Vascular Risk Research Articles (Page 10)

Prevalence of subclinical vascular disease in relation to the estimated cardiovascular risk and the presence of the metabolic syndrome.

Longitudinal relationships among cerebrospinal fluid biomarkers, cerebral blood flow, and grey matter volume in individuals with a familial history of Alzheimer's disease.

Retrospective analysis of vascular surgery complication rates compared to commonly used risk index calculators.

Triggers of transient global amnesia and recurrence: A retrospective analysis.

The relationship between alcohol consumption and cerebral small vessel disease (CSVD) remains uncertain, particularly regarding drinking patterns and beverage types. We investigated how total alcohol intake, drinking frequency, and beverage-specific consumption are associated with CSVD burden using cross-sectional data. We included 27,326 UK Biobank (UKB) participants with MRI data, among whom 21,130 were current drinkers with full alcohol intake data. Alcohol consumption (frequency and beverage type) was self-reported. CSVD burden was measured via normalized white matter hyperintensity volume (WMHV) on T2-FLAIR MRI. Multivariable linear regression models adjusted for demographics, lifestyle, and vascular risk factors were used to examine associations. Compared with non-drinkers, alcohol consumers had greater CSVD burden (Beta = 0.07; 95 % CI, 0.00-0.15). Among them, higher drinking frequency (≥5 times/week) was associated with increased CSVD burden (Beta = 0.10; 95 % CI, 0.07-0.13). High consumption of red wine, white wine/champagne, and spirits (≥7 servings/week) correlated positively with CSVD burden. In contrast, low-to-moderate beer/cider intake (≤3 servings/week) was inversely associated with burden. A dose-response relationship between total ethanol intake and CSVD burden was observed, with minimal intake (<1.97 g/day) showing a mild negative association, and higher levels increasing risk. Greater frequency and volume of alcohol intake, especially from wine and spirits, are linked with higher CSVD burden. Conversely, low beer/cider consumption may be inversely associated with CSVD burden. These findings underscore the importance of moderating alcohol consumption to maintain cerebrovascular health.

Maximizing the potential of Lp(a) in vascular risk assessment: An observational analysis of its underutilization

A Cerebrovascular Accident (CVA) is a primary cause of mortality and morbidity globally, presenting with a diverse range of appearances contingent upon the location of the infarct. Isolated hypoglossal nerve supranuclear palsy is an uncommon clinical manifestation of ischaemic stroke, typically associated with pre-existing vascular risk factors. The neurological finding of isolated unilateral lingual paresis is rarely observed. While Lower Motor Neuron (LMN) lesions involving the hypoglossal nerve (cranial nerve XII) are extensively described, Upper Motor Neuron (UMN) aetiologies are less commonly noted. This case report discusses solitary unilateral lingual paresis resulting from an UMN infarction, emphasising the clinical manifestation, diagnostic difficulties, and underlying pathophysiology. A 62-year-old individual with type 2 diabetes exhibited dysarthria without accompanying neurological deficits. The Magnetic Resonance Imaging (MRI) revealed an acute non-haemorrhagic infarction in the left corona radiata. The patient demonstrated steady improvement while undergoing dual antiplatelet therapy, high-dose statins, and speech therapy. This case highlights a rare UMN cause of isolated hypoglossal nerve palsy

