Major Risk Factor For Stroke Research Articles

Abstract WMP68: Machine Learning Approach In Prediction Of Nasoenteral Tube In Acute Ischemic Stroke

Introduction: Dysphagia occurs in about 20 to 50% of acute stroke patients, and it may persist longer than six months after stroke. Nasoenteral tube feeding (NTF) must be judiciously prescribed to avoid dysphagia complications and, at the same time, prevent its unnecessary usage, which is not free of adverse events. Objective: Our aim was to state independent predictive factors associated with dysphagia and nasoenteral tube feeding. Besides, we aimed to develop a prediction model for nasoenteral tube feeding through a machine learning modeling approach. Methods: This is a prospective cohort study. All consecutive ischemic acute stroke patients were included. All patients had phonoaudiological evaluation for dysphagia screening. Data analyzed included age, sex, Glasgow Coma Scale, NIHSS, Aspects score, Seattle comorbid index, Rankin scale at discharge, TOAST classification for stroke subtypes, presence of major stroke risk factors and data from CT scan of patients. Results: We studied 1101 acute stroke patients. Twenty-eight percent of stroke patients received NTF. They were older (p<0.001), had a more severe stroke (p<0.001), and presented consciousness disturbance and dysarthria more frequently (p<0.001 for both measures). These findings independently predicted nasoenteral tube feeding in acute stroke. The decision tree model disclosed a sensitivity of 75% and specificity of 87%, with 84% accuracy for predicting nasoenteral tube feeding. On the other hand, the artificial neural network predicted 83% accurately, disclosing a sensitivity of 70% and specificity of 86%. Conclusions: Dysphagia occurred in one third of cases. Older age, stroke severity, dysarthria, reduced conscious level at onset independently predict the need for nasoenteral tube. The tree decision model is an accurate tool for predicting NTF in acute ischemic stroke patients.

Relationship between early-onset stroke and triglyceride-glucose index among young Chinese adults

BackgroundThe triglyceride–glucose index (TyG index), an alternative indicator of peripheral insulin resistance (IR), is associated with cardiovascular disease (CVD) in the general population. The aim of this research was to determine the correlation between early-onset stroke and the TyG index among young Chinese adults.MethodsParticipants (age ≤ 40 years) who attended their first physical examination in Kailuan General Hospital or its 11 subsidiary hospitals between 2006 and 2012 were enrolled. The subjects were divided into four equal points according to the quartile of the TyG index, with the lowest quartile (Q1) as the reference group. A Cox proportional hazard model was employed to assess the correlation between early-onset stroke incidence and the TyG index. Restricted cubic spline analysis was further conducted to examine nonlinear associations. The TyG index was calculated as Ln [Triglyceride (TG, mg/dL) × Fasting Blood Glucose (FBG, mg/dL)/2].ResultsOverall, 35,999 subjects met the inclusion criteria. Their mean age was 30.8 ± 5.7 years, and 77.1% of subjects were males. During a median observation period of 11 years, 281 stroke events occurred (62 hemorrhagic strokes and 219 ischemic strokes). Compared to the Q1 group (as the lowest group), subjects in groups Q2-Q4 had significantly higher risks of early-onset stroke (P < 0.05) after adjustment for relevant confounders in the Cox proportional hazards model. Similar results were consistent with ischemic stroke. However, no significant associations were observed between the risk of hemorrhage and the baseline TyG index. The restricted cubic splines revealed that the risk of stroke progressively increased with a high TyG index ≥ 8.41.ConclusionsThe TyG index may be a major risk factor for early-onset stroke among young Chinese adults. A TyG index ≥ 8.41 can be used as an indicator for screening high-risk stroke groups.

Facilitators and barriers to the introduction of atrial fibrillation screening in primary care: a qualitative descriptive study of general practitioners in primary care.

