Modifiable Risk Factor For Stroke Research Articles

Supporting GPs and people with hypertension to maximise medication use to control blood pressure: a pilot cluster RCT of the MIAMI intervention

BackgroundHypertension, or high blood pressure, is a key modifiable risk factor for heart disease and stroke. International guidelines have highlighted ‘poor adherence to treatment’ and ‘physician inertia’ as major barriers to effective blood pressure management. The Maximising Adherence, Minimising Inertia (MIAMI) intervention, a theory-based complex intervention, supports General Practitioners (GPs) and people with hypertension in maximising medication use to manage blood pressure. This pilot cluster randomised control trial (RCT) aimed to collect and analyse feasibility data to refine the MIAMI intervention and assess the feasibility of a definitive RCT.MethodA pilot cluster RCT with a MIAMI intervention arm and usual care control arm was conducted. Quantitative data collection consisting of clinical measures and a self-report questionnaire took place at baseline and twelve week follow up. Semi-structured interviews with GP and patient participants were conducted. Fidelity (as measured by a protocol checklist and through qualitative interviews) and health economics costings were assessed.ResultsSix GP practices (intervention arm n = 3, control arm n = 3) and 52 patients (intervention arm n = 25, control arm n = 27) took part. All six GP practices and 92% of patients were retained. Fidelity, as measured by a checklist and through qualitative interviews, was good but three deviations from protocol were identified. Outcomes and measures used were acceptable. The implementation cost of the MIAMI intervention was estimated at €490 per participant. The qualitative data demonstrated that the intervention was considered acceptable and feasible by both GP and patient participants, except for the urine test component, which GPs found difficult to incorporate into practice due to logistical challenges.ConclusionsThe MIAMI intervention was considered largely acceptable and feasible. Some changes to both intervention components and trial processes are required but with these in place a definitive RCT could be considered worthwhile.Trial registrationISRCTN registry, ISRCTN85009436, registered 17/1/23.

Relationship between socioeconomic status and stroke: An observational and network Mendelian randomization study

BackgroundThe relationship between socioeconomic status (SES) and stroke remains controversial, and the underlying mediator is unclear. This study aimed to assess the causal relationship of SES with stroke and its subtypes and to identify potential modifiable risk factors responsible for this relationship. MethodsThe study included 372,437 participants from the UK Biobank. Over an average period of 12.13 years, 6,457 individuals (2.7 %) were recorded as having experienced a stroke. Cox proportional hazards model was used to determine the relationship between SES (average annual household income before tax and age at the end of full-time education) and stroke, ischemic stroke, and hemorrhagic stroke. Two-sample Mendelian randomization (MR) was employed to assess the causal relationship between SES and stroke and its subtypes. Furthermore, network MR was utilized to evaluate the potential mediating role of modifiable risk factors for stroke in this causal relationship. ResultsAfter adjusting for factors such as sociodemographic characteristics, health behaviors, health status, and past medical history, participants in the second highest income group showed the lowest risk of stroke, with a hazard ratio (HR) of 0.780 (95 % confidence interval [CI]: 0.702–0.866), and for ischemic stroke, the HR was 0.701 (95 % CI: 0.618–0.795). Those who completed full-time education at the latest age group(>18 years) had the lowest risk of stroke (HR: 0.906, 95 % CI: 0.830–0.988) and ischemic stroke (HR: 0.897, 95% CI: 0.811–0.992). MR analysis showed that higher income and education were both associated with a lower risk of stroke (income: inverse-variance-weighted odds ratio [ORIVW] =0.796, 95 % CI: 0.675–0.940, education: ORIVW = 0.631, 95 % CI: 0.557–0.716) and ischemic stroke (income: ORIVW = 0.813, 95 % CI: 0.684–0.966, education: ORIVW = 0.641, 95 % CI: 0.559–0.735). Additionally, hypertension had the highest mediating effect on this relationship. It accounted for 57.12 % of the effect of income on stroke, 51.24 % on ischemic stroke, and 27 % and 24 % for education. ConclusionHigher SES was associated with a lower risk of stroke and ischemic stroke, and hypertension had the highest mediating effect on this causal relationship. The results have significant public health implications, emphasizing the importance of early intervention to reduce the risk of stroke in low SES populations.

Do interaction and joint effects between physical activity and dietary inflammatory index modify stroke risk?

