Lifetime Risk Of Stroke Research Articles

Stroke in Women: A Review Focused on Epidemiology, Risk Factors, and Outcomes.

Stroke is a particularly important issue for women. Women account for over half of all persons who experienced a stroke. The lifetime risk of stroke is higher in women than in men. In addition, women have worse stroke outcomes than men. Several risk factors have a higher association with stroke in women than in men, and women-specific risk factors that men do not have should be considered. This focused review highlights recent findings in stroke epidemiology, risk factors, and outcomes in women.

Awareness of stroke signs, symptoms, and risk factors among Jazan University students: An analytic cross-sectional study from Jazan, Saudi Arabia.

In the Kingdom of Saudi Arabia, the lifetime risk of stroke is estimated to be between 23% and 28.9%, whereas in Jazan region of the Kingdom there is a high prevalence of sickle cell anemia, which is known to increase the risk of stroke. This study aimed to assess awareness of stroke signs, symptoms, and risk factors among university students in the southern region of Saudi Arabia. In this analytical cross-sectional study, data obtained through an online questionnaire were collected from 897 university students. Data were entered, cleaned, and analyzed using SPSS (IBM, Chicago IL) software version 28. Knowledge was assessed using both open- and closed-ended questions (CEQ). The participants were predominantly female (72%), single (86.8%), a fifth had relatives with cerebrovascular accident (CVA), and a third knew a person with CVA. The open-ended questions showed that 11.8% did not know any symptoms or signs and 25% knew only 1, while in the CEQs, hypertension was selected by 83.0%. Regarding knowledge about symptoms and signs, 33.7% and 21.9% recognized weakness and speech disturbance, respectively, whereas in the CEQs, around 60% selected others. Regarding actions that should be taken if CVA is suspected, >80% preferred going directly to the hospital. The best time to seek professional care was considered to be within 4 hours by 47.5%, 10.3% suggested a later timing, and 42.3% had no knowledge of what to do. Multivariate logistic regression revealed that pursuing a health-related specialty and previous stroke experience in close relatives were significantly associated with good stroke knowledge. The level of knowledge and correct timing and action among participants were better than those reported nationally and internationally. However, there is still room for improvement in awareness, which is recommended to improve the outcomes.

Polygenic Risk, Midlife Life's Simple 7, and Lifetime Risk of Stroke.

BackgroundRecent genetic discoveries in stroke have unleashed the potential of using genetic information for risk prediction and health interventions aimed at disease prevention. We sought to estimate the lifetime risk of stroke (LTRS) by levels of genetic risk and to investigate whether optimal cardiovascular health can offset the negative impact of high genetic risk on lifetime risk of stroke.Methods and ResultsStudy participants were 11 568 middle‐aged adults (56% women, 23% Black adults), who were free of stroke at baseline and were followed up for a median of 28 years. The remaining LTRS was estimated according to levels of genetic risk based on a validated stroke polygenic risk score, and to levels of cardiovascular health based on the American Heart Association Life's Simple 7 recommendations. At age 45, individuals with high, intermediate, and low polygenic risk score had a remaining LTRS of 23.2% (95% CI, 20.8%–25.5%), 13.8% (95% CI, 11.7%–15.8%), and 9.6% (95% CI, 7.3%–11.8%), respectively. Those with both a high genetic risk and an inadequate Life's Simple 7 experienced the highest LTRS: 24.8% (95% CI, 22.0%–27.6%). Across all polygenic risk score categories, those with an optimal Life's Simple 7 had a ≈30% to 43% lower LTRS than those with an inadequate Life's Simple 7. This corresponded to almost 6 additional years lived free of stroke.ConclusionsThe LTRS varies by levels of polygenic risk and cardiovascular health. Maintaining an optimal cardiovascular health can partially offset a high genetic risk, emphasizing the importance of modifiable risk factors and illustrating the potential of personalizing genetic risk information to motivate lifestyle changes for stroke prevention.