Atrial fibrillation (AF), the most common cardiac arrhythmia, is a major risk factor for stroke. AF is often asymptomatic and, if identified, treatment can be offered that can reduce stroke risk by up to two thirds. AF screening meets many of the Wilson Jungner criteria for screening. While AF screening is recommended in clinical practice and internationally, the optimal mode and location for AF screening remains under investigation. Primary care has been identified as a potential setting. This study aimed to identify facilitators and barriers to AF screening from the perspective of GPs. The study adopted a qualitative descriptive design conducted in the south of Ireland. 58 GPs were invited from the north Cork region to participate in individual interviews at their practices, rural and urban, with a view to recruiting a purposive sample of up to 12 GPs. The interviews were audio-recorded, transcribed verbatim and analysed using a framework analysis. Eight GPs (four male, four female) from five practices participated. Five GPs were from urban practices and three were from rural practices. Facilitators and barriers were sub-categorised into patient facilitators, practice facilitators, GP facilitators, patient barriers, practice barriers, GP barriers, attitudes to AF screening, willingness to facilitate and priority ranking. All eight participants expressed a willingness to engage in AF screening. Time was the barrier discussed most frequently by all participants along with the need for additional staff. Programme structure was the most discussed facilitator by all participants and patient awareness campaigns. Despite barriers to AF screening identified by GPs, there was a significant willingness to engage and identify potential facilitators to support such screening.

High-intensity training in patients with lacunar stroke: A one-year follow-up

ObjectivesPhysical inactivity is a major risk factor for stroke. It is a challenge for patients to initiate and adhere to regular exercise post-stroke. Early initiation of home-based high-intensity interval training (HIIT) may engage patients in physical activity, improve cardiorespiratory fitness, and reduce risk of recurrent stroke. Materials and MethodsPost-intervention follow-up of patients with lacunar stroke, randomized to three-months HIIT including weekly motivational calls, or usual care. At follow-up (six- and 12-months post-stroke), we investigated changes in cardiorespiratory fitness, physical activity, fatigue, depression, mental well-being, stress, cognition, cardiovascular function, and recurrent stroke. ResultsWe included 71 patients of whom 59 patients (mean age: 63.9 ± 8.8 years) completed six- and 12-month follow-up. No change was detected in cardiorespiratory fitness between groups from baseline to 12-months follow-up. At six months, vigorous-intensity activity (median hours/week [interquartile range]) was maintained in the intervention group (baseline, 0[0;2]; post-intervention, 2[0;3]; six-month, 2[0;4]) and increased in the usual care group (baseline, 0[0;1]; post-intervention, 1[0;2]; six-month, 1[0;3]), with no difference between groups. Vigorous-intensity activity declined to baseline levels at 12-months in both groups. Secondary outcomes improved from baseline to 12-months with no significant differences between groups. Similar rate of recurrent stroke (n=3) occurred in each group with a three-month delay in the intervention group. ConclusionsEarly initiated HIIT did not increase long-term cardiorespiratory fitness, but increased time spent doing vigorous-intensity activities post-stroke. Decline to baseline activity level at 12 months warrants identification of motivators to initiate and sustain physical activity post-stroke.

C1QC, VSIG4, and CFD as Potential Peripheral Blood Biomarkers in Atrial Fibrillation-Related Cardioembolic Stroke.

