Number Of Vascular Risk Factors Research Articles

Thrombus age does not differentiate between cardiogenic and atherosclerotic strokes

ObjectiveInterventional stroke therapy made thrombi available for histological analysis. Unfortunately, simple composition aspects such as erythrocyte versus fibrin/platelet rich did not allow a feasible allocation to thrombi’s cardiac or carotid...

Abstract P253: Lifetime Risk of Dementia by Midlife Vascular Risk Factor Burden: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Vascular risk factors play an important role in the development of dementia and death over the lifecourse. However, no absolute lifetime risk of dementia by individual and composite number of vascular risk factors have been reported. Methods: We conducted a prospective cohort analysis of data from the Atherosclerosis Risk in Communities (ARIC) Study. We examined the associations of vascular risk factors with incident dementia. Risk factors were measured at visit 2 (1990-1992) and included hypertension (SBP140mmHg, DBP90mmHg or medication use), diabetes status (self-reported physician diagnosis, medication use or HbA1C6.5%) and smoking status. Incident dementia was ascertained via active surveillance involving cognitive function assessments, informant reports, hospitalization codes and death records. We performed survival analysis using age as time scale and accounted for death without dementia as a competing event. We used age 60 as the origin and age on December 31 st , 2019, as the administrative censoring endpoint. Results: Among 13,161 participants, 45%, 40%, and 15% had 0, 1 and 2+ risk factors. There was a dose-dependent association between number of risk factors and the cumulative incidence of dementia (Figure A) and death (Figure C) . In competing risk models ( Figure B ), the cumulative incidence of dementia (95% CI) in persons with 0, 1 and 2+ risk factors by age 80 was 7.5% (6.6-8.5%), 10.3% (9.2-11.5%) and 13.7% (11.5-15.7%). By age 90, due to higher risk of mortality among those with vascular risk factors, the dementia risk (95% CI) for 0, 1 and 2+ risk factors were 34.8 (32.3-37.3%), 31.2% (29.0-33.2%) and 26.7% (23.9-29.6%). Conclusion: Preventing vascular risk factors in midlife may substantially reduce the age-specific risk of dementia. However, since fewer risk factors also lead to longer survival to oldest ages where dementia risk is very high, reducing lifetime risk of dementia beyond age 90 years will require additional preventative strategies. Figure: Cumulative incidence of dementia using Kaplan Meier estimator (A), using cumulative incidence function with competing risk of death (B), and cumulative incidence of death (C), according to the number of vascular risk factors in mid-life.

The Correlation Between the Number of Vascular Risk Factors and the Onset of Hemodialysis with Cognitive Impairement in Chronic Kidney Disease (CKD) Patients

Background:Cognitive impairment is common in chronic kidney disease (CKD) patients, affecting at least 50% due to ischemia linked to impaired vascular function. Changes during dialysis, like water loss and ultrafiltration, disrupt brain blood supply, worsening ischemia and cognitive function impairment. Objective: Analyze the correlation between vascular risk factors, dialysis onset, and cognitive impairment in CKD patients. Methods: This analytic observational study sampled CKD patients on hemodialysis between February-July 2023, using purposive sampling. Inclusion and exclusion criteria were applied, and cognitive function was assessed using MOCA-INA. Spearman's rho statistical analysis was employed at a 95% confidence level (p <0.05). Results: Spearman Rho revealed a correlation between hemodialysis for over 5 years and impaired cognitive function (P=0.02). Affected cognitive domains, in sequence, are memory/delayed recall, visuospatial, abstraction, language, attention, and naming. However, the number of vascular risk factors did not correlate with cognitive impairment (P=1.38). Conclusion:CKD patients on hemodialysis for more than 5 years show a correlation with impaired cognitive function, primarily affecting memory/delayed recall, visuospatial, abstraction, language, attention, and naming. Vascular risk factors, however, exhibit no correlation with cognitive impairment.

