scholarly journals Inflammation, Cholesterol, and Stroke Risk: Building Evidence for a Dual Target Strategy for Secondary Prevention

Stroke ◽  
2021 ◽  
Author(s):  
John J. McCabe ◽  
Peter J. Kelly
Keyword(s):  
Secondary Prevention ◽  
Stroke Risk ◽  
Target Strategy ◽  
Dual Target

scholarly journals Global Outcome Assessment Life-long after stroke in young adults initiative—the GOAL initiative: study protocol and rationale of a multicentre retrospective individual patient data meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031144
Author(s):  
Merel Ekker ◽  
Mina Jacob ◽  
Myrna van Dongen ◽  
Karoliina Aarnio ◽  
Arunkar Annamalai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Secondary Prevention ◽  
Stroke Risk ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Stroke Patients ◽  
Young Stroke ◽  
Stroke In Young Adults ◽  
Stroke In Young

IntroductionWorldwide, 2 million patients aged 18–50 years suffer a stroke each year, and this number is increasing. Knowledge about global distribution of risk factors and aetiologies, and information about prognosis and optimal secondary prevention in young stroke patients are limited. This limits evidence-based treatment and hampers the provision of appropriate information regarding the causes of stroke, risk factors and prognosis of young stroke patients.Methods and analysisThe Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18–50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence.Ethics and disseminationEthical approval for the GOAL study has already been obtained from the Medical Review Ethics Committee region Arnhem-Nijmegen. Additionally and when necessary, approval will also be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of worldwide differences in risk factors, causes and outcome of young stroke patients.

scholarly journals Dual target strategy: a proposal to mitigate the risk of overtreatment and enhance patient satisfaction in rheumatoid arthritis

2018 ◽  
Vol 78 (10) ◽  
pp. e109-e109 ◽  
Author(s):  
Ricardo J O Ferreira ◽  
Mwidimi Ndosi ◽  
Maarten de Wit ◽  
Eduardo José Ferreira Santos ◽  
Cátia Duarte ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Patient Satisfaction ◽  
Target Strategy ◽  
Dual Target

Transient ischemic attack: Incidence and early risk of stroke in northern Portugal from 1998–2000 to 2009–2011

2019 ◽  
Vol 15 (3) ◽  
pp. 278-288 ◽  
Author(s):  
Rui Felgueiras ◽  
Rui Magalhães ◽  
Mário R Silva ◽  
Maria C Silva ◽  
Manuel Correia
Keyword(s):  
Secondary Prevention ◽  
Stroke Risk ◽  
Diagnostic Procedures ◽  
Posterior Circulation ◽  
Stroke Severity ◽  
Vascular Risk ◽  
Annual Incidence Rate ◽  
Primary And Secondary Prevention ◽  
Community Based ◽  
Ischemic Attack

Objective A decline in TIA incidence would be expected mirroring stroke trends, but patient's awareness of symptoms/signs, improved diagnostic procedures and changes in severity of vascular disease may raise TIA incidence. We aimed to estimate changes in TIA incidence and 30-day stroke risk in Portugal. Methods Data from two prospective community-based registers of first-ever TIA in 104,700 (1998–2000) and 118,232 (2009–2011) persons were collected using comprehensive case ascertainment methods. Incidence and stroke risk from TIA onset were compared using different inception cohorts. ABCD2 was used to stratified stroke risk. Results Overall, 141 patients were included in 1998–2000 and 174 in 2009–2011. Crude annual incidence rate increased from 67 to 74/100,000 (IRR=1.12; 95% CI, 0.90–1.40), particularly in men under 65 years (IRR=1.79; 95% CI, 1.06–3.04). Male/female IRR increased from 1.20 (0.86–1.68) in 1998–2000 to 1.77 (1.31–2.39) in 2009–2011, after adjustment for age. Better control of vascular risk factors (VRFs) accounted for lower ABCD2 scores in 2009–2011. The 30-day stroke risk was similar in study periods (18.4% vs. 16.7%, p > 0.7), decreasing from 16.1% to 8.2% ( p < 0.042) excluding patients reporting TIA after stroke occurrence and from 12.2% to 4.0% ( p < 0.011) further excluding patients who had stroke in ambulance/hospital. ABCD2 discriminated stroke risk only in 1998–2000; stroke severity decreased while posterior circulation stroke was more common in 2009–2011. Conclusion Despite a stable TIA incidence across periods, the risk increased in men compared to women. Better control of VRF accounted for lower ABCD2 scores and secondary prevention reduced stroke risk. Men under 65 years emerge as a preferential target for primary and secondary prevention.

Inflammation and Stroke Risk: A New Target for Prevention

Stroke ◽  
2021 ◽  
Author(s):  
Peter J. Kelly ◽  
Robin Lemmens ◽  
Georgios Tsivgoulis
Keyword(s):  
Secondary Prevention ◽  
Randomized Controlled Trials ◽  
Observational Studies ◽  
Stroke Risk ◽  
Controlled Trials ◽  
Therapeutic Approaches ◽  
Randomized Controlled ◽  
New Therapeutic Approaches ◽  
Prevention Therapy ◽  
Anti Inflammatory

New therapeutic approaches are required for secondary prevention of residual vascular risk after stroke. Diverse sources of evidence support a causal role for inflammation in the pathogenesis of stroke. Randomized controlled trials of anti-inflammatory agents have reported benefit for secondary prevention in patients with coronary disease. We review the data from observational studies supporting a role for inflammation in pathogenesis of stroke, overview randomized controlled trials of anti-inflammatory therapy in cardiac disease and discuss the potential implications for stroke prevention therapy.

