Stroke In People Research Articles

Anticoagulation and stroke in hospitalized patients newly diagnosed with secondary atrial fibrillation: a population-based cohort study

Abstract Background Atrial fibrillation (AF) can be triggered by acute precipitants, with reversion to sinus rhythm after the stressor resolves. This has been described as "secondary AF", to differentiate it from AF without acute provocation ("primary AF"). Objective To describe anticoagulation patterns and the risk of stroke following hospitalization with a new diagnosis of secondary AF, with comparison to a first hospitalization for primary AF. Methods We created a cohort of adults aged ≥66 years who were discharged alive from hospital after a first diagnosis of AF between April 1, 2013, and March 31, 2019. The main exposure was "secondary" AF, with "primary" AF serving as the comparator group. This was based on a validated approach utilizing the AF discharge diagnosis type. Patients were followed for 1 year. We used drug dispensation records to determine the proportion of people anticoagulated after discharge from hospital. We also identified hospitalizations for stroke. We used the cumulative incidence function to estimate the risk of stroke while not anticoagulated, while censoring on dispensation of anticoagulation and treating death as a competing risk. Inverse probability of censoring weights were used to reduce bias from informative censoring. Cause-specific hazards regression was used to estimate the hazard ratio (HR) for stroke associated with secondary AF (relative to primary AF) while accounting for differences in baseline characteristics and time-varying anticoagulation status. Results We identified 13,011 people with secondary AF and 11,065 with primary AF. People with primary AF were older (mean 79.5 yrs vs. 77.1 yrs for secondary AF), more likely to be female (58.6% vs. 42.3% for secondary AF), and more likely to have prior HF. Secondary AF was positively associated with prior bleeding, diabetes, ischemic heart disease, and peripheral vascular disease. Mortality was higher for people with secondary vs. primary AF: 1.7% (95%CI 1.5%-2.0%) vs. 0.7% (95%CI 0.6%-0.9%) respectively at 7 days, 4.2% (95%CI 3.9%-4.6%) vs. 2.5% (95%CI 2.2%-2.8%) at 30 days, and 16.1% (95%CI 15.5%-16.7%) vs. 14.6% (13.9%-15.2%) at 1-year post-discharge. The proportion of people who were dispensed anticoagulants within 7 days of discharge was lower for secondary than primary AF (26.9% vs. 68%), and this continued to be lower at one year (41.7% vs. 82.3%, p<0.001 for both comparisons). At 1 year, the risk of stroke in people who were not anticoagulated was 2.2% (95% CI 1.6-2.8%) after primary AF and 1.2% (95% CI 1.0-1.4%) after secondary AF (p< 0.001). Relative to patients with primary AF, the hazard of stroke (adjusted for baseline characteristics and time-varying anticoagulation status) was lower in patients with secondary AF (HR 0.74; CI 0.57-0.97; p= 0.03). Conclusion Secondary AF is associated with higher mortality, less anticoagulation, and a lower risk/ hazard of stroke than primary AF. These data can inform post-discharge care in people with secondary AF.Proportion anticoagulated over timeRisk of stroke without anticoagulation

Cost-Utility Analysis of Low-Dose Pioglitazone in a Population With Prediabetes and a History of Stroke or Transient Ischemic Attack.

Pioglitazone significantly reduces the risk of stroke in people with diabetes, and in those with prediabetes, it markedly reduces the risk of stroke/myocardial infarction and new-onset diabetes. Low-dose pioglitazone provides most of the clinical benefits of high-dose pioglitazone, with fewer adverse effects. We report an economic evaluation of the cost-effectiveness of low-dose pioglitazone versus placebo from a Canadian public payer perspective in 2023 Canadian dollars. A Markov model was developed at a lifetime horizon with an annual cycle length and 5 health states (event-free, myocardial infarction, stroke, new-onset diabetes, and death). Transition probabilities were extracted from the IRIS (Insulin Resistance Intervention in Stroke) trial. Health state costs and utilities were based on public sources. Annual discount rates of 1.5% were applied in the reference-case analysis. Probabilistic analyses were conducted to deal with parameter uncertainty through 5000 simulations. The costs were estimated as $24 887 (interquartile range [IQR], $14 632-$41507) for low-dose pioglitazone and $57 301 (IQR, $48 730-$67368) for placebo, resulting in a cost saving of -$30 287 (IQR, -$43 374 to -$14 587) in favor of low-dose pioglitazone. Quality-adjusted life years were estimated as 25.99 (IQR, 24.56-26.81) for the low-dose pioglitazone and 19.44 (IQR, 18.68-20.13) for placebo, resulting in a difference of 6.37 (IQR, 5.07-7.36) in favor of low-dose pioglitazone. Consistent findings were observed from scenario analyses and 1-way probability sensitivity analyses. Holding across a wide range of values in modeling parameters, low-dose pioglitazone is found as the dominant strategy versus a placebo.

