Prevalence Of Stroke Research Articles

Identification of the optimal method for measuring left atrium volume as a marker of undetected atrial fibrillation in patients with cryptogenic stroke and high prevalence of overweight

Abstract Introduction Paroxysmal atrial fibrillation (AF) is detected in approximately one-third of patients diagnosed with cryptogenic stroke undergoing prolonged ECG monitoring. Several risk factors for AF have been described, including left atrium (LA) enlargement, LA deformation, age, cardiovascular risk factors, and biomarkers as N-pro-BNP and troponin. Specifically, LA enlargement is a direct marker of atrial cardiopathy, which predisposes to AF. However, the methods to calculate LA enlargement vary. While LA biplane volume indexed to body surface area (BSA) remains the standardized method of choice according to current guidelines, it may underestimate the degree of enlargement in overweight patients. Additionally, overweight produces a systemic inflammatory state which is also associated with AF. Purpose The primary objective of the study was to define the best parameter among LA end systolic volume (LAESV), LAESV indexed to BSA (LAESV/BSA), and LAESV indexed to ideal BSA for identifying patients admitted for cryptogenic stroke with undetected paroxysmal AF. The secondary objective was to assess the accuracy of these parameters in both normal-weight and overweight patients. Methods Consecutive patients over 65 years-old diagnosed with cryptogenic stroke in our tertiary hospital were enrolled. All patients underwent 15-days ambulatory ECG monitoring to screen for undetected paroxysmal AF. Clinical, echocardiographic and laboratory data were prospectively collected. Ideal BSA was calculated using the Devine method. The accuracy of LA volume parameters in classifying patients with undetected paroxysmal AF was assessed using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. The analysis was stratified for overweight status (BMI < 25 or BMI ≥ 25). Results A total of 66 patients (Mean age 78.4 ± 7.6 years; 48% male) were included. Of them, 39 (59%) had hypertension, 16 (24%) had diabetes and 39 (59%) were overweight. AF was present in 21 (32%) patients. The mean LAESV, LAESV/BSA, LAESV/ideal BSA were 56.2 ± 23.0 ml, 34.2 ± 12.6 ml/m2, and 34.7 ± 14.1 ml/m2, respectively. Figure 1 illustrates the ROC curves for LA volume parameters in the main cohort and stratified by overweight status. Overall, no relevant differences in AUC were observed among LAESV, LAESV/BSA, LAESV/ideal BSA in each scenario. However, BMI significantly altered the discrimination performance of LA volume measures, which resulted optimal in normal-weight patients (AUC from 0.838 to 0.886) and absent in overweight patients (AUC from 0.838 to 0.521 to 0.564). Conclusions LAESV, LAESV/BSA, LAESV/ideal BSA show similar discrimination performance in identifying undetected AF in patients with cryptogenic stroke. However, the presence of overweight considerably impacts on the predictive value of LA volume parameters in this clinical scenario.ROC curves

Aortic valve calcium score to mean gradient ratio: a new frontier in aortic stenosis prognostication

Abstract Introduction Aortic stenosis (AS) presents diagnostic challenges, especially in patients with discordant low gradient AS (LGAS), i.e., small aortic valve area (AVA) and low Doppler mean gradient (MG). LGAS is associated with worse outcomes compared to concordant AS. Aortic valve calcium score (AVCS) is a measure of AS severity independent of flow and helps diagnose severe AS. It is unknown if the degree of discordance in AVCS and MG is of any clinical significance. A high AVCS/MG ratio may indicate impaired ventricular function and response to pressure overload despite preserved LVEF, potentially contributing to worse outcomes. Purpose This study aims to elucidate the prognostic significance of the AVCS/MG ratio in patients with severe AS and preserved left ventricular ejection fraction (LVEF) undergoing TAVR. We hypothesized a higher AVCS/MG ratio correlates with increased mortality. Methods Patients who underwent transcatheter aortic valve replacement (TAVR) from 2010 to 2020 for native valve severe AS with LVEF≥50% were identified from an institutional database. AVCS were obtained within 90 days of pre-TAVR echocardiography. Patients were divided into tertiles based on their AVCS/MG ratio. Primary outcome was overall mortality. Results The analysis included 1067 patients (mean age 79±9 years, 43% female); overall AVA was 0.80±0.14 cm², LVEF 63±6%, MG 46±12 mmHg, AVCS 2630±1528 AU, and AVCS/MG ratio 58±31. Patients stratified by AVCS/MG tertiles showed no difference in overall comorbidity index across tertiles (Figure 1). However, the group in the highest tertile was the oldest (80±8 vs 79±8 vs 77±9 years), predominantly male (87% vs 61% vs 24%), with the highest prevalent atrial fibrillation (44% vs 28% vs 25%) and stroke volume index <35 mL/m² (16% vs 11% vs 5%). 9-year survival was 15% vs 25% vs 36% (p<0.001, Figure 2). In multivariate analysis adjusted for age, sex, comorbidities, LVEF and AVA, AVCS/MG ratio was independently associated with increased risk of mortality (HR 1.005; 95% CI [1.001-1.008], p=0.005). Conclusion Higher AVCS/MG discordance is associated with increased risk of mortality following TAVR. Serial AVCS measurements during progressive AS may help identify patients at higher risk who may potentially benefit from earlier aortic valve intervention.

