Primary Stroke Prevention Research Articles

СОВРЕМЕННЫЕ ПРЕДСТАВЛЕНИЯ О ФАКТОРАХ РИСКА И ПРОФИЛАКТИКИ ИНФАРКТА ГОЛОВНОГО МОЗГА(ОБЗОР ЛИТЕРАТУРЫ)

Stroke is the leading cause of death and disability in the world. Statistics from Uzbekistan show that over 60,000 new strokes occur each year. At the same time, more than 160 new cases occur daily in the country. In Tashkent alone, 25-30 cases of stroke occur every day. In Tashkent alone, 25-30 strokes areobserved daily [1,7]. The main risk factors for atherothromboembolic ischemic stroke are, high blood pressure, high blood cholesterol, smoking and diabetes; and the main risk factors for cardiogenic ischemic stroke are atrial fibrillation and coronary heartdisease. Strategies to reduce the frequency of strokes include the prevention of primary and secondary (repeated) stroke, as well as the rehabilitation period of patients. With a qualitative approach, the mortality and disability of patients is reduced

Ticagrelor for the primary prevention of stroke in patients with coronary artery disease: a systematic review and meta-analysis of randomized controlled trials.

Coronary artery disease (CAD) patients had a higher risk of first-ever stroke than general population even when they were on antiplatelet treatment. It was unknown whether more potent antiplatelet inhibitor ticagrelor which also provided adenosine-mediated protection would improve the primary stroke prevention for CAD. PubMed, Embase, Web of Science and CERNTRAL were searched for randomized clinical trials (RCTs) comparing efficacy and safety outcomes of over 30-day use of ticagrelor versus other antiplatelet drugs or placebo in patients with acute or chronic coronary syndrome. RCTs involving patients with any stroke history were excluded. Based on 5 RCTs with 45,843 patients, ticagrelor-involving regimens significantly reduced first-ever strokes (risk ratio [RR] 0.81; 95% confidential interval [CI] 0.71-0.94; I2 = 0%) in comparison to other antiplatelet regimens in CAD, where the benefits in reducing ischemic strokes (IS) (RR 0.80; 95% CI 0.68-0.94; I2 = 0%) was not canceled out by the increase of intracranial hemorrhage (ICH) (RR 1.41; 95% CI 1.05-1.89; I2 = 0%). According to results of subgroup analyses, the protective effects of ticagrelor on first-ever stroke were more significant with treatment duration of more than 1year, dosage of 60mg twice daily, and in clinical settings of chronic coronary syndrome. In conclusion, available evidence from aggregate data supported a modest advantage of ticagrelor-involving regimens for the primary stroke prevention in CAD compared with other antiplatelet regimens after the trade-off between reducing IS and inducing ICH, where more benefits might be expected from long-term and low-dose use of ticagrelor among patients with chronic coronary syndrome. Further collaborative meta-analysis of individual participant data from well-designed and statistically-powered trials would be needed to generate high quality evidence on this issue.

Primary Prevention of Acute Stroke

Primary Prevention of Acute Stroke Abstract. Strokes are frequent. Vascular risk factors are increasing the stroke risk. Most vascular risk factors are treatable. Their therapy is important in the primary prevention of stroke. According to the INTERSTROKE study, arterial hypertension, inactivity, overweight, dyslipidemia, smoking, unhealthy diet, cardiac pathologies such as major arrhythmia, diabetes mellitus, stress/depression and overconsumption of alcohol are the most important treatable vascular risk factors. In this article, we will also report on at present less well known treatable vascular risk factors such as sleep apnea, atheromatosis of the aortic arch and of arteries supplying the brain, migraine with aura and chronic inflammatory disorders and infections.

Association of magnesium intake with type 2 diabetes and total stroke: an updated systematic review and meta-analysis

ObjectiveThe detailed associations between type 2 diabetes (T2D) and total stroke and magnesium intake as well as the dose–response trend should be updated in a timely manner.DesignSystematic review and meta-analyses.Data...

Factors associated with stroke among adult patients with hypertension in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, 2018: A case-control study.