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

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

Migraine and Stroke: A Scoping Review.

An increased risk of ischemic stroke in migraine with aura (MA) has been consistently demonstrated. The pathophysiology of risk factors is not yet well understood. Several mechanisms have been proposed to explain the association between MA and ischemic stroke including decreased focal cerebral blood flow and other phenomena linked with cortical spreading depression (CSD) as well as neurovascular pathology, which appear to play a key role in MA. In addition to genetic predisposition, other classic stroke risk factors such as atrial fibrillation, emboli, migraine-associated vasculopathy, endothelial dysfunction, platelet dysfunction, coagulation pathway abnormalities, and inflammatory factors have been examined and investigated. For further clarification, distinctions have been made between features of migrainous infarctions and non-migrainous infarctions among migraineurs. Furthermore, the association is less clear when considering the mixed results studying the risk of ischemic stroke in migraines without aura (MO) and the risk of hemorrhagic stroke in people with all types of migraine. Translational research is investigating the role of biomarkers which can help identify vascular links between stroke and migraine and lead to further treatment developments. We performed a scoping review of the PubMed database to further characterize and update the clinical connections between migraine and stroke.

Stroke in sickle cell patients, epidemiology, pathophysiology, systemic and surgical treatment options and prevention strategies

AbstractBackgroundA hereditary haemoglobinopathy known as sickle cell disease (SCD) affects over 100 000 people in the United States severely. Cerebrovascular disease is a prominent consequence of SCD. By the age of 30, 53% of patients have silent cerebral infarcts (SCIs) (a stroke that occurs without any obvious symptoms because it damages a small part of the brain that isn't responsible for any essential functions), and by the age of 40, 3.8% have overt strokes.Main bodyThe multidimensional burden of cerebrovascular illness in SCD is reviewed in detail in this article, which includes both clinical strokes and the frequently asymptomatic SCIs. The intricate pathophysiology of SCD and stroke is explored. With SCD, there are currently very few methods for preventing primary and secondary stroke; the most common ones are hydroxyurea and blood transfusion. Nevertheless, not enough research has been done on the possible contributions of anticoagulation and aspirin to strokes linked to SCD. Promising evidence is also highlighted in the study, suggesting that new drugs intended to treat SCD may be able to alleviate leg ulcers and renal impairment in addition to reducing unusually high transcranial Doppler flow velocity – a crucial component of cerebrovascular events. Given that these novel medications specifically target haemolysis and vaso‐occlusion, the two main causes of strokes in this population, more research is desperately needed to determine whether they are effective in avoiding strokes in people with SCD. The literature review also emphasizes how common healthcare inequities are and how they hinder advancements in SCD research and management in the United States.ConclusionTo successfully address these inequities, the evaluation recommends more funding for both SCD management and research, as well as for patient and clinician education. This multimodal viewpoint highlights the intricate terrain of cerebrovascular problems associated with SCD and the urgent need for all‐encompassing and fair strategies to improve patient outcomes and advance research.

Correction to: Early Versus Late Initiation of Direct Oral Anticoagulants After Ischemic Stroke in People With Atrial Fibrillation and Hemorrhagic Transformation: Prespecified Subanalysis of the Randomized Controlled ELAN Trial.

