Levels Of Vascular Risk Factors Research Articles

Peripheral blood CD19 positive B lymphocytes increase after ischemic stroke and correlate with carotid atherosclerosis.

Atherosclerosis is the primary pathological basis of ischemic stroke, and dyslipidemia is one of its major etiological factors. Acute ischemic stroke patients exhibit imbalances in lymphocyte subpopulations, yet the correlation between these dynamic changes in lymphocyte subpopulations and lipid metabolism disorders, as well as carotid atherosclerosis in stroke patients remains poorly understood. We retrospectively analyzed the demographic data, risk factors of cerebrovascular disease, laboratory examination (lymphocyte subsets, lipid indexes, etc.), clinical features and c;/]-sity from December 2017 to September 2019 and non-stroke patients with dizziness/vertigo during the same period. The results showed that peripheral B lymphocyte proportions are elevated in acute ischemic stroke patients compared with those of the control group (13.6 ± 5.3 vs. 11.7 ± 4.4%, p = 0.006). Higher B lymphocyte proportions are associated with concurrent dyslipidemia, increased levels of vascular risk factors including triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and very-low-density lipoprotein cholesterol (VLDL-C), as well as decreased levels of the protective factor high-density lipoprotein cholesterol (HDL-C). Elevated B lymphocyte proportions are independently correlated with carotid atherosclerosis in stroke patients. We found CD19 positive B Lymphocytes increase after ischemic stroke and correlate with Carotid Atherosclerosis. Lymphocyte subpopulations should be highlighted in stroke patients.

Increased vascular risk factors, atherosclerosis, and psychological distress among Indian adults with refractory epilepsy in comparison to well-controlled epilepsy

ObjectiveComparison of cardiovascular risk factors, atherosclerosis, and psychological distress among adults with refractory versus well-controlled epilepsy. MethodsThe cross-sectional study consisted of two groups of 40 people each: Group I – People with well-controlled epilepsy, Group II – People with refractory epilepsy. Age- and gender-matched people of 20–50 years were recruited. People who were diabetic, smokers, hypertensive, alcoholic, pregnant, with infections, and lactating women were excluded from the study. Biochemical parameters, fasting glucose, lipid profile, fasting insulin, leptin, adiponectin, Lp[a], hsCRP, TyG INDEX, HOMA1-%S, HOMA1-IR, HOMA1-%B, QUICKI, FIRI, AIP, AC, CLTI, MLTI, CRI-I, CRI-II, and CIMT were estimated. Stress levels [PSS-10, GAD-7 & PHQ-9] were assessed based on the scoring system from the questionnaires. ResultsThe existence of metabolic syndrome, levels of triglycerides, TyG index, MDA, OSI, CIMT, AIP, and stress scores [PSS-10, GAD-7 & PHQ-9] were significantly higher in the refractory-epilepsy group in comparison to the well-controlled group. There were associations between LDL -C and CIMT as well as between GAD-7 and CIMT among all the study subjects. There were no significant differences in the levels of glucose homeostasis parameters, hsCRP, leptin, adiponectin, and Lp[a] between the two groups. Based on the ROC analysis, MDA [AUC = 0.853] and GAD-7 [AUC = 0.900] are useful in the differential diagnosis of the study groups. ConclusionPeople with refractory epilepsy had increased levels of vascular risk factors, atherosclerosis, and stress levels compared to people with well-controlled epilepsy. Suitable disease management and therapeutic approaches to address cardiovascular and psychological distress could be planned out among people with refractory epilepsy to improve their quality of life.

Late life vascular risk factors and their association with dementia and Alzheimer’s disease