Prevention of thromboembolic events in atrial fibrillation patients with persistent leaks following the watchman implantation

Abstract Introduction Peri-device leak is not uncommon after percutaneous occlusion of left atrial appendage using the Watchman device. Prior studies have reported the clinical relevance of small leaks (<5mm) as they were associated with a significant increase in ischemic events. Purpose We evaluated the prevalence of stroke in patients with post-watchman leaks on half-dose non-vitamin K oral anticoagulants (HD-NOAC) vs antiplatelet therapy (APT). Methods This consecutive series included post-watchman cases that had a residual leak of ≤5 mm at the 45-day echocardiogram and were unwilling to undergo any leak-closure procedure. Based on their subsequent antithrombotic therapy, they were classified into group 1: HD-NOAC and group 2: dual-APT for 6 months followed by Aspirin only. Patients were closely monitored for thromboembolic (TE) events via telemedicine. Stroke/transient ischemic attacks that occurred while the patients were in full compliance with the anti-thrombotic therapy, were counted as the reportable TE events. Results A total of 141 (age: 66.89± 8.76 years, male: 88 (62.4%), CHA2DS2-VASc score: 3.41 ± 1.56, HAS-BLED: 3.72 ± 1.01) and 154 (age: 72.45 ±7.05 years, male: 99 (64.3%), CHA2DS2-VASc score: 3.75 ± 1.61, HAS-BLED: 3.89 ± 1.05) patients were included in group 1 and 2 respectively. All leaks were between 3-5 mm. TE events were reported in 2 (2/141, 2.12%) patients in group 1 and 9 (9/154, 5.8%) in group 2 while being on antithrombotic therapy (p=04). No residual neurological deficits were detected in the 2 patients from group 1 contrary to the 9 subjects in group 2 that had neurological deficits persistent at follow-up. Of note, 8 (5.6%) patients in group 1 experienced stroke after discontinuing the drug for other medical procedures or due to poor compliance. Conclusion Under full compliance, HD-NOAC is associated with significantly lower TE rate compared to the APT therapy in post-watchman cases with persistent leaks of ≤5 mm. However, discontinuation of the HD-NOAC increases the stroke-risk to a comparable level.

The relationship between retinal vascular parameters measured by artificial intelligence and the risk of new-onset cardiovascular disease in a Chinese community-based population

Abstract Background Studies on the association between retinal vascular diameter and tortuosity and the risk of new-onset cardiovascular disease (CVD) are controversial. The predictive value of retinal vascular parameters, measured through artificial intelligence (AI), for incident CVD risk in the community population, remains to be explored. Objectives Our study aims to investigate the association between retinal vascular parameters (diameter and tortuosity) measured through AI, and the risk of new-onset CVD in the Chinese community-based population. Methods We conducted a prospective cohort study on subjects from a Beijing community in China who were free of prevalent stroke or myocardial infarction and underwent retinal photography at baseline. By deep-learning algorithm, quantitative retinal vascular parameters were measured 0.5 to 1 disc diameter from the optic disc margin, including central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), arteriolar-to-venular ratio (AVR), curvature tortuosity arteriole (cTORTa), and curvature tortuosity venule (cTORTv). The primary endpoint was a new-onset major adverse cardiovascular event (MACE), defined as a composite of cardiovascular death, first non-fatal stroke, and first non-fatal acute myocardial infarction (AMI). The secondary endpoints included cardiovascular death, first stroke, and first AMI. Cox proportional-hazards regression analyses were performed. Results A total of 3,585 participants were included. The mean age was 56.49 ± 8.94 years, and 2,335 (65.1%) were female. Prevalence of prior hypertension and diabetes was 1594 (44.5%) and 676 (18.9%), respectively. During the follow-up (median, 7.53 years), there were 293 cases of new-onset MACE (8.2%), 44 cardiovascular deaths (1.2%), 226 strokes (6.3%), and 57 AMIs (1.6%). The Kaplan–Meier curves showed significant differences in cumulative hazards of new-onset MACE among tertiles of CRAE, CRVE, AVR, and cTORTa, but not for cTORTv (Figure 1). In Cox proportional-hazards models (Figure 2) adjusting for covariates, CRAE was negatively associated with the risk of new-onset MACE (per 10 μm increase, hazard ratio [HR]=0.95, 95% confidence interval [CI]: 0.92-0.99, P=0.009) and the risk of new-onset stroke (per 10 μm increase, HR=0.96, 95%CI: 0.92-1.00, P=0.04). Similarly, AVR was negatively associated with new-onset MACE risk (per 0.1 increase, HR=0.82, 95%CI: 0.72-0.94, P<0.001) and new-onset stroke risk (per 0.1 increase, HR=0.84, 95%CI: 0.73-0.98, P=0.022). No significant associations were observed between CAVE, cTORTa, and cTORTv with any of the primary or secondary endpoints. Conclusions CRAE and AVR, measured through AI, are associated with the risk of new-onset MACE in the Chinese population. These findings suggest the potential for AI-measured parameters in retinal vasculature to aid in stratifying CVD risk in the general population.