Globally, the burden of stroke is increasing at an alarming rate. Factors associated with stroke among hypertensive patients are not consistent across different studies and there are limited studies particularly to hypertensive stroke in the particular setting. This study aimed to assess factors associated with stroke among patients with hypertension in Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, Ethiopia, in 2018. Hospital-based case-control study was conducted from February to April 2018. Cases were adult hypertensive patients with stroke and controls were adult hypertensive patients without a stroke. Cases and controls were identified from the patient's card review. Using a systematic random sampling technique 89 cases and 356 controls were included in this study. Record review, physical measurement, and interview techniques were used to collect data. Data was entered and analyzed by using SPSS version 23. Variables with a p-value of less than 0.25 in the bivariate logistic regression were selected for multivariable logistic regression. The adjusted odds ratio and 95% confidence interval were used to determine the association. P-value <0.05 was used to declare statistical significance. The mean age of cases and controls were 56.3 years (SD±13.53) and 51.9 years (SD±12.67) respectively. Lost to follow-up (AOR = 2.474, 95%CI: 1.368-4.929), alcohol drinking (AOR = 2.440, 95%CI: 1.291-4.613), use of excessive salt in diet (AOR = 3.249, 95%CI: (1.544-6.837), medication non-adherence (AOR = 3.967, 95%CI: 2.256-6.973), uncontrolled systolic blood pressure, (AOR = 3.196, 95%CI: 1.60-6.382), uncontrolled diastolic blood pressure (AOR = 2.204, 95%CI: 1.130-4.297) and high cholesterol level (AOR = 2.413, 95%CI: 1.319-4.414) were found to be significant factors. Lost to follow-up, alcohol drinking, uses of excessive salt in diet, medication non-adherence, and uncontrolled systolic and diastolic blood pressure were associated with stroke. Health education on lifestyle practices and hypertension-related complications in each follow-up visit is very essential for improving the primary stroke prevention.

Effects of Genetic Variants on Stroke Risk.

Effects of Genetic Variants on Stroke Risk.

Abstract WMP113: Serial Cognitive Testing Performance by Baseline Fazekas Category in Stroke Survivors: A Secondary Analysis of the SPS-3 Trial

Introduction: Prior research has shown that an increased burden of white matter hyperintensity (WMH) is an independent risk factor for the development of dementia. However, research has not focused specifically on stroke survivors, who are also predisposed to dementia. Methods: This is a secondary analysis of patients in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, who had a lacunar ischemic stroke within 6 months of enrollment and an MRI at study baseline. The primary outcome is change in the Cognitive Abilities Screening Instrument (CASI) from baseline to a 12 month follow-up. The primary predictor is the Fazekas score on the baseline MRI, with the scores of 0 and 1 collapsed to balance the cohort. We fit regression models to the 12 month CASI and adjusted for baseline CASI, patient age, gender, white race, Barthel Index score at 3 months from enrollment, college education, employment status, diabetes, COPD, and SPS3 randomization arm. Results: We included 2,413 patients with a mean (SD) age of 62.8 (10.6) years and 63.7% were male. There were 946 patients in Fazekas 0-1, 1,009 in Fazekas 2, and 458 in Fazekas 3. The mean (SD) CASI score at baseline and 12 months were 85.3 (12.4) and 86.0 (12.4). In the adjusted linear regression model, compared to a baseline Fazekas of 0-1, a baseline Fazekas of 2 was associated with a worse cognitive score (β coef = -0.55, 95% CI -1.01, -0.08, p=0.020), as was Fazekas of 3 (β coef = -0.76, 95% CI -1.36, -0.16, p=0.013). Conclusion: In patients with recent lacunar stroke, an increased baseline WMH burden is a risk factor for worse performance over a one year period on a validated test of global cognition. Although the absolute difference in score that we found was small (~0.5-0.8 points), this difference is over one year and, over years to decades, could become clinically significant. The implication of this finding is that lacunar ischemic stroke has additive cognitive consequences for patients with an established WMH burden, suggesting that primary stroke prevention in patients with WMH could be an important public health goal to reduce the burden of dementia.