Background : Epidemiological studies have demonstrated associations between higher levels of vascular risk factors in midlife and later development of dementia, particularly Alzheimer's disease (AD). However, in elderly subjects with dementia, some studies have shown that these associations may decrease or even reverse. Therefore , our study aimed to find the association between late life cardiovascular risk factors and neurodegenerative dementia in general and AD in particular. Methods :It is a retrospective case control study using electronic medical records that included elderly patients that were reviewed in Ahmadi hospital geriatric clinic , Kuwait , from the period of 1/7/2019 to 1/2/2020. Two hundred and three (203) elderly patients with neurodegenerative dementia (study group) were recruited for this retrospective study and compared to two hundred and one (201) controls with normal cognition for the presence of vascular risk factors.Results :The study included 404 subjects .Age ranged from 60 to 107 years (mean age 78.79, ± 8.13 SD). AD was found to be the most prevalent type of dementia in the study group , as 49.3 % (100/203) of the demented patients were diagnosed with AD. No significant statistical association was found between vascular risk factors and dementia (P>0.05) , except for obesity which showed negative association (P<0.001). Regarding AD , no statistical significance was found between AD and diabetes, hyperlipidemia, smoking nor atrial fibrillation. On the other hand, we found obesity and hypertension more prevalent in the normal cognition group (negative association with P value <0.001,0.05 respectively). Conclusion : The results of our study support an emerging concept that, while elevated levels of vascular risk factors in midlife increase the risk of development of dementia and AD later in life, once dementia begins , these associations may be diminished or reversed in the elderly

Assessing the role of vascular risk factors in dementia: Mendelian randomization meta-analysis and comparison with observational estimates

Background: Although observational studies demonstrate that higher levels of vascular risk factors are associated with an increased risk of dementia, these associations might be explained by confounding or other biases. Mendelian randomization (MR) uses genetic instruments to test causal relationships in observational data. We sought to determine if genetically predicted modifiable risk factors (type 2 diabetes mellitus, low density lipoprotein cholesterol, high density lipoprotein cholesterol, total cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, body mass index, and circulating glucose) are associated with dementia by meta-analysing published MR studies. Secondary objectives were to identify heterogeneity in effect estimates across primary MR studies and to compare meta-analysis results with observational studies. Methods: MR studies were identified by systematic search of Web of Science, OVID and Scopus. We selected primary MR studies investigating the modifiable risk factors of interest. Only one study from each cohort per risk factor was included. A quality assessment tool was developed to primarily assess the three assumptions of MR for each MR study. Data were extracted on study characteristics, exposure and outcome, effect estimates per unit increase, and measures of variation. Effect estimates were pooled to generate an overall estimate, I2 and Cochrane Q values using fixed-effect model. Results: We screened 5211 studies and included 12 primary MR studies after applying inclusion and exclusion criteria. Higher genetically predicted body mass index was associated with a higher odds of dementia (OR 1.03 [1.01, 1.05] per 5 kg/m2 increase, one study, p=0.00285). Fewer hypothesized vascular risk factors were supported by estimates from MR studies than estimates from meta-analyses of observational studies. Conclusion: Genetically predicted body mass index was associated with an increase in risk of dementia.

A-56 Mild Cognitive Impairment in a Patient with a History of COVID-19 Positivity and co-Morbid Cerebrovascular Disease

Abstract Objective Neurocognitive complaints have been observed in severe cases of post-COVID-19 diagnosis. However, limited information exists regarding specific neurocognitive deficits of patients reporting mild infection symptoms and persistent memory problems after infection. We report on a patient referred for worsening memory complaints 7-months after testing positive. Method Patient was a 74-year-old Caucasian female with a history of COVID-19. Relevant history was significant for sleep apnea, pulmonary embolism, hypertension, hyperlipidemia, and type-2 diabetes. Imaging pre-infection revealed mild cerebrovascular disease. Patient underwent a tele-neuropsychological evaluation to assess the extent of cognitive difficulties. Results Results indicated prominent difficulties were in the domains of immediate and delayed memory and executive functioning. Patient denied anxiety and depression on self-report measures, however, collateral information suggested she experienced a substantial increase in psychiatric symptoms following COVID-19. Activities of daily living (ADLs) were preserved, but she required increased assistance with complex ADLs. Post-infection cerebrovascular disease on imaging was documented as unchanged. Conclusions Although specific cognitive impairments were noted, discernment of direct residual effects of COVID-19 is limited in cases without a pre-COVID-19 neurocognitive baseline and with pre-existing conditions affecting the brain, such as cerebrovascular disease. This case illustrates the rising conundrum of clinical cases with stable underlying medical conditions but presence of cognitive deficits post-infection. Caution is needed to avoid over-interpretation of cognitive test results and necessity for a thorough clinical history that includes duration and clinical characteristics of COVID-19. Future research is needed on larger group studies comparing pre and post-COVID-19 neurocognitive results of patients with varying levels of vascular risk factors.