The associations of triglyceride glucose and its derived indexes with 10-year cardiovascular disease risk in a Chinese community-based population

Abstract Background The triglyceride-glucose (TyG) index has been regarded as a reliable surrogate marker of insulin resistance and an independent predictor of cardiovascular outcomes. However, the associations of the derived TyG indexes with incident CVD risk are controversial, and that the relevant data are sparse for the Chinese population studies. Objectives We aimed to investigate the association of TyG index and its derived indexes with incident CVD risk and to compare their predictive capacity in the Chinese community-based population. Methods We conducted a prospective cohort study on subjects from a Beijing community in China who were free of prevalent stroke or myocardial infarction at baseline. The primary endpoint was a new-onset major adverse cardiovascular event (MACE), defined as a composite of cardiovascular death, first non-fatal stroke, and first non-fatal acute myocardial infarction. Cox proportional-hazards regression analyses and time-dependent receiver operator characteristic curve analyses were performed. Results A total of 8,806 participants were included. The mean age was 56.51 ± 8.93 years, and 5,679 (64.5%) were female. The median value of TyG index, TyG-BMI, TyG-WC, and TyG-WHtR were 8.71 (8.34-9.12), 226.37 (201.02-252.87), 720.80 (653.52-791.03), and 4.47 (4.07-4.90), respectively. During a mean 9.7-year follow-up, a total of 877 (10%) cases of MACE were recorded. The Kaplan–Meier curves showed significant differences in cumulative hazards of new-onset MACE among tertiles of abovementioned indexes (Log rank P < 0.0001) (Figure 1). Multivariable Cox regression analyses revealed that TyG index, TyG-BMI, TyG-WC, and TyG-WHtR were positively associated with the hazards of MACE. Compared with tertile 1, the multivariable adjusted HRs (95% CIs) of incident CVD for tertile 3 were 1.26 (1.01-1.56), 1.57 (1.15-2.14), 1.54 (1.19-2.00), and 1.81 (1.40-2.33) for TyG, TyG-BMI, TyG-WC, and TyG-WHtR, respectively (Figure 2). There are no significant differences in the Harrell's C indexes among the various indexes compared to the TyG index (TyG index: 0.758 [0.743-0.774], TyG-BMI: 0.758 [0.743-0.773], TyG-WC: 0.758 [0.743-0.774], and TyG-WHtR: 0.760 [0.745-0.775]). Conclusions Higher TyG and its derived indexes are significantly associated with an increased risk of 10-year MACE. Our results suggest that TyG and its derived indexes may serve as a useful marker for stratifying CVD risk in the general population.

Ischemic stroke susceptibility associated with ALPK1 single nucleotide polymorphisms by inhibiting URAT1 in uric acid hemostasis

ObjectivesIschemic stroke (IS) prevalence rising annually, the necessity of discovering non-interventional genetic influences is progressing. Single nucleotide polymorphism (SNP) plays a pivotal role in stable inheritance of disease susceptibility. Based on the relationship between Alpha- Kinase 1 (ALPK1) and traditional IS risk factors especially hyperuricemia, our study investigated the association and function of ALPK1 SNPs with IS susceptibility. MethodsA case-control study of 1539 patients and 933 controls from northeast China was conducted. Genotyping information of ALPK1 rs2074379 and rs2074388 was collected. Four types of plasmids including rs2074379/rs2074388 G/G, A/G, G/A, and A/A were transfected into 293T cells to observe ALPK1 and SLC22A12 expression. Possible ALPK1 structures of different SNPs were predicted online. ResultsGenotype GG (OR = 1.371, CI = 1.029–1.828, P = 0.031) and GA (OR = 1.326, CI = 1.110–1.584, P = 0.002) of rs2074379 and GA of rs2074388 (OR = 1.359, CI = 1.137–1.624, P = 0.001) were found significantly susceptible to IS, with G allele on sites to be a risk allele. Rs2074379 had a multiplicative interaction with hyperuricemia (OR = 1.637, CI = 1.157–2.315, P = 0.005). Uric acid levels differed in genotypes (P < 0.001). The expression of ALPK1 (P < 0.01) and SLC22A12 in membrane urate transporter 1 (URAT1) protein (P < 0.05) functionally changed with G allele on either site. With glycine changing into aspartic acid at rs2074388, the protein secondary structure changed, but the ALPK1 protein subtype remained still. ConclusionsALPK1 rs2074379 and rs2074388 SNPs were functionally associated with IS susceptibility. The wild allele progressed IS risk probably by reducing ALPK1 expression and inhibiting URAT1 raising the uric acid level, contributing to further exploration of pathogenetic mechanisms of stroke.Chinese Clinical Trial Registration number: ChiCTR-COC-17013559.

