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  • #76
    Adiposity and ischemic and hemorrhagic stroke

    http://www.neurology.org/content/ear...00000000003171

    ABSTRACT

    Objective: To compare associations of body mass index (BMI) with ischemic stroke and hemorrhagic stroke risk, and to review the worldwide evidence.

    Methods: We recruited 1.3 million previously stroke-free UK women between 1996 and 2001 (mean age 57 years [SD 5]) and followed them by record linkage for hospital admissions and deaths. We used Cox regression to estimate adjusted relative risks for ischemic and hemorrhagic (intracerebral or subarachnoid hemorrhage) stroke in relation to BMI. We conducted a meta-analysis of published findings from prospective studies on these associations.

    Results: During an average follow-up of 11.7 years, there were 20,549 first strokes, of which 9,993 were specified as ischemic and 5,852 as hemorrhagic. Increased BMI was associated with an increased risk of ischemic stroke (relative risk 1.21 per 5 kg/m2 BMI, 95% confidence interval 1.18–1.23, p < 0.0001) but a decreased risk of hemorrhagic stroke (relative risk 0.89 per 5 kg/m2 BMI, 0.86–0.92, p < 0.0001). The BMI-associated trends for ischemic and hemorrhagic stroke were significantly different (heterogeneity: p < 0.0001) but were not significantly different for intracerebral hemorrhage (n = 2,790) and subarachnoid hemorrhage (n = 3,062) (heterogeneity: p = 0.5). Published data from prospective studies showed consistently greater BMI-associated relative risks for ischemic than hemorrhagic stroke with most evidence (prior to this study) coming from Asian populations.

    Conclusions: In UK women, higher BMI is associated with increased risk of ischemic stroke but decreased risk of hemorrhagic stroke. The totality of the available published evidence suggests that BMI-associated risks are greater for ischemic than for hemorrhagic stroke.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

    Comment


    • #77
      Atherosclerotic Risk Factors and Risk of Myocardial Infarction and Venous Thromboembolism; Time-Fixed versus Time-Varying Analyses. The Tromsø Study

      http://journals.plos.org/plosone/art...l.pone.0163242

      Abstract

      Background

      Single measurements of modifiable risk factors may underestimate associations with outcomes in cohorts. We aimed to compare risk estimates of myocardial infarction (MI) and venous thromboembolism (VTE) by atherosclerotic risk factors during long follow-up using time-fixed analyses without and with correction for regression dilution and time-varying analyses.

      Methods

      The study included 5970 subjects enrolled in the fourth survey of the Tromsø Study (1994/95). Blood pressure, lipid levels, body mass index (BMI), diabetes and smoking status were measured at baseline, and subjects still alive at the fifth (2001/02, n = 5179) and sixth (2007/08, n = 4391) survey were re-measured. Incident events of MI (n = 714) and VTE (n = 214) were recorded until December 2010. Time-fixed and time-varying Cox regression models were used to estimate hazard ratios (HR) for MI and VTE adjusted for age and sex.

      Results

      Variations in BMI, blood pressure and lipid levels were small, and did not alter the risk estimates when time-varying analyses were compared to time-fixed analyses. For MI, variables that changed considerably over time yielded the greatest changes in risk estimates (HR for smoking changed from 1.80 (95% CI 1.55–2.10) to 2.08 (95% CI 1.78–2.42)). For VTE, only BMI was associated with increased risk in both time-fixed and time-varying analysis, but the risk estimates weakened in the time-varying analysis. Correction of time-fixed HRs with Rosner´s method tended to overestimate risk estimates compared to time-varying analysis.

      Comment

      For MI and VTE, risk estimates based on baseline and repeated measures corresponded well, whereas correction for regression dilution tended to overestimate risks.
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • #78
        How workplace stress contributes to cardiovascular disease

        https://www.sciencedaily.com/release...0915163807.htm

        A model has been created that illustrates how economic globalization may create stressful employment factors in high-income countries contributing to the worldwide epidemic of cardiovascular disease.
        Jo Bowyer
        Chartered Physiotherapist Registered Osteopath.
        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

        Comment


        • #79
          The Number of Stenotic Intracranial Arteries Is Independently Associated with Ischemic Stroke Severity

          http://journals.plos.org/plosone/art...l.pone.0163356

          Abstract

          Background

          The severity of ischemic stroke symptoms varies among patients and is a critical determinant of patient outcome. To date, the association between the number of stenotic intracranial arteries and stroke severity remains unclear.

