Prevalence Of Ischemic Stroke Research Articles

Investigating undiagnosed Fabry disease in young adults with ischemic stroke: A multicenter cohort study.

The global prevalence of ischemic stroke in young adults is increasing, leading to a significant social impact. Fabry disease is a recognized cause of ischemic stroke in young patients, and although disease-modifying treatments are available, further evidence is needed to confirm their effectiveness in reducing the incidence of ischemic strokes. This study aimed to identify undiagnosed Fabry disease in young adult patients with ischemic stroke in a Taiwanese cohort. This multicenter, prospective cohort study enrolled patients aged 20-55 years who had experienced an ischemic stroke or transient ischemic attack (TIA) within 10 days, from 1 January 2016 to 31 December 2020. Screening for Fabry disease was performed using a dry blood test to measure α-galactosidase activity in male patients and blood globotriaosylsphingosine (lyso-Gb3) levels in female patients. For patients with positive screen results, genetic diagnosis of Fabry disease was pursued through Sanger sequencing of the GLA gene, covering all exons and a segment of intron 4. A total of 977 patients (659 male, 68%) were enrolled from seven hospitals across Taiwan. Four patients (0.4%, all male) had positive screening results, and two patients (0.2%) were genetically diagnosed with Fabry disease. Case 1 had the GLA c.658C>T mutation and experienced ischemic stroke in the bilateral occipital regions. Case 2 had the GLA c.640-801G>A mutation and experienced an ischemic stroke in the left superficial watershed area. The prevalence of undiagnosed Fabry disease in this cohort of Taiwanese young adults with ischemic stroke or TIA was 0.3% among the young male population. Understanding the prevalence of undiagnosed Fabry disease in young adults with ischemic stroke could help shape future Fabry disease screening policies. The collected data will be available upon reasonable request from the corresponding author.

The effects of micro- and macrovascular diabetic complications on ischemic stroke in patients with type 2 diabetes mellitus

Objectives: The present study aimed to examine the effects of diabetes complications on the ischemic stroke risk among patients with type 2 diabetes mellitus (T2DM). Patients and methods: The medical records of all patients (n=5,468) who were admitted to a tertiary care hospital between January 1, 2021, and June 1, 2022, were retrospectively reviewed. Of 911 patients diagnosed with T2DM for at least two years, 37 patients with a history of hemorrhagic cerebrovascular disease were excluded. Consequently, the study was conducted with 874 patients (460 males, 414 females; mean age: 65.5±12.1 years; range, 39 to 92 years) with T2DM. Demographic data, presence of chronic disease other than diabetes, duration of diabetes, retinopathy, nephropathy, peripheral arterial disease, and diabetes medications were recorded. The patients were divided into two groups: those with and without a history of ischemic stroke. The two groups were compared in terms of demographic characteristics and diabetes complications. Results: The prevalence of ischemic stroke was 18.6% (n=163). Patients with ischemic stroke were older than those without ischemic stroke, had longer diabetes durations, and had higher rates of hypertension, hyperlipidemia, and insulin use (p=0.001, p<0.001, p<0.001, p<0.001, and p<0.001, respectively). Diabetic retinopathy (41.7%), diabetic nephropathy (27.6%), and peripheral arterial disease (16.6%) were more commonly observed among patients with ischemic stroke compared to the others. Examining the parameters differing between the groups, diabetes duration, hypertension, insulin use, and peripheral arterial disease were found to be independent risk factors for ischemic stroke (p<0.001, p<0.001, p=0.001, and p=0.001, respectively). Conclusion: Examining the relationship between diabetes complications and ischemic stroke risk from a broader perspective, the present study provided important implications for clinical management. Large-scale studies are needed in the future.

Global, regional, and national burden of ischemic stroke, 1990–2021: an analysis of data from the global burden of disease study 2021

Ischemic stroke remains a major contributor to global mortality and morbidity. This study aims to provide an updated assessment of rates in ischemic stroke prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021, specifically focusing on including prevalence investigation alongside other measures. The analysis is stratified by sex, age, and socio-demographic index (SDI) at global, regional, and national levels. Data for this study was obtained from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). To quantify temporal patterns and assess trends in age-standardized rates of ischemic stroke prevalence (ASPR), incidence (ASIR), mortality (ASDR), and DALYs, estimated annual percentage changes (EAPCs) were computed over the study period. The analyses were disaggregated by gender, 20 age categories, 21 GBD regions, 204 nations/territories, and 5 SDI quintiles. R statistical package V 4.4.2 was performed for statistical analyses and plot illustrations. In 2021, the global burden of ischemic stroke remained substantial, with a total of 69,944,884.8 cases with an ASPR of 819.5 cases per 100,000 individuals (95% UI: 760.3-878.7). The ASIR was 92.4 per 100,000 people (95% UI: 79.8-105.8), while the ASDR was 44.2 per 100,000 persons (95% UI: 39.3-47.8). Additionally, the age-standardized DALY rate was 837.4 per 100,000 individuals (95% UI: 763.7-905). Regionally, areas with high-middle SDI exhibited the greatest ASPR, ASIR, ASDR, and age-standardized DALY rates, whereas high SDI regions had the lowest rates. Geospatially, Southern Sub-Saharan Africa had the highest ASPR, while Eastern Europe showed the highest ASIR. The greatest ASDR and age-standardized DALY rates were observed in Eastern Europe, Central Asia, as well as North Africa, and the Middle East. Among countries, Ghana had the highest ASPR, and North Macedonia had both the highest ASIR and ASDR. Furthermore, North Macedonia also exhibited the highest age-standardized DALY rate. Regions with high-middle and middle SDI continued to experience elevated ASPR, ASIR, ASDR and age-standardized DALY rates. The highest ischemic stroke burden was observed in Southern Sub-Saharan Africa, Central Asia, Eastern Europe, and the Middle East. None.

