Control Of Vascular Risk Factors Research Articles

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada.

Secondary stroke preventive care includes evaluation and control of vascular risk factors to prevent stroke recurrence. Our objective was to evaluate the quality of ambulatory stroke preventive care and its variation by immigration status in adult stroke survivors in Ontario, Canada. We conducted a population-based administrative database-derived retrospective cohort study in Ontario, Canada. Using immigration records, we defined immigrants as those immigrating after 1985 and long-term residents as those arriving before 1985 or those born in Canada. We included community-dwelling stroke survivors 40 years and older with a first-ever stroke between 2011 and 2017. In the year following their stroke, we evaluated the following metrics of stroke prevention: testing for hyperlipidemia and diabetes; among those with the condition, control of diabetes (hemoglobin A1c ≤7%) and hyperlipidemia (low-density lipoprotein <2 mmol/L); medication use to control hypertension, diabetes, and atrial fibrillation; and visit to a family physician and a specialist (neurologist, cardiologist, or geriatrician). We determined age and sex-adjusted absolute prevalence difference (APD) between immigrants and long-term residents for each metric using generalized linear models with binomial distribution and an identity link function. We included 34,947 stroke survivors (median age 70 years, 46.9% women) of whom 12.4% were immigrants. The receipt of each metric ranged from 68% to 90%. Compared with long-term residents, after adjusting for age and sex, immigrants were slightly more likely to receive screening for hyperlipidemia (APD 5.58%; 95% CI 4.18-6.96) and diabetes (5.49%; 3.76-7.23), have visits to family physicians (1.19%; 0.49-1.90), receive a prescription for antihypertensive (3.12%; 1.76-4.49) and antihyperglycemic medications (9.51%; 6.46-12.57), and achieve control of hyperlipidemia (3.82%; 1.01-6.63). By contrast, they were less likely to achieve diabetes control (-4.79%; -7.86 to -1.72) or have visits to a specialist (-1.68%; -3.12 to -0.24). There was minimal variation by region of origin or time since immigration in immigrants. Compared with long-term residents, many metrics of secondary stroke preventive care were better in immigrants, albeit with small absolute differences. However, future work is needed to identify and mitigate the factors associated with the suboptimal quality of stroke preventive care for all stroke survivors.

Resilience in the first year of surviving a stroke in Nigeria

Objectives There is a knowledge gap on resilience and its impact on mental health of Africans who survive a stroke. We describe the trajectory of psychological resilience and its association with depression and quality of life (QoL) across the first poststroke year in Nigeria. Method Prospective observational study of 150 survivors of a first ever stroke. Resilience was ascertained at 3 time-points prospectively over 12 months using the 25-items Resilience Scale (RS). Depression and QoL were also assessed at baseline and follow-up, respectively using the centre for epidemiologic studies depression scale (CES-D 10) and health related quality of life in stroke patients (HRQOLISP-26). Associations were investigated using regression models and presented as adjusted odds ratios (OR) and Wald test coefficients within 95% confidence intervals (CI). Results Resilience improved across time points of measurement (p < 0.001). In multivariate logistic regression analyses adjusted for the effect of age, education, alcohol use, and hypertension, higher resilience was associated with male sex (OR = 5.3, 95% CI= 1.7, 17.2), younger age (OR = 4.8, 95% CI = 1.5,15.7), and baseline hypertension (OR= 0.2, 95% CI ≤ 0.1,0.8). In similarly adjusted mixed effect linear regression analyses, higher resilience was associated with improvement in depression (months 12= −4.2, 95% CI= −5.6, −2.8) and quality of life (months twelve = 5.2, 95% CI = 2.2, 8.2) overtime. Conclusion Resilience, which was associated with better mental health and wellbeing of stroke survivors, was less likely with hypertension. Results suggest an important role for control of vascular risk factors as part of resilience interventions to promote poststroke recovery.

A randomized controlled trial of medication adherence and management of risk factors for secondary prevention of stroke (MaMoRS) using a smartphone-based application.

