Risk Factor For Cerebrovascular Events Research Articles

Abstract 4147634: Important Role of Prediabetes in Stroke Patients including ESUS

Stroke including ESUS is one of the common causes of disability and death worldwide. Furthermore, diabetes mellitus and prediabetes are among the main risk factors for cerebrovascular events. If the criteria for apparent diabetes mellitus is not met, a glucose metabolism disorder may still exist. Prediabetes can be present as impaired fasting glucose (IFG), impaired glucose tolerance or an increased, but not yet diabetic, HbA1c. To determine the frequency of diabetes mellitus (DM) and prediabetes mellitus (PDM) in patients with cardiovascular events, we analyzed the aspects of prediabetes in a stroke population of one of the largest stroke centers in Germany and collected the data in a prospective manner over 6 months. Among 714 included patients, 163 (30.8%) suffered a cryptogenic Stroke, including 98 (19%) ESUS. 185 (26%) TIA, 209 (39%) cardioembolic, 110 (21%) atherosclerotic, 40 (8%) lacunar and 7 (1%) other specific strokes were registered. >50% had a diabetic or prediabetic metabolic state, among which, the highest proportion was seen in lacunar strokes, followed by atherosclerotic infarctions. >80% of lacunar, >70% of atherosclerotic infarctions, 60% of ESUS, 50% of cardioembolic infarctions indicate DM or PDM. Both PDM and DM show a positive correlation with age. PDM is most common in 75-84y old patients. In the male population, PDM is most prevalent in the oldest patients (<85y) at >50%, and least prevalent in the youngest patients (<65y) at 15%. In this age group, women show a significantly higher frequency of DM and PDM. The highest number of female patients with glucose metabolism disorders is seen in the age group of 66-74y at >40%. In the oldest patient group, relatively speaking, more than twice as many men are affected by glucose metabolism disorders as women (52% vs. 24%). In summary the largest relative proportion of prediabetics and diabetics is seen at 80% among the lacunar infarction group and the second largest proportion at 70% among those with atherosclerotic infarctions. Among ESUS and cryptogenic stroke patients show a proportion of over 60% with impaired glucose tolerance. PD presents a positive correlation with increasing age, just like other risk factors. 40% of the 75-84-year-olds have DM or PDM. Therefore, diabetogenic micro- and macroangiopathies could be a major contributing factor to the causes of stroke.

Nomogram for predicting asymptomatic intracranial atherosclerotic stenosis in a neurologically healthy population

Asymptomatic intracranial atherosclerotic stenosis (aICAS) is a major risk factor for cerebrovascular events. The study aims to construct and validate a nomogram for predicting the risk of aICAS. Participants who underwent health examinations at our center from September 2019 to August 2023 were retrospectively enrolled. The participants were randomly divided into a training set and a testing set in a 7:3 ratio. Firstly, in the training set, least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were performed to select variables that were used to establish a nomogram. Then, the receiver operating curves (ROC) and calibration curves were plotted to assess the model’s discriminative ability and performance. A total of 2563 neurologically healthy participants were enrolled. According to LASSO-Logistic regression analysis, age, fasting blood glucose (FBG), systolic blood pressure (SBP), hypertension, and carotid atherosclerosis (CAS) were significantly associated with aICAS in the multivariable model (adjusted P < 0.005). The area under the ROC of the training and testing sets was, respectively, 0.78 (95% CI: 0.73–0.82) and 0.65 (95% CI: 0.56–0.73). The calibration curves showed good homogeneity between the predicted and actual values. The nomogram, consisting of age, FBG, SBP, hypertension, and CAS, can accurately predict aICAS risk in a neurologically healthy population.

Kidney dysfunction predicts 90 days mortality after stroke thrombectomy independent of cardiovascular risk factors and chronic kidney disease.