Background Stroke presents with variable clinical profiles across different geographical locations. Therefore, studying stroke and conducting long-term follow-ups in specific subpopulations will guide us in the initiation of better treatment and preventive measures. Aim To assess tenecteplase’s safety and effectiveness, as well as the clinical characteristics and long-term monitoring of stroke patients in Coimbatore. Methods One hundred individuals with acute ischemic stroke who received tenecteplase within a 4.5-h timeframe were included in this prospective research. The period of these patients’ admissions was August 2018-February 2022. Following patient consent and ethical committee permission, we examined the patients’ clinical characteristics, tenecteplase safety profile, primary and secondary outcomes, and long-term follow-up for a maximum of 18 months. Results The mean age of the 100 patients was 58.9 years, with 71 being men and 29 being women. Fourteen of the patients were younger than 45. The TOAST categorization showed that 34 had lacunar strokes, 14 had cardioembolic strokes, and 55 had massive infarcts. Regardless of their vegetarianism or alcohol consumption, 48 individuals showed either hyperhomocysteinemia or a B12 deficiency. The middle cerebral artery (MCA) was the source of 75 of the 87 anterior circulation strokes and 13 posterior circulation strokes that were found. The average door-to-needle duration was 75.7 min, and the average time of stroke onset (TSO) was 2.7 h. The immediate National Institutes of Health Stroke Scale (NIHSS) score following tenecteplase injection (within 1 h) was 7.6, while the mean NIHSS score at admission was 9.56. Two patients suffered intracerebral hemorrhage, whereas 47% of patients obtained the primary endpoint, and 67% reached the secondary outcome. Recurrent vascular events, such as myocardial infarction (7), peripheral vascular disease (3), recurrent stroke (10), and mortality (16), occurred in 36 patients during the 18-month follow-up. Conclusion Within the 4.5-h window, tenecteplase is a safe and efficient thrombolytic treatment for acute ischemic stroke. In contrast to earlier stroke studies conducted in India, the mean age of presentation in our study was 58.9 years. Therefore, our society should implement basic preventive measures that are effective and based on the population. B12 deficiency and hyperhomocysteinemia are significant vascular risk factors for macrovascular events that require appropriate screening and management. Recurrent macrovascular events, including mortality, occurred in 36% of patients during their follow-up, which is a greater rate even with secondary preventive interventions. This emphasizes how our community has to implement strong primary and secondary prevention measures.

Cerebral small-vessel disease severity, hypertension, and body mass index forecast striatal dopamine D2-receptor decline rates in aging.

Association of dietary macronutrients with MRI-detected vascular brain injury and cognition in 9886 middle-aged participants from four countries: for the Canadian Alliance of Healthy Hearts and Minds (CAHHM) and the Prospective Urban Rural Epidemiological (PURE) Study Investigators.

Cardiovascular diseases, largely driven by atherosclerosis-induced stenosis, remain the leading cause of mortality worldwide. The bifurcation of the brachiocephalic trunk into the subclavian and common carotid arteries is particularly susceptible to disturbed hemodynamics and plaque accumulation. This study presents a computational analysis of the impact of stenosis and bifurcation geometry (45°, 60°, and 75°) on blood flow and oxygen transport using COMSOL Multiphysics®. Pulsatile flow conditions were modeled with coupled laminar flow and transport of diluted species modules to evaluate velocity, wall shear stress (WSS), and oxygen concentration. Results show that stenosis leads to a significant increase in peak systolic velocity (up to ∼31%) and localized WSS (peaking at 16 Pa), especially at lower bifurcation angles. Wider bifurcation geometries (75°) resulted in pronounced flow separation, vortex formation, and reduced oxygen delivery, with concentrations falling as low as 0.10 mol/m 3 in critical downstream regions. These hemodynamic disturbances were most severe in the presence of both wide bifurcation angles and stenotic narrowing. The model was validated against previous numerical and experimental studies, confirming its accuracy. The findings underscore the importance of considering arterial geometry in diagnosing vascular risk and optimizing intervention strategies. Integrating hemodynamic and oxygen transport analysis provides a more comprehensive understanding of stenosis progression and offers a foundation for personalized cardiovascular treatments.

Arterial brain calcium (ABC) volume - A novel radiological marker of atherosclerotic risk and future stroke risk on non-contrast CT.

Schizophrenia is associated with an increased risk of stroke and under-treatment of vascular risk factors, but less is known about adherence to medications for secondary stroke prevention. We sought to understand current rates of adherence to secondary stroke prevention therapies among elderly ischemic stroke survivors with and without schizophrenia. In a population-based cohort study, we used administrative databases to identify all patients aged ≥65 years who were hospitalized with ischemic stroke in the province of Ontario, Canada, between 2004 and 2018, and a validated algorithm to identify those with schizophrenia. Among patients who filled a prescription for antihypertensive, lipid-lowering, or anticoagulant medications within 3 months and were alive 1 year after discharge, we compared the proportion with low adherence (defined as an annual proportion of days covered of <0.4) in those with and without schizophrenia. We used multivariable logistic regression to estimate the association between schizophrenia and low adherence adjusting for age, sex, comorbid conditions, area of residence, and socioeconomic status. Of the 55 842 patients included, the mean age was 79.5 years, 53.3% were women, and 1.0% had schizophrenia. Among those who survived to 1 year after discharge, individuals with schizophrenia were more likely than those without to have low adherence to antihypertensive (28.0% versus 18.8%; adjusted odds ratio, 1.60 [95% CI, 1.28-2.01]), lipid-lowering (38.6% versus 29.8%; adjusted odds ratio, 1.60 [95% CI, 1.31-1.96]), or anticoagulant medications (41.1% versus 32.0%; adjusted odds ratio, 1.61 [95% CI, 1.00-2.58]), even after adjustment for age, sex, comorbid illness, rurality, and neighborhood income quintile. Schizophrenia is associated with poor adherence to medications for secondary stroke prevention. Future work should focus on developing individual- and system-level interventions to improve vascular risk factor management in this population.