Abstract 134: Digital-AF II: Impact of Smartphone-Based Atrial Fibrillation Screening in the General Population for Primary Stroke Prevention

Background: Opportunistic AF screening for primary stroke prevention is recommended in patients aged above 65 based on stroke risk models. Logistics hamper uniform screening with 12-lead ECG. Novel technologies, e.g. photoplethysmography-based (PPG) apps, may overcome this, providing readily available screening at low cost. We assessed the feasibility of smartphone screening and the impact on subsequent clinical care. Methods: A media campaign educated on AF, recruited subjects, and gave access to a PPG-based app to assess the heart rhythm. Subjects were instructed to measure twice daily for 8 days. An algorithm classified the traces as regular, possible AF, non-AF irregularity, or insufficient quality. PPGs of possible irregularities or AF were reviewed by medical technicians and cardiologists. If AF was confirmed, a physician visit was recommended. Questionnaires collected data on clinical care. Results: In 2 weeks, 62,821 subjects onboarded, resulting in 588,336 60-second PPG traces. The screened population was 49±15 years, 58% was male. In 791 subjects (1.3%), AF was diagnosed by the algorithm and offline confirmed. This group was older (62±11 years, p&lt;0.001), more frequently male (76%, p&lt;0.001) and had a higher CHA2DS2-VASc score (1.00±1.00 vs 2.00±2.00, p&lt;0.001). The proportion with CHA2DS2-VASc ≥ 1 is 81.3% for the AF cohort vs 64.3% in non-AF cohort. The AF yield increased from 0.52% with 1 recording to 1.84% after 8 days. Of the AF patients, 335 (42%) were known, 373 (47%) newly identified, and 83 (11%) did not give this information. A physician was consulted by 138 (17%) newly identified patients, findings were confirmed in 71 (9%), 46 (6%) received antithrombotic therapy. Conclusion: This digital screening, targeting the general population and using only smartphones, demonstrates the feasibility to collect data in a scalable and low-cost way. Next to single timepoint ECG, twice-daily PPG may detect a significant number of asymptomatic AF patients.

Cardiac disease and stroke: Practical implications for personalised care in cardiac-stroke patients. A state of the art review supported by the Association of Cardiovascular Nursing and Allied Professions.

Cardiac and stroke conditions often coexist because of common risk factors. The occurrence of stroke may have significant consequences for patients with cardiac conditions and their caregivers and poses a major burden on their lives. Although both cardiac and stroke conditions are highly prevalent, primary stroke prevention in cardiac patients is crucial to avert disabling limitations or even mortality. In addition, specific interventions may be needed in the rehabilitation and follow-up of these patients. However, healthcare systems are often fragmented and are not integrated enough to provide specifically structured and individualised management for the cardiac-stroke patient. Cardiac rehabilitation or secondary prevention services are crucial from this perspective, although referral and attendance rates are often suboptimal. This state of the art review outlines the significance of primary stroke prevention in cardiac patients, highlights specific challenges that cardiac-stroke patients and their caregivers may experience, examines the availability of and need for structured, personalised care, and describes potential implications for consideration in daily practice.

The Use of Oral Anticoagulants in Patients with Atrial Fibrillation in the Emergency Department

Background and aimAtrial Fibrillation is the leading cause of embolic stroke, yet less than half of high-risk patients with atrial fibrillation are on adequate stroke prevention with oral anticoagulants. Guidelines for the primary prevention of stroke recognize the emergency department as a location for physicians to identify atrial fibrillation and initiate anticoagulants. We sought to compare anticoagulant prescription rates in patients with atrial fibrillation in various provider settings to identify opportunities for improvement in cardioembolic stroke prevention. MethodsA retrospective cohort study of 436 patients with atrial fibrillation presenting to the emergency department from 2014 to 2018 was performed. Baseline characteristics, stroke risk, and rates of anticoagulant prescription were compared across 3 groups: (1) patients discharged from the emergency department, (2) patients admitted under observation status, and (3) patients admitted to inpatient hospital service. ResultsAmong 436 patients (47% women, 51% Hispanic), we identified 105 in the emergency department cohort, 131 in the observation cohort and 200 in the inpatient cohort. The average CHA2DS2-VASc score was 2.5 in the emergency department cohort, 2.6 in the observation cohort and 3.3 in the inpatient cohort. Anticoagulants were prescribed for high-risk patients (CHA2DS2-VASc score ≥ 2) in 17.5% (7/40) of the emergency department cohort compared to 73% (38/52, P< .0001) of the observation cohort and 80% (82/103 P< .0001) of the inpatient cohort. ConclusionPatients with atrial fibrillation are more likely to be prescribed anticoagulants if admitted to inpatient or under observation status compared to the emergency department.