Kidney dysfunction (KD) is a risk factor for cerebrovascular events and has been shown to have a detrimental effect on outcome after stroke. We evaluated the influence of KD at admission and pre-existing diagnosis of chronic kidney disease (CKD) before thrombectomy for anterior circulation stroke on functional independence and mortality 90 days after stroke in this cross-sectional study. We included patients with acute ischemic stroke in the anterior circulation treated with thrombectomy at our hospital between June 2015 and May 2022. We analyzed clinical characteristics, laboratory values and pre-existing diagnosis of CKD. KD at admission was defined as glomerular filtration rate (GFR) <60 ml/min/1.73 m2. Outcomes were defined as a modified Rankin Scale Score of 0-2 for functional independence and mortality at 90 days. We fitted multivariate regression analysis to examine the influence of pre-treatment KD and pre-diagnosed CKD on outcome. Nine hundred fifty-three patients were included in this analysis (mean age 73.8 years, 54.2% female). KD was present in 31.8%, and patients with KD were older and more often female, presented more often with comorbidities such as arterial hypertension, diabetes, and atrial fibrillation, and were less often independent before the index stroke. In multivariate analysis adjusted for age, independence before the index stroke, diabetes, hypertension, atrial fibrillation, initial NIHSS, thrombolysis treatment, and recanalization outcome, KD on admission had no significant influence on functional independence 90 days after stroke, but predicted mortality with an odds ratio of 1.80 (95% CI 1.23-2.63, p = 0.003). This influence also persisted when controlling for pre-diagnosed CKD (OR 1.60, 95% CI 1.05-2.43, p = 0.027). KD might function as a surrogate parameter for comorbidity burden and thus increased risk of mortality in this cohort. KD on admission is associated with an 80% higher risk of mortality at 90 days after stroke thrombectomy independent of cardiovascular risk factors and CKD awareness. KD on admission should not exclude patients from thrombectomy but might support prognostic evaluation.

The characteristics and risk factors of cerebrovascular events in young systemic lupus erythematosus patients: A case-control study

We clarified the characteristics and risk factors of CVEs in young SLE patients. We retrospectively reviewed the medical records of patients younger than 50 years of age diagnosed with SLE and first CVEs from 1995 to 2020 in a tertiary medical center in Taiwan. We collected data on the patient characteristics before the CVE and reviewed the laboratory data obtained during the period. At a ratio of 1:3, cases and controls were matched with sex, SLE diagnosis age, diagnosis year, and SLE duration. We enrolled 43 CVE SLE patients and matched 129 non-CVE SLE controls. The median age at the time of the CVE was 39 years. Around 70% of young-aged CVE involved the cerebral lobes of frontal (∼30%), parietal (∼20%), occipital (∼10%), and temporal (∼10%). The peak incidence period for hemorrhagic CVE was within 1st year of SLE diagnosis (37%); in contrast, during the 2nd to 5th year of SLE diagnosis (25%) for ischemia CVEs. Hyperlipidemia (odds ratio [OR]=19.36, p=0.002), anti-phospholipid syndrome (APS) (OR=41.9, p=0.0068), a lower hemoglobin level (OR=0.66, p=0.0192), and a higher SLE Disease Activity Index (SLEDAI-2k) score (OR=1.22, p=0.0019) were independent risk factors for CVEs in young SLE patients. Hyperlipidemia, APS, low Hb level, and high SLEDAI-2k significantly increase the risk of young-aged SLE patients developing CVE.

Prevalence and impact of cerebrovascular risk factors in patients with giant cell arteritis: An observational study from the Spanish national registry

ObjectiveTo assess the prevalence and impact of cerebrovascular risk factors (CRF) on cerebrovascular events (CVE) in patients with giant cell arteritis (GCA). MethodsAnalysis of the patients diagnosed with GCA identified in the Spanish Hospital Discharge Database between 2016 and 2018. Results8,474 hospital admissions from patients diagnosed with GCA were identified. 3.4% of the admissions were motivated by CVE (stroke in 2.8% and transient ischemic attack in 0.6%). When compared with the admissions due to other causes, the patients who suffered from CVE presented a higher rate of male sex (36.2% vs 43.5%, p=0.007), hypertension (66.9% vs 74.4%, p=0.004), diabetes (27.6% vs 33.7%, p=0.016) and atherosclerosis (6.6% vs 10.2%, p=0.0.017). After adjustment, male sex (OR=1.35, 95% CI 1.06–1.72) and mainly hypertension (OR=1.44, 95% CI 1.11–1.90) were associated with a higher risk of CVE. ConclusionHypertension, along with male sex, was the strongest risk factor for cerebrovascular events in GCA patients. In these high-risk patients, antiplatelet therapy should be re-considered and evaluated in prospective studies.