Abstract TP21: The Role Of Interleukin-1α Cytokine In Poststroke Inflammation

Stroke remains the second leading cause of death globally, with a total of 5.5 million deaths in 2016 and an estimated global lifetime risk of stroke for those aged 25 years or older at 24.9%. A key feature of stroke and poststroke injury is the inflammatory response, which is driven by a variety of pro-inflammatory cytokines to include interleukin-1 (IL-1). Evidence from pre-clinical studies have demonstrated a deleterious effect of IL-1 poststroke with a beneficial effect observed after blocking IL-1 in both pre-clinical and clinical settings. The IL-1 family has both IL-1β and IL-1α forms, and although IL-1β has been most closely studied, the distinct roles of both IL-1 isoforms during poststroke inflammation is largely unknown. In this study, we examined the contribution of IL-1α in ischemic stroke. We characterized the spatio-temporal effect of IL-1 in the brain after stroke using an in vivo model of middle cerebral artery thrombosis in an inducible IL-1α knockout mouse through topical application of FeCl3. We found that IL-1α precedes IL-1β expression after ischemic stroke and is restricted to microglia whereas IL-1β is expressed by both neutrophils and microglia. Intriguingly, microglial IL-1α deletion does not influence brain damage after ischemic stroke, and furthermore does not influence cerebral blood flow or neutrophil infiltration and IL-1β expression up to 24h after ischemic stroke. Pathway analysis following RNAseq suggests that microglial IL-1α regulates neuronal activity through CREB signaling. In vitro studies in Neuro2a (N2a) murine cell line additionally show neuronal activity regulation through CREB signaling via microglial IL-1α after oxygen glucose deprivation and reperfusion (OGD/R) model of stroke. As the role of IL-1α in stroke has yet to be fully elucidated, future experiments using both murine and in vitro models will clarify the role that IL-1α has in the pathogenesis of stroke and its relevance to inflammatory features posttroke, which may lead to future therapeutic insight.

Update of the World Stroke Organization Activities.

Update of the World Stroke Organization Activities.

Stroke Risks in Adult Survivors of Preterm Birth: National Cohort and Cosibling Study

Clinicians will increasingly encounter adult patients who were born preterm and will need to understand their long-term sequelae. Adult survivors of preterm birth have been reported to have increased risks of hypertension and other stroke risk factors. However, their stroke risks have seldom been examined and the findings are discrepant, possibly due to small sample sizes, insufficient follow-up, or survivor bias. We examined whether preterm birth is associated with stroke in a large population-based cohort. A national cohort study was conducted of all 2 140 866 singletons born in Sweden from 1973 to 1994 who survived to age 18 years, who were followed up for first-time stroke through 2015 (maximum age 43 years). Cox regression was used to examine stroke risks associated with gestational age at birth, adjusting for other perinatal and parental factors. Cosibling analyses assessed for potential confounding by shared familial (genetic or environmental) factors. In 28.0 million person-years of follow-up, 4861 (0.2%) people were diagnosed with stroke. At ages 18 to 43 years, the adjusted hazard ratio for stroke associated with preterm birth (<37 weeks) was 1.26 (95% CI, 1.12–1.43; P<0.001), and further stratified was 1.42 (1.11–1.81; P=0.005) for early preterm (22–33 weeks) and 1.22 (1.06–1.40; P=0.004) for late preterm (34–36 weeks), compared with full-term (39–41 weeks). Positive associations were found with both hemorrhagic stroke (early preterm: adjusted hazard ratio, 1.42 [95% CI, 1.04–1.94]; any preterm: 1.15 [0.97–1.35]) and ischemic stroke (early preterm: adjusted hazard ratio, 1.33 [95% CI, 0.87–2.03]; any preterm: 1.31 [1.07–1.60]). These findings were similar in men and women and only partially explained by shared determinants of preterm birth and stroke within families. In this large national cohort, preterm birth was associated with increased risks of both hemorrhagic and ischemic stroke in adulthood. Preterm birth survivors need early preventive evaluation and long-term clinical follow-up to reduce their lifetime risk of stroke.

Development and Validation of a Polygenic Risk Score for Stroke in the Chinese Population.