What Is the Best Mix of Population-Wide and High-Risk Targeted Strategies of Primary Stroke and Cardiovascular Disease Prevention?

What Is the Best Mix of Population-Wide and High-Risk Targeted Strategies of Primary Stroke and Cardiovascular Disease Prevention?

Practice patterns for stroke prevention using transcranial Doppler in sickle cell anemia: DISPLACE Consortium.

Children with sickle cell anemia (SCA) are at increased risk for stroke. In 2014, the National Heart, Lung, and Blood Institute (NHLBI) developed guidelines for stroke prevention in SCA informed by the Stroke Prevention Trial in Sickle Cell Anemia (STOP) and Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP II) trials. The guidelines specify the use of transcranial Doppler (TCD) screening and intervention with chronic red cell transfusions (CRCT) in children with SCA who have TCD indication of high stroke risk. The purpose of this study was to describe real-world practice patterns of stroke risk screening and intervention in sites that participated in the Dissemination and Implementation of Stroke Prevention Looking at the Care Environment (DISPLACE) Consortium. Site investigators completed a survey during the formative stages of the study to evaluate their TCD practices relative to the STOP studies. Descriptive statistics and analysis of free-text comments for more complex practices were evaluated. Results suggested universal acceptance of annual TCD screening and initiation of CRCT following an abnormal result among the DISPLACE Consortium, consistent with NHLBI recommendations. However, there was wide variation in methods for conducting TCD screenings (eg, dedicated Doppler vs TCD imaging), classifying TCD results, and actions taken for conditional and inadequate results. Annual TCD screening and initiation of CRCT are critical stroke prevention practices that were universally embraced in the consortium. Additional research would be beneficial for informing clinical practices for areas in which guidelines are absent or unclear.

World Health Organization's Growth Reference Overestimates the Prevalence of Severe Malnutrition in Children with Sickle Cell Anemia in Africa.

Anthropometric indices are widely used to assess the health and nutritional status of children. We tested the hypothesis that the 2007 World Health Organization (WHO) reference for assessment of malnutrition in children with sickle cell anemia (SCA) overestimates the prevalence of severe malnutrition when compared to a previously constructed SCA-specific reference. We applied the WHO and SCA-specific references to children with SCA aged 5–12 years living in northern Nigeria (Primary Prevention of Stroke in Children with SCA in sub-Saharan Africa (SPRING) trial) to determine the difference in prevalence of severe malnutrition defined as body mass index (BMI) Z-score <−3 and whether severe malnutrition was associated with lower mean hemoglobin levels or abnormal transcranial Doppler measurements (>200 cm/s). A total of 799 children were included in the final analysis (median age 8.2 years (interquartile range (IQR) 6.4–10.4)). The application of the WHO reference resulted in lower mean BMI than the SCA-specific reference (−2.3 versus −1.2; p < 0.001, respectively). The use of the WHO reference when compared to the SCA-specific reference population also resulted in a higher prevalence of severe malnutrition (28.6% vs. 6.4%; p < 0.001). The WHO reference significantly overestimates the prevalence of severe malnutrition in children with SCA when compared to an SCA-specific reference. Regardless of the reference population, severe malnutrition was not associated with lower mean hemoglobin levels or abnormal transcranial Doppler (TCD) measurements.

Exercise and Stroke.

