scholarly journals Modifiable Lifestyle Factors and Risk of Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Eric L. Harshfield ◽  
Marios K. Georgakis ◽  
Rainer Malik ◽  
Martin Dichgans ◽  
Hugh S. Markus
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Ischemic Stroke ◽  
Body Mass ◽  
Stroke Risk ◽  
Causal Effect ◽  
Lifestyle Factors ◽  
Small Vessel ◽  
Large Artery ◽  
Modifiable Lifestyle Factors

Background and Purpose: Assessing whether modifiable risk factors are causally associated with stroke risk is important in planning public health measures, but determining causality can be difficult in epidemiological data. We evaluated whether modifiable lifestyle factors including educational attainment, smoking, and body mass index are causal risk factors for ischemic stroke and its subtypes and hemorrhagic stroke. Methods: We performed 2-sample and multivariable Mendelian randomization to assess the causal effect of 12 lifestyle factors on risk of stroke and whether these effects are independent. Results: Genetically predicted years of education was inversely associated with ischemic, large artery, and small vessel stroke, and intracerebral hemorrhage. Genetically predicted smoking, body mass index, and waist-hip ratio were associated with ischemic and large artery stroke. The effects of education, body mass index, and smoking on ischemic stroke were independent. Conclusions: Our findings support the hypothesis that reduced education and increased smoking and obesity increase risk of ischemic, large artery, and small vessel stroke, suggesting that lifestyle modifications addressing these risk factors will reduce stroke risk.

scholarly journals Modifiable lifestyle factors and risk of stroke: a Mendelian randomization analysis

2020 ◽  
Author(s):  
Eric L Harshfield ◽  
Marios K Georgakis ◽  
Rainer Malik ◽  
Martin Dichgans ◽  
Hugh S Markus
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Educational Attainment ◽  
Ischaemic Stroke ◽  
Genetic Predisposition ◽  
Stroke Risk ◽  
Mendelian Randomization ◽  
Lifestyle Factors ◽  
Large Artery ◽  
Modifiable Lifestyle Factors

ABSTRACTAimsAssessing whether modifiable risk factors are causally associated with reduced stroke risk is important in planning public health measures, but determining causality can be difficult in epidemiological data. Leveraging large-scale genetic data in a technique known as Mendelian randomisation, we aimed to determine whether modifiable lifestyle factors including educational attainment, smoking, and body mass index are causal risk factors for ischaemic stroke and its different subtypes and haemorrhagic stroke.Methods and ResultsWe performed two-sample and multivariable Mendelian randomization to assess the causal effect of twelve lifestyle factors on risk of stroke and whether these effects are independent. We found genetic predisposition to increased number of years of education to be inversely associated with ischaemic, large-artery, and small-vessel stroke, as well as with intracerebral haemorrhage. Genetic predisposition to ever smoking regularly, higher body mass index (BMI), and higher waist-hip ratio are also associated with ischaemic and large-artery stroke. Additionally, we found that the effects of education, BMI, and smoking on ischaemic stroke to be independent of each other.ConclusionGenetic predisposition to higher educational attainment can reduce the risk of ischaemic, large-artery, and small-vessel stroke, while genetic predisposition to smoking and higher anthropometry measures can increase the risk of these stroke subtypes. This suggests that lifestyle modification addressing these risk factors will reduce stroke risk.

Abstract T P153: Women and Men with Ischemic Stroke in SiGN Have Different Subtype Distributions and Risk Factors

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kathryn M Rexrode ◽  
Braxton D Mitchell ◽  
Kathleen A Ryan ◽  
Steven J Kittner ◽  
Hakan Ay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Cardioembolic Stroke ◽  
Relative Distribution ◽  
Large Artery ◽  
Stroke Risk Factors ◽  
Stroke Subtypes ◽  
Small Artery Occlusion ◽  
Ischemic Stroke Risk

