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1.
J Am Heart Assoc ; 13(12): e033201, 2024 Jun 18.
Article in English | MEDLINE | ID: mdl-38844434

ABSTRACT

BACKGROUND: Metabolomics studies have identified various metabolic markers associated with stroke risk, yet much uncertainty persists regarding heterogeneity in these associations between different stroke subtypes. We aimed to examine metabolic profiles associated with incident stroke and its subtypes in Chinese adults. METHODS AND RESULTS: We performed a nested case-control study within the Dongfeng-Tongji cohort, including 1029 and 266 incident cases of ischemic stroke (IS) and hemorrhagic stroke (HS), respectively, with a mean follow-up period of 6.1±2.3 years. Fifty-five metabolites in fasting plasma were measured by ultra-high-performance liquid chromatography-mass spectrometry. We examined the associations of metabolites with the risks of total stroke, IS, and HS, with a focus on the comparison of associations of plasma metabolite with IS and HS, using conditional logistic regression. We found that increased levels of asymmetrical/symmetrical dimethylarginine and glutamate were significantly associated with elevated risk of total stroke (odds ratios and 95%, 1.20 [1.08-1.34] and 1.22 [1.09-1.36], respectively; both Benjamini-Hochberg-adjusted P <0.05). When examining stroke subtypes, asymmetrical/symmetrical dimethylarginine was nominally associated with both IS and HS (odds ratios [95% CIs]: 1.16 [1.03-1.31] and 1.39 [1.07-1.81], respectively), while glutamate was associated with only IS (odds ratios [95% CI]: 1.26 [1.11-1.43]). The associations of glutamate with IS risk were significantly stronger among participants with hypertension and diabetes than among those without these diseases (both P for interaction <0.05). CONCLUSIONS: This study validated the positive associations of asymmetrical/symmetrical dimethylarginine and glutamate with stroke risk, mainly that of IS, in a Chinese population, and revealed a novel unanimous association of with both IS and HS. Our findings provided potential intervention targets for stroke prevention.


Subject(s)
Arginine , Biomarkers , Hemorrhagic Stroke , Ischemic Stroke , Metabolomics , Humans , Male , Female , Middle Aged , China/epidemiology , Case-Control Studies , Incidence , Biomarkers/blood , Ischemic Stroke/epidemiology , Ischemic Stroke/blood , Ischemic Stroke/diagnosis , Risk Factors , Hemorrhagic Stroke/epidemiology , Hemorrhagic Stroke/blood , Hemorrhagic Stroke/diagnosis , Metabolomics/methods , Arginine/blood , Arginine/analogs & derivatives , Risk Assessment , Aged , Glutamic Acid/blood , Stroke/epidemiology , Stroke/blood , Stroke/diagnosis , Adult , East Asian People
2.
Cardiovasc Diabetol ; 23(1): 183, 2024 May 29.
Article in English | MEDLINE | ID: mdl-38812009

ABSTRACT

BACKGROUND: People with type 2 diabetes (T2D) are at elevated risk of cardiovascular disease (CVD) including stroke, yet existing real-world evidence (RWE) on the clinical and economic burden of stroke in this population is limited. The aim of this cohort study was to evaluate the clinical and economic burden of stroke among people with T2D in France. METHODS: We conducted a retrospective RWE study using data from the nationally representative subset of the French Système National des Données de Santé (SNDS) database. We assessed the incidence of stroke requiring hospitalization between 2012 and 2018 among T2D patients. Subsequent clinical outcomes including CVD, stroke recurrence, and mortality were estimated overall and according to stroke subtype (ischemic versus hemorrhagic). We also examined the treatment patterns for glucose-lowering agents and CVD agents, health care resource utilization and medical costs. RESULTS: Among 45,331 people with T2D without baseline history of stroke, 2090 (4.6%) had an incident stroke requiring hospitalization. The incidence of ischemic stroke per 1000 person-years was 4.9-times higher than hemorrhagic stroke (6.80 [95% confidence interval (CI) 6.47-7.15] versus 1.38 [1.24-1.54]). During a median follow-up of 2.4 years (interquartile range 0.6; 4.4) from date of index stroke, the rate of CVD, stroke recurrence and mortality per 1000 person-years was higher among hemorrhagic stroke patients than ischemic stroke patients (CVD 130.9 [107.7-159.0] versus 126.4 [117.2-136.4]; stroke recurrence: 86.7 [66.4-113.4] versus 66.5 [59.2-74.6]; mortality 291.5 [259.1-327.9] versus 144.1 [134.3-154.6]). These differences were not statistically significant, except for mortality (adjusted hazard ratio 1.95 [95% CI 1.66-2.92]). The proportion of patients prescribed glucagon-like peptide-1 receptor agonists increased from 4.2% at baseline to 6.6% during follow-up. The proportion of patients prescribed antihypertensives and statins only increased slightly following incident stroke (antihypertensives: 70.9% pre-stroke versus 76.7% post-stroke; statins: 24.1% pre-stroke versus 30.0% post-stroke). Overall, 68.8% of patients had a subsequent hospitalization. Median total medical costs were €12,199 (6846; 22,378). CONCLUSIONS: The high burden of stroke among people with T2D, along with the low proportion of patients receiving recommended treatments as per clinical guidelines, necessitates a strengthened and multidisciplinary approach to the CVD prevention and management in people with T2D.