Aging Is Associated with a Circulating Endothelial Cell-Derived Microvesicle Phenotype that Increases Cerebral Oxidative Stress

Aging is associated with increased risk and prevalence of ischemic stroke. Vascular oxidative stress impairs cell function and is considered to be an important mechanism underlying the age-related increase in cerebrovascular accidents (CVA). However, the direct, and indirect, effects of aging on endothelial cell oxidative stress are complex and not completely understood. Increase in reactive oxygen species coupled with reduced anti-oxidative capacity creates a prooxidative endothelial phenotype resulting in impaired cell dysfunction, accelerated unprogrammed cell death and, in turn, CVAs. Several recent seminal studies have demonstrated that circulating endothelial cell- derived microvesicles (EMVs) are etiologically involved in the development and progression of endothelial dysfunction and CVA. We have previously demonstrated that aging is associated with increased circulating levels of EMVs. The aim of this study was to determine, in vitro, the effect of circulating EMVs isolated from young and older adults on brain endothelial cell oxidative stress. We hypothesized that EMVs from older adults would induce a prooxidative endothelial phenotype. As part of an ongoing study, 16, non-obese, normotensive, sedentary adults were studied: 8 young (5M/3F; age: 25±1 yr) and 8 older (4M/4F; 69±2 yr). EMV identification (CD144+) and isolation from peripheral blood was performed by flow cytometry. Human cerebral microvascular endothelial cells (hCMECs) were cultured and separately treated with EMVs from each subject for 24 hours. Intracellular reactive oxygen species (ROS) production was determined using CellROX Deep Red Reagent. Circulating EMVs were ~75% higher (P=0.002) in older (140±13 EMV/μL) vs young (82±8 EMV/μL) adults. Cellular ROS was significantly higher (~40%) in hCMECs treated with EMVs from older (141±14%) compared with young (101±5%) adults. In addition, intracellular expression of key anti-oxidant proteins were significantly lower in cells treated with EMVs from older adults. Cell expression of both superoxide dismutase 1 (SOD-1: 20.6±2.3 vs 36.3±3.1 AU) and catalase (17.1±1.9 vs 27.5±3.0 AU) were ~35% lower in hCMECs treated with EMVs from older adults. Moreover, intracellular ROS was inversely and significantly correlated with SOD-1 (r=-0.54; P=0.03) and catalase (r=-0.62; P=0.01) expression reflective of the cellular oxidative milieu. In conclusion, circulating EMVs may contribute to the increased risk of ischemic stroke with aging by increasing brain endothelial cell oxidative stress and reducing oxidative defense mechanisms. EMVs may represent a viable therapeutic target for mitigating the risk of CVA with aging. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Elevated Glucose Levels Increase Oxidative Stress in Human Cerebral Microvascular Endothelial Cells