ObjectiveStroke is a major public health threat, and both physical activity (PA) and diet are modifiable risk factors for stroke. This study assessed the interaction and joint effects of PA and the dietary inflammatory index (DII) on stroke. MethodsWe included 18,676 participants from the 2007–2020 National Health and Nutrition Examination Survey. The independent associations, interactions, and joint effects of PA and the DII on stroke were assessed by weighted multivariable logistic regression. ResultsThe weighted mean age of the participants was 48.24 years, and comprised 703 individuals who had experienced a stroke. After adjusting for confounders, increased stroke risk was independently associated with a higher DII (Q4, odds ratio [OR]: 1.72, 95 % confidence interval [CI]: 1.27–2.34) and insufficient PA (inactive, OR: 1.37, 95 % CI: 1.05–1.78). No significant multiplicative (OR: 1.11, 95 % CI: 0.34–1.93) or additive (relative excess risk due to interaction: 0.45, 95 % CI: 0.35–1.25) interactions were found between DII and PA. The results of joint associations indicated that individuals who consumed the most pro-inflammatory diet (DII, Q4) and were physically inactive (OR: 2.39, 95 % CI: 1.61–3.56) had the highest stroke risk than those who consumed the most anti-inflammatory diet (DII, Q1) and were physically active. ConclusionActive PA and low DII scores are independent protective factors against stroke. Although the multiplicative and additive effects of the DII and PA on stroke risk are not statistically significant, the analysis of their joint effects suggest that individuals who consume anti-inflammatory diets and exhibit active PA consistently have the lowest risk of stroke.

Associations Between Genetically Predicted Iron Status and Cardiovascular Disease Risk: A Mendelian Randomization Study.

Mendelian randomization (MR) studies suggest a causal effect of iron status on cardiovascular disease (CVD) risk, but it is unknown if these associations are confounded by pleiotropic effects of the instrumental variables on CVD risk factors. We aimed to investigate the effect of iron status on CVD risk controlling for CVD risk factors. Iron biomarker instrumental variables (total iron-binding capacity [n=208 422], transferrin saturation [n=198 516], serum iron [n=236 612], ferritin [n=257 953]) were selected from a European genome-wide association study meta-analysis. We performed 2-sample univariate MR of each iron trait on CVD outcomes (all-cause ischemic stroke, cardioembolic ischemic stroke, large-artery ischemic stroke, small-vessel ischemic stroke, and coronary heart disease) from MEGASTROKE (n=440 328) and CARDIoGRAMplusC4D (Coronary Artery Disease Genome Wide Replication and Meta-Analysis Plus the Coronary Artery Disease Genetics) (n=183 305). We then implemented multivariate MR conditioning on 7 CVD risk factors from independent European samples to evaluate their potential confounding or mediating effects on the observed iron-CVD associations. With univariate MR analyses, we found higher genetically predicted iron status to be associated with a greater risk of cardioembolic ischemic stroke (transferrin saturation: odds ratio, 1.17 [95% CI, 1.03-1.33]; serum iron: odds ratio, 1.21 [95% CI, 1.02-1.44]; total iron-binding capacity: odds ratio, 0.81 [95% CI, 0.69-0.94]). The detrimental effects of iron status on cardioembolic ischemic stroke risk remained unaffected when adjusting for CVD risk factors (all P<0.05). Additionally, we found diastolic blood pressure to mediate between 7.1 and 8.8% of the total effect of iron status on cardioembolic ischemic stroke incidence. Univariate MR initially suggested a protective effect of iron status on large-artery stroke and coronary heart disease, but controlling for CVD factors using multivariate MR substantially diminished these associations (all P>0.05). Higher iron status was associated with a greater risk of cardioembolic ischemic stroke independent of CVD risk factors, and this effect was partly mediated by diastolic blood pressure. These findings support a role of iron status as a modifiable risk factor for cardioembolic ischemic stroke.

Markers of periodontal disease and risk of stroke: INTERSTROKE case-control study

BackgroundPeriodontal disease may be an important modifiable risk factor for stroke. AimsTo determine the contribution of markers of periodontal disease to stroke risk globally, within subpopulations, and by stroke subtypes. MethodsINTERSTROKE is the largest international case-control study of risk factors for first acute stroke. All participants were asked a standardised set of questions about the presence or absence of painful teeth, painful gums or lost teeth, as markers of periodontal disease, within the previous year. The total number of reported variables was calculated per participant. Multivariable conditional logistic regression examined the association of these variables with acute stroke. ResultsIn 26901 participants, across 32 countries, there was a significant multivariable association between lost teeth and stroke (OR 1.11, 95 % CI 1.01 – 1.22), but not painful teeth (OR 1.00, 95 % CI 0.91-1.10) or painful gums (OR 1.01, 95 % CI 0.89 – 1.14). When these symptoms were considered together there was a graded increased odds of stroke, with the largest magnitude of association seen if a patient reported all three of painful teeth, painful gums and lost teeth (OR 1.34, 95 % CI 1.00 – 1.79). ConclusionsOur findings suggest that features of severe periodontal disease are a risk factor for acute stroke. Periodontal disease should be considered as a potentially modifiable risk factor for stroke.