There are little data on the use of smartphone-based applications for medication adherence and risk-factor control for the secondary prevention of stroke in low-and-middle-income countries (LMICs). The aim was to determine whether a smartphone-based app improved medication adherence, risk-factor control, and provided health education to stroke survivors for lifestyle and behavioral modifications. An unblinded, single-center randomized controlled double arm trial with 1:1 allocation among stroke survivors was performed in South India. The primary outcome was medication adherence, with co-primary outcomes of lifestyle and behavioral factors and control of vascular risk factors, at 3 and 6 months. Among 351 stroke survivors screened, 209 were recruited. The mean (standard deviation (SD)) age of the intervention (n = 105) group was 60 (12) years and that of the control (n = 104) group was 60 (10) years. In the primary outcome, mean medication adherence significantly improved in the intervention group with a between group difference of 0.735 (95% confidence interval (CI) = 0.419 to 1.050), p < 0.001. Being in intervention group (OR = 4.5; 95% CI = 2.3 to 8.9), stroke recurrence (OR = 3.3 (95% CI = 1.9 to 7.8)), and regular physician visits (OR = 2.1; 95% CI = 1.0 to 4.4) were significant predictors of good medication adherence. Considering the co-primary outcomes, compared to the control group, participants in the intervention group had a greater improvement in self-reported healthy diet intake (p = 0.003), intake of fruits (p = 0.005), and were physically more active (p = 0.001). At 6 months, mean fasting blood sugar (p = 0.005) and high-density lipoprotein cholesterol higher (p = 0.024) in the intervention group. The use of a mobile app is an effective method to improve medication adherence and risk-factor control in stroke survivors and is feasible in LMICs like India. Data used during the study are available from the corresponding author on request. The study is registered in Clinical Trial Registry of India (CTRI/2022/06/042980).

National Trends of Vascular Risk Factor Control Among Stroke Survivors: From the National Health and Nutrition Examination Survey 2009 to 2020.

Contemporary data describing the national trends on vascular risk factor control among stroke survivors are limited. This is a cross-sectional analysis of the National Health and Nutrition Examination Survey cycles 2009 to 2010 to 2017 to March 2020. Adults (≥18 years of age) with a self-reported diagnosis of stroke were identified. Age-adjusted trends in hypertension, diabetes, and hyperlipidemia control were examined. Sex and racial differences in vascular risk factor control were also investigated. Among 32 497 adult individuals who participated in the National Health and Nutrition Examination Survey, 1354 participants (4.2%) self-reported a prior diagnosis of stroke (55% were women). The rates of age-adjusted blood pressure control worsened when using the cutoff <140/90 mm Hg (79.1% in 2009-2010 versus 61.5% in 2017-March 2020, Ptrend<0.001) and using the cutoff <130/80 mm Hg (53.3% in 2009-2010 versus 38.6% in 2017-March 2020, Ptrend=0.006). Age-adjusted diabetes control (hemoglobin A1c <7 mg/dL) did not significantly change during the study period (88.8% in 2009-2010 versus 85.9% in 2017-March 2020, Ptrend=0.41). Achieving a total cholesterol level <200 mg/dL did not change during the study period (67.3% in 2009-2010 versus 73.3% in 2017-March 2020, Ptrend=0.16). These findings were mostly consistent in men and women and across the different racial and ethnic groups. In the United States, secondary prevention was suboptimal for stroke survivors, and there has not been any major significant improvement in the rates of achieving the recommended targets for vascular risk factors during the past decade. These findings highlight the need for targeted interventions to improve these modifiable risk factors.

Prevention of Vascular Contributions to Cognitive Impairment and Dementia: The Role of Physical Activity and Exercise.

Vascular contributions to cognitive impairment and dementia, specifically cerebral small vessel disease (CSVD), are the second most common cause of dementia. Currently, there are no specific pharmacological treatments for CSVD, and the use of conventional antidementia drugs is not recommended. Exercise has the potential to prevent and mitigate CSVD-related brain damage and improve cognitive function. Mechanistic pathways underlying the neurocognitive benefits of exercise include the control of vascular risk factors, improving endothelial function, and upregulating exerkines. Notably, the therapeutic efficacy of exercise may vary by exercise type (ie, aerobic versus resistance training) and biological sex; thus, studies designed specifically to examine these moderating factors within a CSVD context are needed. Furthermore, future research should prioritize resistance training interventions, given their tremendous therapeutic potential. Addressing these knowledge gaps will help us refine exercise recommendations to maximize their therapeutic impact in the prevention and mitigation of CSVD.