Atrial fibrillation (AF) is a major risk factor for ischemic stroke. We aimed to identify novel potential biomarkers with diagnostic value in patients with atrial fibrillation-related cardioembolic stroke (AF-CE).Publicly available gene expression profiles related to AF, cardioembolic stroke (CE), and large artery atherosclerosis (LAA) were downloaded from the Gene Expression Omnibus (GEO). Differentially expressed genes (DEGs) were identified and then functionally annotated. The support vector machine recursive feature elimination (SVM-RFE) and least absolute shrinkage and selection operator (LASSO) regression analysis were conducted to identify potential diagnostic AF-CE biomarkers. Furthermore, the results were validated by using external data sets, and discriminability was measured by the area under the ROC curve (AUC). In order to verify the predictive results, the blood samples of 13 healthy controls, 20 patients with CE, and 20 patients with LAA stroke were acquired for RT-qPCR, and the correlation between biomarkers and clinical features was further explored. Lastly, a nomogram and the companion website were developed to predict the CE-risk rate. Three feature genes (C1QC, VSIG4, and CFD) were selected and validated in the training and the external datasets. The qRT-PCR evaluation showed that the levels of blood biomarkers (C1QC, VSIG4, and CFD) in patients with AF-CE can be used to differentiate patients with AF-CE from normal controls (P < 0.05) and can effectively discriminate AF-CE from LAA stroke (P < 0.05). Immune cell infiltration analysis revealed that three feature genes were correlated with immune system such as neutrophils. Clinical impact curve, calibration curves, ROC, and DCAs of the nomogram indicate that the nomogram had good performance. Our findings showed that C1QC, VSIG4, and CFD can potentially serve as diagnostic blood biomarkers of AF-CE; novel nomogram and the companion website can help clinicians to identify high-risk individuals, thus helping to guide treatment decisions for stroke patients.

Sigma-1 Receptor Activation Improves Oligodendrogenesis and Promotes White-Matter Integrity after Stroke in Mice with Diabetic Mellitus

Diabetes mellitus (DM) is a major risk factor for stroke and exacerbates white-matter damage in focal cerebral ischemia. Our previous study showed that the sigma-1 receptor agonist PRE084 ameliorates bilateral common-carotid-artery occlusion-induced brain damage in mice. However, whether this protective effect can extend to white matter remains unclear. In this study, C57BL/6 mice were treated with high-fat diets (HFDs) combined with streptozotocin (STZ) injection to mimic type 2 diabetes mellitus (T2DM). Focal cerebral ischemia in T2DM mice was established via injection of the vasoconstrictor peptide endothelin-1 (ET-1) into the hippocampus. Three different treatment plans were used in this study. In one plan, 1 mg/kg of PRE084 (intraperitoneally) was administered for 7 d before ET-1 injection; the mice were sacrificed 24 h after ET-1 injection. In another plan, PRE084 treatment was initiated 24 h after ET-1 injection and lasted for 7 d. In the third plan, PRE084 treatment was initiated 24 h after ET-1 injection and lasted for 21 d. The Y-maze, novel object recognition, and passive avoidance tests were used to assess neurobehavioral outcomes. We found no cognitive dysfunction or white-matter damage 24 h after ET-1 injection. However, 7 and 21 d after ET-1 injection, the mice showed significant cognitive impairment and white-matter damage. Only PRE084 treatment for 21 d could improve this white-matter injury; increase axon and myelin density; decrease demyelination; and increase the expressions of myelin regulator 2'-3'-cyclic nucleotide 3'-phosphodiesterase (CNpase) and myelin oligodendrocyte protein (MOG) (which was expressed by mature oligodendrocytes), the number of nerve/glial-antigen 2 (NG2)-positive cells, and the expression of platelet-derived growth factor receptor-alpha (PDGFRα), all of which were expressed by oligodendrocyte progenitor cells in mice with diabetes and focal cerebral ischemia. These results indicate that maybe there was more severe white-matter damage in the focal cerebral ischemia of the diabetic mice than in the mice with normal blood glucose levels. Long-term sigma-1 receptor activation may promote oligodendrogenesis and white-matter functional recovery in patients with stroke and with diabetes.

