Risk Of Stroke In Participants Research Articles

Periodontitis is associated with stroke

BackgroundPeriodontitis is considered as a risk factor for cardiovascular diseases and atherosclerosis. However, the relationship between periodontitis and stroke is rarely studied. Therefore, we aimed to explore the relationship between periodontitis and stroke.MethodsStatistical analysis was performed using the complex sampling design. We analyzed data on 6,460 participants, representing 92,856,028 American citizens aged 30 years or older, who had valid data on periodontitis and stroke from the National Health and Nutrition Examination Survey 2009–2014. We used clinical attachment level and probing pocket depth precisely to determine periodontitis and it is the first time to use such a precise method for exploring the relationship between periodontitis and stroke.Results39.9% of participants had periodontitis and 2.1% of participants had a record of stroke diagnosis. Stroke was associated with severity levels of periodontitis (p for trend = 0.018). The odds ratio for stroke was significantly elevated in the severe periodontitis and moderate periodontitis participants compared to participants without periodontitis (OR for severe periodontitis: 2.55, 95% CI 1.25–5.21; OR for moderate periodontitis: 1.71, 95% CI 1.17–2.50). After adjusting for race/ethnicity and sex, the association remained significant (p for trend = 0.009). After further adjusting for BMI, hypercholesterolemia, diabetes, alcohol consumption and physical activity, the association still existed (p for trend = 0.027). The association was significant consistently after further adjusting for age (p for trend = 0.033).ConclusionsIn this nationally representative study, we found an association between periodontitis and stroke. The risk of stroke in participants with severe periodontitis and moderate periodontitis was 2.55 times and 1.71times as high as those without periodontitis. Dental health management may be of benefit to stroke prevention.

Novel insights into stroke risk beyond resting and maximal bicycle exercise systolic blood pressure.

Previous research has shown an association between moderate workload exercise blood pressure (BP) and coronary disease, whereas maximal exercise BP is associated with stroke. We aimed to investigate the association between the increase in BP during maximal exercise and the long-term risk of stroke in healthy, middle-aged men. Two thousand and fourteen men were included in the Oslo Ischemia Study in the 1970s. In the present study, we examined baseline data of the 1392 participants who remained healthy and performed bicycle exercise tests both at baseline and 7 years later. Cox proportional hazard was used to assess the risk of stroke in participants divided into quartiles based on the difference between resting and maximal workload SBP (ΔSBP) at baseline, adjusting for resting BP, age, smoking, serum cholesterol and physical fitness. Follow-up was until the first ischemic or hemorrhagic stroke through 35 years. There were 195 incident strokes; 174 (89%) were ischemic. In univariate analyses, there were significant positive correlations between age, resting SBP, resting DBP and SBP at moderate and maximal workload, and risk of stroke. In the multivariate analysis, there was a 2.6-fold (P < 0.0001) increase in risk of stroke in ΔSBP quartile 4 (ΔSBP > 99 mmHg) compared with ΔSBP quartile 2 (ΔSBP 73-85 mmHg), which had the lowest risk of stroke. ΔSBP quartile 1 had a 1.7-fold (P = 0.02) increased risk compared with quartile 2, suggesting a J-shaped association to stroke risk. Stroke risk increased with increasing difference between resting and maximal exercise SBP, independent of BP at rest, suggesting that an exaggerated BP response to physical exercise may be an independent predictor of stroke.

Association between self-rated health status and risk of stroke in Chinese adults: a prospective study

Objective: To explore the relationship between self-rated health status and risk of stroke in Chinese adults. Methods: Data was collected from the Chronic Disease Risk Factor Surveillance in China (2010) as baseline. A total of 60 follow-up monitors (25 urban and 35 rural) in 11 provinces were selected. A total of 36 195 participants without prior cardiovascular diseases were followed and investigated 27 441 people in 2016 and 2017. Cox proportional hazard regression model was used to analyze the self-assessed health status and stroke onset hazard ratio (HR), further conducted several subgroup analyses by demographic characteristics such as age and gender, and sensitivity analysis was performed by excluding death and baseline diabetes. Results: A total of 26 699 study subjects were included according to the inclusion criteria. We identified 1 332 stroke cases (32 subarachnoid hemorrhage, 197 cerebral hemorrhage, and 1 149 cerebral infarction) during an average of 6.4 years (171 431.1 person-years) of follow-up, and the incidence density was 7.77/1 000 person-years. After adjusting the related factors, the risk of stroke in participants with poor self-related health increased by 68% (HR=1.68, 95%CI:1.22-2.32) and the risk of ischemic stroke increased by 47% (HR=1.47, 95%CI:1.05-2.05), with a reference of excellent ones. In subgroup analysis, only age and BMI had an effect-modifying effect on the association between self-rated health and risk of stroke. Only age and dyslipidemia had an effect-modifying effect on the association between self-rated health and ischemic stroke risk (interaction P<0.05). The results of the sensitivity analysis were consistent with the results of the total population. Conclusion: People with poor self-assessed health, especially for those who were overweight/obesity with poor self-assessed health or age less than 60 or dyslipidemia are at increased risk of stroke and ischemic stroke and should be targeted for intervention.