Introduction: The relative distribution of stroke risk factors, as well as ischemic stroke subtypes, in women compared with men is not well described. Hypothesis: We hypothesized that the distribution of ischemic stroke risk factors and subtypes would differ by sex, with a later onset in women and greater proportion of comorbidities. Methods: The NINDS Stroke Genetics Network (SiGN) consortium was established to evaluate genetic risk factors for ischemic stroke. A total of 23 separate studies performed Causative Classification of Stroke (CCS) typing using standardized criteria on ischemic stroke cases and contributed data on risk factors. We compared the distribution of ischemic stroke risk factors and CCS phenotypes between men and women with ischemic stroke. Results: Of the 16,228 ischemic strokes in SiGN, 8005 (49.3%) occurred in women. Median age at stroke was older in female than male stroke cases (73 vs. 66 years) (p=<0.0001). Among stroke cases, women were more likely than men cases to have hypertension or atrial fibrillation and less likely to have diabetes or coronary artery disease, or to smoke (p <0.003 for all). The distribution of stroke subtypes also differed by sex, with women less likely than men to have large artery infarction and small artery occlusion, and more likely to have cardioembolic stroke and undetermined stroke due to incomplete work-up (p values all <0.0001; see Table). Results were similar when the distribution of stroke subtypes was examined for those <70 years and ≥70 years, except for cardioembolic stroke remaining more common only among women ≥70. Conclusions: In this large group of carefully phenotyped ischemic strokes, the distribution of ischemic stroke subtypes and risk factor profiles differ significantly by sex. Evaluation of the causes of these differences may highlight areas for improved prevention and risk reduction in both genders.

Abstract WP227: Risk Factors for Pathophysiologic Subtypes of Ischemic Stroke Among West Africans: Findings From the SIREN Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Fred S Sarfo ◽  
Bruce Ovbiagele ◽  
Onoja M Akpa ◽  
Rufus Akinyemi ◽  
Albert Akpalu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Vegetable Consumption ◽  
Conditional Logistic Regression ◽  
Meat Consumption ◽  
Small Vessel ◽  
Large Artery ◽  
Green Vegetable ◽  
Catchment Areas ◽  
West Africans

Background: The risk factors associated with the occurrence of the distinct pathophysiologic subtypes of ischemic stroke are unknown among indigenous Africans. Objective: To identify and quantify the contributions of risk factors for occurrence of ischemic stroke and its etiologic subtypes among West Africans. Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Nigeria and Ghana. Cases included adults aged >18 years with CT/MRI confirmed stroke and ischemic strokes were etiologically subtyped using the TOAST protocol. Controls were age-and-gender matched stroke-free adults recruited from the communities in catchment areas of cases. Comprehensive evaluation for vascular, lifestyle and psychosocial factors was performed using standard instruments. We used conditional logistic regression to estimate odds ratios (OR) with 95% CIs. Results: There were 1,721 ischemic stroke cases with a mean age of 62.19 ± 14.03 vs 60.86 ± 13.71 for controls. Using the TOAST etiologic scheme, 867 (50.3%) were small vessel occlusions, 425(24.7%) were large-artery atherosclerotic, 181(10.5%) were cardio-embolic, 204(11.9%) were undetermined and 44(2.6%) were of other determined etiology. The 7 dominant risk factors for ischemic strokes aOR (95%CI) were hypertension 10.76(7.15-16.20), dyslipidemia 5.30(3.86-7.29), diabetes 3.61(2.72-4.80), psychosocial stress 1.68(1.20-2.35), cardiac disease 1.94 (1.25-3.02), meat consumption 2.02(1.54-2.65), green vegetable consumption 0.44(0.33-0.59). Hypertension, dyslipidemia, diabetes, meat consumption and green vegetable intake were confluent factors shared by small-vessel, large-vessel and cardio-embolic ischemic stroke subtypes. Conclusion: We provide empiric evidence of risk factors to be targeted for stroke prevention. Our findings open a vista into future studies aimed at elucidating the genetic factors linked with pathophysiologic subtypes of stroke among Africans.

scholarly journals Association of Body Mass Index with Ischemic and Hemorrhagic Stroke

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2343
Author(s):  
Masahiro Shiozawa ◽  
Hidehiro Kaneko ◽  
Hidetaka Itoh ◽  
Kojiro Morita ◽  
Akira Okada ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Ischemic Stroke ◽  
Body Mass ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Cox Regression ◽  
Cubic Spline ◽  
Overweight And Obesity ◽  
Dependent Manner ◽  
Men And Women