Subject(s)
Databases, Factual , Diabetes Mellitus, Type 2 , Hemorrhagic Stroke , Hypoglycemic Agents , Ischemic Stroke , Humans , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/economics , Diabetes Mellitus, Type 2/mortality , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/therapy , Diabetes Mellitus, Type 2/drug therapy , Female , Male , Incidence , Aged , Retrospective Studies , Middle Aged , France/epidemiology , Time Factors , Hypoglycemic Agents/therapeutic use , Hypoglycemic Agents/economics , Ischemic Stroke/epidemiology , Ischemic Stroke/mortality , Ischemic Stroke/economics , Ischemic Stroke/therapy , Ischemic Stroke/diagnosis , Hemorrhagic Stroke/epidemiology , Hemorrhagic Stroke/mortality , Hemorrhagic Stroke/economics , Hemorrhagic Stroke/therapy , Hemorrhagic Stroke/diagnosis , Risk Assessment , Recurrence , Risk Factors , Health Care Costs , Treatment Outcome , Hospitalization/economics , Aged, 80 and over , Cardiovascular Agents/therapeutic use , Cardiovascular Agents/economics , Stroke/epidemiology , Stroke/mortality , Stroke/economics , Stroke/therapy , Stroke/diagnosis
3.
Lancet Neurol ; 23(6): 625-635, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38760100

ABSTRACT

Haemorrhagic stroke is a severe condition with poor prognosis. Biological sex influences the risk factors, presentations, treatment, and patient outcomes of intracerebral haemorrhage, aneurysmal subarachnoid haemorrhage, and vascular malformations. Women are usually older at onset of intracerebral haemorrhage compared with men but have an increased risk of aneurysmal subarachnoid haemorrhage as they age. Female-specific factors such as pregnancy, eclampsia or pre-eclampsia, postmenopausal status, and hormone therapy influence a woman's long-term risk of haemorrhagic stroke. The presence of intracranial aneurysms, arteriovenous malformations, or cavernous malformations poses unique clinical dilemmas during pregnancy and delivery. In the absence of evidence-based guidelines for managing the low yet uncertain risk of haemorrhagic stroke during pregnancy and delivery in women with vascular malformations, multidisciplinary teams should carefully assess the risks and benefits of delivery methods for these patients. Health-care providers should recognise and address the challenges that women might have to confront when recovering from haemorrhagic stroke.


Subject(s)
Hemorrhagic Stroke , Humans , Female , Risk Factors , Pregnancy , Hemorrhagic Stroke/epidemiology
4.
J Alzheimers Dis ; 99(2): 739-752, 2024.
Article in English | MEDLINE | ID: mdl-38701142