Prediction of Aphasia Outcome Using Low Frequency Transcranial Magnetic Stimulation in Post-Stroke Non-Fluent Aphasia

Background: Stroke, a global health concern, often leads to language impairment (aphasia). In Egypt, with a high stroke prevalence, aphasia affects a significant number of survivors. Noninvasive techniques like repetitive transcranial magnetic stimulation (rTMS) show promise in rehabilitation. Cultural variations in test results emphasize the need for region-specific considerations in standardized assessments for post-stroke care. Aim of the work: To evaluate the role of low frequency rTMS to speed up the recovery of post-stroke aphasia for a better quality of life. Patients and Methods: This randomized clinical trial investigates the effects of (rTMS) on post-stroke aphasia. Patients with post-stroke non-fluent aphasia were divided into two groups, with one receiving inhibitory rTMS and the other sham sessions. Inclusion criteria involve adults with a single left hemisphere stroke, while exclusion criteria include prior strokes. The study includes comprehensive assessments for aphasia, and depression. The stimulation protocol involves 20 minutes of daily rTMS for ten days, targeting the right inferior frontal gyrus. The study aims to evaluate the rTMS impact on language recovery. Results: The study evaluated low-frequency rTMS for post-stroke aphasia recovery in 30 patients, comparing TMS and sham groups. No significant demographic or cerebrovascular risk factor differences were found. While rTMS group showed improvement in depression, there were no significant differences between TMS and sham groups in aphasia improvement. Conclusion: Low-frequency rTMS demonstrated no significant superiority over sham stimulation in post-stroke aphasia recovery. Both groups exhibited improved depression without notable distinctions.

Inside CKD: a microsimulation modelling study projects the clinical and economic burden of chronic kidney disease in Hungary.

The Inside CKD programme implemented a microsimulation modelling approach to project the clinical and economic burden of chronic kidney disease (CKD) between 2024 and 2027 in Hungary. Using the peer-reviewed Inside CKD microsimulation, a virtual Hungarian population was generated that was derived from national records, local demographic data and published epidemiological data. These inputs defined the likelihood of a change in health state for each individual as they progressed through the model in annual increments. Individual CKD status, including disease progression, cardiorenal complications and associated costs, was tracked annually to generate the population-level projections of the clinical and economic burden of CKD. By 2027, people with CKD were projected to constitute 13.3% of the Hungarian national population. The prevalence of heart failure, myocardial infarction and stroke in people with CKD were projected to remain consistently high, reaching 323 447, 69 188 and 120 118 by 2027, respectively. Kidney replacement therapy cases were predicted to remain high at 20 515 in 2024 and 22 325 in 2027, with associated costs increasing from 71.4 billion HUF in 2024 to 79.6 billion HUF in 2027. Total annual healthcare costs associated with treating CKD were projected to constitute 5.4% of the overall national healthcare budget in 2027. Inside CKD demonstrates that the future burden of CKD in Hungary will be substantial unless current management strategies change. The high prevalence of undiagnosed CKD and associated cardiorenal complications highlight the urgent need for policy interventions focused on early diagnosis and timely intervention to mitigate the future burden of CKD.

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.

Cerebral ptosis: An ominous sign in stroke—A retrospective study

AbstractIntroductionCerebral ptosis is defined as the drooping of eyelids due to lesions in the cerebral hemispheres. Cerebral ptosis is due to either unilateral or bilateral hemispheric damage without brainstem involvement. Ischemic strokes are the most common etiology leading to hemispheric damage.AimsTo assess the prevalence of cerebral ptosis in ischemic strokes and to correlate the presence of cerebral ptosis with the outcome of the patients. To also assess the demographic profile of these patients.Materials and MethodsThis is a retrospective study from June 2022 to August 2024. All patients diagnosed as acute stroke presenting with cerebral ptosis within day 3 of stroke were included. Patients with a reduced level of consciousness, brainstem involvement, and those with signs of impending herniation were excluded. The modified Rankin scale (mRS) on the day of admission and the day of discharge were compared.ResultsThere were 26 patients with cerebral ptosis among 649 patients admitted with anterior circulation stroke (prevalence 4.01%). 84.6% (n = 12) had right hemisphere involvement and 15.4% (n = 4) had left side involvement. 88.5% (n− = 23) had middle cerebral artery territory involvement and 7.7% (n = 2) had internal carotid artery territory involvement. The mean mRS on admission was 4.42 and 4.81 on discharge (paired t‐test 0.015). mRS 6 (death) was observed in four patients.ConclusionCerebral ptosis is a supranuclear disorder with the most common etiology being vascular insult to the cerebral hemisphere. It is an ominous and rare clinical sign. Identification of this entity is important, and it is not to be confused with a reduced level of consciousness.