To construct a polygenic risk score (PRS) for stroke and evaluate its utility in risk stratification and primary prevention for stroke. Using a meta-analytic approach and large genome-wide association results for stroke and stroke-related traits in East Asians, we generated a combined PRS (metaPRS) by incorporating 534 genetic variants in a training set of 2,872 patients with stroke and 2,494 controls. We then validated its association with incident stroke using Cox regression models in large Chinese population-based prospective cohorts comprising 41,006 individuals. During a total of 367,750 person-years (mean follow-up 9.0 years), 1,227 participants developed stroke before age 80 years. Individuals with high polygenic risk had an about 2-fold higher risk of incident stroke compared with those with low polygenic risk (hazard ratio [HR] 1.99, 95% confidence interval [CI] 1.66-2.38), with the lifetime risk of stroke being 25.2% (95% CI 22.5%-27.7%) and 13.6% (95% CI 11.6%-15.5%), respectively. Individuals with both high polygenic risk and family history displayed lifetime risk as high as 41.1% (95% CI 31.4%-49.5%). Individuals with high polygenic risk achieved greater benefits in terms of absolute risk reductions from adherence to ideal fasting blood glucose and total cholesterol than those with low polygenic risk. Maintaining favorable cardiovascular health (CVH) profile could substantially mitigate the increased risk conferred by high polygenic risk to the level of low polygenic risk (from 34.6% to 13.2%). Our metaPRS has great potential for risk stratification of stroke and identification of individuals who may benefit more from maintaining ideal CVH. This study provides Class I evidence that metaPRS is predictive of stroke risk.

Safety of antithrombotic therapy in East Asian patients.

Antithrombotic agents are widely used on the globe for prevention of thrombotic events such as atherothrombotic events and thromboembolic stroke in atrial fibrillation or for prevention and treatment of venous thromboembolism. However, the net clinical benefit of antithrombotic intervention may differ substantially in various sub-population of patients. Here, the authors attempt to address the risk of serious bleeding in East Asian as compared to the other regions of the world. The community-based epidemiological data suggest numerically higher risk of hemorrhage stroke in East Asian as compared to the globe. Importantly, the life-time risk of ischemic stroke in East Asia is higher than that of the globe. Regarding the serious bleeding risk in East Asians with the use of antithrombotic agents, various clinical trials and international registries provided conflicting information. It is hard to draw generalized conclusion, but there are some specific sub-population in East Asian with higher risk of specific serious bleeding events with the use of specific antithrombotic agents such as the risk of intra-cranial bleeding (ICH) with Vitamin K antagonists. Specific characteristics in East Asian such as higher prevalence of lacunar stroke may contribute higher risk of ICH in East Asian, but the detailed mechanism is still to be elucidated. In conclusion, further investigations are necessary to clarify the specific conditions where the risk of serious bleeding events in East Asian patients differ substantially compared to the global. In addition, further understanding of the mechanisms causing the different bleeding response in specific conditions in East Asian is awaited.

Correction to: Lifetime Risk of Stroke and Coronary Heart Disease Deaths According to Blood Pressure Level: EPOCH-JAPAN (Evidence for Cardiovascular Prevention From Observational Cohorts in Japan).

Correction to: Lifetime Risk of Stroke and Coronary Heart Disease Deaths According to Blood Pressure Level: EPOCH-JAPAN (Evidence for Cardiovascular Prevention From Observational Cohorts in Japan).

Googling the Lifetime Risk of Stroke Around the World.

Objective: We aimed to utilize the data on lifetime risk of stroke, from Global Burden of Disease (GBD) 2016, in combination with open data platforms to create an interactive map for use by clinicians and members of the public. Further, we explore the relationship between life expectancy and lifetime risk of stroke.Design: Enhancing visual display of large volume of data.Setting: Worldwide estimates of the lifetime risk of stroke obtained from the GBD 2016.Participants: None.Intervention: None.Methods: Data were extracted from a portable document format (pdf) copy of the GBD article on the lifetime risk of stroke and exported into the R programming environment (version 3.4.4). These data were merged with (i) the world map boundary, (ii) open data platforms from the World Bank (life expectancy and income), and (ii) open data from the United Nation Population Prospects 2017. Further we plotted the relationship between the adjusted lifetime risk of stroke and life expectancy.Outcomes: The map of the global burden of stroke shows a higher lifetime risk of stroke among high-income countries than in low-income countries (https://gntem3.shinyapps.io/strokeglobal/). The greatest risk was among upper-middle-income countries such as China and Eastern and Central European countries such as Latvia and Romania. The lifetime risk of stroke increased in countries with higher life expectancy (β = 0.48 ± 0.047, 95% confidence interval = 0.390–0.574, R2 = 0.38, p < 0.01).Conclusion: Overall life expectancy is a major driver of the lifetime risk of stroke. The interactive map enables clinicians to search information about the lifetime risk of stroke interactively and navigate by zooming in and out, while still retaining high resolution.