Although glucose is the primary fuel source for cerebral metabolism and function, chronic exposure to high glucose levels impairs cerebral endothelial cell function and increases the risk of cerebrovascular accidents (CVA). Indeed, hyperglycemia is linked to an increased risk and prevalence of ischemic stroke, primarily attributed to the detrimental impact of glucose on cerebral endothelial cell function. The direct and indirect effects of glucose on brain endothelial cells are complex and not well understood. It is known that hyperglycemia can induce a profound pro-oxidative state with deleterious effects on peripheral vascular function resulting in pathologic outcome. The experimental aim of this study was to determine, in vitro, the effect of elevated glucose concentrations on cerebral endothelial cell oxidative stress. Human cerebral microvascular endothelial cells (hCMECs) were cultured (3rd passage) and incubated with culture media containing 5 mM D-glucose (normal glucose condition [NG]), 6.5 mM glucose (concentration representative of impaired fasting glucose [IFG]), and 8 mM (concentration representative of type 2 diabetes [T2D]) for 3 hours. Cells were harvested and intracellular reactive oxygen species (ROS) production was determined using CellROX Deep Red Reagent and expression of key anti-oxidant defense proteins, superoxide dismutase 1 (SOD-1) and catalase, were determined by capillary electrophoresis immunoassay. In separate experiments, the effect of each glucose condition was determined in the presence of the ROS scavenger, vitamin C (200 μmol). Cells treated with glucose concentration representing IFG (137+8 %) and T2D (162+12%) significantly increased intracellular ROS compared with NG (98+3 %). Concordantly, expression of SOD-1 and catalase were significantly higher in hCMECs treated with glucose concentration representing IFG (190.2+17.8 AU; 134.7+15.4 AU, respectively) and T2D (186.7+19.6 AU; 137.2+17.5 AU, respectively) compared with NG (24.4+1.8 AU; 65.6+4.3 AU, respectively). Pretreatment of cells with vitamin C prevented the increase in ROS in both the IFG and T2D conditions. Of note, there were no significant differences in ROS or the expression of SOD-1 and catalase in hCMECs between the IFG and T2D glucose conditions. In conclusion, glucose concentrations associated with IFG and T2D markedly increased ROS in hCMECs. In addition, there was a compensatory increase in SOD-1 and catalase to counteract the increase in cellular oxidative burden. Similar effects between the IFG and T2D glucose conditions on the oxidative milieu of hCMECs is consistent with the similar clinical cerebrovascular risk burden between these pathologic conditions. Glucose-induced increased oxidative stress in cerebral endothelial cells may contribute to the increased risk of CVA, such as ischemic stroke, associated with IFG and T2D. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Intracranial aneurysms in patients with acute ischemic stroke prevalence and influence on mechanical thrombectomy over 14 years in a tertiary-care center

IntroductionThe prevalence of intracranial aneurysms (IA) in patients with acute ischemic stroke (AIS) requiring mechanical thrombectomy (MT) is unclear. ObjectiveTo describe the prevalence of IA in patients with AIS and their influence on MT. Materials & methodsThis is a retrospective cohort study on all patients admitted with a diagnosis of AIS from January 2008 to March 2022 at a tertiary academic center. The records were reviewed for demographic, clinical, imaging, and outcomes data. Only patients who had CTA at admission were included in this analysis. ResultsAmong 2265 patients admitted with AIS, this diagnosis was confirmed in 2113 patients (93.3 %). We included 1111 patients (52.6 %) who had head CTA and 321 (28.9 %) who underwent MT. The observed prevalence of aneurysms on CTA was 4.5 % (50/1111 patients), and 8 (16 %) had multiple aneurysms. MT was performed in 7 patients harboring IAs: 6 ipsilateral (5 proximal and 1 distal to the occlusion)and 1 contralateral aneurysm.. The patient with a contralateral aneurysm had a TICI 2B score In patients with ipsilateral aneurysms, TICI 2B or 3 was achieved in 3 cases (50 %), which is significantly lower than historical control of MT (91.6 %) without IA (p = 0.01). No aneurysms ruptured during MT. The aneurysm noted distal to the occlusion was mycotic. ConclusionIn this analysis, the observed prevalence of IA in patients with AIS was 4.5%. Ipsilateral aneurysms (proximal or distal to the occlusion site) deserve particular attention, given the potential risk of rupture during MT. Aneurysms located distal to the occlusion were mycotic and the rate of recanization in patients with ipsilateral aneurysms was low compared to historical controls. Further studies are needed to improve the outcomes in patients with IA requiring MT.

Exploring the Insomnia-Ischemic Stroke Nexus: A Comprehensive Review.

Background: This study investigates the relationship between sleep patterns and ischemic stroke beyond the predominant focus on obstructive sleep apnea. Through a systematic review of the existing literature, we aim to elucidate the connections between insomnia, sleep duration, cardiovascular factors, and ischemic stroke onset. Methods: We searched databases, including MEDLINE, SciELO, Scopus, and Science Direct, using an adapted PICO framework. Using a search strategy with MeSH words, keywords, and expressions related to insomnia and stroke, we included clinical trials and analytical observational epidemiological studies, comprising cohort, case-control, and cross-sectional studies. Results: Following the initial search, we identified 984 records, with 779 titles and abstracts screened for eligibility after removing duplicates. From these, 63 full-text articles, including 5 in the data synthesis, were reviewed. Our findings highlight a significant correlation between poor sleep quality, extreme sleep durations, and a heightened risk of ischemic stroke, along with established cardiovascular risk factors, such as hypertension, hyperlipidemia, obesity, and diabetes. Conclusions: This systematic review offers a comprehensive analysis of ischemic stroke prevalence and its association with cardiovascular factors, such as hypertension, hyperlipidemia, obesity, and diabetes. It suggests that poor sleep quality and extreme sleep durations, particularly long ones, are linked to a heightened risk of ischemic stroke.

Left atrial appendage filling defect in exclusive early-phase scanning of dual-phase cardiac computed tomography: An indicator for elevated thromboembolic risk.