PS-R06-3: A CASE OF CEREBRAL INFARCTION IN AN ELDERLY HYPERTENSIVE PATIENT WITH 24-HOUR STRICT BLOOD PRESSURE CONTROL

Introduction: In elderly patients, hypertension is a major risk factor of stroke. Therefore, strict blood pressure (BP) control provides most effective for the prevention of stroke incidence. Here, we report the case of stroke occurred under strict BP control in an elderly patient. Case: A 80-year-old Japanese women with the treatment of hypertension and dyslipidemia was admitted to our hospital with suddenly vertigo. Before admission, her BP control was controlled, which her ambulatory BP monitoring performed three months prior to admission showed that 24-hour, daytime and nighttime BP were 107/61 mmHg, 112/64 mmHg and 94/53 mmHg, respectively, and diurnal BP variation showed dipper pattern. On admission, her electrocardiography showed sinus rhythm, and her head magnetic resonance imaging showed the bilateral cerebellum infarction, which is the area dominated by posterior inferior cerebellar artery. The D-dimer level was 1.2 μg/ml. Transesophageal echocardiography was performed to search for an embolic source of stroke and revealed a patent foramen ovale (PFO). Leg vein echocardiography showed the thrombus in the bilateral soleus veins. Based on the above results, we diagnosed a paradoxical cerebral embolism caused by deep vein thrombosis of the lower extremities and PFO. Conclusion: The patient had achieved strict BP control assessed by ABPM prior to the onset of the stroke and was considered to be at low risk of stroke. Paradoxical cerebral embolism is a common cause of stroke in younger patients, however, physicians should be also noted as a cause of cerebral infarction even in the elderly patients.

PS-B10-3: POST-STROKE LEARNING IMPAIRMENT IS AUGMENTED IN HYPERTENSIVE MICE

Objective: Cognitive impairment is disorder that can arise as a result of cardiovascular pathology or cerebrovascular injury. Due to the aging population, the incidence of cognitive impairment is expected to rise. Hypertension is a major risk factor for stroke and cognitive impairment, but it is unclear whether it may affect post-stroke cognitive outcomes. This study aims to assess the effects of hypertension and/or stroke on the brain and its effect on cognitive impairment. Design and method: C57BL/6J mice (n = 117) aged 3–5 months received infusion of either saline or angiotensin II (0.7 mg/kg/day for 14d or 0.28 mg/kg/day for 28d). 7 d after minipump implantation mice received either sham or photothrombotic stroke surgery targeting the prefrontal cortex. The Barnes maze was utilised to assess cognitive function. RNA sequencing was used to quantify transcriptomic changes in the brain. Results: Angiotensin II increased blood pressure (normotensive: 118 ± 1 mmHg vs. hypertensive: 149 ± 2 mmHg; P &lt; 0.05). In the Barnes maze, hypertensive mice that received stroke surgery had increased latency to enter the escape hole when compared to other groups (day 3 escape latency: hypertensive + stroke = 166.6 ± 6.0 s vs. hypertensive + sham = 122.8 ± 13.8 s vs. normotensive + stroke = 139.9 ± 10.1 s vs. normotensive + sham = 101.9 ± 16.7 s), consistent with a greater learning impairment. Interestingly, we observed 5 incidences of haemorrhage within the HT + stroke group. RNA sequencing revealed &gt; 1500 differentially expressed genes in hypertensive + stroke vs. hypertensive + sham, including genes related to inflammation and synaptic function. Conclusions: These findings indicate that the combination of hypertension and stroke resulted in greater learning impairment and brain injury. If transferrable to humans, the present data suggest that therapeutic approaches to effectively treat hypertension are likely to mitigate worsened post-stroke cognitive outcomes.

