Major Risk Factor For Stroke Research Articles

220 RELATIONSHIP BETWEEN HEIGHT AND SYSTOLIC BLOOD PRESSURE IN OLDER ADULTS

Abstract Background Hypertension is common amongst older adults in Ireland and is a major risk factor for both ischaemic and haemorrhagic stroke. Several studies have investigated the relationship between height and hypertension, however results have been inconsistent. In our Irish tertiary hospital patients undergoing tilt table testing have resting blood pressure measured prior to the test, and height recorded. Our aim was to assess whether there is a relationship between height and resting Systolic Blood Pressure (SBP) in patients aged over 60 years. Methods All tilt table test results between 2000 and 2021 in a single centre were reviewed retrospectively, collecting data on age, height and resting SBP. Any incomplete records were excluded, as were those from patients under 60 years old. Linear regression modelling was used to assess relationship between height and resting SBP. Results A total of 4,729 complete records were included for patients over 60 years old. 2630 (61.5%) of the patients were female. Mean age was 77 ± 7.8 years. 57.7% patients had either an elevated resting systolic and/or diastolic BP ≥130/80 and 28.4% ≥140/90. The linear regression model established that while height could be used to predict resting systolic blood pressure (beta=-0.166, 95% CI: –0.219 to –0.113, p<0.001), height only accounted for 0.8% of variability in resting SBP (R2 = 0.008). Conclusion Our large dataset establishes an association but no meaningful causation between height and resting systolic blood pressure. Current antihypertensive treatment was not recorded, which may have affected the results. Future studies will include further multivariate analysis accounting for antihypertensive use and other factors that may impact hypertension such as age, weight and gender.

Integrative Medicine in the Management of Hypertension

Close to half of adults in the United States have hypertension (HTN), a major risk factor for coronary heart disease and stroke. Current guidelines recommend lifestyle change as a primary target in addressing HTN, including initiation of healthy diet and exercise. This review examines the evidence for nutrition and specific dietary factors (such as garlic), exercise, botanical medicines, and nutrients in the management of HTN. Lifestyle interventions and other integrative supports may have a strong impact on blood pressure control.

Temporal Heterogeneity of Short-Term Effects of Particulate Matter on Stroke Outpatients in Seven Major Cities of the Republic of Korea.

Although particulate matter (PM) is a major risk factor for stroke, its effects on hospital outpatients admitted for stroke have not been documented in Korea. In addition, recent studies have reported that the effects of PM10 on circulatory mortality changed over time. We aimed to estimate the effects of PM10 on stroke and their temporal heterogeneity in seven major cities of Korea during the period 2002–2015. The study period was divided into five years of moving time windows, and city-specific PM10 effects on ischemic and hemorrhagic stroke outpatients were calculated. We pooled the estimates using meta-analysis and plotted them into a sequence to identify their temporal trends. A 10 µg/m3 increase of PM10 was significantly associated with increments in hospital outpatients admitted for ischemic stroke (0.24%, 95% CI: 0.04%, 0.44%), but not for hemorrhagic stroke (0.33%, 95% CI: −0.06%, 0.73%). Effect estimates for strokes increased during the period 2003–2013 but decreased after. For the first time, we have estimated the effects of PM10 on hospital outpatients admitted for stroke in Korea. The observed temporal trend in PM10 effects was similar to patterns of circulatory mortality, suggesting that the temporal heterogeneity in PM10 effects might be due to systematic causes rather than random fluctuations.

Fatty Acids and Lipid Paradox-Neuroprotective Biomarkers in Ischemic Stroke.

