RESUMO
"Eat a variety of foods," or dietary diversity, is a widely accepted recommendation to promote a healthy, nutritionally adequate diet and to reduce the risk of major chronic diseases. However, recent evidence from observational studies suggests that greater dietary diversity is associated with suboptimal eating patterns, that is, higher intakes of processed foods, refined grains, and sugar-sweetened beverages and lower intakes of minimally processed foods, such as fish, fruits, and vegetables, and may be associated with weight gain and obesity in adult populations. This American Heart Association science advisory summarizes definitions for dietary diversity and reviews current evidence on its relationship with obesity outcomes, eating behavior, and food-based diet quality measures. Current data do not support greater dietary diversity as an effective strategy to promote healthy eating patterns and healthy body weight. Given the current state of the science on dietary diversity and the insufficient data to inform recommendations on specific aspects of dietary diversity that may be beneficial or detrimental to healthy weight, it is appropriate to promote a healthy eating pattern that emphasizes adequate intake of plant foods, protein sources, low-fat dairy products, vegetable oils, and nuts and limits consumption of sweets, sugar-sweetened beverages, and red meats.
Assuntos
Dieta Saudável , Obesidade/prevenção & controle , Comportamento de Redução do Risco , Adiposidade , American Heart Association , Comportamento Alimentar , Humanos , Valor Nutritivo , Obesidade/epidemiologia , Obesidade/fisiopatologia , Obesidade/psicologia , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Estados UnidosRESUMO
Background and Purpose- The proportion of patients with acute ischemic stroke or transient ischemic attack (TIA) and obesity who successfully achieve goals for weight reduction recommended by major professional organizations is unknown. Methods- We examined the experience of participants in the placebo group of the IRIS trial (Insulin Resistance Intervention after Stroke) with a body mass index ≥30 kg/m2 at entry. Patients were of age ≥40 years, with a qualifying stroke or TIA within 180 days of randomization and documented insulin resistance without diabetes mellitus. Weights at baseline and at years 1 and 2 after entry were analyzed to determine the proportion of patients achieving a 5% weight loss and achievement of body mass index <27 kg/m2. Results- Of 1937 subjects assigned to placebo, 855 (44%) had obesity at entry. Median age of these 855 subjects was 60 years (interquartile range, 53-68), 41% were women, and median time from stroke/TIA to trial entry was 79 days. Among 788 subjects in the trial at 1 year, 166 (21%) had lost at least 5% of their starting weight and 12 (2%) had achieved a body mass index <27 kg/m2. One hundred nine (14%) participants gained at least 5% of their baseline weight at 1 year. Among 744 subjects in the trial at 2 years, 185 (25%) had lost at least 5% of their baseline weight and 23 (3%) had achieved a body mass index <27 kg/m2. One hundred forty (19%) participants gained at least 5% of their starting weight at 2 years. Conclusions- Only one quarter of obese patients with a recent ischemic stroke or TIA lost a clinically significant amount of weight after their vascular event. Many patients gained weight. Enhancing weight loss after ischemic stroke or TIA may help improve functional outcome and reduce risk for future vascular events, but clinical trials are needed to test and confirm these potential benefits.