Correction to: Early Versus Late Initiation of Direct Oral Anticoagulants After Ischemic Stroke in People With Atrial Fibrillation and Hemorrhagic Transformation: Prespecified Subanalysis of the Randomized Controlled ELAN Trial.

Early Versus Late Initiation of Direct Oral Anticoagulants After Ischemic Stroke in People With Atrial Fibrillation and Hemorrhagic Transformation: Prespecified Subanalysis of the Randomized Controlled ELAN Trial.

Whether hemorrhagic transformation (HT) modifies the treatment effect of early compared with late initiation of direct oral anticoagulation in people with ischemic stroke and atrial fibrillation is unknown. This is a post hoc analysis of the ELAN trial (Early Versus Late Initiation of Direct Oral Anticoagulants in Post-Ischaemic Stroke Patients With Atrial Fibrillation). The primary outcome was a composite of recurrent ischemic stroke, symptomatic intracranial hemorrhage, major extracranial bleeding, systemic embolism, or vascular death within 30 days. Secondary outcomes were the individual components, 30- and 90-day functional outcome. We estimated outcomes based on HT, subclassified as hemorrhagic infarction (HI) or parenchymal hemorrhage (PH) on prerandomization imaging (core laboratory rating) using adjusted risk differences between treatment arms. Overall, 247 of 1970 participants (12.5%) had HT (114 HI 1, 77 HI 2, 34 PH 1, 22 PH 2). For the primary outcome, the estimated adjusted risk difference (early versus late) was -2.2% (95% CI, -7.8% to 3.5%) in people with HT (HI: -4.7% [95% CI, -10.8% to 1.4%]; PH: 6.1% [95% CI, -8.5% to 20.6%]) and -0.9% (95% CI, -2.6% to 0.8%) in people without HT. Numbers of symptomatic intracranial hemorrhage were identical in people with and without HT. With early treatment, the estimated adjusted risk difference for poor 90-day functional outcome (modified Rankin Scale score, 3-6) was 11.5% (95% CI, -0.8% to 23.8%) in participants with HT (HI: 7.4% [95% CI, -6.4% to 21.2%]; PH: 25.1% [95% CI, 0.2% to 50.0%]) and -2.6% (95% CI, -7.1% to 1.8%) in people without HT. We found no evidence of major treatment effect heterogeneity or safety concerns with early compared with late direct oral anticoagulation initiation in people with and without HT. However, early direct oral anticoagulation initiation may worsen functional outcomes in people with PH. URL: http://www.clinicaltrials.gov; Unique identifier: NCT03148457.

Diabetes and Stroke—A Focused Review

Abstract Globally, diabetes mellitus (DM) and stroke are two common chronic illnesses that have a substantial impact on rates of morbidity and mortality. There is significant evidence linking diabetes to an increased risk of stroke in terms of incidence, severity, and mortality. This extensive review looks at shared risk factors, underlying pathophysiological mechanisms, epidemiological trends, and evidence-based therapy approaches to give a thorough analysis of the causal relationship between diabetes mellitus and stroke. Studies using epidemiological data regularly show that people with diabetes have a higher incidence of stroke than people without the disease. Furthermore, diabetes is linked to a less favorable outcome following a stroke, as well as an elevated chance of stroke recurrence. Determining the pathophysiological pathways that connect diabetes and stroke is essential to understanding their relationship. Key pathophysiological processes associated with these disorders include endothelial dysfunction, inflammation, oxidative stress, hyperglycemia, and dyslipidemia. Due to microvascular complications, these mechanisms raise the risk of hemorrhagic stroke and predispose diabetics to an increased risk of ischemic stroke by creating a prothrombotic and atherosclerotic milieu. Diabetes and stroke are linked due to shared risk factors like smoking, obesity, dyslipidemia, hypertension, and poor glycemic control. Lifestyle changes, blood pressure control, lipid-lowering therapy, antiplatelet medicines, and a nutritious diet are essential for stroke risk reduction. Reducing the risk of stroke in people with diabetes requires the implementation of management techniques that focus on both diabetes control and stroke prevention. Optimizing results and lowering the frequency of stroke-related complications in diabetics requires multidisciplinary care. The intricate interactions between diabetes mellitus and stroke are highlighted in this review’s conclusion, which also highlights the value of patient education, risk factor treatment, the effect of antidiabetic therapy on stroke, and integrated care in lowering the incidence of stroke in people with diabetes.