Diagnosis and treatment of vascular cognitive disorders

Cognitive impairment (CI) usually is the earliest and most prevalent manifestation of cerebral vascular disease. Post stroke CI may have different clinical presentation depending on location of vascular lesion, so appropriate temporal association of CI onset with the event of stroke is of most important diagnostic value. Non-stroke (subcortical) variant of cerebral vascular disease usually is associated with small vessel disease. CI in subcortical variant is characterized with attention and executive functions deficit, frequently in combination with emotional disorders, postural instability and gait disturbances of frontal origin. Presence of vascular CI means essential need of thorough vascular risk factor (arterial hypertension, dyslipidemia, diabetes etc.) control. Vasotropic agents are prescribed with pathogenic purposes. The article presents clinical experience of nicergoline treatment of patients with vascular CI of different severity.

Exploring the Chagas Disease-Stroke “Connection”: Findings from a Large Multicenter Study

Introduction: Strokes are traditionally attributed to risk factors like aging, hypertension, diabetes, and atherosclerosis. Chagas disease has emerged as an important risk factor for stroke in Latin American. Our study aims at describing the largest cohort of patients with Chagas disease and ischemic stroke and determining variables associated with stroke recurrence and cardioembolic cause. Methods: This study is the result of a national multicenter cohort study conducted in Brazil. The study spanned from January 2009 to December 2016 and involved a comprehensive retrospective analysis of medical records of patients with both Chagas disease and stroke. This cohort comprised 499 individuals from diverse Brazilian regions, focusing on vascular risk factors and the epidemiological variables associated with Chagas disease and stroke. Results: Our findings underscore the significant prevalence of traditional vascular risk factors among Chagas disease patients who had stroke. 81% of patients had hypertension, 56% dyslipidemia, and 25% diabetes. We observed a 29.7% recurrence rate, especially within the cardioembolic subgroup. 56% of the patients had embolic stroke of undetermined source (ESUS). Specific electrocardiography abnormalities were associated with an increased risk of cardioembolic etiology (with three altered results increasing 81 fold the chance of the stroke being of cardioembolic nature). Age emerged as a protective factor (OR: 0.98, 95% confidence interval [CI]: 0.970–0.997) against cardioembolic etiology. Anticoagulation therapy was associated with reduced risk (OR: 0.221, 95% CI 0.104–0.472), highlighting the importance of accurate etiological classification. Conversely, female gender (OR: 1.83, 95% CI: 1.039–3.249) emerged as a significant risk factor for stroke recurrence. Conclusion: This study significantly advances our epidemiological understanding of the intersection between Chagas disease and stroke. It emphasizes the critical need for extensive epidemiological investigations, a deeper comprehension of stroke recurrence determinants, and accurate etiological classification to reduce the ESUS population. Our findings have substantial clinical implications, suggesting the need of control of vascular risk factors and comorbidities and hold promise for improving patient care and reducing the burden of Chagas disease and stroke worldwide.

Investigation of vascular risk factor control and secondary prevention medication compliance in acute ischemic stroke.

This study aimed to investigate the management of vascular risk factors, with a specific focus on understanding the various factors affecting risk factor control through an in-depth analysis of clinical data and a longitudinal follow-up of patients who have experienced ischemic strokes. A total of 1,572 participants were included in the analysis. We assessed thresholds for blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), and glycated hemoglobin (HbA1c) levels to uncover the contextual conditions and factors affecting vascular risk factor control. Moreover, the study also scrutinized medication compliance at intervals of 3, 6, and 12 months post-onset. Logistic regression was used to adjust for confounding factors. At 3, 6, and 12 months, BP,LDL, hemoglobin control targets were achieved in 50.7, 51.8, and 50.6%; 51.5, 59.4, and 50.6%; 48.1, 44.0, and 48.4%,respectively. Notably, age was associated with the achievement of BP control (odds ratio [OR], 0.96; 95% confidence intervals [CI], 0.94-0.98; p < 0.0001). Ethnic minorities (OR, 4.23; 95% CI, 1.19-15.09; p = 0.02) and individuals with coronary heart disease (OR, 0.5; 95% CI, 0.3-1.0; p = 0.05) experienced decreased BP control ratios. A previous history of stroke (OR, 1.7; 95% CI, 1.0-2.8; p = 0.03) and unrestricted alcohol consumption (OR, 3.3; 95% CI, 1.0-11.1; p = 0.05) was significantly associated with the achievement of lipid control. Furthermore, lifestyle modifications were significantly correlated with the achievement of BP control (OR, 0.19; 95% CI, 0.12-0.30; p < 0.01), blood glucose control (OR, 0.03; 95% CI, 0.01-0.08; p < 0.01), and blood lipid control (OR, 0.26; 95% CI, 0.16-0.42; p < 0.01). The absence of regular physical activity was associated with lower rates of glycemic (OR, 0.14; 95% CI, 0.06-0.36; p < 0.01) and lipid controls (OR, 0.55; 95% CI, 0.33-0.90; p = 0.01). Over time, overall medication compliance declined. Within the cohort of patients under medication, the compliance rate concerning vascular risk factors remains unsatisfactory. Attention should be paid to compliance with secondary prevention medications and enhance the control of vascular risk factors, as compliance emerges as the key to effective prevention.