Dual-phase cardiac computed tomography (CCT) has been applied to detect left atrial appendage (LAA) thrombosis, which is characterized as the presence of left atrial appendage filling defects (LAADF) in both early- and delayed-phase scanning. However, the clinical implication of LAAFD in exclusive early-phase scanning (LAAFD-EEpS) of CCT in patients with atrial fibrillation (AF) is unclear. The baseline clinical data and dual-phase CCT findings in 1183 AF patients (62.1 ± 11.6 years, 59.9% male) was collected and analyzed. A further analysis of CCT and transesophageal echocardiography (TEE) data (within 5 days) in a subgroup of 687 patients was performed. LAAFD-EEpS was defined as LAAFD present in early-phase and absent in delayed-phase scanning of dual-phase CCT. A total of 133 (11.2%) patients were detected with LAAFD-EEpS. Patients with LAAFD-EEpS had a higher prevalence of ischemic stroke or transient ischemic attack (TIA) (p < 0.001) and a higher predefined thromboembolic risk (p < 0.001). In multivariate analysis, a history of ischemic stroke or TIA was independently associated with LAAFD-EEpS (odds ratio [OR] 11.412, 95% confidence interval [CI] 6.561-19.851, p < 0.001). When spontaneous echo contrast in TEE was used as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of LAAFD-EEpS was 77.0% (95% CI 66.5-87.6%), 89.0% (95% CI 86.5-91.4%), 40.5% (95% CI 31.6-49.5%), 97.5% (96.3-98.8%), respectively. In AF patients, LAAFD-EEpS is not an uncommon finding in dual-phase CCT scanning, and is associated with elevated thromboembolic risk.

Abstract WP234: Intracranial Vasculopathy Patterns of RNF213 R4810K Carriers: Does Anatomical Difference Make a Clinical Difference?

Introduction: The 2021 revised diagnostic criteria of Moyamoya’s disease (MMD) of Japan more emphasize terminal ICA involvement than 2012 version. Accordingly, there is still ambiguity about whether MCA steno-occlusion with intact ICA qualifies as MMD. Also, basal collateral is mandated in both versions, while its specificity and sensitivity for MMD remain uncertain. Although the discovery of RNF 213 R4810K variant gave hope for further insight into MMD, its diagnostic role is limited by scarce data on associated vasculopathy pattern. Methods: Patients with intracranial vasculopathy tested for RNF213 genotype between September 2017 and 2022 and positive for R4810K were included. They were classified by two anatomical features of vasculopathy in the latest angiographic image: 1) steno-occlusive degree of ICA and MCA, 2) laterality. The resulting classification composes 3 main and 6 subgroups: A) No involvement. B) MCA involvement and intact ICA, bilaterally (B1) or unilaterally (B2). C) ICA involvement, bilaterally (C1), unilaterally (C2), or unilaterally with contralateral MCA involvement (C3). Their demographic and clinical factors were compared, and fulfillment for MMD by 2012 and 2021 criteria was assessed. Results: Among 240 eligible patients, 84 (35.9%) and 33 (14.1%) did not meet 2021 and 2012 criteria. Notably, though group B showed high basal collateral prevalence of over 80%, all (100%) and 25 (36.8%) of them did not fulfill 2021 and 2012 criteria by ICA and MCA parameters. This group showed no significant contrast in demographic, conventional stroke risk factors and hemorrhagic or ischemic stroke prevalence from those with ICA involvement. Conclusions: Despite their clinical and demographic similarities, a notable number of RNF213 R4810K carriers do not meet MMD criteria due to anatomical features, mainly when ICA involvement is absent. Revising the criteria of MMD to incorporate RNF213 R4810K positivity should be considered to address its weakness.

Risk factors, clinical presentation and 1-year outcome of ischemic stroke caused by small artery disease

BackgroundThe prevalence of ischemic stroke (IS) caused by small-artery disease (SAD) is increasing recently. The present study aimed to report the risk factors, clinical presentations and outcome in patients presented with IS due to SAD with follow up for one year. The present study included 100 patients with IS due to SAD diagnosed on the basis of clinical and radiological findings. All patients were submitted to careful history taking, thorough clinical examination and standard laboratory work-up. Assessment of neurological functions was achieved using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Cognitive functions were evaluated using Trail making test, Stroop color word test, Arithmetic test, Vocabulary test, Wechsler adult intelligence scale IV digit span forward assessment and backward assessment. Magnetic resonance imaging (MRI) was done using a standard 1.5 Tesla unit. According to radiological findings, patients were classified into three groups: GI (n = 40) with IS due to SAD, GII (n = 30) with IS due to SAD plus internal watershed infarcts and GIII (n = 30) with IS due to SAD plus large artery infarctions (n = 30).ResultsComparison between the three groups regarding the reported risk factors identified significantly lower frequency of hyperlipidemia in GI patients as compared to GII and GIII patients (35.0% versus 60.0% and 66.7% respectively, p = 0.018). Clinically, it was shown that GI patients had significantly higher frequency of dizziness, dysphasia and tinnitus in comparison to the other two groups. It was also shown that those patients had significantly lower mean cortical thickness at the end of follow up (3.12 ± 0.9 versus 2.22 ± 0.8, p = 0.031). Finally, MRI brain volumetric study showed significantly decreased total cerebral cortical volume (TCCV) (589,456 ± 1689 versus 559,152 ± 1459) and total cerebral white matter volume (TCWMV) (521,546 ± 1785 versus 501,306 ± 1259) at the end of follow up.ConclusionsIschemic stroke caused by small artery disease is related to poor outcome with deterioration of cognitive functions.