Craniocervical dissection

Craniocervical dissections are among the most common causes of stroke in people aged under 50years, which is why it is essential to clarify, diagnose, and treat them as quickly as possible. Dissections usually occur spontaneously due to bleeding into the vessel wall. The affected segments are usually the motion segments of the internal cerebral artery (C1 segment) and the vertebral artery (V3segment). Clinically, there is head and/or neck pain and neurologic symptoms, which can vary according to the localization of the dissection. Pathognomonic is the detection of an intramural hematoma due to bleeding into the vessel wall. This can best be detected by magnetic resonance imaging (MRI) in native, fat-saturated T1sequences (black-blood sequence). In addition, contrast-enhanced angiography should be performed using MRI or, alternatively, computed tomography (CT). As there is an increased risk of embolic or hemodynamically induced strokes, prophylactic treatment should be initiated immediately; it remains acase-by-case decision whether antiplatelet agents or oral anticoagulants are chosen for this purpose.

Influencing factors of stroke in patients with type 2 diabetes: A systematic review and meta-analysis.

Stroke stands as a significant macrovascular complication among individuals with Type 2 diabetes mellitus (T2DM), often resulting in the primary cause of mortality and disability within this patient demographic. Presently, numerous studies have been conducted to investigate the underlying causes of stroke in individuals with T2DM, yet the findings exhibit inconsistencies. This paper aims to consolidate and summarize the available evidence concerning the influential factors contributing to stroke among patients diagnosed with T2DM. We conducted a comprehensive search across multiple databases, including Cochrane Library, PubMed, Web Of Science, Embase, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang and Weipu up to August 2023. Google Scholar was also searched to retrieve gray literature. We calculated odds ratios (OR) and 95% confidence intervals (CI) using Stata software. Our analysis encompassed 43 observational studies, exploring factors across sociodemographic, biochemical, complications, and hypoglycemic agent categories. The findings identified several risk factors for stroke in patients with T2DM: age, gender, T2DM duration, hypertension, body-mass index (BMI), smoking, Glycated hemoglobin (HbA1c), estimated Glomerular Filtration Rate (eGFR), albuminuria, Triglycerides (TG), Low density lipoprotein cholesterol (LDL-C), Coronary heart disease (CHD), Atrial fibrillation (AF), diabetic retinopathy (DR), Peripheral vascular disease (PVD), and carotid plaque. Conversely, exercise, High density lipoprotein cholesterol (HDL-C), metformin (MET), pioglitazone, and metformin combination therapy emerged as protective factors. This study underscores the multitude of influencing factors contributing to stroke in people with T2DM patients, among which the microvascular complications of T2DM play an most important role. Therefore, we emphasize the importance of screening for microvascular complications in patients with T2DM. However, due to limitations arising from the number of articles reviewed, there remain areas where clarity is lacking. Further research efforts are warranted to expand upon and reinforce our current findings.

Population Attributable Fraction of Total Stroke Associated with Modifiable Risk Factors in the United States.

Stroke is a leading cause of death in the United States across all race/ethnicity and sex groups, though disparities exist. We investigated the potential for primary prevention of total first stroke for Americans aged 20 and older, stratified by sex and race/ethnicity. Specifically, we calculated population attributable fractions (PAF) of first stroke for 7 potentially modifiable risk factors: smoking, physical inactivity, poor diet, obesity, hypertension, diabetes, and atrial fibrillation. PAFs are a function of (1) the relative risk of first stroke for people with the exposure and (2) the prevalence of the risk factor in the population. Relative risks came from recent meta-analyses and sex-race/ethnicity-specific prevalence estimates came from the 2015-2018 NHANES or Multi-Ethnic Study of Atherosclerosis (for atrial fibrillation only). Approximately 1/3 (35.7% [CI: 21.6%-49.0%]) for women, 32.7% [CI: 19.2%-45.1%] for men) of strokes were attributable to the 7 risk factors we considered. A 20% proportional reduction in stroke risk factors would result in approximately 37,000 fewer strokes annually in the United States. The estimated PAF was highest for non-Hispanic Black women (39.3% [CI: 24.8%-52.3%]) and lowest for non-Hispanic Asian men (25.5% [CI: 14.6%-36.2%]). For most groups, obesity and hypertension were the largest contributors to stroke rates.