Physical function characteristics among older adults at high risk of developing cognitive decline

AbstractBackgroundPhysical function profiles of older adults (≥ 60years) cognitively unimpaired but at high risk of dementia (CAIDE dementia risk score ≥6) have not been well described. The CAIDE index evaluates both modifiable, cardiovascular (CVRF), and non‐modifiable risk factors such as age, sex and educational level. The association of these factors with physical function has not been thoroughly studied.MethodWe present preliminary cross‐sectional data from the first 2 (out of 4) recruitment waves of the CITA Go‐On study, a FINGER‐like multimodal intervention prevention trial. Inclusion criteria were based on age (≥60 and ≤85) and CAIDE score (≥6). Participants were categorized according to their cognitive status. Physical function assessment included gait speed, handgrip strength and maximum leg strength measured as 1 repetition maximum (1RM). We explored physical function by CAIDE scale, regarding hypertension (i.e. systolic &gt;140mmHg or diastolic &gt;90mmHg), hypercholesterolemia (i.e &gt;250 mg/dL) and body mass index (BMI) as modifiable risk factors, and accounting for age, sex and educational level as non‐modifiable ones. Analysis was performed with SPSS v.29.ResultSample of 380 subjects aged 68.4 ± 5.6 years (mean, SD), 50% women, Mini‐Mental State Examination (MMSE) mean of 28.4 ±1.7 and CAIDE index mean was 7.4 ± 1.3. Of these, 91.6% were cognitively preserved, 5.5% had subjective complaints and 2.9% mild cognitive impairment. Dyslipidemia was present in 23.4%, hypertension in 46.9% and 63.1% showed BMI of overweight or obese. Univariate regression analysis showed that CAIDE index was significantly associated to maximum leg strength (1RM) (η2 = 0.05, p = 0.008), after adjusting for non‐modifiable risk factors (age η2 = 0.054, p = 0.001; sex η2 = 0.453, p = 0.001; and educational level η2 = 0.003, p = 0.333) and BMI (η2 = 0.156, p = 0.001). Handgrip strength and gait speed were not explained by modifiable factors in our sample (p = 0.12 and p = 0.53).ConclusionPhysical function as measured by maximum leg strength is associated with CAIDE dementia risk index, and most significantly with sex and BMI component, with age displaying a moderate effect. Together with vascular risk factor control, interventions on physical function are important for prevention.

Long-term risk of recurrent cerebrovascular events after patent foramen ovale closure: Results from a real-world stroke cohort.

Patent foramen ovale (PFO)-closure is recommended for stroke prevention in selected patients with suspected PFO-associated stroke. However, studies on cerebrovascular event recurrence after PFO-closure are limited by relatively short follow-up periods and information on the underlying aetiology of recurrent events is scarce. All consecutive patients with a cerebral ischaemic event and PFO-closure at the University Hospital Graz were prospectively identified from 2004 to 2021. Indication for PFO-closure was based on a neurological-cardiological PFO board decision. Patients underwent standardized clinical and echocardiographic follow-up 6 months after PFO-closure. Recurrent cerebrovascular events were assessed via electronical health records. PFO-closure was performed in 515 patients (median age: 49 years; Amplatzer PFO occluder: 42%). Over a median follow-up of 11 years (range: 2-18 years, 5141 total patient-years), recurrent ischaemic cerebrovascular events were observed in 34 patients (ischaemic stroke: n = 22, TIA: n = 12) and associated with age, hyperlipidaemia and smoking in multivariable analysis (p < 0.05 each). Large artery atherosclerosis and small vessel disease were the most frequent aetiologies of recurrent stroke/TIA (27% and 24% respectively), and only two events were related to atrial fibrillation (AF). Recurrent ischaemic cerebrovascular event rates and incident AF were comparable in patients treated with different PFO occluders (p > 0.1). In this long-term follow-up-study of patients with a cerebral ischaemic event who had received PFO-closure with different devices, rates of recurrent stroke/TIA were low and largely related to large artery atherosclerosis and small vessel disease. Thorough vascular risk factor control seems crucial for secondary stroke prevention in patients treated for PFO-related stroke.