Vascular risk and Aβ interact to reduce cortical thickness in AD vulnerable brain regions.

The objective of this study was to define whether vascular risk factors interact with β-amyloid (Aβ) in producing changes in brain structure that could underlie the increased risk of Alzheimer disease (AD). Sixty-six cognitively normal and mildly impaired older individuals with a wide range of vascular risk factors were included in this study. The presence of Aβ was assessed using [(11)C]Pittsburgh compound B-PET imaging, and cortical thickness was measured using 3-tesla MRI. Vascular risk was measured with the Framingham Coronary Risk Profile Index. Individuals with high levels of vascular risk factors have thinner frontotemporal cortex independent of Aβ. These frontotemporal regions are also affected in individuals with Aβ deposition, but the latter show additional thinning in parietal cortices. Aβ and vascular risk were found to interact in posterior (especially in parietal) brain regions, where Aβ has its greatest effect. In this way, the negative effect of Aβ in posterior regions is increased by the presence of vascular risk. Aβ and vascular risk interact to enhance cortical thinning in posterior brain regions that are particularly vulnerable to AD. These findings give insight concerning the mechanisms whereby vascular risk increases the likelihood of developing AD and supports the therapeutic intervention of controlling vascular risk for the prevention of AD.

Plasminogen activator inhibitor-1 and HbA1c defined prediabetes: the Guangzhou Biobank Cohort Study-CVD

To examine the association between plasminogen activator inhibitor-1 (PAI-1) and diabetes status. One thousand three hundred and ninety-three older Chinese were randomly selected from the Guangzhou Biobank Cohort Study. Diabetes status was classified as impaired HbA1c (IA1c) level of 5·7-6·4%, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or diabetes using the American Diabetes Association diagnosis criteria in 2010. Compared to the normoglycemic (NG) group, 421 subjects with IA1c, but without diabetes, IFG or IGT, had adverse levels of vascular risk factors, including PAI-1, lipid profile, blood pressure and anthropometry. After adjusting for multiple potential confounders, compared to the NG group, the level of plasma PAI-1 was independently and significantly increased in the IA1c and the IFG/IGT group (mean difference: 32·0 (95% confidence interval: 5·5-58·6) ng/ml and 33·3 (6·3-60·3) ng/ml, respectively; P<0·01). Plasma PAI-1 level was increased in people with haemoglobin A1c (HbA1c) of 5·7-6·4% but without IFG or IGT, and in people with IFG/IGT, suggesting an increased risk for future diabetes and cardiovascular diseases in these groups.

Ten-year time course of risk factors for increased carotid intima–media thickness: the Hoorn Study

Carotid artery intima-media thickness (IMT) is a measure of atherosclerosis. Levels of vascular risk factors that are associated with increased IMT change over time. This study aimed to examine the time course of vascular risk factors in older persons with 'high' versus 'low' IMT over a 10-year period. The Hoorn Study is a population-based cohort study on glucose metabolism and vascular disease initiated in 1989. Carotid IMT was assessed in 2000-2001 (n = 581) and in 2005-2007 (n = 261). The time course of vascular risk factors from 1989 to 2000-2001 of the group with the highest tertile of IMT in 2000-2001 was compared with the group with the lowest tertile of IMT with linear mixed models, adjusted for age, sex, and medication use. A similar analysis was performed for change in IMT between the 2000-2001 and 2005-2007 examinations. Persons in the highest tertile of IMT at follow-up (2000-2001) had a higher waist circumference, BMI, systolic blood pressure, and higher total cholesterol, low-density lipoprotein cholesterol, triglycerides, fasting glucose and glycated haemoglobin levels at baseline (1989) than persons in the lowest tertile. Both groups showed a similar increase in weight, blood pressure and glucose levels over time, but persons in the highest tertile of IMT showed a greater decrease in lipid levels. None of the risk factors were associated with change in IMT over 5 years. Persons with increased carotid IMT had an unfavourable risk factor profile throughout the preceding decade. This provides a window of opportunity for early prevention of atherosclerosis.