Assuntos
Isquemia Encefálica/terapia , Obesidade/terapia , Acidente Vascular Cerebral/terapia , Redução de Peso , Idoso , Índice de Massa Corporal , Isquemia Encefálica/complicações , Feminino , Objetivos , Guias como Assunto , Humanos , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Acidente Vascular Cerebral/complicações , Resultado do Tratamento , Aumento de PesoRESUMO
Background and Purpose- The insulin sensitizer, pioglitazone, reduces cardiovascular risk in patients after an ischemic stroke or transient ischemic attack but increases bone fracture risk. We conducted a secondary analysis of the IRIS trial (Insulin Resistance Intervention After Stroke) to assess the effect of pretreatment risk for fracture on the net benefits of pioglitazone therapy. Methods- IRIS was a randomized placebo-controlled trial of pioglitazone that enrolled patients with insulin resistance but without diabetes mellitus within 180 days of an ischemic stroke or transient ischemic attack. Participants were recruited at 179 international centers from February 2005 to January 2013 and followed for a median of 4.8 years. Fracture risk models were developed from patient characteristics at entry. Within fracture risk strata, we quantified the effects of pioglitazone compared with placebo by estimating the relative risks and absolute 5-year risk differences for fracture and stroke or myocardial infarction. Results- The fracture risk model included points for age, race-ethnicity, sex, body mass index, disability, and medications. The relative increment in fracture risk with pioglitazone was similar in the lower (
RESUMO
BACKGROUND AND PURPOSE: Intracerebral hemorrhage (ICH) has the highest mortality rate among all strokes. While ICH location, lobar versus non-lobar, has been established as a predictor of mortality, less is known regarding the relationship between more specific ICH locations and functional outcome. This review summarizes current work studying how ICH location affects outcome, with an emphasis on how studies designate regions of interest. METHODS: A systematic search of the OVID database for relevant studies was conducted during August 2015. Studies containing an analysis of functional outcome by ICH location or laterality were included. As permitted, the effect size of individual studies was standardized within a meta-analysis. RESULTS: Thirty-seven studies met the inclusion criteria, the majority of which followed outcome at 3 months. Most studies found better outcomes on the Modified Rankin Scale (mRS) or Glasgow Outcome Score (GOS) with lobar compared to deep ICHs. While most aggregated deep structures for analysis, some studies found poorer outcomes for thalamic ICH in particular. Over half of the studies did not have specific methodological considerations for location designations, including blinding or validation. CONCLUSIONS: Multiple studies have examined motor-centric outcomes, with few studies examining quality of life (QoL) or cognition. Better functional outcomes have been suggested for lobar versus non-lobar ICH; few studies attempted finer topographic comparisons. This study highlights the need for improved reporting in ICH outcomes research, including a detailed description of hemorrhage location, reporting of the full range of functional outcome scales, and inclusion of cognitive and QoL outcomes.
Assuntos
Hemorragia Cerebral/patologia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Hemorragia Cerebral/terapia , HumanosRESUMO
BACKGROUND AND PURPOSE: The term metabolic syndrome describes the clustering of risk factors found in many individuals with obesity. Because of their pathophysiology, we hypothesized that 2 features of metabolic syndrome, central obesity and insulin resistance (IR), would be associated with cerebrovascular changes on magnetic resonance imaging, and specifically with incident lacunar disease and not white matter hyperintensity (WMH) progression. METHODS: Risk factors were defined at study baseline in 934 participants in the Atherosclerosis Risk in Communities (ARIC) study, who completed 2 brain magnetic resonance imagings≈10 years apart. WMH progression and incident lacunes between the 2 magnetic resonance imagings were determined. An IR score for each participant was created using principal component analysis of 11 risk factors, including (among others): insulin, homeostatic model assessment-IR, body mass index, and waist circumference. Metabolic syndrome (presence/absence), using standard clinical definitions, and IR score at the first magnetic resonance imaging, were independent variables, evaluated in multivariate logistic regression to determine odds of WMH progression (Q5 versus Q1-Q4) and incident lacunes. RESULTS: Metabolic syndrome (adjusted odds ratio, 1.98; 95% confidence interval, 1.28-3.05) and IR score (adjusted odds ratio per 1-SD increase, 1.33; 95% confidence interval, 1.05-1.68) were associated with incident lacunes but not with WMH progression. Insulin, homeostatic model assessment-IR, and body mass index were not associated with incident lacunes or WMH progression in separate models. CONCLUSIONS: The IR score and central obesity are associated with incident lacunar disease but not WMH progression in individuals. Central obesity and IR may be important risk factors to target to prevent lacunar disease.
Assuntos
Aterosclerose/diagnóstico , Resistência à Insulina , Imageamento por Ressonância Magnética , Obesidade/diagnóstico , Características de Residência , Acidente Vascular Cerebral Lacunar/diagnóstico , Aterosclerose/epidemiologia , Feminino , Humanos , Incidência , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Microvasos/patologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral Lacunar/epidemiologiaRESUMO
BACKGROUND: Midlife metabolic syndrome (MetS) may impact cognitive health as a construct independently of hypertension, hyperlipidemia and other components. METHODS: 10,866 participants aged 45-64 years at baseline were assessed for MetS and completed cognitive testing at two later time points (3 and 9 years from the baseline visit). RESULTS: MetS is associated with increased odds of low cognitive performance in the domains of executive function and word fluency, but not with 6-year cognitive decline. Individual MetS components explained this association (hypertension, diabetes, low HDL, elevated triglycerides and increased waist circumference). CONCLUSIONS: A focus on the individual risk factors as opposed to MetS during midlife is important to reduce the incidence of cognitive impairment in later life.
