Abstract P679: Ankle-Brachial Index is Independently Associated With Functional Outcome After Stroke

Introduction: The ankle-brachial index (ABI) is the ratio between systolic blood pressure of the upper and lower limbs. A low ABI ( < 0.9) is associated with increased risk of cardiovascular and stroke outcomes. However, ABI relevance for functional outcomes is unknown. Objective: We aimed to investigate if low ABI is associated with functional outcome in stroke patients. Methods: Consecutive patients with imaging-confirmed ischemic stroke were recruited from a public hospital in Salvador, Brazil. Demographic and cerebrovascular risk factor data were collected prospectively. We used NIH stroke scale to quantify stroke severity and ABI was measured on admission. Patients were followed for 90 days and functional outcome was assessed by modified Rankin Scale (mRS). Poor outcome was defined as a mRS = 3 to 6. Logistic regression was used to adjust for potential confounders of poor outcome. Results: We recruited 376 patients with ischemic stroke between October 2018 and October 2019, mean age 64 +/- 13 years, 189 (49%) female. Median ABI was 1.06 (interquartile range - IQR 0.93 to 1.13). After 90 days, 209 (56%) patients had poor outcome. Low ABI was more frequent in patients with poor outcome (38% vs 18%, p=0.0001). After adjustment for age, sex and cerebrovascular risk factors, low ABI remained a significant predictor of poor outcome (odds ratio 2.10; 95% confidence interval 1.24 - 3.55, p=0.006). Conclusions: Low ABI is an independent predictor of poor outcome in acute stroke patients. Assessment of ABI on admission is clinically useful as a prognostic tool and should be more routinely implemented.

Midlife adiposity predicts cognitive decline in the prospective Multicenter AIDS Cohort Study

ObjectiveObesity is a common, modifiable cardiovascular and cerebrovascular risk factor. Among people with HIV, obesity may contribute to multisystem dysregulation including cognitive impairment. We examined body mass index (BMI) and central obesity (waist circumference [WC]) in association with domain-specific cognitive function and 10-year cognitive decline in men with HIV infection (MWH) vs HIV-uninfected (HIV−) men.MethodsA total of 316 MWH and 656 HIV− Multicenter AIDS Cohort Study participants ≥40 years at baseline, with neuropsychological testing every 2 years and concurrent BMI and WC measurements, were included. MWH were included if taking ≥2 antiretroviral agents and had HIV-1 RNA <400 copies/mL at >80% of visits. Mixed-effects models included all visits from 1996 to 2015, stratified by HIV serostatus, and adjusted for sociodemographic, behavioral, and clinical characteristics. At baseline and follow-up, 8% of MWH and 15% of HIV− men and 41% of MWH and 56% of HIV− men were ≥60 years, respectively.ResultsCross-sectionally, higher BMI was inversely associated with motor function in MWH and HIV− men, and attention/working memory in HIV− men. WC was inversely associated with motor function in MWH and HIV− men. Longitudinal associations indicated an obese BMI was associated with a less steep decline in motor function in MWH whereas in HIV− men, obesity was associated with a greater decline in motor function, learning, and memory. WC, or central obesity, showed similar patterns of associations.ConclusionHigher adiposity is associated with lower cognition cross-sectionally and greater cognitive decline, particularly in HIV− men. Overweight and obesity may be important predictors of neurologic outcomes and avenues for prevention and intervention.