Determining the effect of hypertension and diabetes following stroke in tertiary hospital, Aljouf, Saudi Arabia.

Background: Stroke is a common neurological disorder with a high prevalence. The aim of this study was to determine the risk factor, prevalence, and association of types of strokes among diabetes and hypertension patients.&#x0D; Methods: A retrospective study was conducted in King Abdul Aziz, Qurayyat, Sakaka, and Tubarjal hospitals among stroke patients including both sexes within the age &gt; 40 years. Type of stroke was identified by brain computed tomography scans or magnetic resonance imaging and risk factors for stroke and other details were noted on a checklist.&#x0D; Results: Out of 226 stroke patients considered for the present study, in which 48% were males and 52% were females. All lived in the Aljouf region. Most of the patients had risk factors which included Hypertension 49 (21.68%), Diabetes Mellitus 44 (19.46%), Combined (Hypertension and diabetes) 111 (49.11%), and Hyperlipidemia 22 (9.75%). Stroke patients &gt; 60 years of age group showed a higher prevalence of ischemic stroke (p=0.001). The combined risk factor group also showed more prevalence of ischemic stroke (49.11%).&#x0D; Conclusion: Patient having both risk factor Hypertension and diabetes mellitus were major association with ischemic stroke. Majority of the patients with ischemic stroke age at onset &gt; 60 year and irrespectively affected both males and females were equally.&#x0D; Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 171-178

Abstract 13061: Association of Right Ventricular - Pulmonary Arterial Coupling and Progression of Tricuspid Regurgitation in Patients With Non-Valvular Atrial Fibrillation

Introduction: Tricuspid regurgitation (TR) severity in patients with atrial fibrillation (AF) is associated with poor prognosis. Recently, right ventricular-pulmonary arterial (RV-PA) coupling has been shown to be related to clinical outcomes in TR patients. However, data on the relationship of RV-PA coupling to the progression of significant TR is limited. Hypothesis: This study aimed to investigate whether RV-PA coupling affects the progression of significant TR in patients with non-valvular AF. Methods: A total of 300 consecutive AF patients with insignificant TR were included among 371 patients with AF who underwent follow-up echocardiography. Insignificant TR was defined as TR less than a mild degree. We excluded other significant valvular diseases, regional wall motion abnormality, LVEF &lt;50%, the cardiac implantable electronic device, cardiac surgery, and poor echo image for RV analysis. RV-PA coupling was assessed by the ratio of RV global longitudinal strain (GLS) using speckle tracking echocardiography to pulmonary artery systolic pressure (PASP). Results: During a mean 4.7±2.5 years of follow-up, 31 (10.3%) patients (mean age 67.5±11.7 years, 37.0% female) have progressed to significant TR as more than moderate degree. The patients who progressed to significant TR were older, more likely to be female, and had a higher prevalence of ischemic stroke, higher PASP, larger RV size, lower right atrial (RA) strain, lower RVGLS, and lower RVGLS/PASP than patients without TR progression. RV-PA coupling reflected by RVGLS/PASP was independently related to the progression of TR after adjusting for age, gender, and history of stroke (p&lt;0.001). It remained significant for predicting TR progression even after further adjustment for PASP, RA strain, or RV strain (Figure). Conclusions: RV-PA coupling was associated with the progression of TR in patients with non-valvular AF, which might suggest that it can be a helpful parameter in monitoring this population.