Restarting Oral Anticoagulation in Patients With Atrial Fibrillation After an Intracranial Hemorrhage.

Atrial fibrillation is the most common sustained cardiac arrhythmia in the general population. In western countries with aging populations, atrial fibrillation poses a significant health concern, as it is associated with a high risk of thromboembolism, stroke, congestive heart failure, and myocardial infarction. Thrombi are generated in the left atrial appendage, and subsequent embolism into the cerebral circulation is a major cause of ischemic stroke. Therefore, patients have a lifetime risk of stroke, and those at high risk, defined as a CHA2DS2-VASc2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, vascular disease, age 65-74 yrs, sex category) ≥2, are usually placed on oral anticoagulants. Unfortunately, long-term anticoagulation poses bleeding risks, of which intracranial hemorrhage (ICH) is the most feared and deadly complication.In patients who survive an ICH, the question of oral anticoagulation resumption arises. It is a therapeutic dilemma in which clinicians must decide how to manage the risk of thromboembolism versus recurrent hemorrhage. Although there is a substantial amount of retrospective data on the topic of resumption of anticoagulation, there are, at this time, no randomized controlled trials addressing the issue. We therefore sought to address ICH risk and management, summarize high quality existing evidence on restarting oral anticoagulation, and suggest an approach to clinical decision-making.

Lifetime risk of stroke in the general male population.

Most previous studies of incidence rates of stroke are from register studies, while data from prospective cohort studies are limited. The aim of the present study was to describe hazard rates, prevalence and cumulative proportion free from stroke during a lifelong follow-up of a representative sample of middle-aged men sampled from the general population. A population-based sample of 855 men, all born in 1913, was investigated at 50years of age and followed up with repeated medical examinations at age 54, 60, 67, 75 and 80. Data from hospital records and the Cause of Death Register were collected, and all stroke events during 48years of follow-up were registered. Medical records were scrutinized in order to confirm and validate the stroke diagnoses. One man was excluded because of stroke prior to baseline, while 176 of the remaining 854 men (20.7%) suffered a first-ever stroke during follow-up. The total 5-year stroke risk (hazard rate) increased with age, from 3.54 (95% CI: 0-7.55) per 1000 persons at risk at age 50years, to 119.05 (95% CI: 45.39-192.70) at age 90years. The stroke prevalence peaked at age 80 and older, with about 120 cases per 1000years of observation. The survival rate (cumulative proportion free from stroke) at age 98 was 50.0%. One out of five men in this population sample suffered a stroke of any type during follow-up from 50 to 98years of age and the cumulative incidence was close to 50%.

Conceptual framework for establishing the African Stroke Organization.

Africa is the world's most genetically diverse, second largest, and second most populous continent, with over one billion people distributed across 54 countries. With a 23% lifetime risk of stroke, Africa has some of the highest rates of stroke worldwide and many occur in the prime of life with huge economic losses and grave implications for the individual, family, and the society in terms of mental capital, productivity, and socioeconomic progress. Tackling the escalating burden of stroke in Africa requires prioritized, multipronged, and inter-sectoral strategies tailored to the unique African epidemiological, cultural, socioeconomic, and lifestyle landscape. The African Stroke Organization (ASO) is a new pan-African coalition that brings together stroke researchers, clinicians, and other health-care professionals with participation of national and regional stroke societies and stroke support organizations. With a vision to reduce the rapidly increasing burden of stroke in Africa, the ASO has a four-pronged focus on (1) research, (2) capacity building, (3) development of stroke services, and (4) collaboration with all stakeholders. This will be delivered through advocacy, awareness, and empowerment initiatives to bring about people-focused changes in policy, clinical practice, and public education. In the spirit of the African philosophy of Ubuntu "I am because we are," the ASO will harness the power of diversity, inclusiveness, togetherness, and team work to build a strong, enduring, and impactful platform for tackling stroke in Africa.