Data on the association between body mass index (BMI) and stroke are scarce. We aimed to examine the association between BMI and incident stroke (ischemic or hemorrhagic) and to clarify the relationship between underweight, overweight, and obesity and stroke risk stratified by sex. We analyzed the JMDC Claims Database between January 2005 and April 2020 including 2,740,778 healthy individuals (Median (interquartile) age, 45 (38–53) years; 56.2% men; median (interquartile) BMI, 22.3 (20.2–24.8) kg/m2). None of the participants had a history of cardiovascular disease. Each participant was categorized as underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25.0–29.9 kg/m2), or obese (BMI ≥ 30 kg/m2). We investigated the association of BMI with incidence stroke in men and women using the Cox regression model. We used restricted cubic spline (RCS) functions to identify the association of BMI as a continuous parameter with incident stroke. The incidence (95% confidence interval) of total stroke, ischemic stroke, and hemorrhagic stroke was 32.5 (32.0–32.9), 28.1 (27.6–28.5), and 5.5 (5.3–5.7) per 10,000 person-years in men, whereas 25.7 (25.1–26.2), 22.5 (22.0–23.0), and 4.0 (3.8–4.2) per 10,000 person-years in women, respectively. Multivariable Cox regression analysis showed that overweight and obesity were associated with a higher incidence of total and ischemic stroke in both men and women. Underweight, overweight, and obesity were associated with a higher hemorrhagic stroke incidence in men, but not in women. Restricted cubic spline showed that the risk of ischemic stroke increased in a BMI dose-dependent manner in both men and women, whereas there was a U-shaped relationship between BMI and the hemorrhagic stroke risk in men. In conclusion, overweight and obesity were associated with a greater incidence of stroke and ischemic stroke in both men and women. Furthermore, underweight, overweight, and obesity were associated with a higher hemorrhagic stroke risk in men. Our results would help in the risk stratification of future stroke based on BMI.

scholarly journals Frequency of Dyslipidemia in Ischemic Stroke Patients Presented to Tertiary Care Hospital of Lahore

2021 ◽  
Vol 15 (10) ◽  
pp. 3417-3419
Author(s):  
Murtaza Jaffar ◽  
Adil Rafique ◽  
Sidra Khalid ◽  
Shahid Waheed
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Ischemic Stroke ◽  
Blood Glucose ◽  
Family History ◽  
Body Mass ◽  
Fasting Blood Glucose ◽  
Stroke Patients ◽  
Blood Samples ◽  
Low Hdl

Background and Aim: A stroke, also known as a cerebrovascular accident, is defined as the sudden onset of a focal neurologic deficit caused by a disruption in blood flow to parts of the brain. The purpose of this study was to evaluate the frequency of dyslipidemia in stroke patients. Materials and Methods: This cross-sectional study was carried out on 184 stroke patients in Medical department of Services Hospital, Lahore for duration of six months i.e from November 2020 to June 2021. All the stroke patients admitted during the study period were enrolled. Demographic details, past medical and family history, stroke risk factors, blood pressure, body mass index, and diabetic state were noted. Fasting blood samples were taken from individuals of stroke diagnosed based on CT scan. Lipid profiles including triacylglycerol, cholesterol, fasting blood glucose, low-density lipoproteins, and glycosylated hemoglobin were all measured from an individual blood samples. SPSS version 20 was used for data analysis. Results: Of the total 184 stroke patients, 123 (66.8%) were male patients while 61 (33.2%) were females. The overall mean age was 41.35±12.76 years whereas the mean body mass index was 37.61±10.91 Kg/m2. Out of 184 patients, the prevalence of prevalent risk factors such as hypertension, diabetes mellitus, and smoking was found 146 (79.5%), 89 (48.2%), and 58 (31.7%) respectively. The prevalence of Hypercholesterolemia (mg/dl), Hypertriglyceridemia (mg/dl), High LDL (mg/dl) levels, high VLDL (mg/dl), and low HDL was 49 (26.4%), 37 (20.1%), 31 (16.8%), 23 (12.5%), and 13 (7.1%) respectively. The abnormalities in HbA1c and fasting blood glucose were found in 93 (50.6%) and 95 (51.4%). Conclusion: Dyslipidemia was more prevalent in ischemic stroke patients. The smoker and male population are more susceptible to stroke risks that involve high LDL, high HbA1c, low HDL, hypertension, and higher fast blood glucose. Family history and diabetes are other risk factors for stroke. Appropriate intrusion for alteration of uneven lipid profile can improve stroke prognosis and prevention Keywords: Dyslipidemia; Ischemic Stroke, Cholesterol