Risk of Stroke Among HIV Patients: A Systematic Review and Meta-analysis of Global Studies and Associated Comorbidities.

Despite advancements in the management of HIV infection, the factors contributing to stroke development among HIV-positive individuals remain unclear. This systematic review and meta-analysis aim to identify and evaluate the relative risk factors associated with stroke susceptibility in the HIV population. A comprehensive search was conducted in PubMed, Scopus, and Web of Science databases to identify studies investigating the risk of stroke development in HIV patients and assessing the role of different risk factors, including hypertension, diabetes, dyslipidemia, smoking, sex, and race. The quality assessment of case-control studies was conducted using the Newcastle-Ottawa Scale, whereas cohort studies were assessed using the National Institute of Health tool. Meta-analyses were performed using a random-effects model to determine pooled hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs). A total of 18 observational studies involving 116,184 HIV-positive and 3,184,245 HIV-negative patients were included. HIV-positive patients exhibited a significantly higher risk of stroke compared with HIV-negative patients [OR (95% CI): 1.31 (1.20 to 1.44)]. Subgroup analyses revealed increased risks for both ischemic stroke [OR (95% CI): 1.32 (1.19 to 1.46)] and hemorrhagic stroke [OR (95% CI): 1.31 (1.09 to 1.56)]. Pooled adjusted HRs showed a significant association between stroke and HIV positivity (HR: 1.37, 95% CI: 1.22 to 1.54). Among HIV-positive patients with stroke, hypertension [OR (95% CI): 3.5 (1.42 to 8.65)], diabetes [OR (95% CI): 5 (2.12 to 11.95)], hyperlipidemia, smoking, male gender, and black race were associated with an increased risk. Our study revealed a significant increased risk of stroke development among people with HIV. A multitude of factors, encompassing sociodemographic characteristics, racial background, underlying health conditions, and personal behaviors, significantly elevate the risk of stroke in individuals living with HIV. The use of observational studies introduces inherent limitations, and further investigations are necessary to explore the underlying mechanisms of stroke in people with HIV for potential treatment strategies. HIV patients face a higher risk of stroke development, either ischemic and hemorrhagic strokes. Hypertension, diabetes, hyperlipidemia, smoking, male gender, and black race were identified as significant risk factors. Early identification and management of these risk factors are crucial in reducing stroke incidence among patients living with HIV.

Risk of Stroke in Real-World US Individuals with Type2 Diabetes Receiving Semaglutide or a Dipeptidyl Peptidase4 Inhibitor.

People with type2 diabetes (T2D) have a higher risk of stroke and worse outcomes than those without T2D. Pooled data from randomized controlled trials indicate that the glucagon-like peptide1 receptor agonist semaglutide is associated with stroke risk reduction in people with T2D at high cardiovascular risk. We compared real-world stroke risk in people with T2D or T2D plus atherosclerotic cardiovascular disease (ASCVD) initiating either semaglutide or a dipeptidyl peptidase4 inhibitor (DPP4i). Adults (≥ 18years old) in a US claims database with a claim indicating initiation of either semaglutide or a DPP4i (index date) during the index period (1 January 2018-30 September 2020), a diagnosis code for T2D on or before the index date and at least 12months' continuous enrolment in the database pre-index were included and propensity score matched 1:1 on baseline demographic and clinical characteristics. The primary outcome was time to first stroke event during follow-up. Healthcare resource utilization was also compared between groups. The analysis included 17,920 matched pairs with T2D and 4234 matched pairs with T2D and ASCVD. The groups were well matched on baseline characteristics. People initiating semaglutide had a lower risk of stroke over short-term follow-up than those initiating a DPP4i (T2D: hazard ratio 0.63 [95% confidence interval 0.41-0.95], p = 0.029; T2D plus ASCVD: 0.45 [0.24-0.86], p = 0.015). Semaglutide was also associated with a lower rate of inpatient, outpatient and emergency room visits compared with a DPP4i. This proof-of-concept analysis indicates that semaglutide has the potential to reduce the risk of stroke in people with T2D when prescribed in clinical practice.