          Aims

          We aimed to investigate the association between the number of stenotic major intracranial arteries (NSMIA) and ischemic stroke severity, as well as the degree of stenosis and common stroke risk factors.

          Methods

          We performed a retrospective analysis of patients with digital subtraction angiography (DSA)-confirmed ischemic stroke. Clinical stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). The number of stenotic vessels was counted from the internal carotid arteries and vertebral arteries, bilaterally.

          Results

          Eighty three patients were recruited from a single center and included in the study. NSMIA was significantly correlated with stroke severity (Pearson Correlation Coefficient = 0.485, P < 0.001), but not with the degree of stenosis (Pearson Correlation Coefficient = 0.01, P = 0.90). Multivariate regression analysis revealed that NSMIA was significantly associated with the NIHSS score after adjusting for stroke risk factors. The adjusted odds ratio (per lateral) was 2.092 (95% CI, 0.865 to 3.308, P = 0.001). The degree of stenosis was also significantly associated with the NIHSS score after adjusting for common risk factors. The odds ratio (per 10%) was 0.712 (95% CI, 0.202 to 1.223, P = 0.007).

          Conclusions

          The number of stenotic intracranial major arteries is associated with the severity of ischemic stroke independent of the degree of stenosis and other stroke risk factors. To the best of our knowledge, this has not been previosuly studied in great detail using DSA. Our data highlight the importance of examining all major arteries in stroke patients.


          Impact of MCA stenosis on the early outcome in acute ischemic stroke patients
          http://journals.plos.org/plosone/art...l.pone.0175434

          Abstract

          Background

          Asians have higher frequency of intracranial arterial stenosis. The present study aimed to compare the clinical features and outcomes of ischemic stroke patients with and without middle cerebral artery (MCA) stenosis, assessed by transcranial sonography (TCS), based on the Taiwan Stroke Registry (TSR).

          Methods

          Patients with acute ischemic stroke or transient ischemic attack registered in the TSR, and received both carotid duplex and TCS assessment were categorized into those with stenosis (≥50%) and without (<50%) in the extracranial internal carotid artery (ICA) and MCA, respectively. Logistic regression analysis, Kaplan-Meier method and Cox proportional hazard model were applied to assess relevant variables between groups.

          Results

          Of 6003 patients, 23.3% had MCA stenosis, 10.1% ICA stenosis, and 3.9% both MCA and ICA stenosis. Patients with MCA stenosis had greater initial NIHSS, higher likelihood of stroke-in-evolution, and more severe disability than those without (all p<0.001). Patients with MCA stenosis had higher prevalence of hypertension, diabetes and hypercholesterolemia. Patients with combined MCA and extracranial ICA stenosis had even higher NIHSS, worse functional outcome, higher risk of stroke recurrence or death (hazard ratio, 2.204; 95% confidence intervals, 1.440–3.374; p<0.001) at 3 months after stroke than those without MCA stenosis.

          Conclusions

          In conclusion, MCA stenosis was more prevalent than extracranial ICA stenosis in ischemic stroke patients in Taiwan. Patients with MCA stenosis, especially combined extracranial ICA stenosis, had more severe neurological deficit and worse outcome.
          Update 10/04/2017
          Last edited by Jo Bowyer; 10-04-2017, 02:17 PM.
          Jo Bowyer
          Chartered Physiotherapist Registered Osteopath.
          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

          Comment


          • #80
            Serum Soluble Corin Deficiency Predicts Major Disability within 3 Months after Acute Stroke

            http://journals.plos.org/plosone/art...l.pone.0163731

            Abstract

            Objective

            Serum soluble corin has been associated with stroke. However, whether it is associated with stroke prognosis has not yet been studied. Therefore, we aimed to study the association of serum soluble corin with risk of poor outcomes within 3 months after stroke.

            Methods

            We followed 522 stroke patients for 3 months to identify major disability, death and vascular events. Serum soluble corin was measured at baseline for all participants. Logistic regression was used to examine the associations of baseline serum soluble corin with outcomes of stroke, adjusting for age, sex, baseline NIHSS score, hours from onset to hospitalization, smoking, drinking, hypertension, diabetes, coronary heart disease, atrial fibrillation, family history of stroke, and stroke subtype.