The AGED Triad: Opportunities for delaying dementia

AbstractBackgroundApathy, gait impairment, and executive dysfunction (AGED) commonly occur jointly in the elderly, sometimes masked by the generic description of “late life depression.” The recognition of the triad is clinically useful because it often results from hypertension, which is treatable and preventable. Vascular risk factors, especially hypertension, can insidiously cause brain damage which may increase the risk of dementia in older adults. Hence the AGED triad can be a behavioral marker of cerebrovascular damaging which may lead to cognitive disability. It is unclear, however, whether individuals diagnosed with the AGED triad phenotype are at higher risk of earlier conversion to dementia compared with non‐AGED triad phenotype. We also tested the hypothesis that AGED triad would have better predictive capability than each of the three components separately.MethodAfter baseline assessments 275 community‐dwelling older individuals (72.15±6.68 years of age; 58% women) from the Gait and Brain Study underwent face‐to‐face interviews every 6 months for up to 7 years (22.93±20.33 months; 6∼105). Gait performance was assessed electronically; apathy was assessed through the Geriatric Depression Scale‐3A; dysexecutive function was assessed trough the Trail Making test‐part B; dementia was diagnosed through the clinical dementia rating scale. Adjusted Cox‐regression models were used to determine early dementia risk in each exposure group.ResultA greater percentage of AGED triad individuals at baseline had more than 2 vascular risk factors (p<.01) including hypertension, diabetes, hypercholesterolemia, obesity and smoking history. Incidence of dementia in the AGED triad was 16.8% vs. 6% in the non‐AGED triad. AGED triad significantly increased the risk of earlier conversion to dementia compared with non‐AGED triad by 323% independently of the number of vascular risk factors at baseline. AGED triad predicted earlier conversion to dementia more than the three components separately (HR = 6.60 95%CI 1.48 to 29.46; p = .01; see figure 1).ConclusionAGED triad phenotype predicts earlier conversion to dementia compared with non‐AGED triad; and earlier than slow gait, apathy and dysexecutive function separately. AGED triad may be a behavioral marker of severe insidious brain damage over of an individual’s life course likely caused by unmanaged modifiable vascular risk factors.

Current status and value of testing antiphospholipid antibody in patients with acute ischemic stroke: a retrospective single-center study in China.

Testing for antiphospholipid antibodies (aPL) is useful to determine the cause of ischemic stroke in young and female patients. However, the clinical relevance of aPL in older patients with ischemic stroke remains unclear. We aimed to explore the status and diagnostic value of initial aPL testing in all patients with acute ischemic stroke. We retrospectively analyzed patients with acute ischemic stroke who were consecutively hospitalized in our hospital between June 2012 and January 2022 and investigated the factors associated with performing aPL screening in real-world clinical practice. Furthermore, factors associated with initial aPL positivity were evaluated by comparing the demographic, etiological, and therapeutic characteristics. Of 1209 patients, 287 (23.7%) were tested for aPL and 58 (20.2%) tested positive. Physicians tended to conduct aPL testing on female patients (P<0.001), younger patients (P<0.001), patients with fewer vascular risk factors (P<0.001), and multiple infarctions in the multivascular blood supply area (P<0.001). Multivariate logistic regression analysis showed that only stroke of other determined etiology type was a significant influencing factor for positive aPL results (OR 2.97, 95% CI 1.137, 7.774, P=0.026), adjusting for sex, age, and causes of stroke, etc. CONCLUSION: Approximately one-quarter of the patients with acute ischemic stroke were tested for aPL. Age, sex, number of vascular risk factors, and neuroimaging features affected the discretion in performing aPL testing. aPL testing may be appropriate in older patients with no identified cause of ischemic stroke and may provide additional diagnostic opportunities for acute ischemic stroke.

Association of Unfavorable Social Determinants of Health With Stroke/Transient Ischemic Attack and Vascular Risk Factors in Hispanic/Latino Adults: Results From Hispanic Community Health Study/Study of Latinos.

Social determinants of health (SDOH) are non-medical factors that may contribute to the development of diseases, with a higher representation in underserved populations. Our objective is to determine the association of unfavorable SDOH with self-reported stroke/transient ischemic attack (TIA) and vascular risk factors (VRFs) among Hispanic/Latino adults living in the US. We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos. SDOH and VRFs were assessed using questionnaires and validated scales and measurements. We investigated the association between the SDOH (individually and as count: ≤1, 2, 3, 4, or ≥5 SDOH), VRFs and stroke/TIA using regression analyses. For individuals with stroke/TIA (n=388), the mean age (58.9 years) differed from those without stroke/TIA (n=11,210; 46.8 years; P<0.0001). In bivariate analysis, income <$20,000, education less than high school, no health insurance, perceived discrimination, not currently employed, upper tertile for chronic stress, and lower tertiles for social support and language- and social-based acculturation were associated with stroke/TIA and retained further. A higher number of SDOH was directly associated with all individual VRFs investigated, except for at-risk alcohol, and with number of VRFs (β=0.11, 95% confidence interval [CI]=0.09-0.14). In the fully adjusted model, income, discrimination, social support, chronic stress, and employment status were individually associated with stroke/TIA; the odds of stroke/TIA were 2.3 times higher in individuals with 3 SDOH (95% CI 1.6-3.2) and 2.7 times (95% CI 1.9-3.7) for those with ≥5 versus ≤1 SDOH. Among Hispanic/Latino adults, a higher number of SDOH is associated with increased odds for stroke/TIA and VRFs. The association remained significant after adjustment for VRFs, suggesting involvement of non-vascular mechanisms.