Global, Regional, and National Burden of Stroke, 1990-2021: A Systematic Analysis for Global Burden of Disease 2021.

This study aims to perform a comprehensive analysis of stroke burden from the Global Burden of Disease 2021. We conducted a comprehensive analysis of the burden, including prevalence, incidence, mortality, and disability-adjusted life year rates, for stroke across 204 countries and regions from 1990 to 2021 using data from the Global Burden of Disease 2021. We calculated the estimated annual percentage change (EAPC) and performed a joinpoint regression analysis to identify the trends. We also explored the association between the stroke burden and sociodemographic index. The age-standardized prevalence, incidence, mortality, and disability-adjusted life year rates for stroke were 1099.310, 141.553, 87.454, and 1886.196 per 100 000 persons in 2021, respectively. The general stroke burden trends declined in EAPC analysis (age-standardized prevalence: EAPC, -0.37; age-standardized incidence: EAPC, -0.99; age-standardized mortality: EAPC, -1.81; and disability-adjusted life year: EAPC, -1.76). However, we found an increasing burden of stroke in East Asia and Southern Sub-Saharan Africa (EAPC >0). The global burdens of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke showed a similar trend. The stroke, intracerebral hemorrhage, and ischemic stroke burdens were heavier in men than in women, except for that of subarachnoid hemorrhage in women. Our joinpoint regression analysis revealed that the age-standardized burden rates of stroke decreased from 1990 to 2021 (average annual percent change <0), whereas an upward trend was observed between 2019 and 2021 (average annual percent change >0). The burden of stroke was inversely proportional to the sociodemographic index (P<0.05), except in the case of subarachnoid hemorrhage. The actual stroke burden showed an increasing trend for stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke in 2021 (during the coronavirus pandemic). We found age-standardized rates of stroke burden declining over time, but some areas exhibited a notable increase in the prevalence, incidence, mortality, and disability-adjusted life year rates.

Early diagnosis of stroke risk factors in high school students in Makassar, South Sulawesi, Indonesia

The number of stroke patients in Indonesia is ranked as the first country to experience the most strokes in all of Asia. The prevalence of stroke in Indonesia reaches 8.3 out of 1000 population. This prevalence rate increases with increasing age. Indonesian national data shows that stroke is the highest cause of death, at 15.4%, with approximately 750,000 strokes per year in Indonesia and 200,000 recurrent strokes. People who are physically inactive (those who exercise less than three times per week, each for 30 minutes) have an almost 50% increased risk of stroke compared to those who are active. Physical inactivity can lead to weight problems and increased blood pressure and is associated with diabetes, all of which are important risk factors for stroke. Inactivity also contributes to the onset of early atherosclerosis and other cardiovascular diseases, such as heart attacks. This study is an analytical observational study with a cross sectional design to see and observe the risk factors for stroke that exist in school children in Makassar city. Data processing was carried out using computer application programs and SPSS version 22.0 with data analysis methods using the Chi Square Test with the Yate's Correlation formula in SPSS called Continuity Correction and Risk. The number of respondents studied was 896 people. Hypertension is a major risk factor for health problems in society, especially in socioeconomic transition. Hypertension is a primary risk factor for the onset of heart disease and stroke. Doing physical activity will prevent us from various diseases, by doing adequate physical activity we can suppress the increase in blood sugar levels, cholesterol levels, and avoid obesity and strengthen the heart. All of which are risk factors for stroke. So thus by doing adequate physical activity we can avoid stroke. There is a relationship between gender, obesity, hypertension, family history of disease, stress, physical activity, risky diet and smoking on stroke risk factors and there is no relationship between age and knowledge with stroke risk factors.

Socioeconomic disparities and cardio-cerebrovascular diseases: A nationwide cross-sectional study.