Abstract WP246: CHA 2 DS 2 -VASC Score Predicts Outcomes After a Stroke or Transient Ischemic Attack

Introduction: The CHA 2 DS 2 -VASC score is used to predict stroke in people with atrial fibrillation (AF). We determined the utility of this score for predicting outcomes within one-year post-stroke/TIA. Methods: Analysis of adults with acute stroke/TIA (2012-2016) using linked data from the Australian Stroke Clinical Registry and administrative datasets (pharmaceutical, hospital, Medicare), as part of the PRECISE study. CHA 2 DS 2 -VASC score (ranging from 0-9) was estimated based on comorbidities documented in hospital data as of the time of acute stroke/TIA. Outcomes included health-related quality of life (HRQoL) at 90-180 days post-stroke/TIA; and all-cause mortality and hospital readmissions (all-cause, cardiovascular disease) within 1 year post-stroke/TIA. HRQoL was assessed using the EuroQoL 5D-3L visual analogue scale (VAS) score, ranging from 0 (worst health) - 100 (best health), and across health domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression). Regression models were used to determine associations with outcomes, with risk estimates were expressed per 1-point increase in CHA 2 DS 2 -VASC score, and adjusted for covariates (e.g. use of medications) and interaction with AF history. Results: Of 12,613 eligible participants (median age 74 years; 44% female; 26% AF history), the median CHA 2 DS 2 -VASC score was 4 (i.e., high risk; interquartile range 3-6). In multivariable models, greater CHA 2 DS 2 -VASC score was associated with increased rates of mortality (hazard ratio [HR] 1.28 95% CI 1.23-1.33) in people with AF history only. Regardless of AF history, greater CHA 2 DS 2 -VASC score was associated with reduced VAS scores (by -1.57, 95% CI -1.99, -1.15), and increased odds of reporting problems in each HRQoL domain, ranging from odds ratio of 1.36 (95% CI 1.31-1.41) for mobility to 1.05 (95% CI 1.02-1.09) for anxiety/depression. Greater CHA 2 DS 2 -VASC score was also associated with increased rates of readmission for all causes (HR 1.11, 95% CI 1.08-1.14) or cardiovascular causes (HR 1.10; 95% CI 1.05-1.15). Conclusion: CHA 2 DS 2 -VASC score as of the time of acute stroke/TIA is associated with worse long-term outcomes, including HRQoL, within 1 year, and may be useful for risk stratification post-stroke/TIA.

Abstract 13142: Prediction of Embolic Stroke in People Without Atrial Fibrillation and Prior Stroke Using Measures of Atrial Myopathy: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: There is no effective way to predict embolic stroke (ES) in people without atrial fibrillation (AF). Atrial myopathy—characterized by left atrial (LA) remodeling—is associated with ES independent of AF. Hypothesis: An ES prediction model for people without AF or stroke can be developed with measures of atrial myopathy. Methods: ARIC study participants without AF, stroke, or anticoagulation at visit 5 (2011-13) were followed for 5 years. Covariates included CHA 2 DS 2 VASc variables, P-wave indices, echocardiographic measures of LA function and size, and N-terminal B-type Natriuretic Peptide (NTproBNP). The primary outcome was ischemic stroke. A secondary outcome of possible embolic stroke (PES) was defined as non-lacunar strokes and strokes with new AF within 1 year of stroke. Cox proportional hazards models were created for 5-year ischemic stroke (model A) and PES (model B) risk. Stepwise backwards selection (inclusion threshold P<0.20) generated parsimonious models. Model discrimination and calibration were evaluated by the c-statistic and Hosmer-Lemeshow χ 2 statistic, respectively. Results: 91 ischemic strokes (53 PES) were identified in 4154 participants (59.9% female, mean age 75.1(5.0) years). Age, sex, peripheral arterial disease, hypertension, abnormal P-wave axis, and left atrial reservoir strain were included in model A. Model B added NTproBNP. The C-statistics for models A and B were 0.653 (0.596-0.709) and 0.744 (0.680-0.808), respectively. Both models were well calibrated. Conclusions: Prediction of ES may be achieved using measures of atrial myopathy in people without AF and prior stroke. Validation of our model is needed.