Adaptive Metabolic Responses Facilitate Blood-Brain Barrier Repair in Ischemic Stroke via BHB-Mediated Epigenetic Modification of ZO-1 Expression.

Adaptive metabolic responses and innate metabolites hold promising therapeutic potential for stroke, while targeted interventions require a thorough understanding of underlying mechanisms. Adiposity is a noted modifiable metabolic risk factor for stroke, and recent research suggests that it benefits neurological rehabilitation. During the early phase of experimental stroke, the lipidomic results showed that fat depots underwent pronounced lipolysis and released fatty acids (FAs) that feed into consequent hepatic FA oxidation and ketogenesis. Systemic supplementation with the predominant ketone beta-hydroxybutyrate (BHB) is found to exert discernible effects on preserving blood-brain barrier (BBB) integrity and facilitating neuroinflammation resolution. Meanwhile, blocking FAO-ketogenesis processes by administration of CPT1α antagonist or shRNA targeting HMGCS2 exacerbated endothelial damage and aggravated stroke severity, whereas BHB supplementation blunted these injuries. Mechanistically, it is unveiled that BHB infusion is taken up by monocarboxylic acid transporter 1 (MCT1) specifically expressed in cerebral endothelium and upregulated the expression of tight junction protein ZO-1 by enhancing local β-hydroxybutyrylation of H3K9 at the promoter of TJP1 gene. Conclusively, an adaptive metabolic mechanism is elucidated by which acute lipolysis stimulates FAO-ketogenesis processes to restore BBB integrity after stroke. Ketogenesis functions as an early metabolic responder to restrain stroke progression, providing novel prospectives for clinical translation.

Acute Ischemic Stroke and Metabolic Syndrome Comorbidity

Aim Cerebrovascular diseases (CVD) lead to serious disabilities and loss of labor in societyin addition to mortality. Metabolic syndrome (MetS) is a group of known metabolic risk factors such as high blood pressure, dyslipidemia, glucose intolerance, or high blood sugar, due to insulin resistance. The present study aimed to investigate MetS and its components in acute ischemic stroke patients and analyze these components as risk factors. MATERIAL-METHOD The study was conducted with 80 patients, 46 males and 34 females, who were admitted to the Taksim Training and Research Hospital Neurology Clinic with acute ischemic stroke diagnosis between April and October 2007 within the first 48 hours of the disease onset. The presence of MetS was investigated in 80 patients, including large artery atherosclerosis (BAA), small artery occlusion (CAO), and cardioembolic disease (CE). FINDINGS MetS was determined in 48 patients out of 80. TheMetSpresence rate was 60%. The analysis of the MetS rates in disease groups revealed that the highest rate was in 30 of 39 BAA patients (76.90%). The mean MS criterion count was statistically significantly higher in theBAA group when compared to the CE and CAO groups. A statistically significant difference was determined between the abdominal obesity distributionsin BAA, CE, KAO groups. A statistically significant difference was determined between the MS presence in the BAA, CE, CAO groups. CONCLUSION Certain modifiable stroke risk factors are included in a cluster of risk factors called MetS. Efforts to reduce theMetS parameters could be effective in stroke prevention.

Correlation Between HbA1c and Body Mass Index Among Patients with High Lipid Profile Attending Johns Hopkins Aramco Healthcare Hospital in Saudi Arabia

BACKGROUND: Dyslipidemia is a modifiable risk factor for cardiovascular diseases, diabetes, and stroke. Obesity and elevated HbA1c levels are both risk factors for cardiovascular diseases. OBJECTIVES: The main objective of this study was to examine the relationship between HbA1C and body mass index among patients with high lipid profiles. METHODS: This retrospective, hospital-based study was conducted at Johns Hopkins Aramco Healthcare Facilities. Data were extracted from medical health records and included demographics, lipid profiles, and HbA1c measurements. The study included 2368 non-diabetic participants, and DATAtab was used to analyze the data. RESULTS: The participants were 57.05% male and 78.42% Saudi. The mean age was 41.48±12.1 years, and the mean body mass index was 28.44±5.53. There was a statistically significant relationship between the use of lipid lowering medicine and HbA1c (P&lt;0.001). There was a very weak positive but statistically significant relationship between HbA1c and body mass index (r = 0.18, P&lt;0.001). HbA1c and systolic blood pressure appeared to have a statistically significant positive association (r = 0.16, P&lt; 0.001). There was no correlation between HbA1c and low-density lipoprotein cholesterol, total cholesterol, or diastolic blood pressure. There was an inverse correlation between HbA1c and high-density lipoprotein cholesterol (r = -0.11, P&lt; 0.001). Regression was performed using a linear multivariable analysis with HbA1c as the dependent variable and age (B 0.192, P&lt;0.001), body mass index (B 0.119, P&lt;0.001), high-density lipoprotein cholesterol (B -0.058, P&lt;0.005), triglyceride (B 0.093, P&lt;0.001), lipid-lowering medication (B 0.104, P&lt;0.001), and systolic blood pressure (B 0.060, P&lt; 0.003) as independent variables. CONCLUSION: The results indicated that HbA1c is linked to body mass index, age, systolic blood pressure, triglycerides, and high-density lipoprotein cholesterol levels. There was no correlation between HbA1c and low-density lipoprotein cholesterol, total cholesterol, or diastolic blood pressure.