Abstract TMP52: The Hidden Burden of Ischemic Stroke, Transient Ischemic Attack, and Atrial Fibrillation Hospitalizations Among Elderly Women

Background: US women have a greater lifetime risk of stroke than men. Risk factors such as pregnancy and hormones influence sex differences in stroke at younger ages, but less is known about hospitalization rates and the proportion of hospitalizations for ischemic stroke (IS), transient ischemic attack (TIA), and atrial fibrillation (AF) by sex in different age groups. We assessed IS, TIA, and AF hospitalizations by sex and age. Methods: IS (ICD-9 433, 434, 436), TIA (435), and AF (427.31) hospitalizations were identified in the 2014 National Inpatient Sample (NIS). Hospitalization rates per 100,000 population aged ≥18y were calculated using age- and sex-specific Census population denominators and NIS sampling weights to obtain national estimates. We also determined the proportions of condition-specific hospitalizations by sex. Results: There were 338,654 (49.8% women) patients hospitalized for IS, 90,812 (58.0% women) for TIA, and 284,770 (49.9% women) for AF. For IS, TIA, and AF, respectively, the mean ages for women were 72.7y, 71.4y, and 74.0y vs 68.8y, 69.1y, and 66.2y for men. Hospitalization rates were higher for men than women at most ages for IS and AF; however, AF rates were higher in women beginning with age 80-84y (figure). Women represented a greater proportion of hospitalizations among those aged ≥75y for all 3 conditions (58% of IS, 62.5% of TIA, and 64.7% of AF events). The proportion of women hospitalized for TIA was higher in most age groups, but for IS and AF, the proportions of women exceeded those of men beginning at ages 75-80y and 70-75y, respectively. Conclusion: Women were older when hospitalized for IS, TIA, and AF, and women aged ≥75y comprised the majority of these hospitalizations. This highlights the need for early detection of AF and IS risk in elderly women and underscores the importance of treating modifiable conditions to decrease the burden of vascular illness in women. This is critical given the overrepresentation of women among the very elderly.

Lifetime Risk of Stroke and Coronary Heart Disease Deaths According to Blood Pressure Level: EPOCH-JAPAN (Evidence for Cardiovascular Prevention From Observational Cohorts in Japan)

Lifetime risk (LTR) provides an absolute risk assessment during the remainder of one’s life. Few studies have focused on the LTRs of stroke and coronary heart disease (CHD), categorized by fine blood pressure in Asian populations. We aimed to assess it using a large database of a meta-analysis with the individual participant data. The present metaanalysis included 107 737 Japanese (42.4% men; mean age, 55.1 years) from 13 cohorts. During the mean follow-up of 15.2±5.3 years (1 559 136 person-years), 1922 died from stroke and 913 from CHD. We estimated risks after adjusting for competing risk of death other than the outcome of interest. The 10-year risk of stroke and CHD deaths at index age of 35 years was ≤1.9% and ≤0.3%, respectively. The LTRs of stroke death at the index age of 35 years (men/women) were 6.1%/4.8% for optimal, 5.7%/6.3% for normal, and 6.6%/6.0% for high-normal blood pressure groups, and 9.1%/7.9% for grade 1, 14.5%/10.3% for grade 2, and 14.6%/14.3% for grade 3 hypertension groups. The LTRs of CHD death similarly elevated with an increase in blood pressure but were lower (≤7.2%) than those of stroke death. In conclusion, blood pressure was clearly associated with an elevated LTR of stroke or CHD death, although the LTR of CHD death was one-half of that of stroke death in an Asian population. These results would help young people with hypertension to adopt a healthy lifestyle or start antihypertensive therapy early.