Stroke is the primary cause of death and disability worldwide, with ischemic stroke up to 80% of the total cases. Lipid profile was established as a major risk factor for stroke, but recent studies show a paradoxical relationship between serum values and the outcome of stroke patients. Our study aims to analyze the impact of the classic extended lipid profile, including fatty acids as potential neuroprotective biomarkers for the outcome of ischemic stroke patients. We included 298 patients and collected clinical, paraclinical, and outcome parameters. We used a method consisting of high-performance liquid chromatography coupled with mass spectrometry to quantify serum fatty acids. We observed a negative correlation between National Institutes of Health Stroke Scale (NIHSS) at admission and total cholesterol (p = 0.040; r = −0.120), respectively triglycerides (p = 0.041; r = −0.122). The eicosapentaenoic to arachidonic acid ratio has a negative correlation, while the docosahexaenoic to eicosapentaenoic acid ratio positively correlates with all the prognostic parameters, showing a potential neuroprotective role for eicosapentaenoic acid in preventing severe ischemic stroke. The impact of the lipid profile paradox and the dependency relationship with the fatty acids represent a significant predictive factor for the functional and disability prognostic of ischemic stroke patients.

Clinical Characteristics and Risk Factors of First-Ever Stroke in Young Adults: A Multicenter, Prospective Cohort Study.

Stroke in young adults has catastrophic consequences and has increased in prevalence, contrary to the trends of most other diseases. This study aimed to determine the major characteristics and risk factors for stroke in younger adults compared with older adults. From the Korean Stroke Cohort for Functioning and Rehabilitation, 10,584 patients with first-ever stroke between August 2012 and March 2015 were enrolled retrospectively and divided into younger (age ≤ 45) and older groups (age > 45). The clinical characteristics and risk factors of stroke were compared between the younger and older groups. The younger group comprised 915 patients (8.6%). The proportion of hemorrhage strokes in the younger group (42.3%) was significantly higher than in the older group (20.0%) (p < 0.001). Obesity, current smoking, and heavy alcohol consumption were significantly more common risk factors in the younger group than in the older group for all stroke types, whereas hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, and coronary heart disease were significantly more frequent in the older group (both p < 0.001). The major risk factors in the younger group may be lifestyle-related. Therefore, increasing awareness of lifestyle-related risk factors may be necessary to prevent stroke in young adults.

Abstract P126: FXR1 Regulates Vascular Smooth Muscle Cell Cytoskeletal Dynamics By Multiple Mechanisms

Introduction: Hypertension is a major risk factor for cardiovascular disease and stroke. Optimally treated hypertensive patients have a 50% greater cardiovascular risk than untreated normotensive subjects, presenting a need for additional targets. Vascular smooth muscle cells (VSMC) play a critical role in vascular contractility and regulation of blood pressure. Fragile X-related protein (FXR1) is a muscle-enhanced RNA binding protein. In addition to containing mRNA binding domains, FXR1 has an agenet-like domain for protein-protein interactions and four WH2 motif domains to mediate actin dynamics. The structure of FXR1 supports its role in post-transcriptional regulation and though largely ignored, cytoskeletal dynamics via potential protein-protein interactions. This study will test the hypothesis that FXR1 regulates vascular contractility by RNA stability and protein interactions. Results: RNA immuno-precipitation sequencing (RIPseq) analysis in human VSMC identified that FXR1 binds to mRNA that participate in VSMC contractility and cytoskeletal reorganization, and FXR1 depletion decreases mRNA abundance and stability of these transcripts. Mass-spectrometry and co-immunoprecipitation identified that FXR1 interacts with members of the WAVE complex, a five-subunit protein complex involved in the formation of the actin cytoskeleton, including CYFIP1 (Cytoplasmic FMR1-interacting protein 1) and Actin Related Protein 2/3 complex (ARP2). The WAVE complex is activated by an ARP2-mediated interaction with Rac1, promoting actin remodeling and cytoskeletal reorganization in a GTP-dependent manner. FXR1 depletion decreases small GTPases RAC1 and CDC42 activation in VSMC. Additionally, FXR1 depletion decreases VSMC lamellipodia formation, adhesion, migration and collagen gel contraction. Novel, VSMC-specific FXR1 conditional knock out mice show decreased diastolic (P &lt; 0.05) blood pressure at baseline compared to controls. Conclusion: These data are the first to suggest that FXR1 regulates mRNA stability of contractile proteins and interacts with members of the WAVE complex. Deletion of FXR1 abrogates VSMC cytoskeletal reorganization, resulting in a hypotensive phenotype in VSMC-specific conditional knockout mice.