Baseline lifestyle and biomedical stroke risk factors among New Zealand participants in the PERsonalised Knowledge to reduce the risk of Stroke (PERKS-International) randomised controlled trial –preliminary results

Stroke ranks as the world’s second leading cause of death and third in causing disabilities, a preventable disease affecting people of all demographics. Primary prevention is crucial to mitigate its impact by addressing modifiable risk factors such as poor diet, low physical activity (PA), obesity, smoking, high blood pressure (BP), elevated cholesterol, and blood glucose levels. This study evaluated quality of diet and other stroke modifiable risk factors among New Zealand (NZ) participants recruited at the baseline phase of the PERKS-International trial. PERKS is a Phase III, multicentre, prospective, pragmatic, open-label, single-blinded endpoint, two-arm randomised controlled trial conducted across Australia and NZ(1). Participants aged &gt;35 and ≤75 years with ≥2 modifiable risk factors for stroke were assessed using the Life’s Simple 7 (LS7) score. LS7 includes seven components (BMI, BP, total cholesterol, blood glucose, dietary pattern, smoking, and PA) categorising into ideal,intermediate, and poor level. Height, weight, and BP were measured. Total cholesterol and blood glucose were measured via CardioChek PA Analyser. An online FFQ and Physical Activity Questionnaire were administered. Descriptive analyses and correlation coefficients were used to examine the characteristics of participants at the baseline. In NZ, out of 395 targeted participants, 375 (Female = 230, mean age = 57yrs) from diverse ethnic groups (NZ European = 204, Māori = 35, Pacific = 17) were recruited and assessed. Among LS7 metrics, smoking had the highest proportion of those in the ideal category (88%), followed by blood glucose (62%), total cholesterol (49%), dietary pattern (34%), BP (22%) and BMI (13%). Nearly 64% consumed &lt;5 portions of fruits and vegetables per day. Almost half of the participants consumed beans and pulses less than once a week. About 43% and 31% consumed fibre-rich breakfast cereal and wholemeal bread less than once a week. Almost 10% drank fizzy drinks ≥4 times/week. Nearly 40% consumed sweets such as biscuits, cakes, and chocolate at least twice a week. Over half of the participants consumed red meat and chicken 2-3 times/week. In terms of other risk factors, over half of the participants were obese (BMI≥ 30 kg/m2). Only 12% were current smokers. About 10% drank alcohol 5-7 days/week. Physical activity expenditure (MET minutes/week) showed no significant sex difference. The LS7 factors correlated significantly were BMI and blood glucose (r = 0.157, p&lt;0.01), total cholesterol and smoking (r=-0.129, p&lt;0.01), BP and BMI (with a moderate correlation of r = 0.308, &lt;0.001). The NZ participants in the PERKS-International trial, had poor diets, along with suboptimal lifestyle and biomedical stroke risk factors, reflecting the inclusion criteria for the study. Urgent action is required for the primary stroke prevention at population-level. The results of the trial, expected in 2024, will show the benefit of a mobile phone app on reducing these stroke risk factors.