The burden of ischemic stroke due to air pollution in ten European countries

Abstract Background Stroke is one of the leading causes of disability worldwide and there are many reports that the higher risk of ischemic stroke is associated with air pollution. It is noted that the adverse effects of air pollution on health are still invisible and not enough communicated to patients and health professionals. Methods Within the European Burden of Disease Network (COST Action CA18218), we analyzed Disability-Adjusted Life-Years (DALY) rates associated with ischemic stroke per 100,000 among all ages attributable to air pollution. Estimates were taken from the Global Burden of Disease Study 2019, for ten countries with the highest DALY rates per 100,000 ischemic strokes in 2019: Bulgaria, North Macedonia, Montenegro, Georgia, Serbia, Romania, Ukraine, Russian Federation, Bosnia and Herzegovina and Latvia. Results The highest DALY rate per 100,000 ischemic strokes was in Bulgaria (7016.81), followed by North Macedonia (5773.40), Montenegro (5119.61), and Georgia (4967.42). The highest DALY rate attributable to air pollution was in North Macedonia (1462.61), followed by Bulgaria (1240.13), Montenegro (1052.21), and Serbia (1037.41). The highest percentage of ischemic stroke attributable to air pollution was in Bosnia and Herzegovina (25.66%), North Macedonia (25.32%), Serbia (21.23%), and Montenegro (20.55%). Conclusions Air pollution is a significant contributable factor in the prevalence of ischemic stroke. In observed countries, more than 20% of the ischemic stroke burden is attributable to air pollution. The highest DALY rate attributable to air was in Balkan countries. Key messages • The highest DALY and the highest percentage of ischemic stroke attributable to air pollution were in Balkan countries. • There is an emerging need for public health regulations and policies in order to reduce air pollution and stroke.

Low vitamin B12 levels may predict the risk of ischemic stroke: A cross-sectional study

BackgroundTo examine serum vitamin B12 concentrations in relation to the risk of ischemic stroke among hospitalized patients in the Department of Neurology. MethodsWe performed a cross-sectional study involving 2,212 inpatients discharged from the Department of Neurology of the First Affiliated Hospital of Chongqing Medical University, from January 2020 to January 2022. The results of laboratory assays such as serum vitamin B12, homocysteine, and folate levels were measured. Logistic regression analysis was used to investigate the association between serum vitamin B12 concentrations and ischemic stroke, with adjustment for a number of relevant demographic and lifestyle factors and comorbidities. ResultsA total of 961 (43.4%) patients had an ischemic stroke. In the fully adjusted model, logistic regression analysis suggested a positive association between serum vitamin B12 levels<150 pg/mL (aOR: 1.42; 95% CI 1.02–1.97; p = 0.035), serum vitamin B12 150–300 pg/mL (aOR: 1.37; 95% CI 1.11–1.68; p = 0.003) and the prevalence of ischemic stroke. Furthermore, an inverse association was observed between serum vitamin B12 levels ≥ 900 pg/mL (aOR: 0.38; 95% CI: 0.19–0.77; p =0.007) and the prevalence of ischemic stroke. Moreover, the cut-off value of vitamin B12 concentration was 316.4 pg/mL and the discrimination power of the score evaluated by AUC-ROC was 0.71 (95%CI 0.68–0.73, p<0.001) in the vitamin B12 and ischemic stroke. ConclusionFindings suggest that low vitamin B12 levels may predict the risk of ischemic stroke, early and timely supplementation of vitamin B12 can improve the short-term prognosis of ischemic stroke patients.

Evaluation of Endothelial Progenitor Cell Characteristics as Clinical Biomarkers for Elderly Patients with Ischaemic Stroke.

Ageing impairs endothelial function and predisposes the person to ischaemic stroke (IS). Endothelial progenitor cells (EPCs) repair endothelial damage and induce post-ischaemic neovascularisation. Given the prevalence of IS in older population, this study explored whether changes in EPC number and function may reliably predict the type or outcome of stroke in patients ≥ 65years of age. For this, blood samples were collected once from healthy volunteers (HVs, n = 40) and four times (admission and days 7, 30 and 90 post-stroke) from participants with lacunar (n = 38) or cortical (n = 43) stroke. EPCs were counted with flow cytometry and defined as non-haematopoietic cells (CD45-) expressing markers for stemness (CD34 +), immaturity (CD133 +) and endothelial maturity (KDR +). Clonogenesis, tubulogenesis, migration and proliferation assays were performed as measures of EPC functionality. Biochemical profile of plasma inflammatory and angiogenic agents were studied using specific ELISAs. Primary outcome was disability or dependence on day 90 post-stroke, assessed by the modified Rankin Scale (mRS). Compared to HVs, EPC numbers were higher in stroke patients at all time points studied, reaching significance at baseline and day 30. No differences in EPC counts and functionality were observed between lacunar and cortical stroke groups at any time. Plasma endostatin, PDGF-BB, TNF-α and VEGF levels were higher in stroke patients vs HVs. Patient outcome, evaluated by mRS on day 90 post-stroke, did not correlate with EPC count or functionality. Baseline EPC counts may serve as a diagnostic marker for stroke but fail to distinguish between different stroke subtypes and predict post-stroke outcome.