Vascular risk factors and carotid atheromatous disease in patients over 65 years of age

Introduction: Vascular risk factors are decisive in the evolution of atherosclerotic disease and the carotid and vertebral Doppler ultrasound allows monitoring its onset and progress. The measurement of arterial wall thickening allows the early diagnosis of the disease enhancing its treatment and control of vascular risk factors. Aim: Analysing the presence of atheromatous disease in individuals aged &gt; 65 years and understanding its correlation with vascular risk factors. Materials and methods: This is a cross-sectional observational study, in individuals aged &gt; 65 years and underwent carotid echoDoppler between January 1, 2012, and December 31, 2021. The intimal-media index was calculated, as was the presence of atheromatous plaques, their hemodynamic repercussion and vascular risk factors were recorded. Results: A sample of 5885 individuals was obtained with 41.8% female and 58.2% male. The mean age was 76.59 (± 6.69), with a range between 65 and 98 years. Arterial hypertension was the most prevalent 81.3%. There was a significant positive relationship between the intima-media index and age (p = 0.001). In the presence of plaques, male gender, arterial hypertension, diabetes, dyslipidemia, and smoking it presents a positive correlation. Conclusion: In this sample, non-modifiable vascular risk factors seem to be determinants in the presence of increased arterial wall thickness. In the presence of signs of a more advanced stage of atherosclerotic disease, modifiable vascular risk factors are decisive, corroborating the already-known importance of strict control over them for their treatment.

Comorbid amyloid with cerebrovascular disease in domain-specific cognitive and neuropsychiatric disturbances: a cross-sectional memory clinic study

Dementia is a multifactorial disorder that is likely influenced by both Alzheimer’s disease (AD) and vascular pathologies. We evaluated domain-specific cognitive and neuropsychiatric dysfunction using a two-neuroimaging biomarker construct (beta-amyloid [Aβ] and cerebrovascular disease [CeVD]). We analyzed data from 216 memory clinic participants (mean age = 75.9 ± 6.9; 56.5% female) with neuropsychological and neuropsychiatric assessments, 3T-MRI, and Aβ-PET imaging. Structural equation modeling showed that the largest Aβ (A+) effect was on memory (B = −1.50) and apathy (B = 0.26), whereas CeVD effects were largest on language (B = −1.62) and hyperactivity (B = 0.32). Group comparisons showed that the A+C+ group had greater memory impairment (B = −1.55), hyperactivity (B = 0.79), and apathy (B = 0.74) compared to A−C+; and greater language impairment (B = −1.26) compared to A+C−. These potentially additive effects of Aβ and CeVD burden underline the importance of early detection and treatment of Aβ alongside optimal control of vascular risk factors as a potential strategy in preventing cognitive and neurobehavioral impairment.

A Genomic Risk Score Identifies Individuals at High Risk for Intracerebral Hemorrhage.

Intracerebral hemorrhage (ICH) has an estimated heritability of 29%. We developed a genomic risk score for ICH and determined its predictive power in comparison to standard clinical risk factors. We combined genome-wide association data from individuals of European ancestry for ICH and related traits in a meta-genomic risk score ([metaGRS]; 2.6 million variants). We tested associations with ICH and its predictive performance in addition to clinical risk factors in a held-out validation dataset (842 cases and 796 controls). We tested associations with risk of incident ICH in the population-based UK Biobank cohort (486 784 individuals, 1526 events, median follow-up 11.3 years). One SD increment in the metaGRS was significantly associated with 31% higher odds for ICH (95% CI, 1.16-1.48) in age-, sex- and clinical risk factor-adjusted models. The metaGRS identified individuals with almost 5-fold higher odds for ICH in the top score percentile (odds ratio, 4.83 [95% CI, 1.56-21.2]). Predictive models for ICH incorporating the metaGRS in addition to clinical predictors showed superior performance compared to the clinical risk factors alone (c-index, 0.695 versus 0.686). The metaGRS showed similar associations for lobar and nonlobar ICH, independent of the known APOE risk locus for lobar ICH. In the UK Biobank, the metaGRS was associated with higher risk of incident ICH (hazard ratio, 1.15 [95% CI, 1.09-1.21]). The associations were significant within both a relatively high-risk population of antithrombotic medications users, as well as among a relatively low-risk population with a good control of vascular risk factors and no use of anticoagulants. We developed and validated a genomic risk score that predicts lifetime risk of ICH beyond established clinical risk factors among individuals of European ancestry. Whether implementation of the score in risk prognostication models for high-risk populations, such as patients under antithrombotic treatment, could improve clinical decision making should be explored in future studies.