Although socioeconomic status (SES) is considered a risk factor for cardio-cerebrovascular diseases (CCVDs), few studies have examined this association. In this cross-sectional study, we aimed to assess the prevalence and trends of CCVDs across different SES groups over a 12-year period in a representative Korean population. We analysed 47 745 economically active adults aged ≥30 and <65 years from 97 622 patients in the Korean National Health and Nutrition Examination Survey (2007-18), where a new independent sample of the population was examined each year. We categorised the participants into four groups based on education level and income. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CCVD, including angina, myocardial infarction, and stroke, was analysed at four-year intervals. Average age, urban residence, white-collar occupation, and body mass index >30 increased, whereas CCVD prevalence did not change significantly (P = 0.410) over the study period. Low education (odds ratio (OR) = 1.24; 95% confidence interval (CI) = 1.04-1.47, P < 0.001) and low income (OR = 1.14; 95% CI = 1.02-1.28, P = 0.017) were significant determinants of CCVD in addition to existing traditional risk factors. CCVD prevalence was significantly higher in both the low-education and low-income groups compared to the high-education and high-income groups every four years, with no significant change in this gap over the study period (P = 0.239). Despite the increase in the elderly population and the prevalence of obesity, the incidence of CCVDs in Korea has remained unchanged. Individuals with low education or low income had a significantly higher prevalence of CCVD, with the lowest SES group, defined by both low education and low income, consistently having the highest prevalence of CCVDs.

Effectiveness of Bobath Technique on Walking Speed and Balance in Hemiplegic Patients: A Review

Worldwide, stroke is the largest cause of disability, affecting walking speed and balance, especially in hemiplegics. Bobath, or Neurodevelopmental Treatment (NDT), is a specialist physiotherapy method that improves motor control and movement patterns for motor deficits. Given the prevalence of stroke and the importance of rehabilitation in recovery, the Bobath technique's ability to improve walking speed and balance, which are crucial to stroke survivors' functional independence, must be assessed. Methods: This Review examined how the Bobath method affected walking speed and balance in hemiplegic individuals. A total of 15 studies were evaluated. Most of studies uses 2 groups The Bobath group received three-times-weekly motor function and balance training for 12 weeks Data was collected at Baseline, 6-week, and 12-week. Aim: This research focused on to review whether the Bobath approach improved walking speed and balance in hemiplegic patients. Results: The research revealed a substantial improvement in walking speed using the Bobath approach, with a mean increase of 0.25 meters per second compared to 0.10 meters per second in the control group (p &lt; 0.05). Significant balance improvements were seen in the Bobath group, with a mean gain of 10 points on the Berg Balance Scale and 5 cm on the Functional Reach Test, compared to 4 points and 2 centimetres in the control group (p &lt; 0.05). The Bobath approach improved walking speed and balance no more than traditional physiotherapy. Conclusion: This research found that Bobath improves walking speed and balance in hemiplegics no more than traditional physiotherapy. These findings suggest that stroke therapy programs using the Bobath technique may improve functional outcomes. To validate these results and investigate the Bobath technique's long-term stroke healing advantages, bigger sample sizes and longer follow-ups are needed. Keyword: - Bobath concept, stroke, hemiplegia, rehabilitation.

Behavioral Risk Profiles of Stroke Survivors Among US Adults: Geographic Differences Between Stroke Belt and Non-Stroke Belt States.

Stroke, a leading cause of illness, death, and long-term disability in the US, presents with significant disparities across the country, most notably in southeastern states comprising the "Stroke Belt." This study intended to identify differences between Stroke Belt states (SBS) and non-Stroke Belt states (NSBS) in terms of prevalence of stroke, sociodemographic and behavioral risk factors, and health-related quality of life (HRQOL). We analyzed data from the 2019 Behavioral Risk Factor Surveillance System to compare demographic characteristics, risk factors, physical activity adherence, functional independence, and HRQOL among stroke survivors in SBS and NSBS. Of 18,745 stroke survivors, 4,272 were from SBS and 14,473 were from NSBS. Stroke was more prevalent in SBS (odds ratio [OR] = 1.39; 95% CI, 1.35-1.44; P < .001), with significant differences by age, sex, and race and ethnicity, except for Hispanic ethnicity. Selected stroke risk factors were more common in every category in SBS. Stroke survivors in SBS were less likely to meet physical activity guidelines for aerobic (OR = 0.77; 95% CI, 0.69-0.86; P < .001) and aerobic and strengthening combined (OR = 0.77; 95% CI, 0.70-0.86; P < .001) activities. Stroke survivors in SBS were more likely to not meet either physical activity guideline (OR = 1.31; 95% CI, 1.22-1.41; P < .001). Living in SBS significantly increased the odds of stroke occurrence. Stroke survivors from SBS reported lower HRQOL and insufficient physical activity as well as lower functional independence. Specific strategies are needed for residents of SBS, with a focus on policies and primary and secondary prevention practices across healthcare professions.

Research trends and hotspots of post-stroke upper limb dysfunction: a bibliometric and visualization analysis.