Food and Cardiovascular Disease: What to Eat and What Not to Eat

In 2019, the Global Burden of Disease study revealed alarming statistics regarding cardiovascular disease (CVD) in Pakistan. The estimated age-standardized incidence and death rates were 918.18 and 357.88 per 100,000 respectively, surpassing global averages.1 Notably, Pakistan faces unique challenges with a high prevalence of Rheumatic heart disease and early onset coronary artery disease.1&#x0D; The World Health Organization's 2021 factsheet underscores four pivotal modifiable behavioral risk factors for CVD and stroke: unhealthy diet, physical inactivity, tobacco use, and harmful alcohol consumption. These behaviors manifest in individuals as elevated blood pressure, glucose, lipids, and adverse body mass index, exacerbating cardiovascular risk.2 In Pakistan, the consumption of unhealthy foods and excessive calories significantly contributes to adverse cardiometabolic profiles, including obesity and dyslipidemia.2&#x0D; Recent research, such as that by Daruish Mozaffain et al. in "Food is Medicine," advocates for food-based interventions tailored to individual health conditions, ranging from medically tailored meals to nutritional and culinary education.3 However, Pakistani patients with CVD face challenges due to the lack of localized guidelines, educational resources, and accessible nutritionists. Shah et al.'s review underscores the importance of providing clear and culturally relevant dietary guidance for the local population.4&#x0D; Addressing these challenges requires the development of high-quality, culturally sensitive educational materials. These resources should be readily understandable, pictorial, and integrated into both inpatient and outpatient care. Local experts, including dietitians and researchers, can play a crucial role in creating tailored educational content. Figures 1 exemplify the efforts of these experts to provide practical guidance to the Pakistani population.4&#x0D; In conclusion, there is an urgent need for comprehensive, easy-to-understand patient education resources catering to the unique nutritional needs of Pakistani individuals with cardiovascular disease. By addressing these gaps, we can empower patients to make informed dietary choices and improve cardiovascular outcomes.&#x0D; References&#x0D; &#x0D; Samad Z, Hanif B. Cardiovascular Diseases in Pakistan: Imagining a Postpandemic, Postconflict Future. Circulation. 2023;147(17):1261-3.&#x0D; Liaquat A, Javed Q. Current trends of cardiovascular risk determinants in Pakistan. Cureus. 2018;10(10):e3409.&#x0D; Mozaffarian D, Aspry KE, Garfield K, Kris-Etherton P, Seligman H, Velarde GP, et al. “Food Is Medicine” Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024;83(8):843-64.&#x0D; Shah SU, Waseem T, Afridi T, Shah MI. Nutritional Needs for Cardiovascular Health in Pakistani Population. Pak Heart J. 2022;55(2):101-13.&#x0D; American Heart Association. Lifestyle Changes for Heart Failure. Accessed on March 30, 2024. Available at: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/lifestyle-changes-for-heart-failure&#x0D; American Diabetes Association. What superstar foods are good for diabetes? Accessed on March 30, 2024. Available at: https://diabetes.org/food-nutrition/food-and-blood-sugar/diabetes-superstar-foods&#x0D; American Heart Association. The American Heart Association Diet and Lifestyle Recommendations. Accessed on March 30, 2024. Available at: https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/aha-diet-and-lifestyle-recommendations&#x0D; American Heart Association. Managing Blood Pressure with a Heart-Healthy Diet. Accessed on March 30, 2024. Available at: https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/managing-blood-pressure-with-a-heart-healthy-diet&#x0D;

Correlation Between HbA1c and Body Mass Index Among Patients with High Lipid Profile Attending Johns Hopkins Aramco Healthcare Hospital in Saudi Arabia

BACKGROUND AND OBJECTIVES: Dyslipidemia is a modifiable risk factor for cardiovascular diseases, diabetes, and stroke. Obesity and elevated HbA1c levels are both risk factors for cardiovascular disease. The primary objective of this study was to examine the relationship between HbA1C and body mass index (BMI) among patients with high lipid profiles. METHODS: This retrospective, hospital-based study was conducted at Johns Hopkins Aramco Healthcare Facilities. Data were extracted from medical health records and included demographics, lipid profiles, and HBA1c measurements. The study included 2368 non-diabetic participants, and DATAtab was used to analyze the data. RESULTS: The participants were 57.05% male and 78.42% Saudi. The mean age was 41.48±12.1 years, and the mean body mass index (BMI) was 28.44±5.53. There was a statistically significant relationship between the use of lipid lowering medicine and HbA1c (P&lt;0.001). There was a very weak positive but statistically significant relationship between HbA1c and BMI (r = 0.18, P&lt;0.001). HbA1c and systolic blood pressure appeared to have a statistically significant positive association (r = 0.16, P&lt; 0.001). There was no correlation between HbA1c and low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), or diastolic blood pressure. There was an inverse correlation between HbA1c and high-density lipoprotein cholesterol (HDL-C) (r = -0.11, P&lt; 0.001). Regression was performed using a linear multivariable analysis with HbA1c as the dependent variable and age (B 0.192, P&lt;0.001), BMI (B 0.119, P&lt;0.001), HDL (B -0.058, P&lt;0.005), triglyceride (B 0.093, P&lt;0.001), lipid-lowering medication (B 0.104, P&lt;0.001), and systolic BP (B 0.060, P&lt; 0.003) as independent variables. CONCLUSION: The results indicated that HbA1c is linked to BMI, age, systolic blood pressure, triglycerides, and HDL-C levels. There was no correlation between HbA1c and LDL-C, TC, and diastolic blood pressure.