Abstract TP19: Multicenter Experience With A Novel Cadasil Severity Grading System.

Introduction: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetic, progressive microangiopathy caused by mutations in the NOTCH3 gene. Patients often present with migraine and progressive subcortical infarcts resulting in vascular cognitive impairment and death. Currently, there are no disease modifying treatments. Limiting future trials is the lack of an objective construct to classify and monitor severity of disease. The purpose of this study was to gain experience with a novel CADASIL severity grading system. Methods: Neurologists at 5 academic centers retrospectively reviewed charts of those with confirmed CADASIL. Demographic and clinical data were recorded. The CADASIL severity grades were then assigned: 0 (asymptomatic), 1 (migraine alone), 2 (stroke or mild cognitive impairment), 3 (gait impairment or early dementia) and 4 (bedbound) based on available data. Standard descriptive statistical analyses were used. Results: We identified 138 patients; overall mean age of 50.9±13.1 years, 42.8% were men. 15 (10.9%) were grade 0, 50 (36.2%) were grade 1, 41 (44.2%) were grade 2, 12 (8.7%) were grade 3, and none were grade 4. Those with less severe disease tended to be younger, more likely men, had a lower rate of hypertension and diabetes mellitus and were less frequently tobacco users, Table 1. Increasing number of vascular risk factors was associated with higher severity grading. Conclusion: Our study highlights the ability of this severity scale to separate those with CADASIL into an ordinal system. As known in the literature, more advanced phenotypes of CADASIL tend to have more vascular risk factors. Future trials may consider utilizing this ordinal construct to monitor disease progression, response to therapy, or as a screening tool.

Rupture discrimination of multiple small (< 7 mm) intracranial aneurysms based on machine learning-based cluster analysis

BackgroundSmall multiple intracranial aneurysms (SMIAs) are known to be more prone to rupture than are single aneurysms. However, specific recommendations for patients with small MIAs are not included in the guidelines of the American Heart Association and American Stroke Association. In this study, we aimed to evaluate the feasibility of machine learning-based cluster analysis for discriminating the risk of rupture of SMIAs.MethodsThis multi-institutional cross-sectional study included 1,427 SMIAs from 660 patients. Hierarchical cluster analysis guided patient classification based on patient-level characteristics. Based on the clusters and morphological features, machine learning models were constructed and compared to screen the optimal model for discriminating aneurysm rupture.ResultsThree clusters with markedly different features were identified. Cluster 1 (n = 45) had the highest risk of subarachnoid hemorrhage (SAH) (75.6%) and was characterized by a higher prevalence of familiar IAs. Cluster 2 (n = 110) had a moderate risk of SAH (38.2%) and was characterized by the highest rate of SAH history and highest number of vascular risk factors. Cluster 3 (n = 505) had a relatively mild risk of SAH (17.6%) and was characterized by a lower prevalence of SAH history and lower number of vascular risk factors. Lasso regression analysis showed that compared with cluster 3, clusters 1 (odds ratio [OR], 7.391; 95% confidence interval [CI], 4.074–13.150) and 2 (OR, 3.014; 95% CI, 1.827–4.970) were at a higher risk of aneurysm rupture. In terms of performance, the area under the curve of the model was 0.828 (95% CI, 0.770–0.833).ConclusionsAn unsupervised machine learning-based algorithm successfully identified three distinct clusters with different SAH risk in patients with SMIAs. Based on the morphological factors and identified clusters, our proposed model has good discrimination ability for SMIA ruptures.

ADAMTS-13 activity in stroke of known and unknown cause: Relation to vascular risk factor burden.