Aging Is Associated with a Circulating Endothelial Cell-Derived Microvesicle Phenotype that Impairs Cerebral Fibrinolytic Capacity

Aging is associated with increased risk and prevalence of ischemic stroke. Endothelial cell dysfunction is considered to be a central mechanism underlying the age-related increase in cerebrovascular accidents (CVA). However, the direct, and indirect, effects of aging on endothelial cell biology are diverse and not completely understood. Reduced endogenous fibrinolytic activity is a central etiologic factor underlying ischemic stroke. Endothelial cells are the primary site of synthesis and release of tissue-type plasminogen activator (t-PA), the main plasminogen activator in fibrinolysis and central regulator. Clinical interest in circulating extracellular vesicles, particularly endothelial cell-derived microvesicles (EMVs), has intensified due to their involvement in the development and progression of endothelial dysfunction and CVA. The aim of this study was to determine, in vitro, the effect of circulating EMVs isolated from young and older adults on brain endothelial cell fibrinolytic capacity. We hypothesized that EMVs from older adults would reduce brain endothelial cell t-PA production and release and increase PAI-1 production compared with EMVs from young adults. Twenty-two healthy, non-obese, normotensive, sedentary adults were studied: 10 young (6M/4F; age: 25±1 yr) and 12 older (7M/5F; 64±2 yr). EMV identification (CD144 + ) and isolation from peripheral blood were performed by flow cytometry. Human cerebral microvascular endothelial cells (hCMECs) were cultured and separately treated with EMVs from each subject. Cultured hCMECs were treated with EMVs in the absence and presence of thrombin (1 unit/mL) for 24 hours. Basal expression of t-PA (25.2±1.5 vs 39.8±1.8 AU) and the t-PA response to thrombin (32.5±1.5 vs 57.2±2.2 AU) were significantly lower (~35%) in hCMECs treated with EMVs from older compared with young adults. Concordant with changes in cell protein expression, basal t-PA production (55.2±3.5 vs 70.1±3.7 ng/mL) and thrombin-stimulated t-PA production (61.9±3.7 vs 88.4±3.8 ng/mL) was significantly lower in cells treated with EMVs from older adults. In conclusion, circulating EMVs may contribute to the increased risk of ischemic stroke with aging by impairing brain endothelial cell fibrinolytic capacity. Diminished capacity of the endothelium to release t-PA is a key mechanistic factor underlying cerebral thrombosis. Nothing to Disclose This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Impact of glucose intolerance on the risk of carotid plaque instability assessed by MRI

Atherosclerotic disease is a complex multifactorial and systemic condition that affects arteries, including carotid arteries. Atherosclerotic plaque instability can predict plaque rupture, the major cause of ischemic strokes. Intraplaque hemorrhage (IPH) is an important contributor of plaque instability caused by the pro-inflammatory and hypoxic environment of the atherosclerotic plaque promoting the development of intraplaque neo-vessels. Metabolic disturbances are known to promote atherosclerotic plaque formation. Ischemic stroke prevalence is increase in patients with obesity and/or type-2 diabetes. The objective of the present study is to evaluate whether glucose intolerance can increase IPH in patients with carotid atherosclerosis. This study involves 57 patients with carotid atherosclerotic plaque with more than 50% stenosis, asymptomatic for more than 6 months, with no surgical indication for endarterectomy and no recent inflammatory disease. IPH was evaluated by magnetic resonance imaging (MRI). A score was defined for IPH (from 0: non hemorrhage to 3: large hemorrhage). Fasting blood glucose level was measured and patients were allocated in glucose tolerant (< 5,6 mM) or glucose intolerant (> 5,6 mM) groups. We showed that the score of IPH quantified by MRI was increased in the glucose intolerant subgroup of patients (0.39 vs. 0.84, P = 0.04). This result was confirmed by a higher prevalence of hemorrhagic plaque in the glucose intolerant group (73 vs. 41%, P < 0.05). Interestingly, the fasting blood glucose level is higher in patients with a hemorrhagic plaque than non-hemorrhagic plaque (5.6 vs. 6.9 mM, P = 0.04). Moreover, neither other known pro-atherogenic markers (LDL, cholesterol, TG) nor obesity seem to increase the degree of IPH. In conclusion, we demonstrated a strong impact of blood glucose level on the risk of plaque instability reflected by IPH. Further experiments are needed to strengthen the relation between type-2 diabetes, blood glucose level and IPH to understand the underlying mechanisms.

Association between PAI-1 Polymorphisms and Ischemic Stroke in a South Korean Case-Control Cohort.

Stroke is the second leading cause of death in the world. Approximately 80% of strokes are ischemic in origin. Many risk factors have been linked to stroke, including an increased level of plasminogen activator inhibitor-1 (PAI-1). PAI-1 levels increase and remain elevated in blood during the acute phase of ischemic stroke, which can impair fibrinolytic activity, leading to coronary artery disease and arterial thrombotic disorders. Here, we present a case-control study of 574 stroke patients and 425 controls seen for routine health examination or treatment for nonspecific dizziness, nonorganic headache, or anxiety for positive family history of stroke at the Bundang Medical Center in South Korea. Polymorphisms in PAI-1 were identified by polymerase chain reaction/restriction fragment length polymorphism analysis using genomic DNA. Specifically, three variations (-675 4G>5G, 10692T>C, and 12068G>A) were linked to a higher overall prevalence of stroke as well as a higher prevalence of certain stroke subtypes. Haplotype analyses also revealed combinations of these variations (-844G>A, -675 4G>5G, 43G>A, 9785A>G, 10692T>C, 11053T>G, and 12068G>A) that were significantly associated with a higher prevalence of ischemic stroke. To the best of our knowledge, this is the first strong evidence that polymorphic sites in PAI-1 promoter and 3'-UTR regions are associated with higher ischemic stroke risk. Furthermore, the PAI-1 genotypes and haplotypes identified here have potential as clinical biomarkers of ischemic stroke and could improve the prognosis and future management of stroke patients.