ABSTRACT

Background: Early detection of Alzheimer's disease (AD) is a key component for the success of the recently approved lecanemab and aducanumab. Patients with neuroinflammation-related conditions are associated with a higher risk for developing AD. Objective: Investigate the incidence of AD among patients with neuroinflammation-related conditions including epilepsy, hemorrhage stroke, multiple sclerosis (MS), and traumatic brain injury (TBI). Methods: We used Optum's de-identified Clinformatics Data Mart Database (CDM). We derived covariate-matched cohorts including patients with neuroinflammation-related conditions and controls without the corresponding condition. The matched cohorts were: 1) patients with epilepsy and controls (N = 67,825 matched pairs); 2) patients with hemorrhage stroke and controls (N = 81,510 matched pairs); 3) patients with MS and controls (N = 9,853 matched pairs); and 4) patients TBI and controls (N = 104,637 matched pairs). We used the Cox model to investigate the associations between neuroinflammation-related conditions and AD. Results: We identified that epilepsy, hemorrhage stroke, and TBI were associated with increased risks of AD in both males and females (hazard ratios [HRs]≥1.74, p < 0.001), as well as in gender- and race-conscious subpopulations (HRs≥1.64, p < 0.001). We identified that MS was associated with increased risks of AD in both males and females (HRs≥1.47, p≤0.004), while gender- and race-conscious subgroup analysis shown mixed associations. Conclusions: Patients with epilepsy, hemorrhage stroke, MS, and/or TBI are associated with a higher risk of developing AD. More attention on cognitive status should be given to older patients with these conditions.


Subject(s)
Alzheimer Disease , Epilepsy , Humans , Male , Alzheimer Disease/epidemiology , Female , United States/epidemiology , Aged , Middle Aged , Epilepsy/epidemiology , Multiple Sclerosis/epidemiology , Brain Injuries, Traumatic/epidemiology , Brain Injuries, Traumatic/complications , Neuroinflammatory Diseases/epidemiology , Incidence , Hemorrhagic Stroke/epidemiology , Adult , Aged, 80 and over , Cohort Studies , Databases, Factual , Insurance Claim Review
5.
Diabetologia ; 67(7): 1192-1205, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38625582

ABSTRACT

Diabetes mellitus is a significant risk factor for both ischaemic and haemorrhagic stroke, affecting up to a third of individuals with cerebrovascular diseases. Beyond being a risk factor for stroke, diabetes and hyperglycaemia have a negative impact on outcomes after ischaemic and haemorrhagic stroke. Hyperglycaemia during the acute ischaemic stroke phase is associated with a higher risk of haemorrhagic transformation and poor functional outcome, with evidence in favour of early intervention to limit and manage severe hyperglycaemia. Similarly, intensive glucose control nested in a broader bundle of care, including blood pressure, coagulation and temperature control, can provide substantial benefit for clinical outcomes after haemorrhagic stroke. As micro- and macrovascular complications are frequent in people with diabetes, cardiovascular prevention strategies also need to consider tailored treatment. In this regard, the broader availability of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists can allow tailored treatments, particularly for those with heart failure and chronic kidney disease as comorbidities. Here, we review the main concepts of hyperacute stroke management and CVD prevention among people with diabetes, capitalising on results from large studies and RCTs to inform clinicians on preferred treatments.


Subject(s)
Hemorrhagic Stroke , Ischemic Stroke , Humans , Ischemic Stroke/prevention & control , Ischemic Stroke/complications , Hemorrhagic Stroke/epidemiology , Hemorrhagic Stroke/prevention & control , Blood Glucose/metabolism , Blood Glucose/drug effects , Comorbidity , Risk Factors , Hyperglycemia/complications , Hyperglycemia/drug therapy , Glycemic Control , Diabetes Mellitus, Type 2/complications , Stroke/prevention & control , Stroke/complications , Diabetes Mellitus , Hypoglycemic Agents/therapeutic use
6.
Cardiovasc Diabetol ; 23(1): 136, 2024 Apr 25.
Article in English | MEDLINE | ID: mdl-38664827