Abstract T MP101: Association of Obstructive Sleep Apnea and Cardioembolic Stroke: A Retrospective Case Control Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Melissa C Lipford ◽  
Andrew D Calvin ◽  
Jay Mandrekar ◽  
Virend K Somers ◽  
Robert D Brown ◽  
...  
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Stroke Risk ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Large Artery ◽  
Obstructive Sleep

Introduction: Obstructive sleep apnea (OSA) is an independent risk factor for ischemic stroke; however the causal mechanisms are unknown. Understanding etiology of stroke in OSA patients may: (1) aid in ascertaining how OSA exerts its influence in increasing stroke risk, and (2) facilitate tailoring recurrent stroke prevention management strategies in OSA patients. Our study compares stroke subtypes in OSA cases versus controls without significant sleep disordered breathing. Hypothesis: We hypothesized cardioembolic (CE) strokes would occur more frequently in OSA cases than in controls. Methods: Consecutive patients were identified who underwent polysomnography (PSG) at Mayo Clinic and suffered an ischemic stroke within one year after PSG. Patients with an apnea-hypopnea index (AHI) ≤ 10 were classified as controls; AHI > 10 classified as OSA cases. Mechanism of stroke was determined using (1) the Causative Classification System for Ischemic Stroke (CCS) and (2) the phenotype definitions used in the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Information on cardiovascular risk factors, neuroimaging, and echocardiography data were collected on each patient. Results: In 53 total subjects, CE strokes were more common among OSA cases (72% vs 33%, p=0.01). Large artery atherosclerosis and small vessel occlusion strokes were more common in controls. Atrial fibrillation (AF) was more frequent in OSA patients (59% vs 24%, p=0.01). Frequency of CE stroke increased with OSA severity. The association between OSA and CE stroke remained significant after controlling for AF (p=0.03, OR 4.5). Echocardiogram data revealed CE stroke risk factors were more frequent in OSA cases (84% vs 52% p=0.02). There were no significant differences between groups for left ventricular ejection fraction, left atrial volume index, or right ventricular systolic pressure. Conclusions: The results demonstrate a strong association between OSA and CE stroke. In OSA patients presenting with cryptogenic stroke, high clinical suspicion for cardioembolism is warranted. This may lead to consideration of further studies (eg, transesophageal echocardiography, Holter monitoring, or extended cardiac monitoring) to identify cardioembolic risk factors such as paroxysmal AF.

scholarly journals ISCHEMIC STROKE;

2019 ◽  
Vol 26 (02) ◽  
Author(s):  
Shahzad Alam Khan ◽  
Nasir Jamal Khan ◽  
Ikram Fareed Langrial ◽  
Saima Ashraf ◽  
Iqra Imtiaz
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Ischemic Stroke ◽  
Blood Glucose ◽  
Family History ◽  
Blood Glucose Level ◽  
Body Mass ◽  
Glucose Level ◽  
Previous History ◽  
History Of