Using Mathematical and Statistical Analysis to Investigate the Correlation between Exacerbation of Chronic Obstructive Pulmonary Disease and Risk of Subclinical Atherosclerosis.

Purpose: As the number of patients with chronic obstructive pulmonary disease continues to increase, it is increasingly important to understand the impact of cardiovascular risk on the progression of chronic obstructive pulmonary disease, which can provide guidance for clinical medication and recommendations for patient care and rehabilitation. The purpose of this study was to investigate the relationship between cardiovascular risk and the progression of chronic obstructive pulmonary disease (COPD). Methods: Selected COPD patients admitted to hospital from June 2018 to July 2020 were included in the study for prospective analysis, and patients who showed more than two instances of moderate deterioration or severe deterioration within one year before the consultation were defined as COPD patients, and all participants underwent relevant tests and assessments. Results: Multivariate correction analysis showed that a worsening phenotype improved the risk of carotid artery intima-media thickness exceeding 75% by nearly three times, and it had no relation with the degree of COPD severity and global cardiovascular risk; in addition, the relationship between a worsening phenotype and high carotid intima-media thickness (c-IMT) was more pronounced in patients under 65 years of age. Conclusions: The existence of subclinical atherosclerosis is individually related to the worsening phenotype, and the difference is more obvious in young patients. Therefore, the control of vascular risk factors in these patients should be strengthened.

Abstract TP52: Post-acute Transition Of Care In Stroke Patients: A Systematic Review

Background: Post-acute transition of care (TOC) in stroke patients is a multifactorial process. Different TOC interventions have been tested, with inconsistent benefits. Objective: Our aim is to evaluate the effect of post-acute TOC interventions on various stroke patients’ outcomes. Methods: All published interventional studies evaluating the impacts of TOC models for stroke survivors, during their post-acute care disposition, were included. We excluded studies tackling only patients with intracerebral hemorrhage (ICH) or transient ischemic attacks, those with purely rehabilitative interventions, case reports and case studies, as well as systematic reviews and meta-analyses. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) through July 2022. Results: We included 38 studies involving 82,416 patients. TOC services were heterogeneous, commonly including scheduled home visits, telephone calls and office visits, in the setting of a multidisciplinary approach. Outcome measurement time varied between 1 month and 5 years. Activities of daily living (ADLs)-related outcomes, functionality, quality of life (QOL)-related outcomes, readmission rates, mental health-related outcomes, and mortality were reported in 20, 11, 10, 10, 7, and 6 studies, respectively. Only 4 studies looked at rates of medication adherence and 2 studies at control of vascular risk factors. In 6 out of 10 studies, improvements in QOL measurements and patient-reported health surveys were reported, whereas no study reported improvement in mortality rates. Three studies showed improvement for each of the following outcomes: ADLs, functionality, and readmission rates. Only 2 studies noted decrease in mental health problems with the intervention, and 2 noted better control of vascular risk factors. Both studies with medication adherence outcomes showed that the intervention increases rates of compliance to prescribed drugs. Conclusion: Post-acute TOC interventions seem to have a positive effect on stroke survivors’ quality of life and self-perceived health, as well as on rates of medication adherence, but bear no effect on mortality.

Abstract 103: Isomir Diversity Is Increased In Peripheral Blood Following Ischemic Stroke And May Represent Shifts In Regulation Of Neuroinflammatory Response

