Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE) / 대한뇌졸중학회지

Background@#and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes. @*Methods@#Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH). @*Results@#Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P<0.0001). @*Conclusions@#The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.

Stress differentially predicts multiple sclerosis relapses

Background and Objective: For decades, stress has been postulated as a risk factor for multiple sclerosis (MS) relapses. Because of conflicting results in previous studies we conducted a prospective study to investigate this relationship in a less studied, Middle Eastern population. Methods: In this prospective study, 57 Iranian MS patients were followed trimonthly for 12 months. Possible stressful events (measured with validated Persian version of Paykel’s questionnaire) and quality of life (measured with validated Persian version of the Multiple Sclerosis Impact Scale questionnaire) were assessed in successive visits in addition to other variables. Relapses were enquired and confirmed clinically by a Neurologist. Main analysis was done by use of Mixed Generalized Linear Model. Results: Mean age of the participants was 33.5±7.4 years, 81% were females, and all were receiving interferons. Number of stressors, not the stress severity measures, reached near significance in predicting relapses (p=0.054), and showed a trend towards significance in predicting severe relapses (p=0.082). Education and number of previous relapses were the only variables that had a near significance interaction with number of stressors in its association with MS relapse. This association was only significant among subjects with less than college education (P=0.008) and subjects with more than 2 relapses (p=0.038). Conclusion: Number of stressors, not their severity, was associated with MS relapses among Iranian patients. This association had interaction with education and history of previous relapses; it was significant only among lower educated patients or patients with more prior relapses.

Incidence of cardiovascular diseases in an Iranian population: the isfahan cohort study

Introduction: accurate estimates of the incidence of cardiovascular diseases [CVD] comprising of acute myocardial infarction [AMI], unstable angina pectoris [UAP], sudden cardiac death [SCD], and stroke are very important for public health. However, such information is scarce, especially for middle- and low-income countries

Methods: the Isfahan Cohort Study [ICS] prospectively followed up 6504 individuals, 51.8% women, aged 35 years and over, 6323 initially free of CVD, from urban and rural areas in three districts in central Iran including Isfahan, Najafabad, and Arak. A panel of specialists in cardiology and neurology decided on the diagnosis of the occurred events based on patients’ hospital records, verbal autopsy, and death certificates

Results: after 32893 person-years of follow-up, 427 new cases of CVD events [229 in men] were registered. Confirmed cases of AMI, stroke, UAP, and SCD were 57, 43, 93, and 36 in men and 32, 48, 100, and 18 in women, respectively. The corresponding crude incidence rates were 352, 265, 352, and 220 per 100000 person-years in men and 186, 279, 584, and 104 in women, respectively. No significant differences were found in age at the time of events occurrence between men and women and between different event types except for SCD and stroke in women that in average the former occurred nine years later. CVD mortality rate was 331 per 100000 person-years in men and 203 in women

Conclusion: we found substantially high incidence rates for almost all CVDs and mortality. These findings need urgent consideration by health policy makers specifically for women

influence of gender and place of residence on cardiovascular diseases and their risk factors the Isfahan cohort study

To determine the impact of gender and place of residence on cardiovascular disease [CVD] events and related risk factors. In a prospective cohort study, 6323 participants free of CVD [3255 women], with age of more than 35 years from 3 cities [Isfahan, Najafabad, and Arak] and their rural districts in central Iran were followed-up from 2001 to 2007. This study was carried out at the Cardiovascular Research Institute of Isfahan University of Medical Sciences, Isfahan, Iran. Endpoints were defined as fatal- and nonfatal myocardial infarction, sudden cardiac death, unstable angina and stroke that constituted CVD events. Subjects in the rural area had significantly better risk factor profile in terms of most CVD risk factors in both genders, but it was reverse for low density lipoprotein [LDL]-cholesterol in both genders, and smoking in men. Except for smoking, men had an overall better risk factor profile compared to women. The age and risk factors adjusted hazard ratio of living in rural area was 0.71 [95% confidence interval [CI]: 0.51-0.99] for men, and 0.63 [95% CI: 0.44-0.91] for women. The age of CVD occurrence was similar in men and women, and in rural and urban areas. Hypertension was the strongest predictor of these events except for rural men showing that high LDL-cholesterol was the strongest risk factor. The findings in this study documented differences in CVD risk factors affecting the occurrence of CVD events according to gender and place of residence. Such differences should be taken into account in future preventive public health strategies for CVD prevention.