BackgroundThis study investigates the associations between asymptomatic coronary atherosclerosis and subclinical cerebral small vessel disease (CSVD) in a community‐based population, considering potential confounding by intracranial atherosclerosis and cardiac systolic function.MethodsCommunity‐dwelling residents from the PRECISE (Polyvascular Evaluation for Cognitive Impairment and Vascular Events) study in Lishui City, China (n=3021; mean age, 61.2±6.4 years; 46.4% male), underwent assessment of coronary and intracranial atherosclerotic burden via coronary computed tomography angiography and high‐resolution magnetic resonance imaging. CSVD burden and imaging markers (white matter hyperintensities, lacunes, enlarged perivascular spaces, and cerebral microbleeds) were evaluated.ResultsAdvanced coronary atherosclerosis was significantly associated with higher total CSVD burden (adjusted common odds ratio [cOR], 1.54 [95% CI, 1.18–2.01]; P=0.002) after adjusting for age, sex, and vascular risk factors. Heavier coronary atherosclerosis was linked to increased odds of lacunes (adjusted OR, 2.52 [95% CI, 1.59–3.97]; P<0.001), WMHs burden (adjusted OR, 1.46 [95% CI, 1.06–2.02]; P=0.020), modified WMHs burden (adjusted cOR, 1.47 [95% CI, 1.12–1.93]; P=0.005), and moderate‐to‐severe basal ganglia‐enlarged perivascular spaces (adjusted OR, 1.70 [95% CI, 1.17–2.48]; P=0.005), but not cerebral microbleeds (P>0.05). These associations remained after further adjusting for left ventricular ejection fraction and intracranial atherosclerosis. Mendelian randomization analyses suggested a potential role of chronic inflammation in linking coronary atherosclerosis and CSVD.ConclusionsThis community‐based study demonstrates an association between advanced coronary atherosclerosis and CSVD that persists after accounting for intracranial atherosclerosis and cardiac systolic dysfunction. Mendelian randomization analyses provide preliminary evidence suggesting that chronic inflammation may contribute to this association. Longitudinal studies incorporating circulating inflammatory markers are warranted to clarify these associations.

Cardiovascular disease (CVD) contributes to stroke and dementia. Individuals with CVD have high risk for adverse cognitive outcomes and stroke, possibly due to shared risk factors between CVD, stroke, and dementia, which may be attributed to cerebral small vessel disease (CSVD). We aim to determine the association between prevalent CVD and atrial fibrillation (AF) with CSVD. Composite of CVD [coronary heart disease, heart failure (HF)], its individual components, and AF were assessed. Multi-marker CSVD score was used to reflect increasing CSVD burden (cerebral microbleeds (CMBs), high-burden perivascular spaces, extensive white matter hyperintensity, cortical superficial siderosis, or covert brain infarcts were assigned 1 point each, with a range of 0-5). We related prevalent CVD, its individual components, and AF to multi-marker CSVD score and individual CSVD markers using logistic regression analyses adjusted for age, sex, FHS cohort, time between MRI and clinic exam (model-1), and vascular risk factors (model-2). In 3413 participants (mean age: 59 ± 14 years, 53.4% women), 11% had prevalent CVD or AF, 8% had prevalent CVD, and 4% had prevalent AF. One CSVD marker was seen in 23% participants, and 9% had ≥ 2 markers. In multivariable-adjusted analyses, composite prevalent CVD and AF was associated with the presence of one CSVD marker (OR: 1.38, 95% confidence interval [CI]: 1.05-1.84). The association with ≥2 CSVD markers was not significant. Only CMBs were associated with components of CVD and AF, with the highest odds of association with HF. Prevalent CVD (including AF) is associated with the presence of CSVD, with all components associated with CMBs.