Assessing the Awareness and Practices of Physical Therapists in Managing Modifiable Risk Factors for Stroke in Saudi Arabia

Aims &amp; Objective: The current research on physical therapists' understanding of managing modifiable risk factors for stroke in Saudi Arabia is limited. This study aims to evaluate physical therapists' knowledge in Saudi Arabia on managing modifiable stroke risk factors and their prioritization of stroke prevention. It also seeks to understand the connection between therapists' awareness, experience, perceptions, and information access with their readiness to apply stroke prevention measures. Methodology: A cross-sectional online questionnaire survey was administered to registered Physical therapists in the Riyadh region between February and July of 2022. An online questionnaire was developed with 18 questions to evaluate the knowledge and perception of the Physical therapist about the risk factors and management of stroke. Socio-demographic information, participant's knowledge and perception of stroke risk factors, and participant's stroke risk factor sources of information. Results: The results of this survey suggest that while most physical therapists in Saudi Arabia have a good understanding of stroke risk factors, there are still some knowledge gaps that need to be addressed. The fact that a significant percentage of respondents were unsure about the relationship between some risk factors and stroke highlights the need for ongoing education and training for physical therapists in this area. Conclusions: The findings underscore the importance of education, training, work experience, and sources of knowledge in shaping physical therapists' beliefs and practice behaviors.

Updated Perspectives on Lifestyle Interventions as Secondary Stroke Prevention Measures: A Narrative Review.

Despite being highly preventable, stroke is the second-most common cause of death and disability in the world. Secondary prevention is critical as the stroke recurrence risk is 6- to 15-fold higher than the risk of stroke in the general population. Stroke recurrence is associated with higher mortality rates and increased disability levels. Lifestyle modifications should address not single but multiple cardiovascular risk factors to effectively reduce the risk of stroke. Lifestyle modifications on a personal level should include adequate physical activity, a healthy diet, the cessation of smoking and alcohol consumption, and stress reduction. Physical activities should be performed in a healthy environment without air pollution. According to recent studies, up to 90% of strokes might be prevented by addressing and treating ten modifiable stroke risk factors, half of which are related to lifestyle modifications. These lifestyle modifications, which are behavioral interventions, could impact other modifiable risk factors such as arterial hypertension, hyperlipidemia, obesity, diabetes, and atrial fibrillation. The most common obstacles to effective secondary stroke prevention are motor impairment, post-stroke cognitive impairment, post-stroke depression, and stroke subtype. Long-term lifestyle modifications are difficult to sustain and require comprehensive, individualized interventions. This review underlines the benefits of adhering to lifestyle modifications as the most effective secondary stroke prevention measure.

Sex differences in modifiable risk factors for stroke incidence and recurrence: the UCC-SMART study

Background and purposeRisk factors for stroke differ between women and men in general populations. However, little is known about sex differences in secondary prevention. We investigated if sex interacted with modifiable risk factors for stroke in a large arterial disease cohort.MethodsWithin the prospective UCC-SMART study, 13,898 patients (35% women) with atherosclerotic disease or high-risk factor profile were followed up to 23 years for stroke incidence or recurrence. Hypertension, smoking, diabetes, overweight, dyslipidemia, high alcohol use, and physical inactivity were studied as risk factors. Association between these factors and ischemic and hemorrhagic stroke incidence or recurrence was studied in women and men using Cox proportional hazard models and Poisson regression models. Women-to-men relative hazard ratios (RHR) and rate differences (RD) were estimated for each risk factor. Left-truncated age was used as timescale.ResultsThe age-adjusted stroke incidence rate was lower in women than men (3.9 vs 4.4 per 1000 person-years), as was the age-adjusted stroke recurrence rate (10.0 vs 11.7). Hypertension and smoking were associated with stroke risk in both sexes. HDL cholesterol was associated with lower stroke incidence in women but not in men (RHR 0.49; CI 0.27–0.88; and RD 1.39; CI − 1.31 to 4.10). Overweight was associated with a lower stroke recurrence in women but not in men (RHR 0.42; CI 0.23–0.80; and RD 9.05; CI 2.78–15.32).ConclusionsIn high-risk population, sex modifies the association of HDL cholesterol on stroke incidence, and the association of overweight on stroke recurrence. Our findings highlight the importance of sex-specific secondary prevention.

Correlation Between HbA1c and Body Mass Index Among Patients with High Lipid Profile Attending Johns Hopkins Aramco Healthcare Hospital in Saudi Arabia