Vascular Risk Factors and Cognitive Functions in Nondemented Elderly Individuals

The brain-at-risk stage is the earliest phase of the vascular cognitive impairment continuum and includes individuals with vascular risk factors (VRF). However, there is still no clear definition of this concept. The aim of the study is to characterize the neuropsychological profile of elderly individuals by 3 levels of VRF. This is a cross-sectional analysis of the Canadian Study of Health and Aging baseline data; 577 nondemented elderly individuals > or =65 years old were divided into 3 groups: reference group (0 VRF; n = 82); intermediate brain-at-risk group (1-2 VRF; n = 360); high brain-at-risk group (> or =3 VRF; n = 135). A principal component analysis (PCA) and univariate/multivariate analyses of variance were performed to examine the relationships between the groups and various cognitive measures. The PCA produced a 2-component solution (1) executive/psychomotor functions including measures of abstraction and (2) verbal memory. The high brain-at-risk group performed significantly worse than the reference group on the first component. Elderly individuals presenting with > or =3 VRF are more impaired on measures of executive functions/ processing speed than participants without any VRF.

Migraine aura or transient ischemic attacks? A five-year follow-up case-control study of women with transient central nervous system disorders in pregnancy

BackgroundMigraine aura may be difficult to differentiate from transient ischemic attacks and other transient neurological disorders in pregnant women. The aims of the present study were to investigate and diagnose all pregnant women with transient neurological disorders of suspected central nervous system origin, and to compare this group with a control group of pregnant women with regard to vascular risk factors and prognosis.MethodsDuring a 28 month period, 41 patients were detected with transient neurological symptoms during pregnancy. These were studied in detail with thorough clinical and laboratory investigations in order to make a certain diagnosis and to evaluate whether the episodes might be of a vascular nature. For comparison, the same investigations were performed in 41 pregnant controls. To assess the prognosis, both patients and controls were followed with questionnaires every year for five years.ResultsMigraine with aura was the most common cause of symptoms during pregnancy, occurring in 34 patients, while 2 were diagnosed with stroke, 2 with carpal tunnel syndrome, 1 with partial epilepsy, 1 with multiple sclerosis and 1 with presyncope. Patients had more headache before pregnancy than controls, but the average levels of vascular risk factors were similar. None of the patients or the controls reported cerebrovascular episodes during the five-year follow-up.ConclusionThe diagnosis of migraine aura was difficult because for many patients it was their first ever attack and headache tended to be absent or of non-migraineous type. The aura features were more complex, with several aura symptoms and a higher prevalence of sensory and dysphasic aura than usual. Gradually developing aura symptoms, or different aura symptoms occurring in succession as described in the International Classification of Headache Disorders, seem to be useful for differentiating aura from other transient disorders. A meticulous history and clinical neurological examination are more useful than routine supplementary investigations for cerebrovascular disease. The five-year follow-up clearly indicates that migraine with aura in pregnancy usually has a good prognosis with regard to cerebrovascular events.

My health: whose responsibility? Low-dose aspirin and older people

The benefit of aspirin as a prophylactic after a thrombotic event was first observed 30 years ago. Its use after coronary or cerebral thrombosis, and in patients judged to be at increased risk of a thrombotic event, is now virtually mandatory, unless there are signs of intolerance. The present policy in the UK for cardiovascular protection by low-dose aspirin is dependent upon the identification of people at high vascular risk. The policy has had only very limited success, partly owing to the fact that only a relatively small proportion of people with levels of vascular risk factors that would justify aspirin prophylaxis are identified. In fact, it has been demonstrated that the application of accepted guidelines for aspirin prophylaxis to risk factor data in representative UK population samples gives a cost-effective evidence-base for a reasonable extension of prophylaxis to all people aged over approximately 50 years. It is possible that reductions in both dementia and cancer incidence could also follow the wider use of low-dose aspirin but further research on these outcomes is urgently required. The evidence on possible benefits and harm from low-dose aspirin should therefore be publicized widely, and everything possible should be done to stimulate discussion involving the general public. In the end, however, the preservation of health is one’s own responsibility and, therefore, people should generally be encouraged to evaluate the evidence on health-promotion measures, including low-dose aspirin, and take responsibility for their own health.

Albuminuria is a marker of increasing intracranial and extracranial vascular involvement in Type 2 diabetic Chinese patients.