To assess the contribution of Systemic sclerosis (SSc)-specific features on type II diabetes mellitus (T2D) in a large cohort of Italian SSc patients. A total of 613 SSc patients from 11 tertiary Rheumatology Units across Italy were included. All patients underwent full history taking, clinical examination, and relevant laboratory and radiological evaluations. Demographic, socioeconomic, and disease-specific factors were compared between SSc patients with and without T2D. The prevalence of T2D in the study cohort was 7.6%. SSc patients with T2D were significantly older (P < 0.007) and exhibited: higher prevalence of late-stage capillaroscopic pattern (P < 0.001), severe reduction in forced vital capacity (FVC < 50%; P < 0.000), moderate reduction in total lung capacity (TLC 50-69%; P < 0.011), electrocardiographic signs of right ventricular hypertrophy (P < 0.018), higher prevalence of pulmonary arterial hypertension (PAH) confirmed by right heart catheterization (RHC) (P < 0.037) and higher prevalence scleroderma renal crisis (SRC) (P < 0.001); elevated erythrocyte sedimentation rate (ESR) (P < 0.022), and ANA positivity. These patients more frequently assumed angiotensin-converting enzyme inhibitors (ACEi) (P < 0.005) when compared to their non-T2D counterparts, while the use of immunosuppressive therapies was similar between groups. Multivariate analysis identified older age, SRC, and reductions in both TLC and FVC as independent SSc-specific associated factors of T2D. Although the prevalence of T2D in SSc patients is lower than the global estimates reported by the International Federation of Diabetes (IFD), a distinct subgroup of SSc patients with T2D is characterized by unique disease manifestations and complications, including SRC and impaired lung function. These findings underscore the importance of tailored screening and management approaches to address the intersecting metabolic and vascular risks in this population.

Abstract Background Previous studies have demonstrated that both the hemoglobin glycation index (HGI) and the triglyceride-glucose (TyG) index provide superior measures of glucose metabolism compared to traditional blood glucose markers. Furthermore, genetic variants have been identified as significant contributors to the risk of type 2 diabetes mellitus (T2D) and its related complications, highlighting the interplay between metabolic markers and genetic predisposition. Objectives The purpose of this study is to assess the value of the TyG index and the HGI as possible indicators of diabetic vascular complications and investigate their association with the HK-1 (rs7072268) polymorphism. Methods This case-control study included 200 adult participants with T2D and 50 healthy controls. The HGI values were divided into three groups by the tertile method and the TyG index values were divided into two groups by the median level. HK-1 (rs7072268) T&gt;C polymorphism genotyping was done by real-time PCR. Results This study found that participants with diabetic vascular complications showed significantly higher values of HGI and TyG index than controls and those without vascular complications (p &lt;0.001). Elevated HGI was associated with macrovascular complications, while a higher TyG index was linked to both diabetic nephropathy and macrovascular complications, such as stroke and hypertension. The frequencies of HK-1 (rs7072268) TC and TT genotypes, as well as the T allele, were significantly higher in the diabetes with vascular complications group (p &lt;0.001) with higher HGI and TyG index values associated with these genotypes. Conclusions This study suggests that both the HGI and TyG index are valuable indicators of diabetic vascular complications. Additionally, the HK-1 (rs7072268) TC and TT genotypes were strongly associated with increased risk of diabetes and its vascular complications as well as higher values of HGI and TyG index. These results highlight the potential utility of these markers in predicting diabetic vascular risks.

BackgroundDifferent white matter hyperintensities (WMHs) distribution patterns exhibit distinct clinical implications, but their underlying mechanisms remain unclear. This study explores vascular risk factors and neuroimaging features to elucidate their heterogeneity.MethodsWe retrospectively analyzed WMHs patients who underwent multimodal MRI at Zhejiang Hospital. Neuroimaging features included gray matter volume, white matter microstructure (Fractional anisotropy, FA), and cerebral blood flow (CBF) were assessed. Vascular risk factors and imaging features were compared across four different WMHs distribution patterns [multi-spots, peri-basal ganglia, anterior subcortical (SC) patches, and posterior SC patches]. Mediation analysis was performed to explore the role of imaging features on WMHs related cognitive impairment.ResultsA total of 163 patients were included in the final analysis. Among the four WMHs distribution patterns, hypertension was significantly more prevalent in patients with anterior SC patches [48 [85.7%] vs. 71 [66.4%], p = 0.008]. All WMH distribution patterns except multi-spots exhibited reduced gray matter volume (Bonferroni p < 0.0125). Notably, only patients with anterior SC patches exhibited a reduction in white matter FA (0.342 ± 0.049 vs. 0.370 ± 0.043, p < 0.001). Furthermore, patients with posterior SC patches displayed significantly lower CBF in both gray matter (42.65 ± 11.76 vs. 48.02 ± 10.97, p = 0.003) and white matter (35.25 ± 8.81 vs. 38.86 ± 8.07, p = 0.007). Mediation analysis revealed that white matter microstructural injury mediated the association between anterior SC patches WMHs and cognitive impairment [β = −0.371, Bootstrap 95% CI [−0.939, −0.006]].ConclusionThis study demonstrates heterogeneity in vascular risk factors, gray matter volume, microstructural injury, and hypoperfusion across different WMHs patterns, underscoring the importance of subtype-specific mechanistic and therapeutic research.