The identification of the underlying mechanism in ischemic stroke has important implications for secondary prevention. A disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13 (ADAMTS-13) has antithrombotic properties and was repeatedly implicated in the pathophysiology of stroke. In this study, we, therefore, aimed to investigate whether ADAMTS-13 is associated with stroke etiology and the burden of vascular risk factors. We determined ADAMTS-13 activity in two prospectively recruited stroke cohorts in the long-term course after the event. Cohort 1 (n = 88) consisted of patients who suffered a stroke due to embolic stroke of undetermined source (ESUS), cardioembolic stroke due to atrial fibrillation (AF), large-artery atherosclerosis, or small vessel disease. In cohort 2, patients with cryptogenic stroke and patent foramen ovale (PFO) scheduled for PFO closure (n = 38) were enrolled. As measures of vascular risk factor burden, the CHA2DS2VASC score, the Essen Stroke Risk Score (ESRS), and the Risk of Paradoxical Embolism (RoPE) score were calculated, as appropriate. ADAMTS-13 activity was lower in patients with AF-related stroke compared to patients with ESUS (p = 0.0227), which was, however, due to confounding by vascular risk factors. ADAMTS-13 activity inversely correlated with the ESRS (r = -0.452, p < 0.001) and CHA2DS2VASC (r = -0.375, p < 0.001) in cohort 1. In accordance with these findings, we found a positive correlation between ADAMTS-13 activity and the RoPE score in cohort 2 (r = 0.413, p = 0.010). ADAMTS-13 activity is inversely correlated with the number of vascular risk factors across different stroke etiologies. Further study is warranted to establish ADAMTS-13 as a mediator of cerebrovascular risk.

Novel grading system for CADASIL severity: A multicenter cross-sectional study

BackgroundCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited progressive cerebral microangiopathy with considerable phenotypic variability. The purpose of this study was to describe the generalizability of a recently proposed grading system of CADASIL across multiple centers in the United States. MethodsElectronic medical records (EMR) of an initial neurological assessment of adult patients with confirmed CADASIL were reviewed across 5 tertiary referral medical centers with expertise in CADASIL. Demographic, vascular risk factors, and neuroimaging data were abstracted from EMR. Patients were categorized into groups according to the proposed CADASIL grading system: Grade 0 (asymptomatic), Grade 1 (migraine only), Grade 2 (stroke, TIA, or MCI), Grade 3 (gait assistance or dementia), and Grade 4 (bedbound or end-stage). Inter-rater reliability (IRR) of grading was tested in a subset of cases. ResultsWe identified 138 patients with a mean age of 50.9 ± 13.1 years, and 57.2% were female. The IRR was acceptable over 33 cases (κ=0.855, SD 0.078, p<0.001) with 81.8% being concordant. There were 15 patients (10.9%) with Grade 0, 50 (36.2%) with Grade 1, 61 (44.2%) with Grade 2, 12 (8.7%) with Grade 3, and none with Grade 4. Patients with a lower severity grade (grade 0 vs 3) tended to be younger (49.5 vs. 61.9 years) and had a lower prevalence of hypertension (50% vs. 20%, p = 0.027) and diabetes mellitus (0% vs. 25%, p = 0.018). A higher severity grade was associated with an increased number of vascular risk factors (p = 0.02) and independently associated with hypertension and diabetes (p<0.05). Comparing Grade 0 vs. 3, cortical thickness tended to be greater (2.06 vs. 1.87 mm; p = 0.06) and white matter hyperintensity volume tended to be lower (54.7 vs. 72.5 ml; p = 0.73), but the differences did not reach significance. ConclusionThe CADASIL severity grading system is a pragmatic, reliable system for characterizing CADASIL phenotype that does not require testing beyond that done in standard clinical practice. Higher severity grades tended to have a higher vascular risk factor burden. This system offers a simple method of categorizing CADASIL patients which may help to describe populations in observational and interventional studies.