Stroke is a leading cause of mortality and morbidity all around the world. Identification of stroke risk factors and protective lifestyles is necessary for optimizing personalized treatment and reducing mortality. Sedentary lifestyle is a well-known modifiable risk factor in primary and secondary stroke prevention. Also, in recent years, exercise has been described as a neuroprotective and neuroreparative factor. Here we summarized the existing available evidence of the relationship between physical activity and stroke.

Detection of Asymptomatic Carotid Artery Stenosis in High-Risk Individuals of Stroke Using a Machine-Learning Algorithm

Objective Asymptomatic carotid stenosis (ACS) is closely associated to the incidence of severe cerebrovascular diseases. Early identifying the individuals with ACS and its associated risk factors could be beneficial for primary prevention of stroke. This study aimed to investigate a machine-learning algorithm for the detection of ACS among high-risk population of stroke based on the associated risk factors.Methods A novel model of machine learning was utilized to screen the associated predictors of ACS based on 30 potential risk factors. The algorithm of this model adopted a random forest pattern based on the training data and then was verified using the testing data. All of the original data were retrieved from the China National Stroke Screening and Prevention Project (CNSSPP), including demographic, clinical and laboratory characteristics. The individuals with high risk of stroke were enrolled and randomly divided into a training group and a testing group at a ratio of 4:1. The identification of carotid stenosis by carotid artery duplex scans was set as the golden standard. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was used to evaluate the efficacy of the model in detecting ACS.Results Of 2841 high risk individual of stroke enrolled, 326 (11.6%) were diagnosed as ACS by ultrasonography. The top five risk factors contributing to ACS in this model were identified as family history of dyslipidemia, high level of low-density lipoprotein cholesterol (LDL-c), low level of high-density lipoprotein cholesterol (HDL-c), aging, and low body mass index (BMI). Their weights were 11.8%, 7.6%, 7.1%, 6.1%, and 6.1%, respectively. The total weight of the top 15 risk factors was 85.5%. The AUC values of the model for detecting ACS with training dataset and testing dataset were 0.927 and 0.888, respectively.Conclusions This study demonstrated that the machine-learning algorithm could be used to identify the risk factors for ACS among high risk population of stroke. Family history of dyslipidemia may be the most important risk factor for ACS. This model could be a suitable tool to optimize the clinical approach for the primary prevention of stroke.

Community Knowledge and Awareness of Stroke in New Zealand

Introduction: Community knowledge and stroke awareness is crucial for primary prevention of stroke and timely access to stroke treatments including acute reperfusion therapies. We conducted a national telephone survey to quantify the level of community stroke awareness. Methods: A random sample of 400 adults in New Zealand (NZ), stratified by the 4 main ethnic groups, was surveyed. Eligible participants answered stroke awareness questions using both unprompted (open-ended) and prompted questions (using a list). Proportional odds logistic regression models were used to identify factors associated with stroke awareness. Results: Only 1.5% of participants named stroke as a major cause of death. The stroke signs and symptoms most frequently identified from a list were sudden speech difficulty (94%) and sudden 1-sided weakness (92%). Without prompting, 78% of participants correctly identified at least 1 risk factor, 62% identified at least 2, and 35% identified 3 or more. When prompted with the list, scores increased 10-fold compared with unprompted responses. Ethnic disparities were observed, with Pacific peoples having the lowest level of awareness among the 4 ethnic groups. Higher education level, higher income, and personal experience of stroke were predictive of greater awareness (P ≤ .05). Conclusions: Stroke was not recognized as a major cause of death. Although identification of stroke risk factors was high with prompting, awareness was low without prompting, particularly among those with lower education and income. Nationwide, culturally tailored public awareness campaigns are necessary to improve knowledge of stroke risk factors, recognition of stroke in the community and appropriate actions to take in cases of suspected stroke.

Smoking trajectories and risk of stroke until age of 50 years - The Northern Finland Birth Cohort 1966.