Assuntos
Transtornos Cognitivos/epidemiologia , Síndrome Metabólica/complicações , Transtornos Cognitivos/complicações , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
A 41-year-old man, during a neurological consultation, reported "chin twitching" over a period of a week, which was diagnosed as intermittent perioral myoclonia. With only one tonic-clonic seizure seven years before, he had mentioned several episodes of chin twitching over the years. In the clinic, there were intermittent chin movements without apparent confusion, as he was able to provide a complete history and was fully oriented with intact memory. His video-EEG showed paroxysms of polyspike and slow-wave activity, with the longest burst-free interval being 20 seconds. Discharges were maximal over the fronto-central regions, correlating with the chin myoclonus. He was able to tap his hand continuously, and remained alert. The case represents an atypical presentation of idiopathic generalised epilepsy without manifestation of absence or limb myoclonus. Although juvenile myoclonic epilepsy and other idiopathic epilepsies are rarely associated with perioral myoclonia, this sign was the principal clinical feature for this patient. Oral treatment with levetiracetam resolved his seizures.
Assuntos
Epilepsia Mioclônica Juvenil/fisiopatologia , Convulsões/fisiopatologia , Adulto , Diagnóstico Diferencial , Eletroencefalografia/métodos , Humanos , Levetiracetam , Masculino , Epilepsia Mioclônica Juvenil/complicações , Epilepsia Mioclônica Juvenil/diagnóstico , Piracetam/análogos & derivados , Piracetam/uso terapêutico , Convulsões/etiologia , Resultado do Tratamento , Gravação em Vídeo/métodosRESUMO
This article was migrated. The article was marked as recommended. Background: Ample data demonstrates that sleep deprivation leads to impaired functioning including cognitive performance, memory and fine motor skills. Medical students represent a professional sector in which optimizing cognitive performance and functioning is critical from a personal, public health and safety perspective. Aims: To characterize chronotypes of an international cohort of medical students and determine if chronotype is affected by demographics or latitude. Samples: 328 students from medical schools in the United States (US), Malaysia and United Arab Emirates (UAE) were assessed for differences in chronotype and sleep habits. Methods: A cross-sectional, questionnaire-based study from medical schools in the US, Malaysia and UAE between 2013 and 2015. Results: There was a significant difference in mean waking times for Malaysian students who reported awakening earlier than US or UAE students. Malaysian students were most likely to feel their best earlier in the day and consider themselves a "morning type." UAE students were more likely to do "hard physical work" later in the day, followed by US and Malaysian. On average, US students were less likely to shift their bedtime later if they had no commitments the next day. Overall, mean chronotype score was "neither" type for all three groups however the Malaysian group showed a significant preference for morning hours in some individual questions. Conclusion: Medical student sleep patterns vary internationally but chronotype may not. Improving sleep education globally, with awareness of the effects of chronotype, could ultimately result in improved sleep awareness, potentially influencing physician wellbeing, patient care and safety.
RESUMO
BACKGROUND: Previous studies have suggested that adherence to healthy dietary patterns during late life may be associated with improved cognition. However, few studies have examined the association between healthy dietary patterns during midlife and incident dementia. OBJECTIVE: Our study aimed to determine the association between adherence to healthy dietary patterns at midlife and incident dementia. METHODS: We included 13,630 adults from the Atherosclerosis Risk in Communities (ARIC) Study in our prospective analysis. We used food frequency questionnaire responses to calculate four dietary scores: Healthy Eating Index-2015 (HEI-2015), Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean (aMed) diet, and Dietary Approaches to Stop Hypertension (DASH). Participants were followed until the end of 2017 for incident dementia. Cox regression models adjusted for covariates were used to estimate risk of incident dementia by quintile of dietary scores. RESULTS: Over a median of 27 years, there were 2,352 cases of incident dementia documented. Compared with participants in quintile 1 of HEI-2015, participants in quintile 5 (healthiest) had a 14% lower risk of incident dementia (hazard ratio, HR: 0.86, 95% confidence interval, CI: 0.74-0.99). There were no significant associations of incident dementia with the AHEI-2010, aMed, or DASH scores. There were no significant interactions by sex, age, race, education, physical activity, hypertension, or obesity. CONCLUSION: Adherence to the HEI-2015, but not the other dietary scores, during midlife was associated with lower risk of incident dementia. Further research is needed to elucidate whether timing of a healthy diet may influence dementia risk.