Incidence of Stroke in People With Diabetes Compared to Those Without Diabetes: A Systematic Review.

One of the goals of the St. Vincent Declaration was to reduce serious complications of diabetes, including strokes. However, it remains uncertain whether this goal has been achieved. To evaluate the incidence of stroke in the diabetic population and its differences regarding sex, ethnicity, age, and region, to compare the incidence rate in people with and without diabetes, and to investigate time trends. A systematic review was conducted according to the guidelines for meta-analysis of observational studies in epidemiology (the MOOSE group) and the PRISMA group guidelines. Nineteen of the 6.470 studies retrieved were included in the analysis. The incidence of stroke in the population with diabetes ranged from 238 per 100,000 person-years in Germany in 2014 to 1191 during the 1990s in the United Kingdom. The relative risk comparing people with diabetes to those without diabetes varied between 1.0 and 2.84 for total stroke, 1.0 and 3.7 for ischemic stroke, and 0.68 and 1.6 for hemorrhagic stroke. Differences between fatal and non-fatal stroke were significant, depending on the time period and the population. We found decreasing time trends in people with diabetes and stable incidence rates of stroke over time in people without diabetes. The considerable differences between results can partly be explained by differences in study designs, statistical methods, definitions of stroke, and methods used to identify patients with diabetes. The lack of evidence arising from these differences ought to be rectified by new studies.

Study of the obstructive sleep apnea syndrome in cerebral infarction patients.

Obstructive Sleep Apnea Syndrome (OSAS) is the most common respiratory disorder during sleep. Many studies have shown an association between obstructive sleep apnea syndrome and stroke, and OSAS has not been adequately considered in Vietnam compared to the actual clinical dangers. This study aims to assess the prevalence and general characteristics of obstructive sleep apnea syndrome in patients with cerebral infarction and investigate the relationship between obstructive sleep apnea syndrome and the severity of cerebral infarction. Descriptive cross-sectional study. We identified 56 participants from August 2018 to July 2019. Subacute infarcts were identified by neuroradiologists. For each participant, vascular risk factors, medications, clinical symptoms, and neurological examination were abstracted from the medical record. Patients were taken for history and clinical examination. The patients were divided into two groups according to their AHI (Apnea-Hypopnea Index) (<5 and ≥5). A total of 56 patients were registered for the study. The mean age is 67.70 ± 11.07. The proportion of men is 53.6%. AHI has a positive correlation with neck circumference (r = 0.4), BMI (r = 0.38), the Epworth Sleepiness Scale (r = 0.61), LDL cholesterol (r = 0.38), the Modified Rankin Scale (r = 0.49), NIHSS (National Institutes of Health Stroke Scale) (r = 0.53), and an inverse correlation with SpO2 (r = 0.61). Obstructive sleep apnea Syndrome is a factor in the prognosis of cerebral infarction as well as cardiovascular diseases such as hypertension. Thus, understanding the risk of stroke in people with sleep apnea is necessary and working with a doctor to diagnose and treat sleep apnea is important.