In-Stent Restenosis after Carotid Stenting

Carotid artery stenosis is a major risk factor for ischemic stroke. Currently, carotid endarterectomy (CEA) is the surgical treatment of choice for carotid artery stenosis. Carotid artery stenting (CAS) increases the risk of carotid artery stenosis. CAS is one of the treatment options available, particularly for high-risk CEA patients. Although CAS has the advantages of being less invasive, causing less patient discomfort, and requiring a shorter hospital stay, some patients may develop in-stent restenosis (ISR). ISR is closely related to clinical events such as transient ischemic attacks and ischemic stroke recurrence. The author examines the mechanism, influencing factors, and research progress of ISR following CAS, as well as its prevention and treatment, in order to provide clinical insights for clinicians.

The impact of potentially modifiable risk factors for stroke in a middle-income area of China: A case-control study.

AimsTo reveal the impact of eleven risk factors on stroke and provide estimates of the prevention potential.MethodsWe completed a multicenter case-control study in Jiangxi, China, a middle-income area. Neuroimaging examination was performed in all cases. Controls were stroke-free adults recruited from the community in the case concentration area. Conditional logistic regression and unconditional logistic regression were used for subgroup analysis of stroke type, and other groups (sex, age and urban-rural area), respectively. Odds ratios (ORs) and their population attributable risks (PARs) were calculated, with 95% confidence intervals.ResultsA total of 43,615 participants (11,735 cases and 31,880 controls) were recruited from February to September 2018, of whom we enrolled 11,729 case-control pairs. Physical inactivity [PAR 69.5% (66.9–71.9%)] and hypertension [53.4% (49.8–56.8%)] were two major risk factors for stroke, followed by high salt intake [23.9% (20.5–27.3%)], dyslipidemia [20.5% (17.1–24.0%)], meat-based diet [17.5% (14.9–20.4%)], diabetes [7.7% (5.9–9.7%)], cardiac causes [5.3% (4.0–6.7%)], alcohol intake [4.7% (0.2–10.0%)], and high homocysteine [4.3% (1.4–7.4%)]. Nine of these factors were associated with ischemic stroke, and five were associated with intracerebral hemorrhage. Collectively, eleven risk factors accounted for 59.9% of the PAR for all stroke (ischemic stroke: 61.0%; intracerebral hemorrhage: 46.5%), and were consistent across sex (men: 65.5%; women: 62.3%), age (≤55: 65.2%; >55: 63.5%), and urban-rural areas (city: 62.2%; county: 65.7%).ConclusionThe 11 risk factors associated with stroke identified will provide an important reference for evidence-based planning for stroke prevention in middle-income areas. There is an urgent need to improve awareness, management and control of behavioral and metabolic risk factors, particularly to promote physical activity and reduce blood pressure.

Epigenetic and integrative cross-omics analyses of cerebral white matter hyperintensities on MRI.