Assuntos
Aterosclerose/epidemiologia , Demência/epidemiologia , Dieta Saudável/tendências , Vida Independente/tendências , Autorrelato , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/diagnóstico , Aterosclerose/psicologia , Estudos de Coortes , Demência/diagnóstico , Demência/psicologia , Dieta Saudável/psicologia , Feminino , Seguimentos , Humanos , Incidência , Vida Independente/psicologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND AND PURPOSE: Women face a higher mortality after stroke and have different risk factors than men. Despite educational campaigns, women continue to underestimate their own risk for stroke. We present a theoretical model to understand risk perception in high-risk women. METHODS: Eight hundred five women, ages 50 to 70 years, were selected from the University of Connecticut Cardiology Center with at least one risk factor for stroke. A 5-part questionnaire addressed stroke knowledge, risk perception, risk factors, access to health care, and demographics. Two hundred fifteen women responded by mail (28% response rate) and deidentified data were entered in SPSS. Descriptive, bivariate, and multivariate techniques assessed the proposed model. RESULTS: The cohort was predominantly white (91.5%), higher income (33.1% of the population earned >$75,000), and well-educated (28.6% attended graduate or professional school). Only 2 of the 37 (5.4%) women with atrial fibrillation and 11 of the 71 women with heart disease (15.5%) identified their health condition as a risk factor for stroke. Predictors of risk perception included: other women's risk (B=0.336, P<0.001), worrying about stroke (B=0.734, P<0.001), having hypertension (B=0.686, P=0.037), and having diabetes (B=0.893, P=0.004). Only 63.9% of women with atrial fibrillation (n=23) reported taking warfarin. CONCLUSIONS: Women were often unable to identify their health condition as a risk factor for stroke. In addition, many women were not undertaking primary prevention behaviors. Risk perception was low, and high-risk women perceived their risk of stroke to be the same as their peers. Educational strategies must advocate for and target high-risk women.
Assuntos
Comportamentos Relacionados com a Saúde , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Saúde da Mulher , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/psicologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/psicologia , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Hipertensão/psicologia , Pessoa de Meia-Idade , Percepção , Fatores de Risco , Acidente Vascular Cerebral/prevenção & controle , Inquéritos e QuestionáriosRESUMO
Objective: A healthy diet is associated with reduced risk for stroke, myocardial infarction, cancer and death. We examined the prevalence of a healthy diet in patients with a recent stroke or transient ischaemic attack (TIA). Methods: We recruited a convenience sample of 95 patients with a recent ischaemic stroke or TIA. Using information from a 125-item Food Frequency Questionnaire, we calculated dietary quality and the percentage of patients meeting recommended daily intake (RDI) for common macronutrients and elements. Results: The mean age of patients was 66 years (SD: 16) and 46% were women. 39 patients (41%) were classified as having a healthy diet (35% of men and 48% of women). The majority of patients were within the RDI for carbohydrates (56.8%), total fat (61.1%), long-chain n-3 fats (68.4%), polyunsaturated fats (79.0%) and protein (96.8%). Very few patients consumed the recommended intake for sodium (25.3%), and even fewer consumed the RDI for potassium (4.2%), with the majority of patients consuming too much sodium and too little potassium. Conclusion: We found that most patients with recent stroke or TIA were not following a healthy diet before their stroke event. For most patients, sodium intake was much above and potassium intake was much below RDI.