Sex and gender-specific aspects in prediabetes and diabetes mellitus-clinical recommendations (Update 2023)

Metabolic diseases dramatically affect the life of men and women from infancy up to old age in different and manifold ways and are amajor challenge for the healthcare system. The treating physicians are confronted with the different needs of women and men in the clinical routine. Gender-specific differences affect pathophysiology, screening, diagnostic and treatment strategies of diseases as well as the development of complications and mortality rates. Impairments in glucose and lipid metabolism, regulation of energy balance and body fat distribution and therefore the associated cardiovascular diseases, are greatly influenced by steroidal and sex hormones. Furthermore, education, income and psychosocial factors play an important role in the development of obesity and diabetes differently in men and women. Males appear to be at greater risk of diabetes at ayounger age and at alower body mass index (BMI) compared to women but women feature adramatic increase in the risk of diabetes-associated cardiovascular diseases after the menopause. The estimated future years of life lost owing to diabetes is somewhat higher in women than men, with ahigher increase in vascular complications in women but ahigher increase of cancer deaths in men. In women prediabetes or diabetes are more distinctly associated with ahigher number of vascular risk factors, such as inflammatory parameters, unfavourable changes in coagulation and higher blood pressure. Women with prediabetes and diabetes have amuch higher relative risk for vascular diseases. Women are more often morbidly obese and less physically active but may have an even greater benefit in health and life expectation from increased physical activity than men. In weight loss studies men often showed ahigher weight loss than women; however, diabetes prevention is similarly effective in men and women with prediabetes with arisk reduction of nearly 40%. Nevertheless, along-term reduction in all cause and cardiovascular mortality was so far only observed in women. Men predominantly feature increased fasting blood glucose levels, women often show impaired glucose tolerance. Ahistory of gestational diabetes or polycystic ovary syndrome (PCOS) as well as increased androgen levels and decreased estrogen levels in women and the presence of erectile dysfunction or decreased testosterone levels in men are important sex-specific risk factors for the development of diabetes. Many studies showed that women with diabetes reach their target values for HbA1c, blood pressure and low-density lipoprotein (LDL)-cholesterol less often than their male counterparts, although the reasons are unclear. Furthermore, sex differences in the effects, pharmacokinetics and side effects of pharmacological treatment should be taken more into consideration.

Vascular Risk Factors in Ischemic Stroke Survivors: A Retrospective Study in Catalonia, Spain.

The distribution of vascular risk factors (VRFs) and stroke management vary by geographic area. Our aim was to examine the percentage of the VRFs according to age and sex in ischemic stroke survivors in a geographical area on the Mediterranean coast of Southern Catalonia, Spain. This was a multicenter, observational, retrospective, community-based study of a cohort, the data of which we obtained from digital clinical records of the Catalan Institute of Health. The study included all patients with a confirmed diagnosis of ischemic stroke who were treated between 1 January 2011 and 31 December 2020. Patients met the following inclusion criteria: residing in the study area, age ≥ 18 years, and presenting ≥1 modifiable vascular risk factor. The exclusion criteria were as follows: death patients (non-survivors) and patients without modifiable VRFs. We collected the demographic, clinical, and VRF variables of the total of 2054 cases included, and we analyzed the data according to age groups, sex, and number of VRFs. Most of the patients included were in the 55-80 age group (n = 1139; 55.45%). Of the patients, 56.48% (n = 1160) presented ≤ 2 modifiable VRFs, and the age group &lt;55 years old (67.01%) presented more VRFs. Hypertension and (&gt;80 years old (38.82%)) and dyslipidemia (&lt;55 years (28.33%)) were the most prevalent VRFs. In the age group 55-80 (69.59% men), the prevalence of VRFs was higher ((3-4 VRF (42.76%) and &gt;4 VRF (5.35%)). These results suggest the presence of many VRFs in people diagnosed with ischemic stroke-although with a lower percentage compared to other studies-and the need for specific individualized interventions for the control of modifiable RFs related to primary and secondary prevention of stroke.

Risk factors for unfavourable outcomes after shunt surgery in patients with idiopathic normal-pressure hydrocephalus

A number of vascular risk factors (VRFs) have been reported to be associated with idiopathic normal-pressure hydrocephalus (iNPH), but it remains unclear whether these VRFs are related to patient outcomes after shunt surgery. Therefore, we investigated the risk factors for unfavourable outcomes after shunt surgery in iNPH patients using two samples from Tohoku University Hospital and from a multicentre prospective trial of lumboperitoneal (LP) shunt surgery for patients with iNPH (SINPHONI-2). We enrolled 158 iNPH patients. We compared the prevalence of VRFs and clinical measures between patients with favourable and unfavourable outcomes and identified predictors of unfavourable outcomes using multivariate logistic regression analyses. The presence of hypertension, longer disease duration, more severe urinary dysfunction, and a lower Evans’ index were predictors of unfavourable outcomes after shunt surgery. In addition, hypertension and longer disease duration were also predictors in patients with independent walking, and a lower Evans’ index was the only predictor in patients who needed assistance to walk or could not walk. Our findings indicate that hypertension is the only VRF related to unfavourable outcomes after shunt surgery in iNPH patients. Larger-scale studies are needed to elucidate the reason why hypertension can affect the irreversibility of symptoms after shunt placement.