            Results

            Patients with high corin had a significantly lower crude risk for the composite outcome of major disability or death (OR = 0.64, 95%CI: 0.43–0.96) than patients with low corin (the lowest tertile). After adjustment for age and baseline NIHSS score, patients with high corin still had a significantly lower risk for the composite outcome of major disability or death (OR = 0.60, 95%CI: 0.36–0.99). This association became bottom line significant after additionally adjusting for other conventional factors (OR = 0.61, P = 0.058). No association was found between serum soluble corin and other composite outcomes.

            Conclusion

            Serum soluble corin deficiency predicted risk for major disability within 3 months after stroke, independent of baseline neurological deficient. Our results may indicate a probable role of corin in stroke prognosis.

            Human corin, a type II transmembrane serine protease, is highly expressed by cardiomyocytes.[7, 8] It plays a key role in the regulation of blood volume, blood pressure and cardiac function through activating natriuretic peptides.[9, 10] Corin is shed from the myocyte cell surface, enters the circulation, and is easily measurable.[11] Soluble corin in the circulation has been studied in some disease states, such as heart failure [12], hypertension [13], obesity [14], and pregnant hypertension [15], all of which are associated with stroke prognosis. Recently, we found that decreased serum soluble corin was associated with an increased risk for stroke by a case-control study design.[16] While existing evidence may suggest a probable association between serum soluble corin and stroke prognosis, little is known about the association between serum soluble corin and major disability after stroke in human population. Here, we prospectively followed 522 stroke patients for 3 months to study the prognostic value of serum soluble corin.



            Voxelwise distribution of acute ischemic stroke lesions in patients with newly diagnosed atrial fibrillation: Trigger of arrhythmia or only target of embolism?

            http://journals.plos.org/plosone/art...l.pone.0177474

            Abstract

            Objective

            Atrial fibrillation (AF) is frequently detected after ischemic stroke for the first time, and brain regions involved in autonomic control have been suspected to trigger AF. We examined whether specific brain regions are associated with newly detected AF after ischemic stroke.

            Methods

            Patients with acute cerebral infarctions on diffusion-weighted magnetic resonance imaging were included in this lesion mapping study. Lesions were mapped and modeled voxelwise using Bayesian Spatial Generalised Linear Mixed Modeling to determine differences in infarct locations between stroke patients with new AF, without AF and with AF already known before the stroke.

            Results

            582 patients were included (median age 68 years; 63.2% male). AF was present in 109/582 patients [(18.7%); new AF: 39/109 (35.8%), known AF: 70/109 (64.2%)]. AF patients had larger infarct volumes than patients without AF (mean: 29.7 ± 45.8 ml vs. 15.2 ± 35.1 ml; p<0.001). Lesions in AF patients accumulated in the right central middle cerebral artery territory. Increasing stroke size predicted progressive cortical but not pontine and thalamic involvement. Patients with new AF had more frequently lesions in the right insula compared to patients without AF when stroke size was not accounted for, but no specific brain region was more frequently involved after adjustment for infarct volume. Controlled for stroke size, left parietal involvement was less likely for patients with new AF than for those without AF or with known AF.

            Conclusions

            In the search for brain areas potentially triggering cardiac arrhythmias infarct size should be accounted for. After controlling for infarct size, there is currently no evidence that ischemic stroke lesions of specific brain areas are associated with new AF compared to patients without AF. This challenges the neurogenic hypothesis of AF according to which a relevant proportion of new AF is triggered by ischemic brain lesions of particular locations.
            Update 25/05/2017
            Last edited by Jo Bowyer; 25-05-2017, 07:22 AM.
            Jo Bowyer
            Chartered Physiotherapist Registered Osteopath.
            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

            Comment


            • #81
              Self-Reported Sitting Time, Physical Activity and Fibrinolytic and Other Novel Cardio-Metabolic Biomarkers in Active Swedish Seniors

              http://journals.plos.org/plosone/art...l.pone.0163409

              Abstract

              Background

              Too much sitting is linked with an increased risk of cardiovascular disease and mortality. The mediating mechanisms for these associations are largely unknown, however dysregulated fibrinolysis have emerged as a possible contributor.