Abstract MP02: N-Terminal Pro-B-type Natriuretic Peptide and Risk of Stroke in Those With and Without Cerebrovascular Disease: The REGARDS Cohort

Background: N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), a commonly used marker of cardiac function, is associated with presence of stroke symptoms and is a strong risk factor for future atrial fibrillation, stroke and mortality. Little data are available on the association between NT-pro-BNP levels and stroke recurrence. Objective: We studied the relationship between NT-proBNP with the risk of future ischemic stroke across a spectrum of pre-existing cerebrovascular conditions, ranging from history of stroke symptoms, to prior transient ischemic attack (TIA), to prior stroke. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans age 45 years and older in 2003-14. Among a case-cohort study sample including 1109 stroke cases and a 4311-person cohort random sample, we calculated hazard ratios of future ischemic stroke by baseline NT-proBNP stratified by presence of prior cerebrovascular conditions. Results: In the cohort sample, there were 3056 participants without any history of cerebrovascular disease, 738 with prior stroke symptoms, 196 with history of TIA and 338 with history of prior stroke. In a fully adjusted model, elevated NT-proBNP was associated with risk of stroke in participants without a pre-existing cerebrovascular condition (HR 2.32, 95% CI 1.84, 2.94), and in participants with a history of stroke symptoms (HR 1.67 95% CI 1.01, 2.78) or TIA (HR 2.66, 95% CI 1.00, 7.04), but not among those with prior stroke (HR 1.26, 95% CI 0.71, 2.21). Conclusions: These findings further support the potential for NT-proBNP testing to identify patients who are at highest risk for future stroke, although not in those with prior stroke.

Abstract WMP57: Worsening Migraines in Current Hormone Replacement Therapy Users Predicts Higher Risk of Stroke

Background: There has been a long-standing debate in the role of hormone replacement therapy (HRT) and migraines as risk factors for ischemic stroke. HRT are considered a risk factor for migraines. The risk of ischemic stroke may increase as the severity of migraines increases in patients that are currently using HRT. Methods: We analyzed the data for 82,208 women aged 50 - 79 years who were enrolled in the observational arm of the Women’s Health Initiative Study. We determined the risk of ischemic stroke in participants with migraines who had current Hormone replacement therapy (HRT) (unopposed estrogen and/or estrogen plus progesterone), past HRT, and no HRT. We further dichotomized participants with migraines into participants who experienced an increase in migraine severity of one grade or more from baseline on the third-year follow up visit and participants who experienced no change or a decrease in migraine severity from baseline on the third-year follow up visit. The relative risk of developing ischemic stroke was compared between participants who were currently on HRT and participants who were either previously on HRT or never had HRT. Results: Out of the 82,208 women, 37680 (45.8%) were currently using HRT and 44528 (54.2%) were either past users or had never used HRT therapy. Compared with never or past users of HRT, rate of increase in severity of migraines was significantly higher among those who were currently on HRT therapy (17.3% versus 18.7% versus 20.6%, respectively, p&lt;0.0001). Odds ratio (OR) of ischemic stroke for patients who never used HRT or used HRT only in the past compared to those who were current users and experienced no change or a decrease in migraine severity was 0.91 [confidence interval (CI) 0.88 - 0.94] versus 1.1 [CI 1.1 - 1.2], (p&lt;.0001). OR of ischemic stroke for patients who never used HRT or used HRT only in the past compared to those who were current users and experienced an increase in severity of migraines was 0.81 [CI 0.74 - 0.88] versus 1.3 [CI 1.1 - 1.5] (p&lt;.0001). Conclusions: Patients that are current users of HRT that have an increase in severity of one grade or more of migraines are shown to have an increased risk of ischemic strokes. Future studies are required to further investigate these correlations.