Quantitative Water Permeability Mapping of Blood-Brain-Barrier Dysfunction in Aging.

Blood-brain-barrier (BBB) dysfunction is a hallmark of aging and aging-related disorders, including cerebral small vessel disease and Alzheimer’s disease. An emerging biomarker of BBB dysfunction is BBB water exchange rate (kW) as measured by diffusion-weighted arterial spin labeling (DW-ASL) MRI. We developed an improved DW-ASL sequence for Quantitative Permeability Mapping and evaluated whole brain and region-specific kW in a cohort of 30 adults without dementia across the age spectrum. In this cross-sectional study, we found higher kW values in the cerebral cortex (mean = 81.51 min–1, SD = 15.54) compared to cerebral white matter (mean = 75.19 min–1, SD = 13.85) (p < 0.0001). We found a similar relationship for cerebral blood flow (CBF), concordant with previously published studies. Multiple linear regression analysis with kW as an outcome showed that age was statistically significant in the cerebral cortex (p = 0.013), cerebral white matter (p = 0.033), hippocampi (p = 0.043), orbitofrontal cortices (p = 0.042), and precunei cortices (p = 0.009), after adjusting for sex and number of vascular risk factors. With CBF as an outcome, age was statistically significant only in the cerebral cortex (p = 0.026) and precunei cortices (p = 0.020). We further found moderate negative correlations between white matter hyperintensity (WMH) kW and WMH volume (r = −0.51, p = 0.02), and normal-appearing white matter (NAWM) and WMH volume (r = −0.44, p = 0.05). This work illuminates the relationship between BBB water exchange and aging and may serve as the basis for BBB-targeted therapies for aging-related brain disorders.

Determinants of Quality of Life after Stroke in Southern Portugal: A Cross Sectional Community-Based Study

Introduction: the perception of Quality of Life (QoL) has been used to evaluate the treatment and evolution of several pathologies. QoL evaluation allows a better understanding of the patient and his adaptation to the disease. An observational, community-based and descriptive correlational study was carried out to analyze stroke survivors’ perception of QoL. Methods: consecutive case-series of stroke survivors (≥3 months) followed in a single public primary health center (“Tavira Primary Health Centre”) from Algarve, southern Portugal. The Portuguese version of the World Health Organization Quality of life instrument was administered in 102 stroke survivors. Results: Perception of QoL was associated (p < 0.05) with specific sociodemographic (age, sex, marital status, academic training), economic (monthly family income) and clinical factors (number of vascular risk factors, type of stroke, evolution, chronic mRankin score). On multivariate analysis, chronic mRankin score on physical (R2 = 0.406; F = 8.757; p < 0.001), psychological (R2 = 0.286; F = 5.536; p < 0.001) and general domain (R2 = 0.357; F = 7.287; p < 0.001); and family income (R2 = 0.160; F = 3.156; p < 0.005) on environmental domain, emerged as predictors of QoL. Conclusion: Different socio-demographic, economic and health factors are associated with post-stroke QoL. Description of QoL contributes to the overall evaluation of the impact of stroke on health and should be a priority for health professionals.

Vascular Risk Factors, Imaging, and Outcomes in Transient Ischemic Attack/Ischemic Stroke Patients with Neuroimaging Evidence of Probable/Possible Cerebral Amyloid Angiopathy.