              Objective

              We examined the associations of self-reported overall sitting time and physical activity with fibrinolytic and other novel cardio-metabolic biomarkers in older adults.

              Materials and Methods

              Data was analysed for 364 participants (74±7 yrs) of the Active Seniors group (retired, living independently in their own homes). Linear regression analyses examined associations of categories of categories of sitting time (≤3, 3–6, >6 hrs/day) and overall physical activity (Low, Moderate and High) with biomarkers in serum or plasma, adjusting for age, gender and smoking (with further adjustment for either overall physical activity or sitting time and BMI in secondary analyses).

              Results

              Compared to sitting ≤ 3 hrs/day, sitting >6 hrs/day was associated with higher tissue plasminogen activator (tPA) and tissue plasminogen activator/plasminogen activator inhibitor-1 complex (tPA-PAI-1 complex). These associations were not independent of overall physical activity or BMI. Compared to those in the high physical activity, low physical activity was associated with a higher BMI, high-sensitivity C-reactive protein (hs-CRP) and tPA-PAI-1 complex levels. Only the associations of BMI and hs-CRP were independent of sitting time.

              Conclusions

              These findings provide preliminary cross-sectional evidence for the relationships of sitting time with fibrinolytic markers in older adults. They also reinforce the importance of regular physical activity for cardio-metabolic health.
              Jo Bowyer
              Chartered Physiotherapist Registered Osteopath.
              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

              Comment


              • #82
                Hoarse Speech: An Unusual Presentation of Vertebral Artery Dissection

                http://practicalneurology.com/2016/0...ry-dissection/

                Vertebral Artery Dissection (VAD) refers to a non-hemorrhagic cerebrovascular event caused by a flap-like tear in the vertebral arteries of the cervical vasculature. VAD events along with carotid artery dissection (CAD) are generally spontaneous and are among the more common causes of ischemic stroke in the younger patient population.1 The clinical sequelae of VADs follow that of posterior circulation infarctions. Signs and symptoms can range from vision loss to dysphagia.2 We present the case of a patient who underwent a lumbar laminectomy at an outside hospital, and five days later presented to our institution with hoarseness. He was later found to have a left VAD.
                via @acpivr

                It's rare, but I saw one in the '80s, he also had swallowing difficulties which I had to deal with as there wasn't a speech therapist available.
                Last edited by Jo Bowyer; 27-09-2016, 01:58 AM.
                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                Comment


                • #83
                  Pre-screening for young athletes at risk of sudden cardiac death. What works and what doesn't, and at what cost

                  https://www.sciencedaily.com/release...0929111715.htm

                  Although rare, sudden cardiac death in young athletes raises serious concerns, especially because most victims report no warning symptoms. Pre-participation screening aims to identify children, adolescents, and young adults at risk, but there is not yet consensus regarding the best way to accomplish this. A new report sheds light on this controversial topic by describing a new screening protocol that offers advantages over American Heart Association (AHA) recommendations and shows that the electrocardiogram (ECG) is the best single screening method.
                  Jo Bowyer
                  Chartered Physiotherapist Registered Osteopath.
                  "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                  Comment


                  • #84
                    Twitter as a Potential Data Source for Cardiovascular Disease Research

                    http://cardiology.jamanetwork.com/ar...icleid=2556216

                    Importance As society is increasingly becoming more networked, researchers are beginning to explore how social media can be used to study person-to-person communication about health and health care use. Twitter is an online messaging platform used by more than 300 million people who have generated several billion Tweets, yet little work has focused on the potential applications of these data for studying public attitudes and behaviors associated with cardiovascular health.

                    Objective To describe the volume and content of Tweets associated with cardiovascular disease as well as the characteristics of Twitter users.

                    Design, Setting, and Participants We used Twitter to access a random sample of approximately 10 billion English-language Tweets originating from US counties from July 23, 2009, to February 5, 2015, associated with cardiovascular disease. We characterized each Tweet relative to estimated user demographics. A random subset of 2500 Tweets was hand-coded for content and modifiers.

                    Main Outcomes and Measures The volume of Tweets about cardiovascular disease and the content of these Tweets.