S-15-4: EFFORTS AIMED TO ACHIEVE HYPERTENSION ZERO IN COMMUNITY; EXPERIENCE IN MAKURAZAKI CITY

Although hypertension is the major risk factor for stroke, cardiovascular diseases and renal failure, more than half of hypertensive patients is uncontrolled, named as hypertension paradox. We hypothesize the simple scheme measure and normalize blood pressure (BP) reduces stroke, cardiovascular diseases and renal failure as well as creates abundant and healthy town via improvement of health literacy. Therefore, we planned 4 plans; Kagoshima hypertension seminar (intensive lecture for general physician); Prediction of hypertension development system by general check-up; Hypertension class for Tarumizu citizens; Hypertension zero city project in Makurazaki city. We analyzed 350,000 general check-up data and determined prediction of hypertension development system for effective use in health guidance. We performed 4 serial lectures for general physicians and granted the title of Kagoshima Hypertension Meister after passing a small test. Around 400 citizens in Tarumizu city measured home BP for more than 3 years and health guidance was performed each 2 months. Hypertension zero city project in Makurazaki city (21,960 people, the highest incidence of stroke in Kagoshima prefecture), to achieve hypertension zero in community. The project includes BP measurement at any area in the city, hypertension lecture for high school students and so on. According to these plans, BP measured by general check-up reduced more than 1.5mmHg in systole for 6 years only in Kagoshima. In this symposium, I would like to talk about our efforts to achieve hypertension zero in community.

Physiology of Ageing

Gerontology studies the elderly. Gerontologists say ageing is four-dimensional. Ageing theories attempt to explain ageing over a 120-year lifespan. The ageing theory can be traced back to Dr. August Weismann's 18th-century theorem that metabolism and lifespan are inversely related. Free radicals from basic metabolic processes damage cells and organs. Studies showed that pituitary-deficient mice lived longer and aged later. Joint, bone, fat, and muscle changes with age affect our physical and mental development. Presbyopia occurs when the lens loses flexibility and thickens, making close-up vision difficult. Brain mass decreases by 30% by age 80. Early learning and short-term memory are affected. Kidney thickening and permeability decrease with age. These are major risk factors for arterial fibrillation, hypertension, and stroke. Leakage, urine retention, and UTIs increase as bladder muscles weaken. Malnutrition, postprandial hypotension, dysphagia, constipation, and faecal incontinence are common in older people. Several types of calcium and iron are malabsorbable in achlorhydria. Vitamin D malabsorption worsens elderly hypovitaminosis.

Effect of Continuous Training versus Interval Training on Functional Parameters of Stage-1 Hypertensive Patients: A Randomised Clinical Study

Introduction: Hypertension is one of the major risk factors for heart attack and stroke, often referred to as the “silent killer.” Non pharmacological therapy can be used to manage hypertension in addition to pharmacological therapy. Exercise such as continuous and interval training are types of physical exercises. Findings indicate that Moderate-Intensity Continuous Training (MICT) and High-Intensity Interval Training (HIIT), lower average blood pressure in Stage-1 hypertensive patients. Need of the study: To evaluate the effectiveness of interval training and continuous training on patients with Stage-1 hypertension and to prevent the progression to the next stage of hypertension. Aim: To compare the effects of continuous training versus interval training on blood pressure, heart rate, and Rate of Perceived Exertion (RPE) in Stage-1 hypertension. Materials and Methods: This randomised clinical study will be conducted at the Cardiovascular and Thoracic Surgery Unit, Acharya Vinobha Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India, for a duration of six months. In this study, 130 patients diagnosed with Stage-1 hypertension will be divided into two groups. The first 65 will be randomly assigned to Group A as the interval training group, while the remaining 65 will be assigned to Group B as the continuous training group. Each patient’s demographic information, including name, age, gender, height, and weight, will be recorded. Before the intervention, patients’ blood pressure and heart rate will be measured, taking an average of three readings. Training will then commence, and patients will be reassessed to determine the effectiveness. Statistical analysis will be performed using paired and unpaired t-tests.

Fumarate hydratase as a potential target to ameliorate salt sensitive hypertension

Salt sensitive hypertension is a major risk factor for stroke, heart failure, and end-stage renal disease. The development of salt sensitive hypertension is involved in genetic and environmental factors. Excessive dietary salt intake is known as a main risk factor and one of the most important environmental determinants, exacerbates the salt sensitive hypertension by a renal redox metabolism.

Red cell exchange transfusions increase cerebral capillary transit times and may alter oxygen extraction in sickle cell disease.