The global prevalence of stroke has been increasing. Motor dysfunction is observed in approximately 55 to 75% of stroke patients, with upper limb impairment affecting around 85% of them. Following upper limb dysfunction, the body's recovery time is not only slower compared to the lower limbs, but the restoration of its fine motor skills is significantly more challenging, greatly impacting the daily lives of patients. Consequently, there is an increasing urgency for study on the upper limb function in stroke. A search was conducted in the Web of Science Core Collection: Science Citation Index Expanded (SCI-Expanded) database for material published from January 1, 2004 to December 31, 2023. We included all relevant literature reports and conducted an analysis of annual publications, countries/regions, institutions, journals, co-cited references, and keywords using the software packages CiteSpace, VOSviewer, and Bibliometrix R. Next, we succinctly outlined the research trends and hotspots in post-stroke upper limb dysfunction. This analysis comprised 1,938 articles from 1,897 institutions, 354 journals, and 53 countries or regions. A yearly rise in the production of publications was noted. The United States is the foremost nation on the issue. Northwestern University has the most amounts of papers compared to all other institutions. The journal Neurorehabilitation and Neural Repair is a highly significant publication in this field, with Catherine E. Lang serving as the principal author. The majority of the most-cited references focus on subjects such as the reliability and validity of assessment instruments, RCT of therapies, systematic reviews, and meta-analyses. The intervention measures primarily comprise three types of high-frequency phrases that are related, as determined by keyword analysis: intelligent rehabilitation, physical factor therapy, and occupational therapy. Current areas of focus in research include randomized clinical trials, neurorehabilitation, and robot-assisted therapy. Current research has shown a growing interest in studying upper limb function assessment, occupational therapy, physical therapy, robot-assisted therapy, virtual reality, brain-computer interface, telerehabilitation, cortical reorganisation, and neural plasticity. These topics have become popular and are expected to be the focus of future research.

Prospective Association of the Mediterranean Diet with the Onset of Cardiometabolic Multimorbidity in a UK-Based Cohort: The EPIC-Norfolk Study

BackgroundCardiometabolic multimorbidity (CMM), defined as the co-occurrence of 2 or more cardiometabolic diseases, including myocardial infarction (MI), stroke, and type 2 diabetes (T2D), is an increasing public health challenge. Although poor diet is a known risk factor for a first cardiometabolic disease (FCMD), the relationship with subsequent occurrence of CMM is less studied. ObjectivesThis study aims to investigate the prospective association between baseline adherence to the Mediterranean diet and the onset of CMM across various follow-up durations. MethodsWe used data from the European Prospective Investigation into Cancer-Norfolk cohort study of 21,900 adults, aged 40–79 free of prevalent MI, stroke, and T2D at baseline (1993–1997). A median-based Mediterranean diet score and a pyramid-based MDS (pyr-MDS) were used to measure baseline adherence to the Mediterranean diet. Multistate modeling was employed to investigate associations with the FCMD and the subsequent CMM event. ResultsOver the entire follow-up period of 21.4 y (median), we observed 5028 FCMD and 734 CMM events. Multistate analysis indicated that the association between baseline Mediterranean diet and the risk of CMM may be stronger in shorter follow-up durations. Particularly, baseline pyr-MDS was significantly associated with the risk of subsequent CMM transitioning from FCMD when follow-up durations were limited to 10 and 15 y, with hazard ratio (95% confidence interval) being 0.67 (0.53, 0.84) and 0.80 (0.70, 0.92) per SD increase in pyr-MDS, respectively. Additionally, we observed that the risk of CMM transitioning from FCMD was modified by social class across shorter to longer follow-ups, where the impact of baseline Mediterranean diet was only significant in nonmanual workers. ConclusionsBaseline adherence to the Mediterranean diet was potentially associated with a lower risk of CMM transitioning from FCMD, particularly during shorter follow-up periods.

A contemporary evaluation of the frequency & factors associated with overt stroke across the lifespan: A Ghanaian sickle cell disease registry analysis