Treating Dyslipidemia for the Primary and Secondary Prevention of Stroke

2017 ◽  
Vol 37 (03) ◽  
pp. 286-293
Author(s):  
Fotios Barkas ◽  
Haralampos Milionis
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Stroke Risk ◽  
Therapeutic Interventions ◽  
Lipid Lowering ◽  
Prevention Measures ◽  
Primary And Secondary Prevention ◽  
Beneficial Effects ◽  
Reductase Inhibitors ◽  
Coa Reductase

AbstractStroke is associated with a heavy burden of mortality and disability, underscoring the importance of effective primary and secondary prevention measures. Dyslipidemia as a risk factor for ischemic stroke has long been disputed. Nevertheless, accumulating epidemiological evidence supports a role of lipid abnormalities in increasing ischemic stroke risk and representing a potential target for therapeutic interventions. 3-hydroxy-3-methyl-glutaryl- (HMG-) CoA reductase inhibitors (i.e., statins) are currently the mainstay of therapy for the management of hypercholesterolemia in patients with cardiovascular disease and stroke. Although their beneficial effects on stroke risk have been attributed chiefly to their lipid-lowering capacity, they also have pleiotropic effects. Other lipid lowering modalities have been shown to reduce the risk of ischemic stroke in individuals at high cardiovascular risk, but data regarding their use in secondary stroke prevention are lacking.

Stroke risk in atrial fibrillation patients on warfarin

2009 ◽  
Vol 101 (02) ◽  
pp. 367-372 ◽  
Author(s):  
Emilia Antonucci ◽  
Elisa Grifoni ◽  
Rosanna Abbate ◽  
Gian Franco Gensini ◽  
Domenico Prisco ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Adverse Events ◽  
Secondary Prevention ◽  
Stroke Risk ◽  
Predictive Accuracy ◽  
Oral Anticoagulant Therapy ◽  
Separate Analysis ◽  
Moderate Risk

SummaryAtrial fibrillation (AF) patients are widely heterogeneous in terms of ischaemic stroke risk, and several risk stratification schemes have been developed. We performed a prospective study on 662 AF patients on long-term oral anticoagulant therapy (OAT), evaluating the agreement among the different schemes and their correlation with adverse events recorded during follow-up. Patients at low risk were similarly distributed among the different models. Instead, patients classed at moderate risk were 49.2% by CHADS2 score, 27.6% by NICE and 2.3% by ACCP. As a consequence patients classed at high risk were 46.1% by CHADS2, 69.8% by NICE and 95.3% by ACCP. CHADS2 and NICE scores were associated to the best predictive accuracy. A separate analysis was performed for patients on treatment for secondary prevention, and we observed that they were included in high risk groups by all models, except for 14 patients (6.3%) classed at moderate risk by CHADS2 even though these patients are at very high risk and the use of aspirin could be unsafe for them. During follow-up 32 major bleeding (1.35 per 100 patient/years) and 39 thrombotic events (1.64 per 100 patient/ years) were observed. Among patients on OAT for secondary prevention, both bleeding and thrombotic events mostly occurred in high-risk patients. Even if the absolute rate of adverse events is low, this finding seems to confirm the high stroke risk of this group of patients. For patients on secondary prevention there is no need for further stratification and warfarin should be the treatment of choice.

scholarly journals Is Blood Pressure Lowering in the Very Elderly With Previous Stroke Associated With a Higher Risk of Adverse Events?

2021 ◽  
Author(s):  
Damien Tharmaratnam ◽  
Christopher C. Karayiannis ◽  
Taya A. Collyer ◽  
Hisatomi Arima ◽  
Leslie A. McClure ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Adverse Events ◽  
Secondary Prevention ◽  
Stroke Risk ◽  
Intervention Group ◽  
Blood Pressure Lowering ◽  
Very Elderly ◽  
Increased Risk ◽  
Pressure Lowering ◽  
Risk Of Falls

Background We investigated whether blood pressure lowering for secondary prevention is associated with a reduction in recurrent stroke risk and/or a higher risk of adverse events in very elderly compared with younger trial participants. Methods and Results This is a random effects meta‐analysis of randomized controlled trials of blood pressure lowering for secondary stroke prevention to evaluate age‐stratified (<80, ≥80 years) risk of adverse events. Ovid‐MEDLINE was searched for trials between 1970 and 2020. Summary‐level data were acquired including outcomes of stroke, cardiovascular events, mortality, and adverse events. Seven trials were included comprising 38 596 participants, of whom 2336 (6.1%) were aged ≥80 years. There was an overall reduction in stroke risk in the intervention group compared with controls (risk ratio [RR], 0.90 [95% CI, 0.80, 0.98], I 2 =49%), and the magnitude of risk reduction did not differ by age subgroup (<80, ≥80 years). There was no increase in the risk of hypotensive symptoms in the intervention group for patients aged <80 years (RR, 1.19 [95% CI, 0.99], 1.44, I 2 =0%), but there was an increased risk in those ≥80 years (RR, 2.17 [95% CI, 1.22], 3.86, I 2 =0%). No increase was observed in the risk of falls, syncope, study withdrawal, or falls in either age subgroup. Conclusions Very elderly people in secondary prevention trials of blood pressure lowering have an increased risk of hypotensive symptoms, but with no statistical increase in the risk of falls, syncope, or mortality. However, evidence is lacking for frail elderly with multiple comorbidities who may be more vulnerable to adverse effects of blood pressure lowering.

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