Risk Factors for Cerebrovascular Events in Moyamoya Angiopathy Using 4D Flow MRI: A Pilot Study.

Little is known about internal carotid artery (ICA) hemodynamics in patients with moyamoya angiopathy (MMA) and its role in cerebrovascular events. To characterize ICA hemodynamics in MMA patients by 4D flow MRI and investigate its relationship with cerebrovascular events. Prospective. Seventy MMA patients (50 years old ± 9, 30 males). Time-resolved three-directional velocity encoded fast field echo sequence (4D flow) MRI, T1-weighted fast field echo sequence, T2 weighted turbo spin echo sequence, diffusion weighted echo planar imaging; T2-weighted fluid-attenuated inversion recovery turbo spin echo sequence, susceptibility weighted fast field echo sequence, and time-of-flight MR angiography fast field echo sequence at 3.0T. ICA hemodynamics (maximum and average velocity [Vmax , Vavg ], average blood flow [Flowavg ], and wall shear stress) were analyzed based on 4D flow data. Cerebral infarction, defined as the occurrence of events, in 124 brain hemispheres was determined according to clinical symptoms and conventional brain MR imaging. The independent-samples T test was used to evaluate differences in ICA hemodynamics between infarcted and non-infarcted hemispheres. Binary logistic regression was performed to investigate the relationship between ICA hemodynamics and events. A P value < 0.05 was considered statistically significant. Sixty-one infarcted hemispheres (eight hemispheres with acute ischemic damage, 30 with chronic ischemic damage, and 23 with chronic hemorrhagic damage) had cerebrovascular events and 63 non-infarcted hemispheres did not. The hemodynamic parameters in the infarcted hemispheres (Vmax : P < 0.001; Vavg : P=0.003; and Flowavg : P=0.004) were significantly lower than those in the non-infarcted hemispheres. However, Vmax (P=0.052), Vavg (P=0.107), and Flowavg (P=0.074) were not significantly different among hemispheres with acute ischemic lesions, chronic ischemic lesions and chronic hemorrhagic lesions. Vmax (odds ratio 3.033, 95% CI: 1.075-8.562) was independently associated with cerebrovascular events. Vmax maybe a higher risk factor of cerebrovascular events in MMA patients. 2 TECHNICAL EFFICACY STAGE: 3.

Residual risks of comorbidities after parathyroidectomy in a nationwide cohort of patients with primary hyperparathyroidism.

Primary hyperparathyroidism (PHPT) is a common endocrine disorder with increasing incidence, while epidemiologic data in Asian population has been lacking. Therefore, we aimed to identify the incidence, prognosis, and prognostic factors of PHPT patients who underwent parathyroidectomy in Korea. In this retrospective nationwide cohort, patients with PHPT were defined as those with diagnostic codes of PHPT and procedural codes for parathyroidectomy, excluding chronic renal failure or secondary hyperparathyroidism based on National Health Insurance Services database in Korea in 2002-2018. Main primary outcomes were all-cause mortality, cardiovascular, and cerebrovascular events. A total of 5561 patients were diagnosed with PHPT and had parathyroidectomy. The mean age was 54.5 years, and 71.8% were women. The age-standardized incidence was 10.1/100,000 person-year in 2018, rising from 1.7/100,000 person-year in 2002. During a mean of 5.9 years, history of cardiovascular disease, mood disorder, and genitourinary stone had increased risks of mortality with hazard ratios (HRs) of 1.59 (95% confidence interval [CI] 1.10-2.29), 1.43 (CI 1.14-1.80), and 1.40 (CI 1.09-1.80), respectively. History of hypertension, cerebrovascular disease, diabetes mellitus, and mood disorder were risk factors for cardiovascular events with HRs of 1.42 (CI 1.22-1.66), 1.29 (CI 1.05-1.58), 1.22 (CI 1.07-1.40), and 1.14 (CI 1.00-1.29), respectively. Mood disorder was a significant risk factor for cerebrovascular events (HR 1.30, CI 1.11-1.52). The incidence of PHPT patients who underwent parathyroidectomy has been rising in Korea as reported in other countries. Patients with complications, especially mood disorder, had increased cardiovascular and cerebrovascular events and mortality risks.