                    Results Of 550 338 Tweets associated with cardiovascular disease, the terms diabetes (n = 239 989) and myocardial infarction (n = 269 907) were used more frequently than heart failure (n = 9414). Users who Tweeted about cardiovascular disease were more likely to be older than the general population of Twitter users (mean age, 28.7 vs 25.4 years; P < .01) and less likely to be male (59 082 of 124 896 [47.3%] vs 8433 of 17 270 [48.8%]; P < .01). Most Tweets (2338 of 2500 [93.5%]) were associated with a health topic; common themes of Tweets included risk factors (1048 of 2500 [41.9%]), awareness (585 of 2500 [23.4%]), and management (541 of 2500 [21.6%]) of cardiovascular disease.

                    Conclusions and Relevance Twitter offers promise for studying public communication about cardiovascular disease.
                    Lateral thinking! :thumbs_up
                    Jo Bowyer
                    Chartered Physiotherapist Registered Osteopath.
                    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                    Comment


                    • #85
                      Modifying Risk Factors Could Prevent Most Strokes Worldwide, Two International Studies Find

                      http://journals.lww.com/neurotodayon...trokes.12.aspx

                      ARTICLE IN BRIEF

                      In two different international trials, investigators identified modifiable risk factors that could prevent stroke worldwide. One study found that controlling hypertension could prevent nearly half of strokes worldwide; the other study found that nearly 20 percent of strokes related to atrial fibrillation could be prevented if more people were treated with anticoagulants.
                      Hmmm....most strokes? It's worth looking at in terms of populations, but how about family history and lifestyle issues. N=1.



                      Relationship Between Gut Bacteria and Common Brain Disease Discovered

                      http://neurosciencenews.com/microbiome-ccm-6635/

                      Bacteria in the gut microbiome drive the formation of cerebral cavernous malformations (CCMs), clusters of dilated, thin-walled blood vessels in the brain that can cause stroke and seizures, according to new research published this week in Nature by researchers from the Perelman School of Medicine at the University of Pennsylvania. Led by Mark Kahn, MD, a professor of Cardiovascular Medicine, the team’s research suggests that altering the microbiome in CCM patients may be an effective therapy for this cerebrovascular disease. CCM disease, which occurs in about one in 100 to 200 people, can present in two forms. One is sporadic, accounting for 80 percent of cases, and is most frequent in older individuals. The remaining 20 percent are familial, inherited cases.
                      10/05/2017


                      Changes in the living arrangement and risk of stroke in Japan; does it matter who lives in the household? Who among the family matters?

                      http://journals.plos.org/plosone/art...l.pone.0173860

                      Abstract

                      Previous studies have suggested associations of family composition with morbidity and mortality; however, the evidence of associations with risk of stroke is limited. We sought to examine the impact of changes in the household composition on risk of stroke and its types in Japanese population. Cox proportional hazard modelling was used to assess the risk of incident stroke and stroke types within a cohort of 77,001 Japanese men and women aged 45–74 years who experienced addition and/or loss of family members [spouse, child(ren), parent(s) and others] to their households over a five years interval (between 1990–1993 and 1995–1998). During 1,043,446 person-years of the follow-up for 35,247 men and 41,758 women, a total of 3,858 cases of incident stroke (1485 hemorrhagic and 2373 ischemic) were documented. When compared with a stable family composition, losing at least one family member was associated with 11–15% increased risk of stroke in women and men; hazard ratios (95% confidence interval) were 1.11 (1.01–1.22) and 1.15 (1.05–1.26), respectively. The increased risk was associated with the loss of a spouse, and was evident for ischemic stroke in men and hemorrhagic stroke in women. The addition of any family members to the household was not associated with risk of stroke in men, whereas the addition of a parent (s) to the household was associated with increased risk in women: 1.49 (1.09–2.28). When the loss of a spouse was accompanied by the addition of other family members to the household, the increased risk of stroke disappeared in men: 1.18 (0.85–1.63), but exacerbated in women: 1.58 (1.19–2.10). In conclusion, men who have lost family members, specifically a spouse have higher risk of ischemic stroke, and women who gained family members; specifically a parent (s) had the higher risk of hemorrhagic stroke than those with a stable family composition.
                      Update 14/07/2017
                      Last edited by Jo Bowyer; 10-05-2017, 09:23 PM.
                      Jo Bowyer
                      Chartered Physiotherapist Registered Osteopath.
                      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                      Comment