Background In TIA/ischemic stroke patients, the clinical significance of lobar microbleeds potentially indicating cerebral amyloid angiopathy (CAA) is unknown. We assessed vascular risk factors and outcomes, including cognition, in TIA/ischemic stroke patients with neuroimaging evidence of probable/possible CAA. Methods This prospective cohort was conducted from August 2015 and January 2018 at 40 centers. 2625 participants were collected. Eligible participants were aged at least 55 years. Montreal Cognitive Assessment (MoCA) score is less than or equal to 26. A total of 1620 patients were included. 1604 (99.0%) and 1582 (97.7%) participants are followed up at 3 and 12 months. The primary outcomes were death or disability (mRS score, 3-6) and Montreal Cognitive Assessment (MoCA) at 3 months and 12 months. Demographic and vascular risk factors were measured at baseline (smoking, alcohol, diabetes, atrial fibrillation, hypertension, hypercholesterolemia, coronary artery disease, ischemic stroke, and transient ischemic attack). Blood samples were collected within 24 hours of admission. MRI was recommended for all patients. MoCA score was evaluated at baseline and follow-up. Results In total, 291/1620 patients with ischemic stroke/TIA (32.7% female and mean age, 67.8 years) had neuroimaging evidence of probable/possible CAA. Higher age, history of hypertension, atrial fibrillation, ischemic stroke, alcohol, and high glucose at the admission were more common in the patients. Mean MoCA changed from 21.4 at 3 months (SD 5.2) to 22.3 at 12 months (SD 4.7), difference 0.3 (SD 3.8). At the 3-month and 12-month follow-up, there were significant differences in age, education level, and sex among different cognitive groups. Higher age, lower education (less than high school), and female sex were the predictors of changing in MoCA score from 3 months to 12 months. Moreover, age (more than 66 years) and education (less than high school) are strongly associated with MoCA at 3- and 12-month follow-up. 30 of 286 (10.5%) and 37 of 281 (13.2%) patients had poor outcome of death or disability (modified Rankin Scale score, 3-6) at follow-up 3 and 12 months. Cortical superficial siderosis (cSS) was associated with higher mRS at follow-up. cSS status, cSS count 1-2, cSS strictly lobar, and strictly deep might be the risks of outcomes in adjusted analyses. Conclusion This study suggested that an increasing number of vascular risk factors and imaging markers were significantly associated with outcomes of TIA/ischemic stroke patients with CAA pattern. Male, young patients with high education should get better cognitive recovery.

Hippocampal atrophy is independent of amyloid status 3 years after ischemic stroke

AbstractBackgroundHippocampal atrophy, long thought to be an imaging signature of Alzheimer’s disease, is seen in a range of neurodegenerative disorders, and in association with vascular risk factors in people without dementia. We examined hippocampal volume (HV) in a group of ischemic stroke patients who participated in an amyloid PET imaging study 3 years after their stroke. Given the complex interactions between normal brain aging, vascular risk factors and brain histopathology, we hypothesized that there would be no association between HV and amyloid status.MethodThe Cognition And Neocortical Volume After Stroke (CANVAS) study is an observational cohort study of 135 patients with ischemic stroke examining brain volume and cognition over 3 years compared to healthy controls. Amyloid 18F‐NAV4694 PET imaging was offered at 3 years as a sub‐study. Only participants with usable MRI scans at 3 years were included. We report centiloids (CLs) not SUVRs for comparison of our results with others using different amyloid PET tracers. CL amyloid status was classified as: CL&lt;15 NEGATIVE; CL 15‐25 UNCERTAIN; CL&gt;25 POSITIVE. In addition, Brain Banking was offered to all CANVAS participants: participants are classified amyloid‐positive with Braak staging&gt;3. We compared HVs between the amyloid‐positive and ‐negative groups and associations between co‐morbidities and vascular risk factors (VRFs) by comparing Charlson Co‐morbidity Indices (CCI) and number of VRF using Multiway ANOVA (anovan, MATLAB 2019b).ResultOne participant was Brain Banked; 34 (27 men) participated in the PET imaging sub‐study. There were no differences in years of education, VRF and CCI between PET and non‐PET participants, although PET participants had larger heads (Fig1). CCI was significantly associated with HV (p&lt;0.0001) but CCI variability was explained by age (collinear). VRFs were not significantly associated with HV. PET participants were significantly older than the 61 (42 men) non‐PET participants (69.6+/‐8.6 vs 64.2+/‐13.5 years; p=0.037). Five participants were amyloid‐positive: Brain Bank participant (Braak Stage 5), 4 PET participants (Fig2). There was no association between amyloid CLs and HV, but amyloid positivity was associated with greater CCI.ConclusionIn this small study of stroke patients, hippocampal atrophy occurred independently of amyloid pathology and was more associated with age and co‐morbidity.

