Prevalence Of Transient Ischemic Attack Research Articles

Atrial fibrillation, transient ischaemic attack and stroke in older people. A themed collection in age and ageing journal

With an increase in the ageing population, there is a rise in the burden of cardiovascular disease. Age and Ageing have compiled collections of their key cardiovascular themed papers. The first Age and Ageing Cardiovascular Collection focussed on blood pressure, coronary heart disease and heart failure. In this second collection, publications since 2011 were selected with emphasis on atrial fibrillation, transient ischaemic attack (TIA) and stroke. The prevalence of TIA and stroke increases as people get older. In this commentary we summarise studies published in Age and Ageing that bring to the fore the need for a multidisciplinary, person-centred approach to care, conscientious identification of risk factors and their management and prevention strategies, which will inform policy ultimately reducing the burden of cost placed by stroke care on healthcare financing. Read the latest Cardiovascular Collection here.

РАСПРОСТРАНЕННОСТЬ И ФАКТОРЫ РИСКА РАЗВИТИЯ ИШЕМИЧЕСКОГО ИНСУЛЬТА У РАБОТНИКОВ ПРАВООХРАНИТЕЛЬНЫХ ОРГАНОВ

Background. Stroke is the second leading cause of death worldwide and the third leading cause of long-term disability in adults. In law enforcement officers, stress may contribute to the development of cardiovascular disease, exacerbating a number of stroke risk factors. Aim. Study of prevalence and identification of leading risk factors for ischemic stroke in law enforcement workers. Material and methods. A retrospective analysis of case records of patients diagnosed with atrial fibrillation, acute insufficiency of cerebral circulation and transient ischemic attack who received treatment in the Republican Hospital of the Ministry of Internal Affairs of Azerbaijan from 2016 to 2020 (n=1864) was performed. Of these, 225 case records of patients with a concomitant diagnosis of ischemic stroke [(12,07±2,2)%] were selected. We studied such pathological conditions as transient ischemic attack, hypertensive cerebral crisis and chronic forms of cerebrovascular disease as risk factors for stroke. Results and discussion. We found that there were 81 [(36,0±3,2)%] cases of cerebrovascular disease among the 225 examinees, including 64 [(28,44±2,9)%] established and 17 [(7,56±3,6)%] probable cases of cerebrovascular disease. Acute forms of cerebrovascular disease often occurred together with chronic forms. (6,98±3,2)% of patients aged 40–54 years (n=129) and (17,70±3,9)% of patients aged 55–65 years (n=96) had discirculatory encephalopathy. There was a total of 6 cases of transient ischemic attack [(2,67±1,4)%] in the patients examined, of which 2 cases [(0,89±1,2)%] were «definite» and 4 cases [(1,78±0,9)%] were «possible». The overall prevalence of transient ischemic attack in patients was (2,67±1,4)%. In 75,0% of the cases detected, transient ischemic attacks were registered predominantly once. Out of the total number of all detected cases of transient ischemic attack, 4 (66,67%) cases were registered for the first time upon history taking. Arterial hypertension was registered in 198 of 225 [(88,0±2,1)%] patients examined. Hypertensive crisis during ischemic stroke was detected in 14 of 225 patients (6,22% of all patients examined) and in (17,68±2,7)% of patients with arterial hypertension (34 patients). Additionally, there were 15 [(6,67±3,83)%] cases of hypertensive cerebral crisis: 5 (2,22%) established cases of hypertensive cerebral crisis and 10 [(4,44±2,80)%] «possible» cases. Conclusion. A comprehensive study of the clinical features, course, and complications of ischemic stroke will allow us to develop new approaches to solve the urgent research problem, which is the management strategy to be applied to patients in the acute period of ischemic stroke.

Abstract P696: Organic Sleep Disorders Are Linked With Stroke- A Nationwide Population Study