                      • #86
                        National clinical guideline for stroke

                        http://guideline.ssnap.org/2016Strok...ine/index.html
                        Jo Bowyer
                        Chartered Physiotherapist Registered Osteopath.
                        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                        Comment


                        • #87
                          Executive Cognitive Functioning and Cardiovascular Autonomic Regulation in a Population-Based Sample of Working Adults

                          http://journal.frontiersin.org/artic...016.01536/full

                          Objective: Executive cognitive functioning is essential in private and working life and is sensitive to stress and aging. Cardiovascular (CV) health factors are related to cognitive decline and dementia, but there is relatively few studies of the role of CV autonomic regulation, a key component in stress responses and risk factor for cardiovascular disease (CVD), and executive processes. An emerging pattern of results from previous studies suggest that different executive processes may be differentially associated with CV autonomic regulation. The aim was thus to study the associations between multiple measures of CV autonomic regulation and measures of different executive cognitive processes.

                          Method: Participants were 119 healthy working adults (79% women), from the Swedish Longitudinal Occupational Survey of Health. Electrocardiogram was sampled for analysis of heart rate variability (HRV) measures, including the Standard Deviation of NN, here heart beats (SDNN), root of the mean squares of successive differences (RMSSD), high frequency (HF) power band from spectral analyses, and QT variability index (QTVI), a measure of myocardial repolarization patterns. Executive cognitive functioning was measured by seven neuropsychological tests. The relationships between CV autonomic regulation measures and executive cognitive measures were tested with bivariate and partial correlational analyses, controlling for demographic variables, and mental health symptoms.

                          Results: Higher SDNN and RMSSD and lower QTVI were significantly associated with better performance on cognitive tests tapping inhibition, updating, shifting, and psychomotor speed. After adjustments for demographic factors however (age being the greatest confounder), only QTVI was clearly associated with these executive tests. No such associations were seen for working memory capacity.

                          Conclusion: Poorer CV autonomic regulation in terms of lower SDNN and RMSSD and higher QTVI was associated with poorer executive cognitive functioning in terms of inhibition, shifting, updating, and speed in healthy working adults. Age could largely explain the associations between the executive measures and SDNN and RMSSD, while associations with QTVI remained. QTVI may be a useful measure of autonomic regulation and promising as an early indicator of risk among otherwise healthy adults, compared to traditional HRV measures, as associations between QTVI and executive functioning was not affected by age.
                          Jo Bowyer
                          Chartered Physiotherapist Registered Osteopath.
                          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                          Comment


                          • #88
                            The Association between Educational Level and Cardiovascular and Cerebrovascular Diseases within the EPICOR Study: New Evidence for an Old Inequality Problem

                            http://journals.plos.org/plosone/art...l.pone.0164130

                            Abstract

                            Background

                            A consistent association has been reported between low socioeconomic status (SES) and cardiovascular events (CE), whereas the association between SES and cerebrovascular events (CBVD) is less clear. The aim of this study was to investigate the association between SES (measured using education) and CE/CBVD in a cohort study, as well as to investigate lifestyle and clinical risk factors, to help to clarify the mechanisms by which SES influences CE/CBVD.

                            Material and Methods

                            We searched for diagnoses of CE and CBVD in the clinical records of 47,749 members of the EPICOR cohort (average follow-up time: 11 years). SES was determined by the relative index of inequality (RII).

                            Results

                            A total of 1,156 CE and 468 CBVD were found in the clinical records. An increased risk of CE was observed in the crude Cox model for the third tertile of RII compared to the first tertile (hazard ratio [HR] = 1.39; 95% confidence interval [CI] 1.21–1.61). The increased risk persisted after adjustment for lifestyle risk factors (HR = 1.19; 95%CI 1.02–1.38), clinical risk factors (HR = 1.35; 95%CI 1.17–1.56), and after full adjustment (HR = 1.17; 95%CI 1.01–1.37). Structural equation model showed that lifestyle rather than clinical risk factors are involved in the mechanisms by which education influences CE. No significant association was found between education and CBVD. A strong relationship was observed between education and diabetes at baseline.