Smoking is a well-known risk factor for stroke. However, the relationship between smoking trajectories during the life course and stroke is not known. We aimed to study the association of smoking trajectories and smoked pack-years with risk of ischemic and haemorrhagic strokes in a population-based birth cohort followed up to 50 years of age. Within the Northern Finland Birth Cohort 1966, 11,999 persons were followed from antenatal period to age 50 years. The smoking behaviour was assessed with postal questionnaires at ages 14, 31 and 46 years. Stroke diagnoses were collected from nationwide registers using unique study number linkage. The associations between smoking behaviour and stroke risk were estimated using Cox regression models. Six different patterns in smoking habits throughout the life course were found in trajectory modelling. During 542,140 person-years of follow-up, 352 (2.9%) persons had a stroke. Continuous smoking during the life course was associated with increased stroke risk (HR = 1.69; 95% CI 1.10-2.60) after adjusting for sex, educational level, family history of strokes, leisure-time physical activity, body mass index, alcohol consumption, hypertension, hypercholesterolemia, and diabetes. Per every smoked pack-year the stroke risk increased 1.04-fold (95% CI 1.03-1.06). Other smoking trajectories were not significantly associated with stroke risk, nor were starting or ending age of smoking. Accumulation of smoking history is associated with increased risk of stroke until age of 50 years. The increased stroke risk does not depend on the age at which smoking started. Given that the majority starts smoking at young age, primary prevention of strokes should focus on adolescent smoking.

Statins in Stroke.

Stroke is a major cause of mortality and disability in modern societies. Statins are effective medications in decreasing cardiovascular events through lipid lowering and pleiotropic effects. To summarize current evidence regarding the role of statins in the prevention and management of stroke. A narrative review of current evidence regarding the effect of statins in stroke management. Electronic searches of MEDLINE, EMBASE and Cochrane Databases were performed. In primary prevention of stroke in patients with risk factors but no established cardiovascular disease, potent statins such as atorvastatin and rosuvastatin have shown some benefits, but the clinical relevance of this effect is questionable. In populations at higher risk of stroke, such as patients with established coronary heart disease, the majority of relevant studies have shown a beneficial effect of statins in preventing stroke. Similarly, in patients with a previous cerebrovascular event, there is a clear benefit of statins for the prevention of recurrent events. The use of statins is not associated with an increased risk of intracranial bleeding in primary prevention studies. There may be an increased incidence of non-fatal hemorrhagic stroke with high dose statins in patients with a previous cerebrovascular event. Patients who experience a stroke while on statins should not discontinue statins. In addition, statins are associated with better survival and improved functional outcome when administered during the acute phase of stroke in statin-naive patients. In contrast, statins do not confer any benefit in patients with acute ischemic stroke who receive thrombolysis. Treatment with statins prevents ischemic stroke, especially in patients with high cardiovascular risk and established atherosclerotic disease. It seems that both lipid lowering and pleiotropic effects contribute to these effects.

Prevalence and the Risk Factors for Asymptomatic Carotid Artery Stenosis Among Type II Diabetes Mellitus Patients

Prevalence and the Risk Factors for Asymptomatic Carotid Artery Stenosis Among Type II Diabetes Mellitus Patients

Pola Pencegahan Primer Stroke Oleh Pasien Hipertensi Di Rumah Sakit Muhammadiyah Palembang: Studi Deskriptif

Background: Hypertension can lead stroke complications if not handled optimally. Disruption of blood flow causes the diameter of blood vessels of shrink, resulting in a lack of oxygen and glucose supply to the brain. Prevention is one of the best strategies to reduce the incidence of stroke. One of them is by implementing primary preventions such as regulating healthy food consumption, getting enouh rest, checking health regurarly, arranging nutrition diets, maintaining ideal body weight, doing physical activities regurarly, stop smoking, and avoiding drinking alcohol. Objective: To describe the primary preventions of stroke by hypertensive patients in Muhammadiyah Hospital of Palembang in 2019. Method: This was quantutative descriptive study using survey design. Result: Most of the respondents limited their consumption of foods containing excess salt (64.4%) and consumed protein foods regurarly such as fish (93.2%); all respondents consumed vegetables and fruits (100%), checked their health every month and did not consume alcohol. Conslusion: Primary prevention of stroke by hypertensive patients was considered as good category since they had a fairly healthy and good life behavior.