Association of left ventricular abnormalities with incident cerebrovascular events and sources of thromboembolism in patients with chronic Chagas cardiomyopathy

BackgroundAlthough Chagas cardiomyopathy is related to thromboembolic stroke, data on risk factors for cerebrovascular events in Chagas disease is limited. Thus, we assessed the relationship between left ventricular (LV) impairment and cerebrovascular events and sources of thromboembolism in patients with Chagas cardiomyopathy.MethodsThis retrospective cohort included patients with chronic Chagas cardiomyopathy who underwent cardiovascular magnetic resonance (CMR). CMR was performed with a 1.5 T scanner to provide LV volumes, mass, ejection fraction (LVEF), and myocardial fibrosis. The primary outcome was a composite of incident ischemic cerebrovascular events (stroke or transient ischemic attack—TIA) and potential thromboembolic sources (atrial fibrillation (AF), atrial flutter, or intracavitary thrombus) during the follow-up.ResultsA total of 113 patients were included. Median age was 56 years (IQR: 45–67), and 58 (51%) were women. The median LVEF was 53% (IQR: 41–62). LV aneurysms and LV fibrosis were present in 38 (34%) and 76 (67%) individuals, respectively. The median follow-up time was 6.9 years, with 29 events: 11 cerebrovascular events, 16 had AF or atrial flutter, and two had LV apical thrombosis. In the multivariable model, only lower LVEF remained significantly associated with the outcomes (HR: 0.96, 95% CI: 0.93–0.99). Patients with reduced LVEF lower than 40% had a much higher risk of cerebrovascular events and thromboembolic sources (HR: 3.16 95% CI: 1.38–7.25) than those with normal LVEF. The combined incidence rate of the combined events in chronic Chagas cardiomyopathy patients with reduced LVEF was 13.9 new cases per 100 persons-year.ConclusionsLV systolic dysfunction is an independent predictor of adverse cerebrovascular events and potential sources of thromboembolism in patients with chronic Chagas cardiomyopathy.

Associations Between Relative Morning Blood Pressure, Cerebral Blood Flow, and Memory in Older Adults Treated and Controlled for Hypertension.

[Figure: see text].

PM Association Between Silent Lacunar Infarcts And Muscle Strength: The Bunkyo Health Study

Silent lacunar infarcts by definition, lack clinically overt stroke-like symptom, are occasionally found by brain magnetic resonance imaging (MRI) scan in asymptomatic elderly individuals. A previous study revealed that more than 25% of elderly people have silent lacunar infarcts. The main risk factors for lacunar infarcts and stroke were reported as aging, hypertension, and smoking. While a recent study showed that low muscle strength is also a risk factor for cerebrovascular events, it remains unclear whether low muscle strength is a risk factor for silent lacunar infarcts. PURPOSE: To investigate the association between muscle strength and silent lacunar infarcts in the elderly people living in urban community. METHODS: This study included 1,536 elderly people without past history of cerebral vascular events, aged 65-84 years living in an urban area of Tokyo, Japan (Bunkyo Health Study). All participants underwent brain MRI scan and silent lacunar infarcts were defined as the presence of 1 or more lacunar infarcts. Isokinetic muscle strength of knee extensors was evaluated at angular velocity of 60 degree per seconds using dynamometer. Subjects was categorized tertiles (high, medium, and low) by muscle strength, and compared the prevalence of silent lacunar infarcts. RESULTS: Mean age of subjects was 73.0±5.4 years old and 58.9% were female. Two hundred fifty-two (16.4%) subjects were diagnosed as silent lacunar infarcts, and the subjects categorized as lower muscle strength showed higher prevalence of silent lacunar infarcts (high: 12.3%, medium: 17.7%, and low: 19.3%, p for trend 0.003), while skeletal muscle indices among the groups were similar. After multivariate adjustment by age, sex, body mass index, smoking status, physical activity, hypertension, diabetes, and dyslipidemia, the trend was still significant and the odds ratio for having silent lacunar infarcts was significantly higher in the lowest muscle strength tertile compared to the highest tertile [(High: 1.00 (reference), medium: 1.42 (95%CI: 0.98-2.04), Low: 1.48 (1.02-2.14), p for trend 0.043]. CONCLUSIONS: In the elderly people living in urban community, lower muscle strength of knee extensors was associated with higher prevalence of silent lacunar infarcts independent of other established risk factors.