Objective: Primary aim of this study is to identify prevalence of organic sleep disorders (OSDs) [REM sleep behaviour disorder (REMSBD), hypersomnia, parasomonia, insomnia, circadian rhythm] and compare prevalence of stroke [acute ischemic stroke (AIS), transient ischemic attack (TIA), intracerebral hemorrhage (ICeH), subarachnoid hemorrhage (SAH)] amongst OSDs. Secondary aim of the study is to evaluate the association between OSDs and stroke subtypes. Methods: A retrospective study was performed using National Inpatient Sample [2016-2017] for adult hospitalizations. We extracted a cohort of diagnoses of OSDs amongst which diagnoses of stroke were identified using ICD 10 code. Weighted analysis using chi-square test and mix-effects multivariable survey logistic regression was performed to evaluate the prevalence and odds of stroke amongst OSDs. Results: Out of 58,259,589 US hospitalizations, 2715 (0.00005%), 4120 (0.01%), 3420 (0.01%), 1,301,209 (2.23%) and 24870 (0.04%) had REMSBD, parasomnia, circadian rhythm, insomnia, and hypersomnia, respectively. Prevalence of AIS was higher in REMSBD [3.1 vs 2.1% p<.0004], hypersomnia [2.7 vs 2.1% p<.0001], parasomnia [2.6 vs 2.1% p=.0714], and circadian rhythm [2.8 vs 2.1% p=.0102]. Prevalence of TIA was higher in REMSBD [1.3 vs 0.6% p<.0001], parasomnia [1.3 vs 0.6% p<.0001] and hypersomnia [0.7 vs 0.5% p=.0188]. Prevalence of ICeH was higher in hypersomnia [0.5 vs 0.4% p=.0043], parasomnia [0.5 vs 0.4% p=.3239], and circadian rhythm [1.3 vs 0.4% p=.0188]. Prevalence of SAH was higher in circadian rhythm [0.6 vs 0.1% p<.0001]. In analysis, patients with parasomnia had higher odds of TIA [aOR 2.8; 95%CI 1.02-7.5] and a weak association with ICeH [1.9 (0.5-7.9)]. Circadian rhythm OSD had 214% [3.1 (1.6-6.1)] and 310% [4.1 (1.5-11.0)] higher risk of ICeH and SAH, respectively and a weak association with AIS [1.3 (0.8-2.1)]. Hypersomnia had a weak association with AIS [1.2 (1.0-1.4)], TIA [1.1 (0.8-1.6)] and ICeH [1.4 (0.9-2.0)]. REMSBD had a weak association with AIS [3.6 (0.8-15.4)]. Conclusion: Our study shows organic sleep disorders (OSDs) are associated with strokes. Even Though the extent of association varies in each OSDs, early identification and prompt management of OSDs may mitigate the risk of stroke.

The Safety of Carotid Artery Stenting for Patients in the Acute Poststroke Phase

The efficacy of carotid artery stenting (CAS) for patients in the acute poststroke phase has not been established. We investigated the outcome of CAS for patients with symptomatic internal carotid artery (ICA) stenosis in the acute poststroke phase. We performed a retrospective analysis of all patients who underwent CAS for symptomatic ICA stenosis in our institution. Patients in whom the time interval between neurological deterioration and the CAS procedure was less than 3 days were included in the early group, and the other patients were included in the delayed group. Perioperative complications including major adverse events (MAEs) were compared between the early and the delayed groups. One hundred five patients were included in the study. Forty patients were assigned to the early group and 65 patients were assigned to the delayed group. The overall MAE rate was 4.8%. There was no significant increase in the perioperative MAE in the early group compared with the delayed group (early group 2.5% versus delayed group 6.5%, P = .65). In the early group, 25 of 40 patients (62.5%) were functionally independent (modified Rankin scale [mRS] score of 0-2) at discharge. Significant differences between the independent patients and the disabled patients (mRS score of 3-6) included age (independent 72 versus disabled 79, P < .01) and prevalence of transient ischemic attack (36.0% versus .0%, P = .02). CAS performed within 3 days from the last ischemic event did not increase the risk of perioperative complication. Early CAS may be a useful option for the treatment of symptomatic carotid artery stenosis.

Specific plasma oxylipins increase the odds of cardiovascular and cerebrovascular events in patients with peripheral artery disease.