ABSTRACT

BACKGROUND: As the retina is suggested to mirror the brain, we hypothesized that diabetic retinopathy and macular edema are indicative of stroke risk in type 1 diabetes and sought to assess this association in individuals with type 1 diabetes. METHODS: We included 1,268 adult FinnDiane Study participants with type 1 diabetes (age 38.7 ± 11.8 years, 51.7% men vs. 48.3% women, and 31.5% had diabetic kidney disease), data on baseline diabetic retinopathy severity, and first stroke during our observational follow-up. Retinopathy was graded by the Early Treatment Diabetic Retinopathy Study (ETDRS) scale, and macular edema as clinically significant (CSME) or not. Strokes identified from registries were confirmed from medical files. Adjusted hazard ratios (HR) for stroke by retinopathy severity and CSME were calculated by Cox models adjusted for clinical confounders, including diabetic kidney disease. RESULTS: During median 18.0 (14.1-19.3) follow-up years, 130 strokes (96 ischemic, 34 hemorrhagic) occurred. With no-very mild (ETDRS 10-20) retinopathy as reference, the adjusted HR for stroke was 1.79 (95%CI 1.02-3.15) in non-proliferative (ETDRS 35-53), and 1.69 (1.02-2.82) in proliferative (ETDRS 61-85) retinopathy. Corresponding adjusted HR for ischemic stroke was 1.68 (0.91-3.10) in non-proliferative and 1.35 (0.77-2.36) in proliferative retinopathy. The adjusted HR for hemorrhagic stroke was 2.84 (0.66-12.28) in non-proliferative and 4.31 (1.16-16.10) in proliferative retinopathy. CSME did not increase HR for any stroke type after adjustment for clinical confounders (data not shown). CONCLUSIONS: Stroke incidence increases with the severity of diabetic retinopathy independently of comorbid conditions, including diabetic kidney disease.


Subject(s)
Diabetes Mellitus, Type 1 , Diabetic Retinopathy , Macular Edema , Severity of Illness Index , Humans , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/complications , Diabetic Retinopathy/epidemiology , Diabetic Retinopathy/diagnosis , Female , Male , Macular Edema/epidemiology , Macular Edema/diagnosis , Incidence , Adult , Middle Aged , Risk Factors , Time Factors , Finland/epidemiology , Risk Assessment , Registries , Ischemic Stroke/epidemiology , Ischemic Stroke/diagnosis , Stroke/epidemiology , Stroke/diagnosis , Hemorrhagic Stroke/epidemiology , Hemorrhagic Stroke/diagnosis
7.
Stroke ; 55(6): 1543-1553, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38591228

ABSTRACT

BACKGROUND: Stroke is one of the leading causes of death among children, yet evidence on stroke incidence and prognosis in this population is largely neglected worldwide. The aim of this study was to estimate the latest burden of childhood stroke, as well as trends, risk factors, and inequalities from 1990 to 2019, at the global, regional, and national levels. METHODS: The Global Burden of Disease 2019 study was utilized to evaluate the prevalence, incidence, years lived with disability, years of life lost (YLLs), and average annual percentage changes in stroke among populations aged 0 to 19 years from 1990 to 2019. RESULTS: The global age-standardized incidence of stroke increased (average annual percentage change, 0.15% [95% uncertainty interval, 0.09%-0.21%]), while YLLs decreased substantially (average annual percentage change, -3.33% [95% uncertainty interval, -3.38% to -3.28%]) among children and adolescents between 1990 and 2019. Ischemic stroke accounted for 70% of incident cases, and intracerebral hemorrhage accounted for 63% of YLLs. Children under 5 years of age had the highest incidence of ischemic stroke, while adolescents aged 15 to 19 years had the highest incidence of hemorrhagic stroke. In 2019, low-income and middle-income countries were responsible for 84% of incident cases and 93% of YLLs due to childhood stroke. High-sociodemographic index countries had a reduction in YLLs due to stroke that was more than twice as fast as that of low-income and middle-income. CONCLUSIONS: Globally, the burden of childhood stroke continues to increase, especially among females, children aged <5 years, and low-sociodemographic index countries, such as sub-Saharan Africa. The burden of childhood stroke is likely undergoing a significant transition from being fatal to causing disability. Global public health policies and the deployment of health resources need to respond rapidly and actively to this shift.