Albuminuria has been reported to be a marker of cardiovascular risk factors and disease morbidity and mortality, but its relationship with intracerebral atherosclerotic disease is less clear. The aim of this study was to investigate the association between albuminuria and intracranial and extracranial vascular involvement in Chinese Type 2 diabetic patients. The anthropometric and fasting biochemical measurements of 966 Type 2 diabetic patients with normoalbuminuria (55.6%), microalbuminuria (27.7%) or macroalbuminuria (16.7%) were compared. The prevalence of microvascular and macrovascular disease and middle cerebral artery (MCA) stenosis, measured by transcranial Doppler ultrasound, were also compared between the groups. Albuminuria was closely associated with a range of adverse parameters, including high BP, dyslipidaemia, smoking and adiposity (all p<0.01). The prevalence of microvascular disease (retinopathy p<0.001) and macrovascular disease (peripheral vascular disease p=0.012, myocardial infarction, p=0.004, MCA stenosis p<0.001) increased significantly with increasing levels of albuminuria. Albuminuria was also found to be an independent predictor of microvascular and macrovascular disease. Albuminuria was an independent predictor of increasing levels of vascular risk factors and microvascular and macrovascular disease in this group of Type 2 diabetic patients, and a possible role for albuminuria as a marker of intracranial cerebrovascular disease should be further investigated.

Rapid ELISA for detecting Epstein-Barr virus infection.

<h3>Abstract</h3> <h3>Importance</h3> Although observational studies demonstrate that higher levels of vascular risk factors are associated with an increased risk of dementia, these associations might be explained by confounding or other biases. Mendelian randomization (MR) uses genetic instruments to test causal relationships in observational data. <h3>Objective</h3> To determine if genetically predicted modifiable risk factors (type 2 diabetes mellitus, low density lipoprotein cholesterol, high density lipoprotein cholesterol, total cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, body mass index, and circulating glucose) are associated with dementia by meta-analysing published MR studies. Secondary objectives were to identify heterogeneity in effect estimates across primary MR studies and to compare meta-analysis results with observational studies. <h3>Data sources</h3> MR studies identified by systematic search of Web of Science, OVID and Scopus. <h3>Study selection</h3> Primary MR studies investigating the modifiable risk factors of interest. Only one study from each cohort per risk factor was included. A quality assessment tool was developed to primarily assess the three assumptions of MR for each MR study. <h3>Data extraction and synthesis</h3> Data were extracted on study characteristics, exposure and outcome, effect estimates per unit increase, and measures of variation. Effect estimates were pooled to generate an overall estimate, I² and Cochrane Q values using fixed-effect model. <h3>Main outcomes and measures</h3> Odds ratio (OR) of developing dementia per standardized unit increase in the risk factor of interest. <h3>Results</h3> We screened 5211 studies and included 12 primary MR studies after applying inclusion and exclusion criteria. Higher genetically predicted body mass index was associated with a higher odds of dementia (OR 1.03 [1.01, 1.05] per 5 kg/m² increase, one study, p = 0.00285). Overall estimates from MR studies showed a smaller number of associations than those from meta-analyses of observational studies. <h3>Conclusion and relevance</h3> Genetically predicted body mass index was associated with an increase in risk of dementia. <h3>Key points</h3> <h3>Question</h3> Are genetically predicted modifiable risk factors associated with dementia? <h3>Findings</h3> Genetically predicted higher body mass index was associated with a higher odds of dementia. No evidence was found to support an association between genetically predicted type 2 diabetes mellitus, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, total cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, plasma glucose and dementia risk. <h3>Meaning</h3> Many modifiable risk factors associated with dementia in observational studies may not play a causative role.

Multiple sclerosis in Asia.

Cases of multiple sclerosis were collected by Asian neurologists from recognized medical centers, using standardized formats similar to those used for the Japan nationwide multiple sclerosis survey. As a result, information on a total of 61 cases was collected from six neurologic centers in five Asian countries excluding Japan. Multiple sclerosis appears to be a rare disease throughout Asia. Certain clinical characteristics that had been previously noted in Japanese and other individual Asian series were again observed in the present Asian series. When compared with Western multiple sclerosis, the Asian multiple sclerosis cases showed a relatively higher frequency of optic nerve involvement, frequently bilateral and severe, at the onset, as well as during the course of illness, and no rare occurrence of Devic's syndrome.