Oxylipins and fatty acids may be novel therapeutic targets for cardiovascular disease. The objective was to determine if plasma oxylipins or fatty acids can influence the odds of cardiovascular/cerebrovascular events. In 98 patients (25 female, 73 male) with peripheral artery disease, the prevalence of transient ischemic attacks, cerebrovascular accidents, stable angina, and acute coronary syndrome was n = 16, 10, 16, and 24, respectively. Risk factors such as being male, diagnosed hypertension, diabetes mellitus, and hyperlipidemia were not associated with events. Plasma fatty acids and oxylipins were analyzed with gas chromatography and HPLC-MS/MS, respectively. None of 24 fatty acids quantified were associated with events. In contrast, 39 plasma oxylipins were quantified, and 8 were significantly associated with events. These 8 oxylipins are known regulators of vascular tone. For example, every 1 unit increase in Thromboxane B2/Prostaglandin F1α and every 1 nmol/L increase in plasma 16-hydroxyeicosatetraenoic acid, thromboxane B2, or 11,12-dihydroxyeicosatrienoic acid (DiHETrE) increased the odds of having had ≥2 events versus no event (p < 0.05). The greatest predictor was plasma 8,9-DiHETrE, which increased the odds of acute coronary syndrome by 92-fold. In conclusion, specific oxylipins were highly associated with clinical events and may represent specific biomarkers and (or) therapeutic targets of cardiovascular disease.

Risk factors of transient ischemic attack: An overview.

Transient ischemic attack (TIA) is a transient episode of neurologic dysfunction caused due to loss of blood flow to the brain or spinal cord without acute infarction. Depending on the area of the brain involved, symptoms of TIA vary widely from patient to patient. Since the blockage period in TIA is very short-lived, there is no permanent damage. Risk factors for TIA include family history of stroke or TIA, age above 55 years or older, higher risk of TIA in males than females, high blood pressure, diabetes mellitus, and tobacco smoking. Genetics, race, and imbalance in lipid profile are other risk factors of TIA. TIA is usually diagnosed after taking a thorough history and a physical examination. Several radiological tests such as computed tomography and magnetic resonance imaging are useful in the evaluation of patients who have had a TIA. Ultrasound of the neck and an echocardiogram of the heart are other tests useful in the diagnosis and evaluation of the attack. The treatment following acute recovery from a TIA depends on the underlying cause. Patients who have more than 70% stenosis of the carotid artery, removal of atherosclerotic plaque is usually done by carotid endarterectomy surgery. One-third of the people with TIA can later have recurrent TIAs and one-third can have a stroke because of permanent nerve cell loss. Having a TIA is a risk factor for eventually having a stroke. Educating the patients and inculcating lifestyle modifications in them are initial steps to minimize the prevalence of transient ischemic attack.

Epidemiology of non-fatal cerebrovascular stroke and transient ischemic attacks in Al Quseir, Egypt

Background and purposeStroke is a medical emergency that can cause permanent neurological damage, complications, and disability. We aim to determine the epidemiology of non-fatal cerebrovascular stroke (CVS) and transient ischemic attacks (TIAs) in Al Quseir City, Red Sea, Egypt.MethodsThe total population (n=33,285) was screened through a door to door study by three specialists of neurology and 15 female social workers (for demographic data collection). All suspected stroke patients were subjected to a full clinical examination, computerized tomography (CT) and/or magnetic resonance imaging (MRI) of their brain, blood sugar, lipogram, serum uric acid, complete blood cells, blood urea, and serum creatinine, as well as evaluated by Barthel Index and Scandinavian Stroke Scale. Carotid doppler, echocardiography, and thyroid functions were done for selected cases.ResultsCVS was recorded among 130 patients out of 19,848 subjects aged 20 years and more, yielding a total prevalence of 6.55/1,000 population. From June 1, 2010 to May 31, 2011, 36 patients were recorded to have stroke within 1-year, yielding an incidence rate of 1.81/1,000. Prevalence and incidence rates were higher among males than females, and both indices increased steadily with advancing age to reach the highest prevalence (37.02/1,000) and incidence rate (9.5/1,000) among aged persons 60 years and more.ConclusionThe prevalence of non-fatal stroke in Al Quseir city (6.55/1,000) was at the lower range of that recorded in developing countries (5–10/1,000) and slightly higher than that recorded in industrialized countries (5/1,000 population). Ischemic stroke is the most common type of stroke. The prevalence of TIAs was 0.15/1,000.

Transient ischaemic attack: clinical relevance, risk prediction and urgency of secondary prevention

Transient ischaemic attack (TIA) is increasingly recognized as a harbinger of stroke and an important opportunity for secondary prevention. We have reviewed recent evidence on the burden of TIA and prediction and prevention of stroke in the acute phase. Although recent data on the incidence and prevalence of TIA are lacking, available data suggest that the burden of TIA is higher than previously estimated and may be expected to increase with the ageing of the population. Prospective prognostic studies have shown that the early risk of stroke after TIA is approximately 5% at 7 days and 10-15% at 90 days depending on clinical settings and study methodology. This risk can be reliably predicted by risk scores based on clinical features (the ABCD system), TIA aetiology and findings on brain imaging, although the optimal combined prognostic strategy is uncertain because the interaction between individual predictors is not established. Studies of the urgent assessment and initiation of secondary prevention in specialist centres suggest that the early risk of stroke after TIA can be reduced by up to 80%. The risk of stroke after TIA is considerable. However, recent advances have shown that this risk can be predicted for individuals and substantially reduced by appropriate secondary prevention measures.