In patients with minor stroke, intravenous thrombolysis is recommended only for those with disabling symptoms, yet no standardized definition exists, and the treatment decisions remain subjective. This study aimed to evaluate the effect of thrombolysis in minor stroke using routine care registry data. A Danish nationwide register-based cohort study included patients with minor stroke (Scandinavian Stroke Scale (SSS) ⩾ 45) from 2011 to 2021. Patients were categorized as having mild strokes (SSS 45-49, approximated National Institutes of Health Stroke Scale (NIHSS) = 5-6) or very mild strokes (SSS 50-58, approximated NIHSS 1-4) to pragmatically distinguish disabling from non-disabling symptoms. Return-to-work, use of homecare, typical stroke complications, recurrent stroke, and mortality were compared in patients treated with and without thrombolysis. Analyses were adjusted for vascular risk factors, demographics, and clinical characteristics using inverse probability of treatment weighting. Among 31,007 included patients, 1910 with mild strokes and 4052 with very mild strokes received thrombolysis. In patients with mild strokes, thrombolysis was associated with a higher rate of return-to-work (adjusted hazard ratio = 1.33), lower risk of pneumonia (adjusted relative risk (aRR) = 0.40), and lower mortality (aRR = 0.58, 0.50, and 0.50 at 30, 90, and 365 days, respectively). In patients with very mild strokes, thrombolysis was not associated with improved outcomes, except lower mortality at 365 days (aRR = 0.78). Intravenous thrombolysis was more often associated with better outcomes in patients with mild strokes than in patients with very mild strokes.

Background Lacunar infarcts are small, deep brain infarctions traditionally attributed to intrinsic small vessel disease, such as lipohyalinosis and microatheroma formation. However, emerging evidence suggests that a subset of lacunar strokes may result from embolic occlusions originating from proximal large arteries or the heart. Identifying the underlying etiology is crucial for optimizing secondary prevention strategies, as embolic strokes require different management approaches compared to non-embolic small vessel disease. Objective This study aims to evaluate the prevalence of proximal embolic sources in patients with lacunar infarcts and assess their clinical and imaging characteristics to determine whether embolism plays a significant role in their pathogenesis. Methods In this prospective observational study over 18 months at a tertiary care hospital, 337 ischemic stroke patients were screened. Sixty patients (17.8%) with radiologically confirmed lacunar infarcts were enrolled. Demographic data, vascular risk factors, and clinical presentations were recorded. Investigations included computed tomography (CT) angiography to assess large-artery pathology, 2D echocardiography to identify cardiac embolic sources, and 72-h Holter monitoring to detect atrial fibrillation or other arrhythmias. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS), and functional outcomes were assessed using the modified Rankin scale (MRS). Results The prevalence of lacunar strokes was 17.8%, with the majority (60%) occurring in individuals aged 41-60 years. Hypertension was the most common risk factor (45%), followed by diabetes mellitus (31.67%) and dyslipidemia (41%). Proximal embolic sources were identified in 36.6% of patients based on CT angiography, with the most common sites being the internal carotid artery (40.9%) and the middle cerebral artery (13.6%). Cardiac abnormalities were detected in 18.3% of cases on echocardiography, and Holter monitoring identified atrial fibrillation in 3.3%. Functional outcomes showed moderate to severe disability (MRS 3-5) in 43.34% of patients, with neurological deterioration occurring in 40% within the first week. Conclusion This study suggests that embolic mechanisms contribute to a significant proportion of lacunar infarcts. Routine vascular and cardiac imaging should be considered in lacunar stroke patients to identify potential embolic sources, which may necessitate anticoagulation for secondary stroke prevention. Further research is needed to refine diagnostic criteria and optimize treatment strategies for embolic versus non-embolic lacunar strokes.