Lipid Accumulation Product and Hypertension Related to Stroke: a 9.2-Year Prospective Study Among Mongolians in China.

We aimed to assess the relationship between lipid accumulation product (LAP) and stroke incidence and whether increased LAP would further enlarge the risk of stroke in participants with hypertension in an Inner Mongolian population of China. Based on the baseline survey conducted in 2002-2003, a prospective cohort study was conducted among 2547 Mongolian people from Inner Mongolia, China. LAP was calculated by waist circumference (WC) and triglyceride (TG) concentration for men and women, respectively. Cox proportional hazards models and receiver operating characteristic (ROC) curves were used to evaluate the associations between LAP, hypertension, and stroke incidence. During the follow-up period, a total of 121 stroke events were observed. Participants with higher LAP were associated with higher risk of stroke [adjusted hazard ratio (HR), 1.67; 95% confidence interval (CI), 1.08-2.58] than the participants in the lower LAP group. However, no significant dose-response relationship was detected between LAP levels and risk of stroke (P-trend=0.103). The Kaplan-Meier curves showed that hypertensives with high LAP had highest cumulative stroke incidence rate (log-rank P ＜0.001). The multivariate-adjusted HRs (95% CIs) of stroke for normotensives with high LAP, hypertensives with low LAP, and hypertensives with high LAP were 1.80 (0.84-3.89), 2.94 (1.51-5.74), and 4.23 (2.15-8.34), respectively, compared with normotensives with low LAP. The present study showed that high LAP was associated with an increased risk of future stroke, and hypertensives with high LAP had the highest risk of stroke among Inner Mongolians. These findings indicate that LAP and hypertension may be valuable to predict and prevent stroke incidence.

Stroke incidence and association with risk factors in women: a 32-year follow-up of the Prospective Population Study of Women in Gothenburg

ObjectiveTo study stroke incidence among women over 32 years of age with a focus on subdividing by stroke type, to consolidate end points and associations with risk factors.DesignProspective population study...

Polymorphisms in migraine-associated gene, atp1a2, and ischemic stroke risk in a biracial population: the genetics of early onset stroke study

In a recent meta-analysis migraine was associated with a two-fold increase in stroke risk. While the mechanism driving this association is unknown, one intriguing hypothesis is that migraineurs are genetically predisposed to developing ischemic stroke. Mutations in the ATP1A2 gene are implicated in familial hemiplegic migraine type II and increase the severity of ischemic brain injury in animal models. To further explore these observations, we assessed the association between ATP1A2 polymorphisms, migraine, and the risk of ischemic stroke in participants of the Genetics of Early-Onset Stroke Study, a population-based case–control study of ischemic stroke among men and women aged 15–49. Using responses to a headache symptoms questionnaire, subjects were classified as having no migraine, or migraine with or without visual aura. Evaluating a total of 134 ATP1A2 polymorphisms genotyped using a combination of Illumina platforms (Cardiovascular Gene-centric 50 K SNP Array and HumanOmni1-Quad_v1-0_B Bead Chip), only one polymorphism (rs2070704) demonstrated a nominally significant association with stroke in an age-, gender-, ethnicity-adjusted model (OR = 0.83, 95% CI = 0.71-0.98, p = 0.025) and in a vascular risk factor model adjusting for age, gender, ethnicity, hypertension, diabetes, smoking, and myocardial infarction (OR = 0.74, 95% CI = 0.63-0.89, p = 0.001). Ethnicity-stratified analyses demonstrated a significant association for rs2070704 among African-Americans (OR = 0.68, 95% CI = 0.53-0.90, p = 0.005) but not Caucasians (OR = 0.82, 95% CI = 0.64-1.04, p = 0.107). These associations were unchanged when migraine subtypes were included as co-variates. We did not observe an association between ATP1A2 polymorphisms and migraine. While our results do not demonstrate a strong relationship between ATP1A2 polymorphisms and migraine associated stroke risk, the results are hypothesis generating and indicate that an association between ATP1A2 polymorphisms and stroke risk may exist. Additional studies are required.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-2-46) contains supplementary material, which is available to authorized users.