Persons with sickle cell disease (SCD) suffer from chronic hemolytic anemia, reduced blood oxygen content, and lifelong risk of silent and overt stroke. Major conventional stroke risk factors are absent in most individuals with SCD, yet nearly 50% have evidence of brain infarcts by the age of 30 years, indicating alternative etiologies for ischemia. We investigated whether radiological evidence of accelerated blood water transit through capillaries, visible on arterial spin labeling (ASL) magnetic resonance imaging, reduces following transfusion-induced increases in hemoglobin and relates to oxygen extraction fraction (OEF). Neurological evaluation along with anatomical and hemodynamic imaging with cerebral blood flow (CBF)-weighted pseudocontinuous ASL and OEF imaging with T2 -relaxation-under-spin-tagging were applied in sequence before and after blood transfusion therapy (n = 32) and in a comparator cohort of nontransfused SCD participants on hydroxyurea therapy scanned at two time points to assess stability without interim intervention (n = 13). OEF was calculated separately using models derived from human hemoglobin-F, hemoglobin-A, and hemoglobin-S. Gray matter CBF and dural sinus signal, indicative of rapid blood transit, were evaluated at each time point and compared with OEF using paired statistical tests (significance: two-sided p < 0.05). No significant change in sinus signal was observed in nontransfused participants (p = 0.650), but a reduction was observed in transfused participants (p = 0.034), consistent with slower red cell transit following transfusion. The dural sinus signal intensity was inversely associated with OEF pretransfusion (p = 0.011), but not posttransfusion. Study findings suggest that transfusion-induced increases in total hemoglobin may lengthen blood transit times through cerebral capillaries and alter cerebral OEF in SCD.

Insertable cardiac monitoring devices versus external cardiac monitoring for detecting atrial fibrillation and preventing the recurrence of stroke: A systematic review and meta-analysis

BackgroundAtrial Fibrillation (AF) is a major risk factor for stroke, which is the second leading cause of death worldwide. It remains uncertain whether insertable cardiac monitors (ICMs) enhance the ability to recognize AF over external cardiac monitoring in patients who have experienced a stroke. AimWe conducted a systematic review and meta-analysis to determine whether ICM devices are more effective than external cardiac monitoring for the detection of AF in stroke patients. MethodsWe included studies that reported an AF detection rate in stroke patients with a follow-up of at least 12 months. We analyzed the data of 1233 patients from 3 randomized control trials (RCTs). ResultsWhen compared to external cardiac monitoring, ICM devices (Medtronic Reveal LINQ and Reveal XT) showed a significantly higher detection rate of AF (RR = 5.04, 95% CI = 2.93–8.68; p < 0.05; ARR = 10.47%, NNT = 10). The ICM arm had significantly higher usage of oral anticoagulants (OAC) as compared to the control arm. (RR = 2.76, 95% CI = 1.89–4.02, p < 0.05). Additionally, ICM usage was associated with a higher incidence of mild to moderate adverse events (RR = 10.52, 95% CI =1.35–82.14; p = 0.02) and a higher number of severe adverse events as compared to the control arm (RR = 7.61, 95% CI = 1.36–42.51; p = 0.02). ConclusionICM devices are associated with better detection rates of AF and higher usage of OAC as compared to external cardiac monitoring in post-stroke patients. However, ICM insertion is associated with a higher incidence of mild/moderate and severe adverse effects.

Associations of clonal hematopoiesis with recurrent vascular events and death in patients with incident ischemic stroke