BACKGROUND AND OBJECTIVES: Dyslipidemia is a modifiable risk factor for cardiovascular diseases, diabetes, and stroke. The primary objective of this study was to examine the relationship between HbA1C and body mass index (BMI) among patients with high lipid profiles. METHODS: This retrospective, hospital-based study was conducted at Johns Hopkins Aramco Healthcare Facilities. Data were extracted from medical health records and included demographics, lipid profiles, and HBA1c measurements. The study included 2368 non-diabetic participants, and DATAtab was used to analyze the data. RESULTS: The participants were 57.05% male and 78.42% Saudi. The mean age was 41.48±12.1 years, and the mean body mass index (BMI) was 28.44±5.53. There was a statistically significant relationship between the use of lipid lowering medicine and HbA1c (P&lt;0.001). There was a very weak positive but statistically significant relationship between HbA1c and BMI (r = 0.18, P&lt;0.001). HbA1c and systolic blood pressure appeared to have a statistically significant positive association (r = 0.16, P&lt; 0.001). There was no correlation between HbA1c and low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), or diastolic blood pressure. There was an inverse correlation between HbA1c and high-density lipoprotein cholesterol (HDL-C) (r = -0.11, P&lt; 0.001). Regression was performed using a linear multivariable analysis with HbA1c as the dependent variable, and age (B 0.192, P&lt;0.001), BMI (B 0.119, P&lt;0.001), HDL (B -0.058, P&lt;0.005), triglyceride (B 0.093, P&lt;0.001), lipid-lowering medication (B 0.104, P&lt;0.001), systolic BP (B 0.060, P&lt; 0.003) as independent variables. CONCLUSION: The results indicated that HbA1c is linked to BMI, age, systolic blood pressure, triglycerides, and HDL-C levels. There was no correlation between HbA1c and LDL-C, TC, and diastolic blood pressure.

Assessing the Awareness on Symptoms and Risk Factors of Stroke amongst Rural Community in Central Region of Malaysia: A Cross-Sectional Survey.

As the third leading cause of mortality in Malaysia, stroke is recognised as a medical emergency which requires urgent medical attention within a limited timeframe to prevent exacerbation of the brain damage and death in patients. Recent report revealed a high prevalence of pre-hospital delay amongst the stroke patients due to the lack of awareness on symptoms and risk factors of stroke, as well as poor understanding on appropriate action towards stroke. A number of studies had assessed stroke awareness amongst urban population residing in central region of Malaysia but yet amongst rural population. A cross-sectional survey was conducted amongst individuals residing in rural districts of Selangor by using a set of questionnaires assessing the sociodemographic characteristics, as well as the awareness and action towards stroke symptoms and risk factors. All 343 respondents were able to recognise at least one modifiable risk factor for stroke. Meanwhile, only 36.44% were able to identify all the stroke symptoms. Despite majority of them were familiar with the stroke term, less than half of the respondents were aware of calling the emergency medical service as the appropriate action towards stroke symptoms. The present study indicated a poor level of awareness and action towards stroke symptoms and risk factors amongst rural population residing in Selangor.

Correlation Between HbA1c and Body Mass Index Among Patients with High Lipid Profile Attending Johns Hopkins Aramco Healthcare Hospital in Saudi Arabia

BACKGROUND AND OBJECTIVES: Dyslipidemia is a modifiable risk factor for cardiovascular diseases, diabetes, and stroke. The primary objective of this study was to examine the relationship between HbA1C and body mass index (BMI) among patients with high lipid profiles. METHODS: This retrospective, hospital-based study was conducted at Johns Hopkins Aramco Healthcare Facilities. Data were extracted from medical health records and included demographics, lipid profiles, and HBA1c measurements. The study included 2368 participants, and DATAtab was used to analyse the data. RESULTS: The participants were 57.05% male and 78.42% Saudi. The mean age was 41.48±12.1 years, and the mean body mass index (BMI) was 28.44±5.53. There was a statistically significant relationship between the use of lipid lowering medicine and HbA1c (P&lt;0.001). There was a very weak positive but statistically significant relationship between HbA1c and BMI (r = 0.18, P&lt;0.001). HbA1c and systolic blood pressure appeared to have a statistically significant positive association (r = 0.16, P&lt; 0.001). There was no correlation between HbA1c and low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), or diastolic blood pressure. There was an inverse correlation between HbA1c and high-density lipoprotein cholesterol (HDL-C) (r = -0.11, P&lt; 0.001). Regression was performed using a linear multivariable analysis with HbA1c as the dependent variable, and the age (B 0.192, P&lt;0.001), BMI (B 0.119, P&lt;0.001), HDL (B -0.058, P&lt;0.005), Triglyceride (B 0.093, P&lt;0.001), lipid lowering medication (B 0.104, P&lt;0.001), systolic BP (B 0.060, P&lt; 0.003) as independents variables. CONCLUSION: The results indicated that HbA1c is linked to BMI, age, systolic blood pressure, triglycerides, and HDL-C levels. There was no correlation between HbA1c and LDL-C, TC, and diastolic blood pressure.