Objectives: To establish the association of raised LDL levels withvarious risk factors causing cerebral ischemia in stroke patients. Background: Cerebrovascular accident (CVA) is a health concern worldwide. Itcauses enormous disabilities in adult age group, and is 2ndcommonest cause of deaths throughout the world. It has been established thatapproximately 15 million people succumb to stroke each year worldwide, out of this 5 million don’t survive and another 5 million become permanently handicapped and thus put significant burden on catering families. This study was conducted to identify contribution of different risk factorsin causing ischemic stroke in our population. Study Design: Descriptive, purposive case series study. Setting: Medical Unit-IV, Nishtar Medical College/Hospital, Multan. Period: One Year tenure spread between January 2017 to December 2017. Material and Methods: 205 cases between 40-70 years of age includingboth male and female patients with ischemic stroke, irrespective of disease duration were included in study. History of raised BP, previous stroke, history of stroke in family, diabetes and smoking was recorded on pre-designed questionnaire. Body mass index was calculated after noting weight and height of the patient.Venous blood (5 ml) sample was drawn and sent to the pathology laboratory of Nishtar Hospital Multan for estimation of serum LDL level and blood glucose level. Results: Of these 205 study cases, 92 (44.9%) patients were male while 113 (55.1%) patients were female. Mean age of patients in our setting was noted to 51.58 ± 8.05 years. In our study, 50 (24.4%) patients were smokers and 40 (19.5%) had history of hypertension. In our setting, family history of stroke was present in 39 (19%) and previous history of stroke was found in 31 (15.1%). Mean body mass index of our patients was calculated to be 23.17± 2.85 kg/m2and 30(14.6%) cases were obese in our study. Mean fasting blood glucose level was 118.32 ± 23.21 mg/dl(48 (23.4%) had diabetes). Mean low density lipoprotein level (LDL) noted in our study was 109.59 ± 49.15 mg/dl and raised level of LDL was seen in 88 (42.9%) of our study cases. Conclusion: By identifying the share of various risk factors contributing in ischemic stroke, we can target population at risk of ischemic stroke and strict control and regulation of modifiable risk factors we can prevent this ominous condition to occur. Our study results point towards early diagnosis which will ultimately lead to proper management to improve clinical outcome in such patients. Raised levels of LDL were significantly associated with gender, diabetes, hypertension, obesity, family history and previous history of stroke.

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans

Stroke ◽  
2021 ◽  
Author(s):  
Fred S. Sarfo ◽  
Bruce Ovbiagele ◽  
Onoja Akpa ◽  
Albert Akpalu ◽  
Kolawole Wahab ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Vegetable Consumption ◽  
Conditional Logistic Regression ◽  
Small Vessel ◽  
Large Artery ◽  
Vessel Occlusion ◽  
West Africans ◽  
And Gender

Background and Purpose: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. Methods: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. Results: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91–15.45); dyslipidemia, 5.16 (3.78–7.03); diabetes, 3.44 (2.60–4.56); low green vegetable consumption, 1.89 (1.45–2.46); red meat consumption, 1.89 (1.45–2.46); cardiac disease, 1.88 (1.22–2.90); monthly income $100 or more, 1.72 (1.24–2.39); and psychosocial stress, 1.62 (1.18–2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively ( P <0.0001). Conclusions: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.

scholarly journals Genetically Predicted Blood Pressure Across the Lifespan

Hypertension ◽  
2020 ◽  
Vol 76 (3) ◽  
pp. 953-961
Author(s):  
Marios K. Georgakis ◽  
Dipender Gill ◽  
Rainer Malik ◽  
Athanase D. Protogerou ◽  
Alastair J.S. Webb ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Mendelian Randomization ◽  
Causal Effect ◽  
Later Life ◽  
Large Artery ◽  
Using Data

Hypertension is the leading risk factor for stroke. Yet, it remains unknown whether blood pressure pulsatility (pulse pressure [PP]) causally affects stroke risk independently of the steady pressure component (mean arterial pressure [MAP]). It is further unknown how the effects of MAP and PP on stroke risk vary with age and stroke cause. Using data from UK Biobank (N=408 228; 38–71 years), we selected genetic variants as instruments for MAP and PP at age ≤55 and >55 years and across age deciles. We applied multivariable Mendelian randomization analyses to explore associations with ischemic stroke, intracerebral hemorrhage, and their subtypes. Higher genetically predicted MAP was associated with higher risk of ischemic stroke and intracerebral hemorrhage across the examined age spectrum. Independent of MAP, higher genetically predicted PP only at age >55 years was further associated with higher risk of ischemic stroke (odds ratio per-SD-increment, 1.23 [95% CI, 1.13–1.34]). Among subtypes, the effect of genetically predicted MAP on large artery stroke was attenuated, whereas the effect of genetically predicted PP was augmented with increasing age. Genetically predicted MAP, but not PP, was associated with small vessel stroke and deep intracerebral hemorrhage homogeneously across age deciles. Neither genetically predicted MAP nor PP were associated with lobar intracerebral hemorrhage. Beyond an effect of high MAP at any age on ischemic and hemorrhagic stroke, our results support an independent causal effect of high PP at older ages on large artery stroke. This finding warrants further investigation for the development of stroke preventive strategies targeting pulsatility in later life.

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