Diabetic and Non-diabetic Subjects with Ischemic Stroke: Risk Factors, Stroke Topography and Hospital Outcome

Background and Purpose: Diabetes and ischemic stroke are common diseases that frequently occurring together. Several studies have shown that people with diabetes have approximately twice the risk of ischemic stroke compared with those without diabetes. Although diabetes is a strong risk factor for ischemic stroke, it is still unclear whether risk factors, neuroimaging findings and hospital outcome are different in diabetic and nondiabetic patients. The aim of the present study was to evaluate cerebrovascular risk factor prevalence, neuroimaging findings and hospital outcome in patients between diabetic and non-diabetic of ischaemic stroke.Methods: We conducted a prospective study of 380 consecutive patients with cerebral infarction admitted into Rangpur Medical College Hospital over a 18-month period. With the use of a simple identical data sheet, we recorded the demographics, cardiovascular risk factors, neuroimaging findings and outcome in ischemic stroke patients with and without diabetes.Results: Overall, diabetes was present in 76 patients (20%). Diabetic patients, compared with those without diabetes, were younger (p=.034) and they were more likely to have hypertension (69.7%), hyperlipidemia (28.9%), ischemic heart disease (22.4%), previous cerebral infract (23.7%) and renal impairment (19.7%). Diabetic infract more frequently occurred in thalamus (11.8%), pons (9.2%) and with cerebral posterior involvement (13.2%). Mortality was higher in diabetic group (P = .046).Conclusions: Diabetic patients had higher risk burden for ischemic stroke with poorer short term hospital outcome than non-diabetic subjects. So control of diabetes and other risk factors along with a strict observation of adult individuals’ healthy life-style should warrant successful ischemic stroke prevention in our country.J MEDICINE July 2017; 18 (2) : 75-79

STUDY OF HS-CRP IN PEOPLE OF HUE CITY

Background: High sensitivity C reactive protein is a protein that occur in acute phase of inflammation. hs-CRP is considered as a predict factor of cardiovascular and cerebrovascular risk. Framingham risk score is a strong predictor of cardiovascular and cerebrovascular risk and death. In Viet Nam there was still few studies about hs-CRP and Framingham risk score. Objective: To study the concentration of hs-CRP in peoples in Hue city, also the correlation of hs-CRP and cardiovascular and cerebrovascular risk factor, Framingham risk score. Methods: Clinical data of 1471 people age from 30-74 living in Hue city. We do clinical exam, paraclinical exam. We find out the correlations between hs-CRP and the cardiovascular and cerebrovascular risk factor, the correlations between hs-CRP and Framingham risk score. Results: (i) The concentration of hs-CRP of people in Hue city was 1.54 ± 3.81 mg/l. The concentration of hs-CRP in hyper cholesterol, hyper LDL, hypertension, smoke, obesity and hypo HDL group was significant higher than in the others groups (p<0.05). There was positive significant correlation between the concentration of hs-CRP and systolic blood pressure r=0.061(p< 0.05); (ii) There was positive significant correlation betwee the concentration of hs-CRP and cardiovascular risk (r=0.083; p<0.01) cerebrovascular risk (r=0.068; p<0.05). Conclusions: hs-CRP was a predict risk factor in cardiovascular and cerebrovascular. Key words: hs-CRP, Framingham, cardiovascular, cerebrovascular

A novel Aβ-fibrinogen interaction inhibitor rescues altered thrombosis and cognitive decline in Alzheimer’s disease mice

Many Alzheimer’s disease (AD) patients suffer from cerebrovascular abnormalities such as altered cerebral blood flow and cerebral microinfarcts. Recently, fibrinogen has been identified as a strong cerebrovascular risk factor in AD, as it specifically binds to β-amyloid (Aβ), thereby altering fibrin clot structure and delaying clot degradation. To determine if the Aβ–fibrinogen interaction could be targeted as a potential new treatment for AD, we designed a high-throughput screen and identified RU-505 as an effective inhibitor of the Aβ–fibrinogen interaction. RU-505 restored Aβ-induced altered fibrin clot formation and degradation in vitro and inhibited vessel occlusion in AD transgenic mice. Furthermore, long-term treatment of RU-505 significantly reduced vascular amyloid deposition and microgliosis in the cortex and improved cognitive impairment in mouse models of AD. Our studies suggest that inhibitors targeting the Aβ–fibrinogen interaction show promise as therapy for treating AD.