Cerebral white matter hyperintensities on MRI are markers of cerebral small vessel disease, a major risk factor for dementia and stroke. Despite the successful identification of multiple genetic variants associated with this highly heritable condition, its genetic architecture remains incompletely understood. More specifically, the role of DNA methylation has received little attention. We investigated the association between white matter hyperintensity burden and DNA methylation in blood at ∼450 000 cytosine-phosphate-guanine (CpG) sites in 9732 middle-aged to older adults from 14 community-based studies. Single CpG and region-based association analyses were carried out. Functional annotation and integrative cross-omics analyses were performed to identify novel genes underlying the relationship between DNA methylation and white matter hyperintensities. We identified 12 single CpG and 46 region-based DNA methylation associations with white matter hyperintensity burden. Our top discovery single CpG, cg24202936 (P = 7.6 × 10-8), was associated with F2 expression in blood (P = 6.4 × 10-5) and co-localized with FOLH1 expression in brain (posterior probability = 0.75). Our top differentially methylated regions were in PRMT1 and in CCDC144NL-AS1, which were also represented in single CpG associations (cg17417856 and cg06809326, respectively). Through Mendelian randomization analyses cg06809326 was putatively associated with white matter hyperintensity burden (P = 0.03) and expression of CCDC144NL-AS1 possibly mediated this association. Differentially methylated region analysis, joint epigenetic association analysis and multi-omics co-localization analysis consistently identified a role of DNA methylation near SH3PXD2A, a locus previously identified in genome-wide association studies of white matter hyperintensities. Gene set enrichment analyses revealed functions of the identified DNA methylation loci in the blood-brain barrier and in the immune response. Integrative cross-omics analysis identified 19 key regulatory genes in two networks related to extracellular matrix organization, and lipid and lipoprotein metabolism. A drug-repositioning analysis indicated antihyperlipidaemic agents, more specifically peroxisome proliferator-activated receptor-alpha, as possible target drugs for white matter hyperintensities. Our epigenome-wide association study and integrative cross-omics analyses implicate novel genes influencing white matter hyperintensity burden, which converged on pathways related to the immune response and to a compromised blood-brain barrier possibly due to disrupted cell-cell and cell-extracellular matrix interactions. The results also suggest that antihyperlipidaemic therapy may contribute to lowering risk for white matter hyperintensities possibly through protection against blood-brain barrier disruption.

Hyperglycemia aggravates ischemic brain damage via ERK1/2 activated cell autophagy and mitochondrial fission.

BackgroundHyperglycemia is one of the major risk factors for stroke and stroke recurrence, leading to aggravated neuronal damage after cerebral ischemia/reperfusion (I/R). ERK1/2 signaling pathway plays a vital role in cerebral ischemic injury. However, the role of the ERK1/2 pathway in hyperglycemia-aggravated ischemic brain damage is not clear.MethodsStreptozotocin (STZ; 50 mg/kg)-induced diabetes (blood glucose ≥12 mmol/L) or control groups in adult Sprague-Dawley rats were further subdivided into I/R (carotid artery/vein clamping), I/R + PD98059 (I/R plus ERK1/2 inhibitor), and Sham-operated groups (n = 10 each). Neurobehavioral status (Neurological behavior scores) and the volume of the cerebral infarction (TTC staining); brain mitochondrial potential (JCI ratio test) and cell apoptosis (TUNEL assay); RAS protein expression, phosphorylated/total ERK1/2 and Drp-1 (Dynamic-related protein 1) protein levels (Western blotting); mitochondrial fusion-related proteins mitofusin-1/2 (Mfn1/2), optic atrophy (OPA-1) and mitochondrial fission 1 (Fis1), and autophagy-associated proteins Beclin-1, LC3-I/II and P62 (Western blotting and immunohistochemistry) were analyzed.ResultsThe I/R + PD98059 group demonstrated better neurobehavior on the 1st (p < 0.05) and the 3rd day (p < 0.01) than the I/R group. Compared to the Sham group, cerebral ischemia/reperfusion brought about neuronal damage in the I/R group (p <0.01). However, treatment with PD98059 showed an improved situation with faster recovery of mitochondrial potential and less apoptosis of neuronal cells in the I/R + PD98059 group (p < 0.01). The I/R group had a higher-level expression of RAS and phosphorylated ERK1/2 and Drp-1 than the diabetes mellitus (DM) group (p < 0.01). The PD98059 treated group showed decreased expression of p-ERK1/2, p-Drp-1, Fis1, and Beclin-1, LC3-I/II and P62, but increased Mfn1/2 and OPA-1 than the I/R group (p < 0.01).ConclusionHyperglycemia worsens cerebral ischemia/reperfusion-induced neuronal damage via ERK1/2 activated cell autophagy and mitochondrial fission.