MicroRNA (miRNA) expression is altered following ischemic stroke. Advances in RNA sequencing and bioinformatic tools allow study of isomiRs, isoforms of miRNA, which can have altered regulatory actions from canonical parent miRNA due to base modifications within the molecule or on the flanking regions. Here, we characterize isomiRs in the blood of ischemic stroke patients compared to vascular risk factor controls (VRFCs) and elucidate diversity of the post-stroke miRNA environment. Total RNA was isolated from peripheral blood of 47 ischemic stroke patients and 31 VRFCs using PAXgene protocol. Small RNA libraries were prepared using QIAseq miRNA Library Kit and sequenced to 14±2 M 1x75 bp reads. Raw sequence reads were trimmed, de-duplicated, and profiled using isomiRmap , which separates isomiRs from canonical miRNA sequences based on 3’ and 5’ miRNA modifications. Analysis of differentially expressed isomiRs was performed with DESeq2. A total of 74,562 unique isomiRs were identified, the majority expressed at very low level. Filtering for low abundance left 2,133 isomiRs (from 335 canonical miRNA) expressed in all subjects. Of these, 505 isomiRs (from 129 canonical miRNA) were differentially expressed (LFC &gt; |0.5|, p adj &lt; 0.05) between stroke and VRFCs. These isomiRs represent significant elevations in 3’ modifications (68.3% of DE isomiRs), 5’ modifications (20.2%) and non-template additions (34.3%). miRNA previously implicated in stroke had diverse isomiR profiles including cases where all isomiRs within a miRNA group were differentially expressed (e.g. let-7i) and cases where multiple isomiRs were present but not differentially expressed (e.g. miR-363). Four of 28 differentially expressed let-7i isomiRs have changes to the seed region that interacts with mRNA. Thus, miRNA-mRNA interactions distinct from the canonical let-7i seed may exist and play an altered role in stroke pathology and neuroinflammation. Analysis of small noncoding RNA sensitive to base-specific variations detects many differentially expressed isomiRs and highlights the complexity of the post-stroke miRNA environment. Further study of these isomiRs within mRNA regulatory networks will deepen our understanding of stroke related neuroinflammation and neural repair.

Iatrogenic Strokes and Covert Brain Infarcts After Percutaneous Cardiac Procedures: An Update.

Millions of cardiac procedures are performed worldwide each year, making the potential complication of periprocedural iatrogenic stroke an important concern. These strokes can occur intraoperatively or within 30 days of a procedure and can be categorised as either overt or covert, occurring without obvious acute neurologic symptoms. Understanding the prevalence, risk factors, and strategies for preventing overt and covert strokes associated with cardiac procedures is imperative for reducing periprocedural morbidity and mortality. In this narrative review, we focus on the impacts of perioperative ischemic strokes for several of the most common interventional cardiac procedures, their relevance from a neurologic standpoint, and future directions for the care and research on perioperative strokes. Depending on the percutaneous procedure, the rates of periprocedural overt strokes can range from as little as 0.01% to as high as 2.9%. Meanwhile, covert brain infarctions (CBIs) occur much more frequently, with rates for different procedures ranging from 10%-84%. Risk factors include previous stroke, atherosclerotic disease, carotid stenosis, female sex, and African race, as well as other patient- and procedure-level factors. While the impact of covert brain infarctions is still a developing field, overt strokes for cardiac procedures lead to longer stays in hospital and increased costs. Potential preventative measures include screening and vascular risk factor control, premedicating, and procedural considerations such as the use of cerebral embolic protection devices. In addition, emerging treatments from the neurologic field, including neuroprotective drugs and remote ischemic conditioning, present promising avenues for preventing these strokes and merit investigation in cardiac procedures.

Abstract TP54: Organized Post-stroke Care: Results From A Prospective Cohort Study

Introduction: Pilot data suggests that organized post-stroke care enhances achievement of secondary prevention goals in stroke patients. We aimed to further investigate whether organized post-stroke care favourably affects stroke recurrence and survival. Methods: Prospective, quasi-experimental study of consecutive stroke patients admitted at two tertiary stroke centers in Saxony, Germany. According to health insurance provider status, patients were non-randomly assigned to either 12-months post-stroke pathway plus conventional care or conventional care alone. The organized post-stroke care pathway was facilitated by certified case managers and included pre-scheduled home- and phone visits aiming at educational intervention and achievement of guideline-based secondary prevention treatment goals. Primary outcomes were stroke recurrence and vascular death at 12-months. Further outcomes included favourable functional outcome (i.e. mRS 0-1), health-related quality of life and vascular risk factor control at 12-months. Results: In total, 1109 patients were recruited between 11/2011 and 12/2020. Of these, 1009 patients (91%) were assigned to organized post-stroke care and 100 (9%) to conventional care (mean age 70.6±12.8 years, 54% male, median NIHSS 3 [IQR, 1-5] points, 77.5% AIS, 17.9% TIA and 4.6% ICH). Baseline demographics and clinical characteristics were well balanced between both groups (p≥0.05). At 12-months, recurrent stroke rate was lower in the post-stroke care than in the conventional care group (5.5% vs. 14%; aOR 0.35, 95%CI 0.18-0.66; p=0.001). This association was not modified by stroke severity (TIA/minor stroke versus major stroke). Vascular death occurred in 0.2% in the post-stroke care and 3% in the conventional care group (aOR 0.07, 95%CI 0.01-0.41; p=0.003). Organized post-stroke care more frequently yielded individual treatment goals for hypertension, lipids, HbA1c, body-mass-index and secondary prevention adherence than conventional care (p&lt;0.05). Conclusions: Our results substantiate the effectiveness of case management-based post-stroke care in unselected stroke patients.