Retrospective analysis of the prevalence of ischemic stroke and the appointment of anticoagulant therapy in patients with atrial fibrillation depending on the body mass index

Aim. To estimate the prevalence of ischemic stroke (IS) and the appointment of anticoagulant therapy in patients with atrial fibrillation (AF) depending on body mass index (BMI) as part of a retrospective analysis of big data from certain subjects of the Russian Federation using artificial intelligence technologies.Material and methods. The information was obtained from the Webiomed predictive analytics platform, which includes depersonalized data from electronic health records of patients in 6 Russian constituent, extracted using artificial intelligence technologies. Individuals with AF aged ≥18 years were selected with available data on BMI of 18,5-60,0 kg/m2 inclusive (n=56003; men, 41,0%; age, 67,4±14,5 years, CHA2DS2-VASc score, 3,4±1,8). The following BMI ranges were identified: 18,5-21,9 kg/m2, 22,0-24,9 kg/m2 (taken as a reference), 25,0-29,9 kg/m2, 30,0-34,9 kg/m2, 35,0-39,9 kg/m2 and 40,0-60,0 kg/m2. The indicators were analyzed in age ranges (≤64 years, 65-74 years, ≥75 years) separately among men and women.Results. Among men ≤64 years of age, patients with overweight and class 2 obesity were characterized by a significantly higher incidence of IS. Among women ≤64 years, a significantly higher frequency of IS was found in subgroups with overweight and class 1-3 obesity, while among women aged 65-74 years — in a subgroup with a BMI of 18,5-21,9 kg/m2. Patients aged ≥75 years showed an insignificant trend towards the maximum frequency of IS with a BMI of 18,5-21,9 kg/m2. A higher frequency of anticoagulant therapy prescription was found in subgroups with overweight and class 1-3 obesity; in most age and sex subgroups, the differences are significant. A significantly lower frequency of anticoagulant therapy prescription to persons ≥75 years of age with a BMI of 18,5-21,9 kg/m2 was noted.Conclusion. The study showed a significant BMI paradox in the context of the relationship between the frequency of IS and BMI value in patients with AF. A higher incidence of IS in persons ≤64 years of age with a BMI ≥25 kg/m2 compared with pa­tients with normal weight may be an additional argument for establishing an inde­pen­-dent prognostic role of obesity in the development of thromboembolic events in AF.

Hyperlipidemia and Hypertension Are Associated With Intracerebral Hemorrhage Incidence: A Retrospective Study.

Introduction Stroke places a huge burden on the socioeconomic systems. Hemorrhagic stroke (HS) is the second most common type of stroke and the second leading cause of disability and death. The updated data on the prevalence of intracerebral hemorrhage (ICH) stroke and related physiological risk factors in Saudi Arabia were limited. The aim of this study was to identify the prevalence of ICH stroke and the related physiological risk factors. Methods This was a retrospective, hospital-based, and chart review study that utilized the BESTCare system at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Patients who attended the neurology department (inpatient/outpatient) between 2015 and 2020 were studied.The statistical tool JMP (JMP Inc., Cary, NC, USA) was used for data entry and analysis. Results Patientdata (N = 1,870, 58.6 ± 13.87 years old) were screened for comorbidities, hypertension (66.1%), diabetes mellitus (DM) (57.7%), hyperlipidemia (28.4%), and history of an old stroke (22.3%). Ischemic stroke (IS) was more dominant than ICH stroke with ratios of 94.5% (n = 1767) versus 5.5% (n = 103), respectively. The prevalence of ICH stroke among the patients (n = 103) was 10.6%, 20.3%, 24.2%, and 28.1% in the age groups of <40, 41-50, 51-60, and 61-70 years old, respectively. There was a significant gender effect on the distribution of both IS and ICH (p = 0.003). ICH strokes were more prevalent in males than in females. Body mass index (BMI) has no significant effect on the prevalence of IS and ICH stroke (p = 0.081). ICH stroke was significantly associated with DM (p = 0.032), hypertension (p = 0.01), and hyperlipidemia (p = 0.002). Regression analyses show that only hypertension (positive association) and hyperlipidemia (negative association) were significantly associated with the incidence of ICH stroke. Conclusion IS was more prevalent than ICH stroke. ICH strokes were more prevalent in males than in females. Also, hypertension was the most common factor leading to ICH stroke, unlike hyperlipidemia, which was revealed to be protective against ICH stroke.