Neural Networks for Ischemic Stroke

To have uniform criteria for evaluating populations for prevalence of transient ischemic attack (TIA)/stroke, validated instruments are necessary for objective assessment and classification. Patient responses compatible with symptoms of TIA or ischemic stroke, obtained from participants in a substudy of the Asymptomatic Carotid Atherosclerosis Study, were used to program a neural network for each symptom. Models were designed for rapid classification into 1 of 7 outputs: no event, TIA, or stroke (in left carotid, right carotid, or vertebrobasilar). The networks were then tested by comparing decisions with a validated questionnaire used to access an independent data set of 381 patients. There were 144 patients who reported sudden speech change, 89 with sudden vision loss, 67 with double vision, 189 with sudden numbness, 223 with episodic dizziness, and 108 with paralysis, for a total of 820 reported symptoms among the 381 patients tested. For each category, an equal number of individuals reporting "No" to these phenomena were randomly selected and analyzed. Neural network classification correlated with the diagnoses made by specially trained stroke clinicians (e.g., all who responded "No" were correctly classified as having no neurologic event). Ten symptomatic patients were misclassified, with the most common reason being incomplete data. After adjustment of the network logic, these misclassifications did not recur. Computer networks can be trained to produce a rapid and accurate classification of TIA or stroke by vascular distribution, enabling screening of populations for assessment of their incidence and prevalence.

Letter Regarding Article by Markus et al, “Dual Antiplatelet Therapy With Clopidogrel and Aspirin in Symptomatic Cardiac Stenosis Evaluated Using Doppler Embolic Signal Detection: The Clopidogrel and Aspirin for Reducton of Emboli in Symptomatic Carotid Stenosis (CARESS) Trial”

Letter Regarding Article by Markus et al, “Dual Antiplatelet Therapy With Clopidogrel and Aspirin in Symptomatic Cardiac Stenosis Evaluated Using Doppler Embolic Signal Detection: The Clopidogrel and Aspirin for Reducton of Emboli in Symptomatic Carotid Stenosis (CARESS) Trial”

Does HIV Infection Increase Risks for Stroke and TIA

These authors examined the prevalence of transient ischemic attacks (TIAs) and of completed strokes in people with HIV infection. Of 772 HIV-infected

Prevalence of stroke and transient ischaemic attack in the elderly population of an Italian rural community.

To evaluate the prevalence of stroke and transient ischaemic attack in the elderly population, including the oldest residents, of a rural Italian community. A door-to-door survey was performed between April and October 2001 in 2390 subjects aged 65 years and over. A symptom questionnaire validated by medical records and neurological examination was employed. Complete information was available for 2260 subjects. The overall prevalence of stroke was 8.2% in males and 5.1% in females. In the very elderly, this increased to 10.7% in males and 10% in females and decreased only in males aged 90 years or over. The overall prevalence of transient ischaemic attack was 7% in males and 4.9% in females. This, too, increased with age, reaching 10.2% in males and 7.4% in females and decreased only in subjects of both sexes aged 85 years or over. An actual estimate of the high prevalence of cerebrovascular disease in the elderly population, even in very old subjects, was thus achieved. Appropriate health care services consequently need to be planned.

Transient ischemic attacks and risk of stroke in an elderly poor population.

The significance for stroke and correlates of transient ischemic attacks (TIA) were studied prospectively in a population of 2,772 persons aged 65 to 74. The prevalence of TIA at the beginning of the study was 63 per 1,000. TIA prevalence was substantially higher among blacks and women than among whites and men. Only 13% of those with TIA were free from any other major evidence of cardiovascular disease. White men, black men and black women with TIA had higher observed incidence rates of stroke than those without TIA. White women were a notable exception to this trend. There was a positive association between frequency of TIA and risk of stroke. Those with TIA and hypertension experienced higher stroke incidence rates than normotensive persons with TIA.