Management of Dyslipidemia after Stroke

Dyslipidemia is a major risk factor for stroke, following hypertension, diabetes, and smoking. Treatment of dyslipidemia is important for the prevention and treatment of various vascular diseases, including stroke, coronary artery disease, and peripheral vascular disease. Statins, ezetimibe, and proprotein convertase subtilisinkexin type 9 (PCSK9) inhibitors have been shown to reduce the risk of stroke and cardiovascular disease in previous studies. When prescribing dyslipidemia drugs for secondary prevention of stroke, the combination, type, and dose of dyslipidemia drugs should be appropriately selected according to the patient's comorbidity and stroke subtype. In the case of statins, highintensity statin administration should be considered, but it is essential to take into account side effects, comorbidities, and individual characteristics of each patient. If the target low density lipoproteincholesterol level is not reached or inappropriate drug dosing due to the side effects of statins, ezetimibe or a PCSK9 inhibitor may be considered. Finally, statin discontinuation due to improper judgment may be detrimental to the patient in the longterm view.

Evaluation of the anti-hyperlipidemic effects of Triphala in high fat diet fed rats

Abstract Background: Hyperlipidemia is one of the major risk factors for coronary heart disease and stroke. Triphala, a polyherbal Ayurvedic formulation made from dried fruits of Haritaki (Terminalia chebula Retz.), Bibhitaki (Terminalia bellirica Roxb.), and Amalaki (Phyllanthus emblica Gaertn.) has been suggested to be useful in mitigating hyperlipidemia. In the Ayurveda texts, depending on the patient’s condition and body type, Triphala is formulated and used in one of the two combination (1:1:1 and 1:2:4 of individual constituents) forms. Aims: The present study aimed at evaluating the efficacy of two combinations (1:1:1 and 1:2:4 of individual constituents) of Triphala against high fat diet induced-hyperlipidemia in rats. Materials and method: Hyperlipidemia was induced in Spraque−Dawley albino rats by feeding them with high fat diet. The animals were concomitantly administered with graded dose of one of the two combination (combination of Haritaki, Bibhitaki, and Amalaki in ratio of 1:1:1 or 1:2:4, respectively) of Triphala (250, 500, or 1000 mg/kg body wt.) or atorvastatin. The animals were sacrificed on day 22 and serum was processed for lipid profile and the liver for lipid peroxidation. The statistical analysis was performed by the mean analysis of variance followed by Dunnet’s test. Results: The results indicated that when compared to placebo group, levels of serum total cholesterol, and triglyceride were significantly lower, while high-density lipoprotein cholesterol increased in both the Triphala combination and atorvastatin groups. Of the two groups of Triphala, the formulation having 1:2:4 ratio was better than the 1:1:1. The group having highest drug dose (1000 mg/kg body wt.) of 1:2:4 formulation was better than atorvastatin in rectifying high fat diet-induced dyslipidemia and the atherogenic index was equal to that of atorvastatin. Conclusions: The results of the study indicate that of the two Triphala formulations, the 1:2:4 ratio was better than the 1:1:1 ratio for anti-hyper-lipidemic effects.

Potential Therapeutic Effect of All-Trans Retinoic Acid on Atherosclerosis.

Atherosclerosis is a major risk factor for myocardial infarction and ischemic stroke, which are the leading cause of death worldwide. All-trans retinoic acid (ATRA) is a natural derivative of essential vitamin A. Numerous studies have shown that ATRA plays an important role in cell proliferation, cell apoptosis, cell differentiation, and embryonic development. All-trans retinoic acid (ATRA) is a ligand of retinoic acid receptors that regulates various biological processes by activating retinoic acid signals. In this paper, the metabolic processes of ATRA were reviewed, with emphasis on the effects of ATRA on inflammatory cells involved in the process of atherosclerosis.

The modifying role of major cardiovascular risk factors in the association between retirement and cardiovascular disease: Results from SHARE Portugal.