Assuntos
Dieta/efeitos adversos , Ataque Isquêmico Transitório/etiologia , Valor Nutritivo , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Registros de Dieta , Comportamento Alimentar , Feminino , Humanos , Ataque Isquêmico Transitório/diagnóstico , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Recomendações Nutricionais , Fatores de Risco , Acidente Vascular Cerebral/diagnósticoRESUMO
BACKGROUND: The obesity paradox refers to the finding in observational studies that patients with obesity have a better prognosis after stroke than normal weight patients. AIM: To test the hypothesis that there might be important heterogeneity within the obese stroke population, such that those with metabolic syndrome would be at higher risk for stroke or myocardial infarction and all-cause mortality compared to patients without metabolic syndrome. METHODS: The Insulin Resistance Intervention after Stroke trial enrolled non-diabetic patients with a recent ischemic stroke or transient ischemic attack and insulin resistance. We examined the association between metabolic syndrome and outcome risk in patients with normal weight at entry (body mass index (BMI) = 18.5-24.9 kg/m2), overweight (BMI = 25-29.9 kg/m2), or obesity (BMI ≥ 30 kg/m2). Analyses were adjusted for demographic features, treatment assignment, smoking, and major comorbid conditions. RESULTS: Metabolic syndrome was not associated with greater risk for stroke or myocardial infarction among 1536 patients who were overweight (adjusted hazard ratio (HR), 0.95; 95% confidence interval (CI): 0.69-1.31) or 1626 obese patients (adjusted HR, 1.00; 95% CI: 0.70-1.41). However, among 567 patients with a normal BMI, metabolic syndrome was associated with increased risk for stroke or myocardial infarction (adjusted HR, 2.05; 95% CI: 1.25-3.37), and all-cause mortality (adjusted HR, 1.70; 95% CI: 1.03-2.81) compared to patients without metabolic syndrome. CONCLUSIONS: The presence of metabolic syndrome identified normal weight patients with insulin resistance but no diabetes who have a higher risk of adverse cardiovascular outcomes, compared with patients without metabolic syndrome.
Assuntos
Peso Corporal , Resistência à Insulina , Síndrome Metabólica/mortalidade , Acidente Vascular Cerebral/epidemiologia , Idoso , Índice de Massa Corporal , Feminino , Humanos , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Obesidade/complicações , Sobrepeso/complicações , Recidiva , Fatores de Risco , Método Simples-Cego , Acidente Vascular Cerebral/complicaçõesRESUMO
Importance: The incidence of epilepsy is higher in older age than at any other period of life. Stroke, dementia, and hypertension are associated with late-onset epilepsy; however, the role of other vascular and lifestyle factors remains unclear. Objective: To identify midlife vascular and lifestyle risk factors for late-onset epilepsy. Design, Setting, and Participants: The Atherosclerosis Risk in Communities (ARIC) study is a prospective cohort study of 15â¯792 participants followed up since 1987 to 1989 with in-person visits, telephone calls, and surveillance of hospitalizations (10â¯974 invited without completing enrollment). The ARIC is a multicenter study with participants selected from 4 US communities. This study included 10â¯420 black or white participants from ARIC with at least 2 years of Medicare fee-for-service coverage and without missing baseline data. Data were analyzed betweeen April 2017 and May 2018. Exposures: Demographic, vascular, lifestyle, and other possible epilepsy risk factors measured at baseline (age 45-64 years) were evaluated in multivariable survival models including demographics, vascular risk factors, and lifestyle risk factors. Main Outcomes and Measures: Time to development of late-onset epilepsy (2 or more International Classification of Diseases, Ninth Revision codes for epilepsy or seizures starting at 60 years or older in any claim [hospitalization or outpatient Medicare through 2013]), with first code for seizures after at least 2 years without code for seizures. Results: Of the 10â¯420 total participants (5878 women [56.4%] and 2794 black participants [26.8%]; median age 55 years at first visit), 596 participants developed late-onset epilepsy (3.33 per 1000 person-years). The incidence was higher in black than in white participants (4.71; 95% CI, 4.12-5.40 vs 2.88; 95% CI, 2.60-3.18 per 1000 person-years). In multivariable analysis, baseline hypertension (hazard ratio [HR], 1.30; 95% CI, 1.09-1.55), diabetes (HR, 1.45; 95% CI, 1.17-1.80), smoking (HR, 1.09; 95% CI, 1.01-1.17), apolipoprotein E ε4 genotype (1 allele HR, 1.22; 95% CI, 1.02-1.45; 2 alleles HR, 1.95; 95% CI, 1.35-2.81), and incident stroke (HR, 3.38; 95% CI, 2.78-4.10) and dementia (HR, 2.56; 95% CI, 2.11-3.12) were associated with an increased risk of late-onset epilepsy, while higher levels of physical activity (HR, 0.90; 95% CI, 0.83-0.98) and moderate alcohol intake (HR, 0.72; 95% CI, 0.57-0.90) were associated with a lower risk. Results were similar after censoring individuals with stroke or dementia. Conclusions and Relevance: Potentially modifiable risk factors in midlife and the APOE ε4 genotype were positively associated with risk of developing late-onset epilepsy. Although stroke and dementia were both associated with late-onset epilepsy, vascular and lifestyle risk factors were significant even in the absence of stroke or dementia.