AbstractClonal hematopoiesis (CH) is common among older people and is associated with an increased risk of atherosclerosis, inflammation, and shorter overall survival. Age and inflammation are major risk factors for ischemic stroke, yet the association of CH with risk of secondary vascular events and death is unknown. We investigated CH in peripheral blood DNA from 581 patients with first-ever ischemic stroke from the Prospective Cohort With Incident Stroke–Berlin study using error-corrected targeted sequencing. The primary composite end point (CEP) consisted of recurrent stroke, myocardial infarction, and all-cause mortality. A total of 348 somatic mutations with a variant allele frequency ≥1% were identified in 236 of 581 patients (41%). CH was associated with large-artery atherosclerosis stroke (P = .01) and white matter lesion (P < .001). CH-positive patients showed increased levels of proinflammatory cytokines, such as interleukin-6 (IL-6), interferon gamma, high-sensitivity C-reactive protein, and vascular cell adhesion molecule 1. CH-positive patients had a higher risk for the primary CEP (hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.04-2.31; P = .03), which was more pronounced in patients with larger clones. CH clone size remained an independent risk factor (HR, 1.30; 95% CI, 1.04-1.62; P = .022) in multivariable Cox regression. Although our data show that, in particular, larger and TET2- or PPM1D-mutated clones are associated with increased risk of recurrent vascular events and death, this risk is partially mitigated by a common germline variant of the IL-6 receptor (IL-6R p.D358A). The CH mutation profile is accompanied by a proinflammatory profile, opening new avenues for preventive precision medicine approaches to resolve the self-perpetuating cycle of inflammation and clonal expansion.

Diabetes and cardiovascular health literacy in childhood and adolescence - a 12-year follow-up

The incidence of diabetes mellitus and cardiovascular diseases is increasing worldwide and also in Germany. The aim of the study was to assess the health literacy regarding these diseases in childhood and adolescence. Students of the 5th-12th grade (grammar school ("Gymnasium"), secondary school forms ("Realschule" and "Hauptschule")) were interviewed in 2007 (n = 4383) and 2019 (n = 572) about diabetes and secondary complications. In addition, questions about other cardiovascular risk factors were asked in 2019. Diabetes-related questions were answered correctly by 56 % in 2007 as well as 53 % in 2019. Among others, 70 % (2007) as well as 75 % (2019) of the students stated "ate too much sugar" as a cause for type 1 diabetes. Further, questions about major risk factors for heart attack and stroke were answered correctly by only 33 % (for diabetes) and 43 %-53 % (for smoking) of students.Across all questions, a positive association indicated between the rate of correct answers and the educational level of the school institution; however, the differences remained marginal at 5-19 % between Gymnasium and Hauptschule or Realschule at both survey time points. A difference between genders was indicated in 2007 (girls: 59 % vs. boys: 52 %) and 2019 (girls: 56 % vs. boys: 51 %). Changes in health literacy regarding diabetes and other cardiovascular risk factors among 5th-12th grade students over the past 12 years could not be observed. The assumed self-infliction of type 1 diabetes may be perceived as discrimination by those affected.

Abstract 14929: Dedicator of Cytokinesis 2 Promotes Atherosclerosis Through Mediating Vascular Inflammation

Atherosclerosis is a leading cause of sudden death in patients with cardiovascular disease. It is the major risk factor of coronary artery disease and stroke. The pathophysiological mechanisms of atherosclerosis are complex and there is lack of effective pharmacotherapy for treating atherosclerosis. Dedicator of cytokinesis 2 (DOCK2) plays important roles in immune functions and inflammatory processes. This study aims to explore the role of DOCK2 in the development of atherosclerosis. We generated double knockout (DOCK2-/-;LDLR-/-) mice. The LDLR-/- and DOCK2-/-;LDLR-/- male mice were fed high-fat diet (HFD) for 4 weeks and/or 12 weeks followed by the collection of the aorta and aortic roots. IHC staining showed that DOCK2 was induced in atherosclerotic lesions with increased expression of ICAM-1, VCAM-1, and MCP-1 after HFD for 4 weeks in LDL-/- mice. DOCK2-/-;LDLR-/- mice exhibited a significantly decreased lesion formation compared to LDLR-/- mice after HFD for 12 weeks as shown by Oil-Red O (ORO) staining of the aorta. ORO staining of aortic roots confirmed the reduced lesion size in DOCK2-/-;LDLR-/- mice. DOCK2 deficiency also attenuated the induction of ICAM-1, VCAM-1, and MCP-1 expression by HFD for 12 weeks. These data indicate that DOCK2 is essential for the lesion formation by inducing the adhesion and invasion related molecule expression. Macrophages have been reported to contribute to atherogenesis. Therefore, we evaluated macrophage infiltration in aortic roots of LDLR-/- and DOCK2-/-;LDLR-/- mice fed with HFD for 12 weeks. The data show that there was significantly attenuated macrophage infiltration in aortic roots of DOCK2-/-;LDLR-/- mice compared with that in LDLR-/- mice, as shown by the decreased F4/80-positive cells. Together, our data demonstrate that DOCK2 deficiency attenuates atherosclerosis by alleviating vascular inflammation.