Despite the actual demographic trends and the global burden of cardiovascular diseases, there is little knowledge concerning the effects of retirement on this health outcome. We aimed to quantify the associations between retirement, and retirement age, with cardiovascular disease (heart disease and stroke) in the Portuguese population. We used data from the first Portuguese wave of the Survey of Health Ageing and Retirement in Europe. Logistic regression was applied to quantify the associations. The major risk factors for cardiovascular diseases and several features of retirement were considered as possible confounders or effect modifiers. Analysis was restricted to retirees in retirement process (retired for 5 years or less) and not retired because of illness. An opposite direction of the association between retirement and heart disease was observed according to hypertension status, although not significant. Early retirement increased the odds of having a stroke, merely in individuals without heart disease (OR = 8.87; 95% CI 1.63-48.26). On the contrary, in individuals with heart disease, decreased the odds of having a stroke (OR = 0.08; 95% CI 0.01-0.68). Our findings suggest that retirement and retirement age may be beneficial or harmful, respectively, in the presence or absence of major risk factors for heart disease and stroke. We suggest that work-related stress affecting differently workers with and without these risk factors may eventually explain these findings.

Sex Difference in the Associations among Obesity-Related Indices with Incident Hypertension in a Large Taiwanese Population Follow-Up Study.

Hypertension is a major risk factor for stroke, atherosclerosis, and other cardiovascular diseases, and obesity is a major risk factor for hypertension. The aim of this longitudinal study was to investigate sex differences in the correlations among obesity-related indices and incident hypertension in a large Taiwanese cohort. We included 21,466 enrollees in the Taiwan Biobank and followed them for 4 years. Of the 21,466 patients enrolled in this study, 6899 (mean age, 49.6 ± 10.9 years) were male and 14,567 (mean age, 49.7 ± 10.0 years) were female. Data on visceral adiposity index (VAI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), lipid accumulation product (LAP), conicity index (CI), body roundness index (BRI), body mass index (BMI), body adiposity index (BAI), and abdominal volume index (AVI) were collected and analyzed. The results showed that all of the studied obesity-related indices were significantly associated with incident hypertension. Among them, WHtR was the strongest predictor of hypertension in both sexes. In addition, interactions between VAI, LAP, CI, BMI, and AVI with sex on incident hypertension were also statistically significant. CI and AVI were more strongly associated with hypertension in the men than in the women, while VAI, LAP, and BMI were more strongly associated with hypertension in the women. In conclusion, the studied obesity-related indices were found to be predictors of incident hypertension, and there were differences in the associations between the male and female participants. Our findings may imply that reducing body weight may be associated with a lower risk of developing hypertension.

Decoding the PITX2-controlled genetic network in atrial fibrillation.

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia and a major risk factor for stroke, often arises through ectopic electrical impulses derived from the pulmonary veins (PVs). Sequence variants in enhancers controlling expression of the transcription factor PITX2, which is expressed in the cardiomyocytes (CMs) of the PV and left atrium (LA), have been implicated in AF predisposition. Single nuclei multiomic profiling of RNA and analysis of chromatin accessibility combined with spectral clustering uncovered distinct PV- and LA-enriched CM cell states. Pitx2-mutant PV and LA CMs exhibited gene expression changes consistent with cardiac dysfunction through cell type–distinct, PITX2-directed, cis-regulatory grammars controlling target gene expression. The perturbed network targets in each CM were enriched in distinct human AF predisposition genes, suggesting combinatorial risk for AF genesis. Our data further reveal that PV and LA Pitx2-mutant CMs signal to endothelial and endocardial cells through BMP10 signaling with pathogenic potential. This work provides a multiomic framework for interrogating the basis of AF predisposition in the PVs of humans.