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Apolipoproteína E4/genética , Negro ou Afro-Americano/estatística & dados numéricos , Demência/epidemiologia , Diabetes Mellitus/epidemiologia , Epilepsia/epidemiologia , Exercício Físico , Hipertensão/epidemiologia , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , População Branca/estatística & dados numéricos , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Aterosclerose , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To explore the association of intracranial atherosclerotic disease (ICAD) with mild cognitive impairment (MCI) and dementia. METHODS: From 2011 to 2013, 1,744 participants completed high-resolution vessel wall MRI from the population-based Atherosclerosis Risk in Communities Study by a sampling strategy that allowed weighting back to the cohort. We defined ICAD by plaque features (presence, territory, stenosis, number). Trained clinicians used an algorithm incorporating information from interviews and neuropsychological and neurologic examinations to adjudicate for MCI and dementia. We determined the relative prevalence ratio (RPR) of MCI or dementia after adjusting for risk factors at midlife using multinomial logistic regression. RESULTS: A total of 601 (34.5%) participants had MCI (mean age ± SD, 76.6 ± 5.2 years), 83 (4.8%) had dementia (79.1 ± 5.3 years), and 857 (49.1%) were current or former smokers. Anterior cerebral artery (ACA) plaque (adjusted RPR 3.81, 95% confidence interval [CI] 1.57-9.23), >2 territories with plaque (adjusted RPR 2.12, 95% CI 1.00-4.49), and presence of stenosis >50% (adjusted RPR 1.92, 95% CI 1.01-3.65) were associated with increased prevalence of dementia in separate models. Posterior cerebral artery plaque was associated with MCI but did not reach statistical significance for dementia (adjusted RPR MCI 1.43, 95% CI 1.04-1.98; adjusted RPR dementia 1.58, 95% CI 0.79-2.85). There were no associations with middle cerebral artery atherosclerotic lesions or cognitive impairment. Many participants had plaque in >1 territory (n = 291, 46%) and participants with ACA plaques (n = 69) had the greatest number of plaques in other territories (mean 6.0, SD 4.4). CONCLUSIONS: This study demonstrates associations between ICAD and clinical MCI and dementia.
Assuntos
Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Arteriosclerose Intracraniana/epidemiologia , Idoso , Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Estudos Transversais , Demência/diagnóstico por imagem , Feminino , Humanos , Entrevistas como Assunto , Arteriosclerose Intracraniana/diagnóstico por imagem , Modelos Logísticos , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Prevalência , Risco , Fatores de Risco , Fumar/epidemiologia , Estados UnidosRESUMO
Importance: There is growing recognition that patients may respond differently to therapy and that the average treatment effect from a clinical trial may not apply equally to all candidates for a therapy. Objective: To determine whether, among patients with an ischemic stroke or transient ischemic attack and insulin resistance, those at higher risk for future stroke or myocardial infarction (MI) derive more benefit from the insulin-sensitizing drug pioglitazone hydrochloride compared with patients at lower risk. Design, Setting, and Participants: A secondary analysis was conducted of the Insulin Resistance Intervention After Stroke trial, a double-blind, placebo-controlled trial of pioglitazone for secondary prevention. Patients were enrolled from 179 research sites in 7 countries from February 7, 2005, to January 15, 2013, and were followed up for a mean of 4.1 years through the study's end on July 28, 2015. Eligible participants had a qualifying ischemic stroke or transient ischemic attack within 180 days of entry and insulin resistance without type 1 or type 2 diabetes. Interventions: Pioglitazone or matching placebo. Main Outcomes and Measures: A Cox proportional hazards regression model was created using baseline features to stratify patients above or below the median risk for stroke or MI within 5 years. Within each stratum, the efficacy of pioglitazone for preventing stroke or MI was calculated. Safety outcomes were death, heart failure, weight gain, and bone fracture. Results: Among 3876 participants (1338 women and 2538 men; mean [SD] age, 63 [11] years), the 5-year risk for stroke or MI was 6.0% in the pioglitazone group among patients at lower baseline risk compared with 7.9% in the placebo group (absolute risk difference, -1.9% [95% CI, -4.4% to 0.6%]). Among patients at higher risk, the risk was 14.7% in the pioglitazone group vs 19.6% for placebo (absolute risk difference, -4.9% [95% CI, -8.6% to 1.2%]). Hazard ratios were similar for patients below or above the median risk (0.77 vs 0.75; P = .92). Pioglitazone increased weight less among patients at higher risk but increased the risk for fracture more. Conclusions and Relevance: After an ischemic stroke or transient ischemic attack, patients at higher risk for stroke or MI derive a greater absolute benefit from pioglitazone compared with patients at lower risk. However, the risk for fracture is also higher. Trial Registration: clinicaltrials.gov Identifier: NCT00091949.