Incidence of atrial fibrillation in patients with cryptogenic stroke

Background: Stroke can cause serious disability and mortality among the worldwide population. Atrial fibrillation (AF) is one of the major risk factors for ischemic stroke and a common cause of cardioembolism in old age. Aims and Objectives: The aim of the study was to study the incidence of AF in patients with cryptogenic stroke (CS). Materials and Methods: A prospective and observational study on AF and stroke was carried out in the Department of Cardiology/Neurology, in a tertiary care hospital. Data were collected in the form of chief complaints, medical history, clinical examination, and treatment given in the enclosed proforma for 1 year. On follow-up, specified goals including hypertension (HTN) management, lipid management, and diabetes management were done as per current guidelines. Results: Out of 100 CS patients, 69 were male and the mean age of the patients in this study was 59±13.37 years. The incidence of AF was 11% at the end of 1 year with male predominance (64%) and a mean age of 62±12.94 years. The mean CHADS2 Score in this study group was 1.40 with a standard deviation of 1.31. Stroke reoccurred in 12% of patients at the end of 1-year follow-up. Patients with recurrent stroke were mostly elderly with a mean age of 70 years (SD=9.78, P=0.03). Conclusion: It is found that a longer duration of electrocardiographic monitoring after CS increases the proportion diagnosed with AF and should be done in selected high-risk cases, especially in patients with HTN, dyslipidemia, diabetes mellitus, chronic kidney disease, and high CHADS2 score.

Cardiac thrombi detected by CT in patients with acute ischemic stroke: A substudy of Mind the Heart.

Cardiac thrombi are a major risk factor for ischemic stroke, but are rarely diagnosed in the acute phase. We examined characteristics and functional outcome of patients with ischemic stroke and a concomitant cardiac thrombus detected on cardiac CT performed in the acute phase. We used data from "Mind the Heart," a prospective cohort study in which consecutive adult patients with acute ischemic stroke underwent prospective ECG-gated cardiac CT during their acute stroke imaging protocol. We compared characteristics, functional outcome (modified Rankin scale) and stroke recurrence rate at 90 days of patients with a cardiac thrombus on CT (defined as filling defect <100 Hounsfield Units) to those without a cardiac thrombus. Among 452 included patients, cardiac CT detected 41 thrombi in 38 (8%) patients. Thrombi were most often located in the left atrial appendage (31/38 [82%]). Patients with a cardiac thrombus more frequently had intracranial occlusions in multiple vascular territories (5% vs 0.5%, p = 0.04) and a higher baseline NIHSS score (17 [IQR 6-22] vs 5 [IQR 2-3], p < 0.001) compared to patients without a cardiac thrombus. In 13/38 (34%) patients with a cardiac thrombus, no atrial fibrillation was detected. A cardiac thrombus was associated with worse functional outcome (adjusted common odds ratio 3.18 95%CI 1.68-6.00). Recurrence rate was not significantly different (8% vs 4%, aOR 1.50 (0.39-5.82). Cardiac CT detected a cardiac thrombus in one in every 12 patients with acute ischemic stroke, and these patients had more severe deficits, multivessel occlusions, and a worse functional outcome.

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&amp;lt;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.