Early-onset stroke among people with disabilities: a national database study in South Korea from 2008 to 2017

This study investigated 10-year trend in the incidence and prevalence of ischemic, hemorrhagic, and overall strokes according to the severity and type of disability between people with and without disabilities. This serial cross-sectional analysis was conducted using national health information data during a 10-year period from 2008 to 2017. Age-standardized incidence and prevalence were analyzed for each year, according to the presence, severity, and type of disability. The odds ratio (OR) of stroke was examined using multivariable logistic regression after adjusting for socio-demographic and clinical variables collected in2017. In total, 413,398,084 people were enrolled between 2008 and 2017. In 2017, 43,552,192 people aged 19 or older were included and 5.8% was disabled. For 10 years, age-standardized incidence of ischemic and hemorrhagic stroke decreased significantly regardless of the presence of disability. However, age-standardized incidence of stroke in disabled were almost 2.5 times higher than the non-disabled in 2017. Stroke occurs 20 years earlier in people with disabilities than in those without disabilities. In 2017, people with disabilities had higher odds of stroke compared to those without disability (OR=4.11, 95% confidence interval [CI]: 4.06-4.16), particularly among those with severe disabilities (OR=4.75, 95% CI: 4.67-4.84). People with major internal organ impairment showed the highest incidence of stroke (OR=5.95, 95% CI: 5.73-6.17). The main risk factors for stroke presented in this study were disability factors, chronic diseases, and advanced age. People with disabilities are at a greater risk of developing stroke incidence. Developing a public health policy and identifying the risk factors for stroke in people with disabilities would be beneficial. This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. 2022R1I1A3070074).

Trends in incidence of ischaemic stroke in people with and without diabetes in Ireland 2005-2015.

We aim to describe the epidemiology of ischaemic stroke and in-hospital mortality associated with stroke among men and women with and without diabetes from 2005 to 2015. Secondary data analysis of national hospital discharge data from the Hospital Inpatient Enquiry database. Stroke incidence and in-hospital mortality rates in people with and without diabetes were calculated. Poisson regression models were used to estimate the incidence rate ratio (IRR) and assess trends over time. The age-adjusted incidence of stroke was twice as high in people with diabetes compared to those without diabetes (men IRR 2.0 [95% CI 1.95-2.06] and women IRR 2.2 [95% CI 2.12-2.27]). The incidence of ischaemic stroke decreased by an average 1.7% per year in men with diabetes and 3.3% per year in women with diabetes. In people without diabetes, the average annual reduction was smaller (0.2% per year in men and 1% per year in women). In-hospital mortality associated with admission with ischaemic stroke was approximately twice as high in those with diabetes compared to those without diabetes among men [IRR 1.81 (1.67-1.97)] and women [IRR 2 (95% CI 1.84-2.18)]. Despite decreases in incidence of ischaemic stroke and associated in-hospital mortality, there remains a twofold increased risk of ischaemic stroke and mortality in people with diabetes. Therefore, priority must be given to management of risk factors for ischaemic stroke in people with diabetes as well as continued development of targeted stroke prevention strategies.

Resting-State Connectivity in Acute and Subacute Poststroke Aphasia: A Functional Near-Infrared Spectroscopy Pilot Study.

Background: Understanding how brain function and language skills change during early (acute and subacute) stroke phases is critical for maximizing patient recovery, yet functional neuroimaging studies of early aphasia are scarce. In this pilot study, we used functional near-infrared spectroscopy (fNIRS) to investigate how resting-state functional connectivity (rs-FC) in early aphasia differs from neurologically healthy adults and is related to language deficits. Materials and Methods: Twenty individuals with aphasia (12 acute and 8 subacute phase) and 15 healthy controls underwent rs-fNIRS imaging with a 46-channel montage centered over bilateral perisylvian language areas. FC was computed using a prewhitening, autoregressive Pearson correlation routine applied to preprocessed oxyhemoglobin (HbO) data. Connections were classified as left intra-, right intra-, or interhemispheric. We then compared rs-FC between groups by connection type and examined Spearman correlations between rs-FC averages and language measures within patients. Results: Participants in the acute phase had significantly reduced global rs-FC across all HbO-based connections compared to healthy controls. No significant differences were found in rs-FC between controls and patients in the subacute phase. Controlling for days since stroke, stronger right intra- and interhemispheric rs-FC was related to milder aphasia across all patients. Exploratory correlations revealed that relationships between language measures and rs-FC differed between acute and subacute patient groups. Conclusion: This study provides preliminary evidence that fNIRS-based rs-FC measures may be a viable metric to index the early impacts of stroke in people with aphasia.