Associations between the size and location of myocardial infarction and cerebral infarction

BackgroundMyocardial infarction (MI) is a known cause of cerebral infarction. We assessed whether the size and location of MI is associated with the risk of cerebral infarction. Methods and resultsWe performed a cross-sectional study of adults who underwent both brain MRI and delayed-enhancement cardiac MRI (DE-CMR) within 365 days of each other at Weill Cornell Medicine between 2014 and 2017 and had evidence of MI on DE-CMR. We used multiple logistic regression to evaluate associations between MI size and any cerebral infarction, apical MI location and any cerebral infarction, and MI size/location and cortical versus subcortical cerebral infarction. Models were adjusted for demographics, and the total number of vascular risk factors. Among 234 patients who underwent both DE-CMR and brain MRI within 365 days, 76 had evidence for MI on DE-CMR. Among these 76 patients, 51 (67.1%) had evidence of cerebral infarction. The size of MI (global MI burden) was not associated with any cerebral infarction (OR per 5% increase in MI size, 1.12; 95% CI, 0.85–1.47), but was associated with cortical cerebral infarction (OR per 5% increase in MI size, 1.30; 95% CI, 1.00.-1.68). Similarly, apical MI location was not associated with any cerebral infarction (OR 2.63, 95% CI, 0.78–8.87), but was associated with cortical cerebral infarction (OR, 3.67; 95% CI, 1.19–11.33). ConclusionAmong patients with MI on cardiac MRI, both size and apical location of MI were associated with cortical cerebral infarction. Our results may help stratify cardioembolic risk and inform antithrombotic treatment algorithms among patients with MI.

The effect of vascular risk factor burden on the severity of COVID-19 illness, a retrospective cohort study

BackgroundPatients with cardiovascular comorbidities are at high risk of poor outcome from COVID-19. However, how the burden (number) of vascular risk factors influences the risk of severe COVID-19 disease remains unresolved. Our aim was to investigate the association of severe COVID-19 illness with vascular risk factor burden.MethodsWe included 164 (61.8 ± 13.6 years) patients with COVID-19 in this retrospective study. We compared the difference in clinical characteristics, laboratory findings and chest computed tomography (CT) findings between patients with severe and non-severe COVID-19 illness. We evaluated the association between the number of vascular risk factors and the development of severe COVID-19 disease, using a Cox regression model.ResultsSixteen (9.8%) patients had no vascular risk factors; 38 (23.2%) had 1; 58 (35.4%) had 2; 34 (20.7%) had 3; and 18 (10.9%) had ≥4 risk factors. Twenty-nine patients (17.7%) experienced severe COVID-19 disease with a median (14 [7–27] days) duration between onset to developing severe COVID-19 disease, an event rate of 4.47 per 1000-patient days (95%CI 3.10–6.43). Kaplan-Meier curves showed a gradual increase in the risk of severe COVID-19 illness (log-rank P < 0.001) stratified by the number of vascular risk factors. After adjustment for age, sex, and comorbidities as potential confounders, vascular risk factor burden remained associated with an increasing risk of severe COVID-19 illness.ConclusionsPatients with increasing vascular risk factor burden have an increasing risk of severe COVID-19 disease, and this population might benefit from specific COVID-19 prevention (e.g., self-isolation) and early hospital treatment measures.

Cerebellar infarction presenting with isolated positional vertigo: differentiating factors for benign paroxysmal positional vertigo.

Isolated central positional vertigo (CPV) due to cerebellar infarction is often difficult to differentiate from benign paroxysmal positional vertigo (BPPV). Here, we aimed to evaluate whether vascular risk factors and serum vitamin D level can differentiate between positional vertigo types. A total of 78 consecutive patients were consecutively enrolled from January 2017. All CPV patients had a National Institutes of Health Stroke Scale score of 0 and cerebellar infarctions confirmed by brain MR imaging. Vascular risk factors and serum 25-hydroxyvitamin D levels were compared between the two groups of patients. The proportion of men was higher in the CPV than in the BPPV group (p = 0.004). Atrial fibrillation was common in the CPV group on univariate analysis (p = 0.046). However, there were no independent differentiating factors between the two groups. The proportion of patients according to the number of risk factors was significantly different between the two groups (linear by linear association test, p = 0.02). The mean serum 25-hydroxyvitamin D level did not differ. Also, the proportions of vitamin D insufficiency and deficiency did not differ significantly between the two groups. Increased number of vascular risk factors including male sex suggested more CPV than BPPV. However, the serum vitamin D level was below the normal range in both groups. Our results demonstrate that serum vitamin D level has little value in the differential diagnosis of positional vertigo. Efforts to identify differentiating factors are warranted, and accumulating evidences including our research may lead to a diagnostic algorithm for isolated positional vertigo.