diagnosis of AOVD (a documented primary cerebrovascular, myocardial, or peripheral arterial ischemic events) who were treated between 1995 to 2004. Classical risk factors for AOVD and aspects of pregnancy outcome were compared with healthy women matched individually for age, parity and body mass index. RESULTS: 1. Overall, 101 women with AOVD were identified, of them; 53 had a myocardial ischemic event, 33 a cerebrovascular event, and 15 a peripheral ischemic arterial event. 2. On multivariate analysis, in addition to the known risk factors for AOVD (diabetes, hypertension, dyslipidemia and family history of vascular disease) intrauterine growth restriction was found to be an independent risk factor for development of AOVD (O.R 8.41, 95% C.I 2.36-29.9, p 0.001). 3. Women with more than one of the following pregnancy complication (GDM, PET, spontaneous preterm delivery, placental abruption, or fetal loss) were at increased risk for more than one arterial occlusive event (O.R 13.71, 95% C.I 1.56-120.39, p 0.02). CONCLUSION: Intrauterine growth restriction and multiple pregnancy complications are independent, early risk factor for subsequent AOVD in pre-menopausal women

Guidelines for Screening of Extracranial Carotid Artery Disease: A Statement for Healthcare Professionals from the Multidisciplinary Practice Guidelines Committee of the American Society of Neuroimaging; Cosponsored by the Society of Vascular and Interventional Neurology

The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the screening for asymptomatic carotid artery stenosis in the general population and selected subsets of patients. Recommendations are included for high-risk persons in the general population; patients undergoing open heart surgery including coronary artery bypass surgery; patients with peripheral vascular diseases, abdominal aortic aneurysms, and renal artery stenosis; patients after radiotherapy for head and neck malignancies; patients following carotid endarterectomy, or carotid artery stent placement; patients with retinal ischemic syndromes; patients with syncope, dizziness, vertigo or tinnitus; and patients with a family history of vascular diseases and hyperhomocysteinemia. The recommendations are based on prevalence of disease, anticipated benefit, and concurrent guidelines from other professional organizations in selected populations.

La prevención primaria con aspirina de enfermedades cardiovasculares en personas diabéticas: revisión de las pruebas disponibles

The benefits of aspirin treatment in reducing the risk of myocardial infarction, cerebrovascular accidents and vascular death is well-documented among individuals having prior cardiovascular disease, including the subgroup with diabetes mellitus. The role of aspirin in primary prevention is less clear and debatable: the results of the clinical trials currently available are not consistent, although the meta-analyses are favorable in some aspects. There seems to be a disparity between the type of benefit (when found to exist) and gender, the findings being particularly contradictory for diabetic subjects, totalling a minor percentage of the population sample included in the studies. Despite this fact, in 1997, the American Diabetes Association and more recently other scientific societies (including several Spanish societies) have been recommending the use of aspirin in low doses in primary prevention in all type 1 or type 2 diabetic patients over 40 years of age and in all those within the 21-40 age range having any other cardiovascular risk factor in addition to diabetes (family history of vascular disease, hypertension, smoking, dyslipidemia or albuminuria). This study reviews the findings of the randomized, controlled clinical trials on primary cardiovascular prevention with aspirin, on which the official American Diabetes Association guidelines might be based, the conclusion being reached that there is not currently sufficient scientific evidence to uphold these guidelines.