Distinctive chronic health risks in the context of disaster exposure: Findings from a nationally representative population survey

Introduction Exposure to natural and man-made disasters has the potential to lead to a range of acute adverse impacts on human health and well-being and may also exacerbate pre-existing health conditions. Yet, little is known about the impact of such potentially traumatic events on the risk of chronic physical health conditions. This study therefore sought to examine the full spectrum of chronic physical health risks associated with natural and man-made disaster exposure. Methods Data from a nationally representative, cross-sectional Australian population survey (n = 8841) were analysed through multivariate logistic regression analysis. Key survey measures were based on the chronic conditions module of the World Health Organization World Mental Health Composite International Diagnostic Interview (WMH-CIDI). Key outcomes examined included a wide spectrum of lifetime chronic physical health conditions, including national health priority conditions (asthma; cancer; stroke; gout/rheumatism/arthritis; diabetes/high blood sugar levels; heart/circulatory conditions) and other health conditions of six or more months in duration (hay fever; sinusitis; emphysema; bronchitis; anaemia; epilepsy; oedema; hernias; kidney problems; migraine; psoriasis; stomach/gastrointestinal ulcer; thyroid/goiter; tuberculosis; back or neck conditions). Multivariate analyses controlled for sociodemographic variables (age, gender, country of birth, marital status, qualification, labour force status, household location, relative socioeconomic disadvantage), exposure to natural and man-made disasters, and exposure to any other type of potentially traumatic event. Results Natural disaster exposure was primarily associated with an increased lifetime risk of stroke (AOR: 2.06, 95% CI [1.54, 2.74] P Conclusion Notwithstanding limits to causal attribution in cross-sectional survey data, the analysis of nationally representative population data provides a consistent method to explore the national spectrum of chronic physical health risks in the context of disaster exposure. Distinctive patterns of chronic health risks associated with varying types of disaster exposure warrant further investigation. Despite the relatively greater chronic health risks associated with man-made disaster, the national burden of chronic health conditions in Australian natural disaster contexts is particularly high.

Abstract 107: Differential Ischemic Stroke Risk Among Women Veterans Across Age Strata

Background: Ischemic stroke disproportionately affects women. Women have a higher lifetime risk of stroke, experience worse functional recovery post-stroke, and are more likely to be institutionalized after stroke than men. Despite the pronounced differences in which stroke may affect women compared to men, stroke research specifically focusing on women has not been published until recently. For instance, stroke specific guidelines for women were not published until 2014. This study sought to determine whether differences in stroke risk exist between women and men across age strata using the Framingham Stroke Risk (FRS) score in a large cohort of Veterans. Methods: Study participants were Veterans receiving care within Veterans Health Administration facilities between April 2011 and May 2012 (N=57,072). In this secondary analysis, patients were excluded (n=39,978) based on age less than 55 years and prior history of stroke. FRS was calculated for each patient based on race- and sex-specific pooled cohort equations that accounted for age, atrial fibrillation, systolic blood pressure, diabetes mellitus, cigarette smoking, prior cardiovascular disease, and antihypertensive medication use. FRS scores ≥15% were classified as high risk for stroke. SAS Version 9.1 statistical software was used to calculate FRS, perform chi-square analysis, and perform logistic regression analysis. Results: Among 39,978 eligible patients, the mean age (standard deviation [SD]) was 71.6 ± 10.1 years with 1,842 (4.6%) patients within the cohort being women. The mean FRS score for women was 11.29 (± 4.29 SD) and was 14.52 (± 4.37 SD) for men. Risk factors for stroke including age, atrial fibrillation, systolic blood pressure, diabetes mellitus, and antihypertensive use were significant predictors of women’s high 10-year risk of stroke in unadjusted OR unadjusted analyses? ( P =&lt;.0001). When stratified into groups of high 10-year risk of stroke, this study found that nearly half (47.9%) of all Veterans were high-risk for stroke. Women 55-73 years old had a lower risk of future stroke than men of the same age; however, women Veterans 71 years and older had a higher risk of future stroke than similarly aged men ( P &lt;0.001). Conclusions: Nearly half of all women Veterans were found to be at high risk of ischemic stroke within the next 10-years. Furthermore, sex differences were noted across age strata, with women having a lower risk of stroke then men at younger ages and a higher risk at older ages. Given that women tend to have more severe strokes, higher mortality, and delayed diagnosis compared to men, further work is required to understand reasons for the differential stroke risk across sexes. Based on these study findings, implementing primary prevention programs for women Veterans would help to mitigate future ischemic stroke risk.