Disease duration, age at diagnosis and organ damage are important factors for cardiovascular disease in SLE

ObjectiveTo report the incidence rate ratios (IRR) of acute myocardial infarctions (AMI) and cerebrovascular events (CVE) in incident SLE cases from a defined population. To study the risk factors for...

Fibrinogen Levels and the Risk of Cerebrovascular Events in Older Adults With Both Depressive Symptoms and Cognitive Impairment: A Prospective Study.

Depression and cognitive impairment have been identified as risk factors for cerebrovascular events (CVE), and one of their potential etiological pathways is inflammatory status. This prospective study aims to investigate the association between inflammatory markers and the risk of CVE in a population of 2659 older adults, enrolled in the Progetto Veneto Anziani (Pro.V.A.), with depressive symptoms, cognitive impairment, or both conditions. For each individual, we assessed at baseline the presence of depressive symptoms (defined as a Geriatric Depression Scale ≥11), cognitive impairment (defined as a Mini-Mental State Examination <24), and serum levels of fibrinogen, white blood cells (WBC), and erythrocyte sedimentation rate (ESR). During a 4.4-year follow-up, 188 (7.1%) participants had CVE. Among the inflammatory markers, high fibrinogen values were associated with a 50% higher risk of CVE in the whole sample, and with a 4-fold higher risk in individuals with both depressive symptoms and cognitive impairment (hazard ratio = 4.04, 95% confidence interval: 1.45-11.23). Elevated WBC were associated with a 5% higher risk of CVE in the whole sample and in those with both conditions. No significant association was observed with the ESR. In conclusion, our study found that high fibrinogen levels may predict the risk of CVE in older people with concomitant depressive symptoms and cognitive impairment. Therefore, fibrinogen could be considered as an easily accessible aging biomarker, which might estimate the chronic inflammatory status and its potential detrimental effects on the most vulnerable older adults.

Emotional stress-induced transient global amnesia with bilateral hippocampal ischemic lesion

The paper describes a clinical case of transient global amnesia (TGA) in a male patient who has experienced prolonged stress at work and at home. The middle-aged man was admitted to hospital disoriented, constantly repeating the same questions. The patient did not remember what had happened that morning before his admission to the hospital. Brain magnetic resonance imaging revealed bilateral punctate hippocampal DWI hyperintensity. The patient has not been observed to have risk factors for cerebrovascular events. Neuropsychological examination has shown that the patient does not have adequate strategies to cope with the sequels of long-term intense stress accompanied with emotion suppression. The described case confirms that psychological instability may be one of the precipitating factors for TGA.

Frequency of Undiagnosed Diabetes Mellitus among Patients with Stroke

Background: Stroke is one of the common causes of disability and death in the world. Furthermore, diabetes mellitus is among the main risk factors for cerebrovascular events. However, a high percentage of individuals with diabetes mellitus are unaware of their disease. Objectives: To determine the frequency of Undiagnosed Diabetes mellitus (UD) in patients with stroke. Materials &amp; Methods: In a descriptive cross-sectional study, all patients with stroke hospitalized in neurology ward of an academic hospital in the north of Iran were included in the study in 2016. A questionnaire was used to collect data including all demographic, laboratory and clinical factors such as high blood pressure, hypercholesterolemia and stroke type. Finally, the data were analyzed using Chi square, Fisher’s exact test and multinomial binary logistic regression in SPSS V. 21. Results: Most samples were male (53.8%) with a mean age of 69.2±10.1 years. The percentage of the UD was 21.7% based on level of HbA1c. The highest percentage of UD was observed in Subarachnoid Hemorrhage(SAH) (66.7%). The frequency of UD in patients with family history of diabetes mellitus (16.7%) was lower than that in patients without that history (27.7%). There was a significant relationship between UD and cholesterol and triglyceride levels and, in general, dyslipidemia (P&lt;0.05). Conclusion: In this study, a large percentage of patients with stroke suffered UD. Therefore, it is recommended that extensive screening be conducted for diabetes mellitus in the community in order to prevent stroke.