TRENDS IN ANTIHYPERTENSIVE MEDICATION USE AFTER ISCHEMIC STROKE (1999–2020)

Objective: Hypertension (HT) is a major risk factor for stroke. The guidelines for the management of HT in stroke patients have been updated periodically and changed. We aimed to examine trends in antihypertensive medications use after ischemic stroke Design and method: Retrospective study on ischemic stroke patients discharged from 3 tertiary general hospitals, during the periods: 1999–2001, 2014–16 and 2019–2020. Data analysis was performed using SPSS statistical software (IBM SPSS Statistics 24; Chicago, IL, USA). Results: We included 1,806 patients, 753 (41.6%) women, mean age 69.7 (± 10) years. Comparing the periods, the patients are now older (68.7–69.9–71.3; p = 0.003) and have a higher frequency of HT (67.3% vs. 73.8% vs. 75.4%; p = 0.0001). HT was the most prevalent vascular risk factor in all periods. At discharge, more antihypertensive drugs were used progressively (in 56.4% vs 69.1% vs 84.7% of patients; p = 0.0001). There was a clear increase in the number of antihypertensive drugs used (mean 0.94 ± 0.8 vs 1.6 ± 1.05 vs 2.1 ± 0.5 drugs; p = 0.0001). Use of diuretics (14%-41.1%-63.8%; p = 0.0001), angiotensin-converting enzyme inhibitors (37.1%-43.8%-54%; p = 0.0001), and angiotensin receptor blockers (12.3%-24.3%-31.1%; p = 0.0001) increased progressively. On the contrary, use of calcium antagonists decreased (25%-22.5%-15.1%; p = 0.0001) Conclusions: The last 20 years has seen a significant increase in antihypertension medication use after ischemic stroke. At present, antihypertensive drugs are one of the most important medications in these patients.

Maternal Dietary Choline Deficiencies Reduce Cerebral Blood Flow in Three-Month-Old Female Mouse Offspring Following Ischemic Stroke to the Sensorimotor Cortex

ObjectivesA maternal diet that provides adequate nutrition during pregnancy and lactation is vital to the neurodevelopment of offspring. Deficiencies in nutrients during fetal growth can lead to altered early life nutritional programming such as spina bifida, a neural tube defect. One-carbon metabolism plays a vital role in the closure of the neural tube of the developing embryo; however, the impact of maternal dietary deficiencies on offspring neurological function later in life remains relatively unknown. Stroke is one of the leading causes of death globally, and its prevalence is expected to increase in younger age groups as the incidence of various risk factors for stroke increases. Furthermore, dietary deficiencies in one-carbon metabolism are a major risk factor for ischemic stroke. The aim of our study was to determine the impact of maternal nutritional deficiencies on cerebral and peripheral blood flow after ischemic stroke in adult offspring. MethodsAdult female C57BL/6J mice were placed on either control (CD), choline (ChDD) or folic acid (FD) deficient diets for four weeks to deplete stores prior to mating. Females were maintained on the assigned diet during pregnancy and lactation. Offspring were weaned onto a control diet. Ischemic stroke was induced in the sensorimotor cortex of 2-month-old female (n = 18) offspring using the photothrombosis model. Four weeks after induction of stroke, peak velocity measurements were taken using Pulse Wave Doppler tracing of the posterior cerebral artery. The data was analyzed by 2 individuals blinded to experimental groups and statistical analysis involved conducting a one-way ANOVA followed by Tukey’s pairwise comparison for any significant main effects. ResultsFemale offspring from ChDD mothers had reduced blood flow in the posterior cerebral artery compared to CD mice. We did not observe any changes in offspring from FD dams. ConclusionsThe findings of our study suggest that a maternal diet deficient in choline results in reduced blood flow in female offspring after ischemic stroke. This result points to the important role of the maternal diet in early life programming, while emphasizing its effects on both fetal development and long-term cerebrovascular health. Additional studies are currently underway to measure blood flow in males and analyze peripheral blood flow in all offspring. Funding SourcesAHA and NIH.