Diabetes and lifetime risk of stroke and subtypes in an urban middle-aged population

AimsLifetime risk (LTR) is defined as the cumulative probability of developing a disease in one's remaining lifetime from a given index age. The impact of diabetes on the LTR of stroke events in Asians, where stroke incidence is higher than for Westerners, has not been estimated yet. These estimates can be useful for diabetes knowledge translation activities. MethodsAll participants who were stroke-free at baseline in the Suita Study, a cohort study of cardiovascular diseases in Japan, were included in the study sample. Age, in years, was used as the time-scale. Age-specific incidence rates were calculated using the person-years method within five-year bands. We estimated the sex- and index-age-specific LTR of first-ever stroke accounting for the competing risk of death. ResultsIn this cohort study, we followed 5515 participants from 1989 to 2007 for 71,374.23 person-years. At age 40, the LTRs, adjusted for competing risk of death, for all strokes were 15.98% for men without diabetes and 26.64% for men with diabetes. The LTR for stroke was 10.66% higher for men with diabetes than men without diabetes. For women of same index age, the LTR of stroke was 17.29% and 30.72% with diabetes and without diabetes, respectively. The difference in LTR between persons with diabetes and without diabetes was 13.43%. This increased LTR of strokes for persons with diabetes was observed among both men and women across all index ages. Similar results were observed for cerebral infarction stroke subtype. ConclusionsIn this urban community-based population we observed that diabetes has a significant effect on the residual LTR of stroke for both men and women of middle age. This knowledge can be used to inform public health education and planning.

Hypertension and lifetime risk of stroke.

The lifetime risk (LTR) articulates the probability of disease in the residual lifetime for an index age. These estimates can be useful for general audience-targeted knowledge translation activities against hypertension. There are only a few reports on lifetime of impact of hypertension on stroke events in Asians in whom stroke incidence is higher than Westerners. The Suita Study, a cohort study of cardiovascular diseases in Japan, was established in 1989. We included all participants who were stroke free at baseline. Age (in years) was used as the time scale. Age-specific incidence rates were calculated with person-year method within 10-year bands. We estimated the sex and index-age specific LTR of first-ever stroke with taking the competing risk of death into account. We followed 5783 men and women during 1989-2007 for 74 933 person-years. During the follow-up period, 276 (149 men and 127 women) participants had incident stroke. Of them, majority were cerebral infarction; 166 (102 men and 64 women). The LTR of stroke, accounted for competing risk of death, at 45 years of age for men without hypertension was 17.21% and it was 32.79% for hypertensive men. Among the hypertensive patients, participants with stage 2 or greater hypertension had higher LTR of stroke than the participants with stage 1 hypertension. This increased LTR of stroke for hypertensive patients were also observed among women and across all index ages for stroke. In this urban community-based population, we observed that hypertension has significant effect on the residual LTR of stroke among both men and women of middle age, specifically for ischemic stroke.

Atypical Presentation of a Posterior Inferior Cerebellar Artery Stroke Found by Magnetic Resonance Imaging, on a Woman without Prior Known Comorbid on Implantable Contraception: A Case Report

On average, every 40 seconds, someone in the United States has a stroke. Women have a higher lifetime risk of stroke, with 1 in 5 chances during age 55-75; but they have a lower age-adjusted incidence below this age range. Migraines and hormone-releasing contraception are two relevant risk factors that contribute to the development of a stroke in women. We present a case of a 37-year-old Hispanic woman with an implantable hormonal device (Implanon®) that developed a posterior inferior cerebellar artery infarct (PICA), and during evaluation a history of intermittent migraines was noted, which was not previously diagnosed or treated by a medical provider. Clinically, the patient presented with acute vertigo, severe headache and associated neck pain, nausea, vomiting and gait instability. Brain Magnetic Resonance Imaging (MRI) revealed an acute infarct involving the right PICA territory and neck MR angiography demonstrated absent visualization of the posterior inferior cerebellar arteries bilaterally. Historically hormonal contraception has been linked to increase risk of thromboembolic events, in particular when it was associated with high doses of estrogen. The newer hormonal contraception, which now has lower estradiol levels still, has a trend to increase risk of thromboembolic events, although the results from various studies are not that clear. This rationale makes it seem plausible that the answer relies on progestin’s hemostasis effect. The combination of migraines and hormone-releasing contraception in woman <45 years of age, are not well described. We conclude that, although the hormonal implantable device and migraines individually increases the risk for cardiovascular events, their combined risk may be additive and should be considered in the appropriate clinical setting.