A2676 Hypertension, Diabetes and the Risk of Cerebrovascular Events

Objectives: Hypertension and diabetes are both significant risk factor for cerebrovascular events, but the relationship between all these events and gender were not clear. To determine this issue, we conducted a prospective cohort study. Methods: The Kailuan study (n = 78380) was a community-based, prospective cohort study and workforce survey. Baseline information was collected and followed up for 10 years. We divided all the participants to 6 groups according to hypertension and diabetes status. The incidence of new-onset cerebral ischemic stroke (CI) and stroke was respectively calculated by gender. Results: In total, the incidence of new-onset CI in men was higher than that in women. After adjusted for age, sex, income level and some other factors, men with baseline hypertension and diabetes were most likely to be attacked by CI [Hazard Ratio (HR) = 2.45], and men with baseline diabetes were least likely to have CI (HR = 0.88). But on the contrary, patients with baseline diabetes were most probably to have new-onset CI (HR = 1.17). There was a similar situation in stroke. Men with baseline hypertension and follow-up diabetes had the highest HR (HR = 2.53) to have stroke and men with baseline diabetes had the lowest HR (HR = 0.73). However, that was complete opposite in women. The HR of stroke in baseline hypertension and follow-up diabetes group and baseline diabetes group in women was 0.90 and 2.73 separately. Conclusion: There is a gender difference in cerebral vascular events. It is different from the conventional conceptions of hypertension and diabetes. Men with baseline hypertension and diabetes or follow-up diabetes may have more possibility to have cerebrovascular disease. Women with baseline diabetes may be most likely to have cerebrovascular disease.

Cerebral Thromboembolic Events During Anterior Cervical Spine Surgery: Retrospective Case Series Study With Diffusion-Weighted Magnetic Resonance Imaging Follow-up in the Immediate Postoperative Period.

ObjectiveWe evaluated the efficacy of diffusion-weighted magnetic resonance imaging (DW-MRI) in detecting perioperative cerebral thromboembolic events after anterior cervical discectomy and fusion (ACDF).MethodsThis retrospective case series included 51 consecutive patients that underwent ACDF. To assess baseline presence of plaque or stenosis, all patients were assessed for risk factors of cerebrovascular events and underwent carotid ultrasound preoperatively and cerebral DW-MRI was performed in all patients postoperatively, with areas of high signal intensity interpreted as a cerebral thromboembolic event. ResultsOne male patient who underwent a C4/5 ACDF had a focal diffusion abnormality on DW-MRI concerning for cerebral thromboembolic events in the right posterior cerebral artery territory. He remained asymptomatic and did not display related neurological symptoms, such as visual deficits. ConclusionAsymptomatic cerebral thromboembolic events can be detected by DW-MRI after ACDF. The incidence of such events remains very rare despite the direct manipulation and associated alteration of common carotid artery flow dynamics.

Clinical Characteristics and Natural History of Quasi-Moyamoya Disease

Quasi-moyamoya disease (quasi-MMD) is a rare cerebrovascular disease and its clinical features and natural history remain unclear. The aim of the study is to describe the clinical characteristics and the natural histories of this disease, with analysis of the risk factors for future cerebrovascular events. We identified 64 patients with quasi-MMD from 693 moyamoya vasculopathy patients referred to our hospital between 2011 and 2015. Demographic data, associated disorders, clinical manifestation, angiographic findings, natural history, and risk factors for cerebrovascular events were analyzed. Patients included in the study had a mean age of 31.5 years. A unimodal age distribution was noted. Atherosclerosis was the most frequently associated disorder. Forty-five (70.3%) patients had ischemic events as their initial clinical manifestation and 14 (21.9%) patients presented as hemorrhagic stroke. The majority of patients presented with Suzuki grades 3 and 4 (20.3% and 42.2%). The annual risk of cerebrovascular events was 19.4% per patient-year. Prior hemorrhage (HR 2.77, 95% CI 1.20-6.41) and ischemic stroke (HR 2.77, 95% CI 1.26-6.07) were 2 risk factors for future events. Several clinical characteristic differences were observed in our mainland China cohort compared with the Japanese and European cohorts. The annual risk of cerebrovascular events was relatively high in quasi-MMD patients. Patients with prior hemorrhage and ischemic stroke were inclined to have future cerebrovascular events. Close follow-up is needed for these patients.