                            Conclusion

                            The most important burden of inequality in CE incidence in Italy is due to lifestyle risk factors.
                            Jo Bowyer
                            Chartered Physiotherapist Registered Osteopath.
                            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                            Comment


                            • #89
                              Developing the Stroke Exercise Preference Inventory (SEPI)

                              http://journals.plos.org/plosone/art...l.pone.0164120

                              Abstract

                              Background

                              Physical inactivity is highly prevalent after stroke, increasing the risk of poor health outcomes including recurrent stroke. Tailoring of exercise programs to individual preferences can improve adherence, but no tools exist for this purpose in stroke.

                              Methods

                              We identified potential questionnaire items for establishing exercise preferences via: (i) our preliminary Exercise Preference Questionnaire in stroke, (ii) similar tools used in other conditions, and (iii) expert panel consultations. The resulting 35-item questionnaire (SEPI-35) was administered to stroke survivors, along with measures of disability, depression, anxiety, fatigue and self-reported physical activity. Exploratory factor analysis was used to identify a factor structure in exercise preferences, providing a framework for item reduction. Associations between exercise preferences and personal characteristics were analysed using multivariable regression.

                              Results

                              A group of 134 community-dwelling stroke survivors (mean age 64.0, SD 13.3) participated. Analysis of the SEPI-35 identified 7 exercise preference factors (Supervision-support, Confidence-challenge, Health-wellbeing, Exercise context, Home-alone, Similar others, Music-TV). Item reduction processes yielded a 13-item version (SEPI-13); in analysis of this version, the original factor structure was maintained. Lower scores on Confidence-challenge were significantly associated with disability (p = 0.002), depression (p = 0.001) and fatigue (p = 0.001). Self-reported barriers to exercise were particularly prevalent in those experiencing fatigue and anxiety.

                              Conclusions

                              The SEPI-13 is a brief instrument that allows assessment of exercise preferences and barriers in the stroke population. This new tool can be employed by health professionals to inform the development of individually tailored exercise interventions.
                              Jo Bowyer
                              Chartered Physiotherapist Registered Osteopath.
                              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                              Comment


                              • #90
                                No Impact of Body Mass Index on Outcome in Stroke Patients Treated with IV Thrombolysis BMI and IV Thrombolysis Outcome

                                http://journals.plos.org/plosone/art...l.pone.0164413

                                Abstract

                                Background and Purpose

                                The impact of excess body weight on prognosis after stroke is controversial. Many studies report higher survival rates in obese patients (“obesity paradox”). Recently, obesity has been linked to worse outcomes after intravenous (IV) thrombolysis, but the number and sample size of these studies were small. Here, we aimed to assess the relationship between body weight and stroke outcome after IV thrombolysis in a large cohort study.

                                Methods

                                In a prospective observational multicenter study, we analyzed baseline and outcome data of 896 ischemic stroke patients who underwent IV thrombolysis. Patients were categorized according to body mass index (BMI) as underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2) or severely obese (>35 kg/m2). Using uni- and multivariate modeling, we assessed the relationship of BMI with favorable outcome (defined as modified Rankin Scale 0 or 1) and mortality 3 months after stroke as well as the occurrence of symptomatic intracerebral hemorrhages (sICH). We also measured the incidence of patients that had an early neurological improvement of >40% on the National Institutes of Health Stroke Scale (NIHSS) after 24 hours.

                                Results

                                Among 896 patients, 321 were normal weight (35.8%), 22 underweight (2.5%), 378 overweight (42.2%), 123 obese (13.7%) and 52 severely obese (5.8%). Three-month mortality was comparable in obese vs. non-obese patients (8.1% vs. 8.3%) and did not differ significantly among different BMI groups. This was also true for favorable clinical outcome, risk of sICH and early neurological improvement on NIHSS at 24 hours. These results remained unchanged after adjusting for potential confounding factors in the multivariate analyses.

                                Conclusion

                                BMI was not related to clinical outcomes in stroke patients treated with IVT. Our data suggest that the current weight-adapted dosage scheme of IV alteplase is appropriate for different body weight groups, and challenge the existence of the obesity paradox after stroke.
                                Obesity makes stroke rehab difficult for all concerned. It is good to know that thrombolysis may be equally effective in this group.
                                Jo Bowyer
                                Chartered Physiotherapist Registered Osteopath.
                                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                                Comment

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