Histone deacetylase inhibition by suberoylanilide hydroxamic acid during reperfusion promotes multifaceted brain and vascular protection in spontaneously hypertensive rats with transient ischaemic stroke

Hypertension is the most prevalent modifiable risk factor for stroke and is associated with worse functional outcomes. Pharmacological inhibition of histone deacetylases by suberoylanilide hydroxamic acid (SAHA) modulates gene expression and has emerged as a promising therapeutic approach to reduce ischaemic brain injury. Here, we have tested the therapeutic potential of SAHA administered during reperfusion in adult male spontaneously hypertensive (SHR) rats subjected to transient middle cerebral artery occlusion (tMCAO; 90 min occlusion/24 h reperfusion). Animals received a single dose of SAHA (50 mg/kg) or vehicle i.p. at 1, 4, or 6 h after reperfusion onset. The time-course of brain histone H3 acetylation was studied. After tMCAO, drug brain penetrance and beneficial effects on behavioural outcomes, infarct volume, oedema, angiogenesis, blood-brain barrier integrity, cerebral artery oxidative stress and remodelling, and brain and vascular inflammation were evaluated. SAHA increased brain histone H3 acetylation from 1 to 6 h after injection, reaching the ischaemic brain administered during reperfusion. Treatment given at 4 h after reperfusion onset improved neurological score, reduced infarct volume and oedema, attenuated microglial activation, prevented exacerbated MCA angiogenic sprouting and blood-brain barrier breakdown, normalised MCA oxidative stress and remodelling, and modulated brain and cerebrovascular cytokine expression. Overall, we demonstrate that SAHA administered during early reperfusion exerts robust brain and vascular protection after tMCAO in hypertensive rats. These findings are aligned with previous research in ischaemic normotensive mice and help pave the way to optimise the design of clinical trials assessing the effectiveness and safety of SAHA in ischaemic stroke.

Abstract TP250: Poor Control of Hyperlipidemia Prior to Ischemic Stroke

Introduction: Hyperlipidemia is a key modifiable risk factor for ischemic stroke. Data suggest a strong correlation between low-density lipoprotein cholesterol (LDL) levels and the incidence of cardiovascular events. Few studies have addressed the scope of LDL undertreatment prior to ischemic stroke. Methods: A retrospective analysis was conducted on patients with ischemic stroke to study patterns of hyperlipidemia undertreatment using LDL levels as a marker. A total of 826 patients admitted from 2018-2020 were stratified into three LDL categories: 1) High (130-159), 2) Very High (160-189), and 3) Extremely High (190 or higher). A chi-squared analysis was performed to determine if there was a significant difference in proportion based on sex, race, age, diabetes (DM) status, history of heart disease and statin use among patients across the three LDL categories. An ANOVA analysis was also performed to determine if a significant difference exists between the mean ages of the three LDL categories. Results: Of the 826 patients, there were 178 patients (21.5%) whose LDL-C values were greater than 130. 106 (12.8%) were classified as High, 50 (6.0%) as Very High, and 22 (2.7%) as Extremely High. For the High group, 61 (57.5%) were male, 29 (27.4%) had DM, 32 (30%) were older than 70, and 89 (84%) had a history of heart disease. For the Very High group, 16 (32%) had DM and 40 (80%) had a history of heart disease. For the Extremely High group, 32% had DM and 36% had heart disease. There was no significant correlation between the three LDL categories and the various patient characteristics. Conclusion: A broad group of patients (including those of different sexes, races, and ages) presented with markedly elevated LDL at the time of an ischemic stroke. Despite the recommendation for intensive LDL lowering with DM and heart disease, a large portion of patients with these conditions were poorly controlled. Achieving guideline adherence for lipid control could reduce the stroke rate, especially for those with DM and prior heart disease.

Abstract TP304: Ischemic Stroke Increases Levels of One-Carbon Enzymes and the Folate Receptor in Male and Female Brain Tissue

Stroke is the second most common cause of death worldwide and predominantly affects individuals over 65 years old. Its prevalence is projected to increase in parallel with the aging global population. Nutrition is a modifiable risk factor for ischemic stroke. Folates, B-vitamins and choline play a central role in one-carbon (1C) metabolism, which is a key metabolic network that integrates nutritional signals with biosynthesis, redox homeostasis, epigenetics, regulation of cell proliferation, and stress resistance. Our research group has previously shown that deficiencies in 1C lead to worsened stroke outcomes using preclinical models. However, the impact of ischemic stroke on 1C enzymes remains unknown. The objective of this study is to investigate whether ischemic stroke contributes to a change in the levels of 1C enzymes after ischemic stroke in male and female patients. Brain tissue sections from ischemic stroke patients and controls were stained, all tissue was co-stained with neuronal nuclei (NeuN) and DAPI (4′,6-diamidino-2-phenylindole). The colocalization of all three markers was evaluated by two individuals who were blinded to the experimental groups. Ischemic stroke increased neuronal levels of the folate receptor and 1C enzymes, methylenetetrahydrofolate reductase (MTHFR), thymidylate synthase (TS) and serine hydroxymethyltransferase (SHMT). In male stroke brain tissue was observed to have increased levels of MTHFR, TS, and SHMT. Female brain tissue had increases in the folate receptor and TS. The results suggest that ischemic stroke leads to increased demand on 1C and that there are some small differences between males and females.