Assuntos
Hipoglicemiantes/farmacologia , Resistência à Insulina , Ataque Isquêmico Transitório/prevenção & controle , Infarto do Miocárdio/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Acidente Vascular Cerebral/prevenção & controle , Tiazolidinedionas/farmacologia , Idoso , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pioglitazona , Recidiva , RiscoRESUMO
OBJECTIVES: To examine the effect of gender on three key elements of communication with elderly individuals: effectiveness of the communication, perceived relevance to the individual, and effect of gender-stereotyped content. DESIGN: Survey. SETTING: University of Connecticut Health Center. PARTICIPANTS: Thirty-three subjects (17 female); aged 69 to 91 (mean+/-standard deviation 82+/-5.4). MEASUREMENTS: Older adults listened to 16 brief narratives randomized in order and by the sex of the speaker (Narrator Voice). Effectiveness was measured according to ability to identify key features (Risks), and subjects were asked to rate the relevance (Plausibility). Number of Risks detected and determinations of plausibility were analyzed according to Subject Gender and Narrator Voice. Narratives were written for either sex or included male or female bias (Neutral or Stereotyped). RESULTS: Female subjects identified a significantly higher number of Risks across all narratives (P=.01). Subjects perceived a significantly higher number of Risks with a female Narrator Voice (P=.03). A significant Voice-by-Stereotype interaction was present for female-stereotyped narratives (P=.009). In narratives rated as Plausible, subjects detected more Risks (P=.02). CONCLUSION: Subject Gender influenced communication effectiveness. A female speaker resulted in identification of more Risks for subjects of both sexes, particularly for Stereotyped narratives. There was no significant effect of matching Subject Gender and Narrator Voice. This study suggests that the sex of the speaker influences the effectiveness of communication with older adults. These findings should motivate future research into the means by which medical providers can improve communication with their patients.
Assuntos
Acidentes por Quedas/prevenção & controle , Educação em Saúde/métodos , Voz , Idoso , Idoso de 80 Anos ou mais , Comunicação , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Fatores Sexuais , EstereotipagemRESUMO
BACKGROUND AND AIMS: Carbohydrates and fat intake have both been linked to development of atherosclerosis. We examined associations between glycemic index (GI) and fat intake with carotid atherosclerosis. METHODS: The Atherosclerosis Risk in Communities (ARIC) cohort enrolled participants during the period 1987-1989 and the Carotid MRI sub-study occurred between 2004 and 2006 (1672 participants attending both visits). Measures of carbohydrate quality (usual GI), fat intake (total, polyunsaturated and saturated) and overall dietary quality index (DASH Diet Score) were derived from a 66-item food frequency questionnaire administered at baseline. Trained readers measured lipid core presence and maximum wall thickness. Using multivariate logistic regression, we determined the odds of lipid core presence by quintile (Q) of energy-adjusted dietary components. Restricted cubic spline models were used to examine non-linear associations between dietary components and maximum wall thickness. RESULTS: Mean daily polyunsaturated fat intake was 5 g (SD 1.4). GI and polyunsaturated fat intake had a nonlinear relationship with maximum wall thickness. Low (1-4 g) and high (6-12 g) polyunsaturated fat intake were associated with a statistically significant decreased odds of lipid core presence compared to intake in a majority of participants (OR Q5 vs. Q2-4: 0.64, 95% CI 0.42 to 0.98; OR Q1 vs. Q2-4: 0.64, 95% CI 0.42, 0.96), however, the association with lipid core was attenuated by adjustment for maximum wall thickness, hypertension, hyperlipidemia, and diabetes. CONCLUSIONS: GI and polyunsaturated fat intake were not associated with high-risk plaque features, such as lipid core presence, independent of traditional vascular risk factors.