Abstract WP223: Identification Of Cerebral Amyloid Angiopathy With A Leukocyte Gene Expression Profile

Introduction: Cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease featuring beta-amyloid deposits within the cerebral vasculature. It is a major cause of cognitive decline and intracerebral hemorrhage in the elderly. This study evaluated whether gene expression profiles in peripheral blood can differentiate patients with CAA from vascular risk factor and healthy controls. Methods: In 27 patients with CAA blood cell gene expression was compared to 55 controls. Total RNA was isolated from PAXgene tubes and measured by RNA sequencing. Differentially expressed genes between CAA and controls were identified by ANOVA adjusting for age and sex. Functional pathway analysis identified pathways associated with CAA. A prediction model to distinguish CAA from controls was developed using linear discriminant analysis with feature selection by forward selection. Model performance was evaluated by 10-fold leave-one-out cross validation. Results: 686 differentially expressed genes were identified (p&lt;0.05, fold change &gt;|1.2|), of interest ADAM15, CAMK1D, CAP1 and TGFB1 . Canonical pathway analysis identified cell movement of phagocytes, activation of phagocytes, CREB, degranulation of leukocytes, immune response of cells, inflammatory response, and IL-23 signaling. A 24 gene panel differentiated patients with CAA from controls with &gt;95% sensitivity and specificity. The identified genes reveal differences in immune system regulation in patients with CAA compared to vascular risk factor and healthy control patients. Differences identified include a potential shift in beta-amyloid uptake by phagocytes ( TGFB1, CREB, CAMK1D ), an increase in vascular extracellular matrix disruption ( ADAM15, CAP1 ), and a possible alteration in amyloid precursor processing ( BRI3BP, SORCS3 ). Conclusion: Differences in peripheral leukocyte gene expression are present in patients with CAA compared to control patients. These relate to differences in immune activation and signaling associated with CAA. The differences in blood cell gene expression shows promise to distinguish CAA from controls, though further evaluation in larger cohorts is required to further evaluate potential diagnostic utility of this gene expression profile.

An Intervention Mapping Approach to Developing a Stroke Literacy Video for Recent Stroke Survivors: Development and Usability Study.

Most vascular events after stroke may be prevented by modifying vascular risk factors through medical and behavioral interventions. Stroke literacy-an understanding of stroke symptoms, risk factors, and treatment-likely contributes to vascular risk factor control and in turn stroke recurrence risk. Stroke literacy is the lowest among adults belonging to racial and ethnic minority populations in the United States. Video-based interventions targeting stroke literacy may help acute stroke survivors understand stroke and subsequently reduce the risk of stroke recurrence. However, the failure of prior stroke literacy interventions may be due in part to the fact that the interventions were not theory-driven. Intervention mapping (IM) provides a framework for use in the development, implementation, and evaluation of evidence-informed, health-related interventions. We aimed to develop a video-based educational intervention to improve stroke literacy in hospitalized patients with acute stroke. The 6-step iterative process of IM was used to develop a video-based educational intervention and related implementation and evaluation plans. The six steps included a needs assessment, the identification of outcomes and change objectives, the selection of theory- and video-based intervention methods and practical applications, the development of a video-based stroke educational intervention, plans for implementation, and evaluation strategies. A 5-minute video-based educational intervention was developed. The IM approach led to successful intervention development by emphasizing stakeholder involvement, generation and adoption, and information retainment in the planning phase of the intervention. A planned approach to video adoption, implementation, and evaluation was also developed. An IM approach guided the development of a 5-minute video-based educational intervention to promote stroke literacy among acute stroke survivors. Future studies are needed to assess the use of technology and digital media to support widespread access and participation in video-based health literacy interventions for populations with acute and chronic stroke. Studies are needed to assess the impact of video-based educational interventions that are paired with stroke systems of care optimization to reduce the risk of stroke recurrence. Furthermore, studies on culturally and linguistically sensitive video-based stroke literacy interventions are needed to address known racial and ethnic disparities in stroke literacy. RR2-10.1371/journal.pone.0171952.