Hemorheological alterations in carotid artery stenosis.

Carotid artery stenosis (CAS) is not only an important risk factor of cerebrovascular events but it can also indicate generalized atherosclerosis. Hemorheological parameters are altered in CAS and in chronic cerebrovascular disorders as well, but it is controversial if hemorheological parameters could be markers of stenosis or atherosclerosis. 107 patients were investigated, 40% of them had stroke or TIA in case history and 48% had CAS. Routine lab parameters were determined and hemorheological variables were measured: hematocrit, plasma viscosity, whole blood viscosity, red blood cell aggregation, and deformability. In the stenotic group whole blood viscosity and red blood cell aggregation were deteriorated (p < 0.05). Whole blood and plasma viscosity were higher and red blood cell deformability was lower in the symptomatic group (p < 0.05). Plasma viscosity and red blood cell deformability were altered in the evolving atherosclerosis group and the CAS groups compared to patients having no signs of stenosis (p < 0.05), but there was no difference among the CAS groups. Although hemorheological parameters are impaired both in CAS and chronic cerebrovascular disorders, the severity of stenosis cannot be detected based on hemorheological parameters. Our investigation suggests that alteration of hemorheological parameters could indicate carotid atherosclerosis.

PP.17.15] PREVALENCE OF COGNITIVE DYSFUNCTION IN CHRONIC KIDNEY DISEASE

Objective: Cognitive dysfunction (CD) is an independent risk factor for cerebrovascular events, heart failure and cardiovascular death. The aim of the present study was the detection and identification of CD (primary prevention) in patients with Chronic Kidney Disease (CKD).Design and method: One hundred fifty-one patients were included in the study, of whom 44 patients with CKD stage I, 47 patients with stage II, 25 patients with stage III, and 35 patients with stage IV. Cognitive function was evaluated with the Mini Mental State Examination (MMSE), Clock Drawing Test (CDT), and Instrumental Activity of Daily living (IADL). The age of the patients was 58.4 years (64.5% men). Results: Severe cognitive impairment was found in 3.8 % of patients with CKD stage I to III, whereas it was present in 19% of patients with CKD stage IV. For every change of CKD stages downwards, the risk of CD increases by 2.25 times. In CKD stage I through IV, there was a decrease by 3.1 points in MMSE (p < 0.001), 1.5 points in CDT (p < 0.001) and 5.3 points in IADL (p < 0.001) respectively. (Figure 1) Multivariate analysis showed that independent factors contributing to CD in CKD were: MMSE: age (p < 0.001), CDT: higher aortic pulse pressure (PP) (p < 0.035) with negative impact, higher educational level (p < 0.001) and higher glomerular filtration rate (p < 0.001) with a positive one. IADL: age (p < 0.001) and brachial PP (p < 0.032) with positive impact, higher educational level (p < 0.001) and glomerular filtration rate (p < 0.001) with a negative one, respectively. Conclusions: For every downward change in CKD stage, CD increases by 2.25 times. Severe CD in CKD I-III is present in 3.8% whereas in stage IV it is found in 19% of patients. The brain-protective role of antihypertensive drugs remains to be defined.

Carotid artery stenosis and coronary artery disease coincidence

Cerebrovascular event is one of the important causes of death in the world. Carotid artery stenosis is one of main risk factors of cerebrovascular events. Risk factors for atherosclerosis are found in carotid artery stenosis. Thus, coincidence of coronary artery disease and carotid artery stenosis were observed. In an individual with high risk of coronary artery plaque formation, peripheral artery stenosis is imaginable. Histological morphology and plaque formation in coronary artery disease and carotid artery stenosis are similar and they occur together most of the time. Although many similar findings were shown in coronary artery disease and carotid artery stenosis, carotid artery stenosis is associated with more severe stenosis compare with coronary artery disease. Carotid artery stenosis does not have exact similar biological activity with coronary artery disease.Some invasive and non-invasive diagnostic methods are established for carotid artery stenosis detection.Same medical and surgical treatment techniques could be used for carotid artery stenosis management that vary due to patient-to-patient specific conditions.