708-P: Hypertension Control among People with Diabetes Using a Self-Management Multicondition Digital Platform

Introduction: Digital multicondition platforms seek to assist persons with diabetes in management of their diabetes and comorbidities. Hypertension is reported in over two-thirds of patients with type 2 diabetes. Both are major risk factors for cardiac, stroke, and kidney disorders. Dario’s digital therapeutics platform for chronic conditions supports self-management of diabetes and high blood pressure. The platform enables digital evaluation of blood glucose and blood pressure levels in real time and supports interventions based on clinical indicators. Method: A retrospective data evaluation was performed on the Dario data base since 2019. A population of active users who started with hypertension stage 1 as baseline was identified. Blood glucose and blood pressure readings were assessed at first month and 6th month of use. A subgroup of users who started at hypertension stage 2 was evaluated as well. Systolic, diastolic pressures and average blood glucose were evaluated along of the study. Results: For the 2554 users identified with diabetes and hypertension, more than two thirds improved their systolic blood pressure by 13 mmHg (P&amp;lt;0.001; 144±14 to 131±13) . A group of 38.7% (N=990) moved to a lower hypertensive stage (P&amp;lt;0.001) . The subset of 1367 users with stage 2 hypertension improved their systolic blood pressure from 150±12.4 to 141±15.2 mmHg on average and 43.9% (N=600) improved their blood pressure by more than mmHg over six months (P&amp;lt;0.001) . A subgroup of 3users who started at high-risk blood glucose levels significantly reduced their blood glucose average by 15% over 6 months (232.4±46 to 198±65 mg/dL) (P&amp;lt;0.001) . Conclusion: A multicondition digital therapeutic platform may promote behavioral modifications and result in sustainable improvements in both glycemic control and blood pressure levels. The study demonstrates an improvement in multiple chronic conditions (diabetes and Hypertension) for people using one digital platform. Disclosure Y.Hershcovitz: None. M.Tamir: None. O.Manejwala: Employee; DarioHealth Corp., Stock/Shareholder; DarioHealth Corp.

Stroke in Maputo central hospital, Mozambique: a cross-sectional study 2014–18

Objective: Stroke is the second leading cause of death worldwide. The prevalence of hypertension (the major risk factor for stroke) in Mozambique increased from 33.1% in 2005 to 38.9% in 2014/2015, although awareness and control remained at very low levels (15% and 3%, respectively). The aim of this study is to characterize the demographic and clinical pattern of stroke in Maputo Central Hospital (MCH), Mozambique. Methods: A cross-sectional hospital-based study was carried out in MCH, collecting secondary data from hospitalized patients with stroke. Using systematic probabilistic sampling, clinical records were used to analyze data for the period 2014-18. Results: Of the 402 clinical records, 53.5% were female. The mean age was 60.68 years (13.98 SD). Around 96% was an acute stroke event, and 91% was first-ever episode. Thirty one percent did not receive a CT scan for confirmation. Of the 247 CT scanned patients, 50.2% were ischemic. The area of middle cerebral artery was affected in 83.4% patients. The most common co-morbidity was hypertension (87.1%). Near 96% of hemorrhagic stroke were associated with hypertension (Ischemic = 78.7%, p &lt; 0.001). The overall case-fatality was 22.9%. Confirmed hemorrhagic stroke patients were 6.47 years younger than ischemic (56.40 vs 62.87 years; p &lt; 0.001). Younger ages and female were associated with clinical improvement (aOR = 0.964; p = 0.002 and aOR = 1.890; p = 0.044, respectively). Hemorrhagic stroke were 56.8 percent points more likely associated with death (aOR = 0.432; p = 0.010). The likelihood of clinical improvement was 20.5 percent points better over the years (aOR = 1.205; p = 0.086) Conclusions: Stroke associated with hypertension is common in MCH, mostly likely due to an increase in hypertension prevalence and extremely low awareness and control. Favorable clinical outcome improved over the years. Efforts for CT scan to all stroke episodes should be emphasized by MCH managers.