BackgroundStroke is a devastating complication of Sickle Cell Disease (SCD) with significant mortality and substantial morbidity. The burden of prevalent stroke in SCD is highest in sub-Saharan Africa and estimated at 4.2 % to 6.4 % in the era where evidence-based prevention strategies such as use of hydroxyurea therapy and transcranial doppler ultrasound were not routine care. PurposeTo assess the contemporary frequency and factors associated with prevalent stroke across the lifespan in an SCD registry at the tertiary medical center in Ghana. MethodsThis is a cross-sectional study conducted at the Komfo Anokye Teaching Hospital, a tertiary medical center in the middle belt of Ghana. The center has comprehensive Sickle Cell Clinics for children, adolescents, and adults with a patient registry established as part of the Sickle Pan-African Research Consortium (SPARCo)-Ghana study from 2017 to date. Data captured in the registry and analyzed for the present study include demographics, stroke status using the WHO criteria supplemented by the Questionnaire for Verifying Stroke Free Status (QVSFS), use of hydroxyurea, and complete blood count. Logistic regression modeling was utilized to assess factors associated with stroke. ResultsAmong a registry cohort of 4115 individuals with confirmed SCD, 35 (0.85 %, 95 % CI: 0.59–1.18 %) had overt or clinically confirmed stroke. The frequency of stroke differed significantly across the lifespan being 0.38 % (95 % CI: 0.12–0.64 %) among children <10 years, 1.23 % (95 % CI: 0.73–1.94 %) among adolescents aged 10 to 17 years, and 1.44 % (95 % CI: 0.66–2.71 %) among adults 18 years or more, p = 0.007. In adjusted analysis, each 10-year increase in age was associated with odds ratio, OR (95 % CI) of 1.90 (1.42–2.54) and hydroxyurea use, OR of 6.09 (2.65–13.99). The association between hydroxyurea and stroke observed in this cross-sectional study is not causal. ConclusionApproximately 1 in 120 SCD patients in this large Ghanaian cohort had clinically overt stroke. The gradual uptake of hydroxyurea therapy into routine care for SCD in this resource-limited setting, may partly explain the lower frequency of stroke.

Alternative Scenarios for Projected Prevalence of Stroke and Post-Stroke Dementia to 2046 in Ireland: A Model-Based Analysis

Abstract Background Understanding future population need is key for informing stroke service planning. This study aims to evaluate alternative scenarios for future trends in stroke age-specific incidence and case-fatality and estimate impact on projected stroke and post-stroke dementia prevalence in Ireland. Methods We used a probabilistic Markov model to project and track incidence and prevalence of stroke and post-stroke dementia in the Irish population aged 40-89 years to 2046. Using systematic review and observational evidence, we extrapolated trends in stroke age-specific incidence and case-fatality from 1990-2019 to 2016-2046. We defined optimistic, realistic and pessimistic scenarios, including scenarios where trends decelerated over time. Results The stable (pessimistic) scenario indicates a projected 95,278 stroke survivors in 2046 (95% uncertainty interval, UI = 91,404-99,487) (30.1 per 1000 pop), an increase of 53% from 2022 to 2046. The most optimistic scenario would involve a 3.2% increase from 2022 to 2046, to a projected 61,000 survivors. More realistic scenarios based on lower rates of incidence/case-fatality decline, or rates of decline slowing over time, imply an increase ranging between 22.9% and 37.2%. There will be a projected 19,430 with post-stroke dementia in 2046 (95% UI 17,182-21,904), an increase of 69.2% from 2022. In the most optimistic scenario, the increase would be 22.6%, with realistic scenarios implying an increase ranging between 38.9% and 53.2%. Conclusion Future stroke healthcare needs will vary substantially depending on epidemiological trends. A large increase in post-stroke dementia is projected across scenarios. Further work is needed to identify optimal policies to promote continuing decline in stroke incidence.

Prevalence of sarcopenic obesity among older adults in communities of China: A multicenter, cross-sectional study.

This study investigated the prevalence of sarcopenic obesity (SO) among older adults in Chinese communities and its association with chronic diseases. We conducted a post-hoc analysis of a 2014-2015 multicenter cross-sectional study involving adults aged ≥60 years from three representative cities in China. The Asian Working Group for Sarcopenia diagnostic criteria and Chinese local cutoffs were employed to define SO. Data on medical history, lifestyle, quality of life, and cognitive function were collected. The overall prevalence of SO was 3.58% in men and 2.88% in women among 2821 participants. There was a notable increase in prevalence with age, with rates reaching 6.58% for men and 4.40% for women aged 70-79 years. In the group aged ≥80 years, the prevalence rate increased significantly, reaching 13.16% for men and 18.18% for women. Those with SO had higher body mass index (25.29 ± 1.55 kg/m² vs 24.16 ± 2.48 kg/m²; P < 0.001) and triceps skinfold thickness (21.17 ± 5.93 mm vs 19.34 ± 6.87 mm; P < 0.05) than the normal group. The prevalence of cardiovascular disease (15.38% vs 6.59%; P < 0.01), hypertension (56.04% vs 38.93%; P < 0.01), and stroke (7.69% vs 2.25%; P < 0.01) was also significantly higher in the SO group. Logistic regression showed that those with SO were more likely to have cardiac disease (odds ratio [OR] = 2.20; P = 0.016) and stroke (OR = 2.61; P = 0.039). The prevalence of SO increases with age among the older adult population in China, notably after age 80 years. SO individuals were more likely to have cardiac disease and stroke. It is important to focus on early identification and management strategies.