Subject(s)
Global Burden of Disease , Stroke , Humans , Adolescent , Child , Child, Preschool , Female , Male , Infant , Stroke/epidemiology , Global Burden of Disease/trends , Young Adult , Incidence , Infant, Newborn , Global Health , Risk Factors , Prevalence , Hemorrhagic Stroke/epidemiology , Ischemic Stroke/epidemiology , Cerebral Hemorrhage/epidemiology , Cost of Illness
8.
Am J Cardiol ; 219: 85-91, 2024 May 15.
Article in English | MEDLINE | ID: mdl-38458584

ABSTRACT

Surgery for type A aortic dissection (TAAD) is frequently complicated by neurologic complications. The prognostic impact of neurologic complications of different nature has been investigated in this study. The subjects of this analysis were 3,902 patients who underwent surgery for acute TAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD). During the index hospitalization, 722 patients (18.5%) experienced stroke/global brain ischemia. Ischemic stroke was detected in 539 patients (13.8%), hemorrhagic stroke in 76 patients (1.9%) and global brain ischemia in 177 patients (4.5%), with a few patients having had findings of more than 1 of these conditions. In-hospital mortality was increased significantly in patients with postoperative ischemic stroke (25.6%, adjusted odds ratio [OR] 2.422, 95% confidence interval [CI] 1.825 to 3.216), hemorrhagic stroke (48.7%, adjusted OR 4.641, 95% CI 2.524 to 8.533), and global brain ischemia (74.0%, adjusted OR 22.275, 95% CI 14.537 to 35.524) compared with patients without neurologic complications (13.5%). Similarly, patients who experienced ischemic stroke (46.3%, adjusted hazard ratio [HR] 1.719, 95% CI 1.434 to 2.059), hemorrhagic stroke (62.8%, adjusted HR 3.236, 95% CI 2.314 to 4.525), and global brain ischemia (83.9%, adjusted HR 12.777, 95% CI 10.325 to 15.810) had significantly higher 5-year mortality than patients without postoperative neurologic complications (27.5%). The negative prognostic effect of neurologic complications on survival vanished about 1 year after surgery. In conclusion, postoperative ischemic stroke, hemorrhagic stroke, and global cerebral ischemia increased early and midterm mortality after surgery for acute TAAD. The magnitude of risk of mortality increased with the severity of the neurologic complications, with postoperative hemorrhagic stroke and global brain ischemia being highly lethal complications.


Subject(s)
Aortic Aneurysm, Thoracic , Aortic Dissection , Hospital Mortality , Ischemic Stroke , Postoperative Complications , Registries , Humans , Aortic Dissection/surgery , Aortic Dissection/mortality , Male , Female , Middle Aged , Postoperative Complications/epidemiology , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Thoracic/mortality , Hospital Mortality/trends , Aged , Ischemic Stroke/epidemiology , Prognosis , Hemorrhagic Stroke/epidemiology , Brain Ischemia/etiology , Brain Ischemia/epidemiology , Risk Factors , Europe/epidemiology , Retrospective Studies , Survival Rate/trends
9.
Environ Res ; 251(Pt 2): 118512, 2024 Jun 15.
Article in English | MEDLINE | ID: mdl-38458591

ABSTRACT

BACKGROUND: Air pollution is one of the most serious environmental risks to mortality of stroke. However, there exists a noteworthy knowledge gap concerning the different stroke subtypes, causes of death, the susceptibility of stroke patient, and the role of greenness in this context. METHODS: We analyzed data from an ecological health cohort, which included 334,261 patients aged ≥40 years with stroke (comprising 288,490 ischemic stroke and 45,771 hemorrhagic stroke) during the period 2013-2019. We used Cox proportional hazards models with time-varying exposure to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the associations of annual average fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) with both all-cause and cause-specific mortality. Additionally, we conducted analyses to examine the effect modification by greenness and identify potential susceptibility factors through subgroup analyses. RESULT: In multivariable-adjusted models, long-term exposure to PM2.5 and NO2 was associated with increased risk of all-cause mortality (HR: 1.038, 95% CI: 1.029-1.047 for PM2.5; HR: 1.055, 95% CI: 1.026-1.085 for NO2, per 10 µg/m3, for ischemic stroke patients; similar for hemorrhagic stroke patients). Gradually increasing effect sizes were shown for CVD mortality and stroke mortality. The HRs of mortality were slightly weaker with high versus low vegetation exposure. Cumulative exposures increased the HRs of pollutant-related mortality, and greater greenness decreased this risk. Two subtypes of stroke patients exhibited diverse patterns of benefit. CONCLUSION: Increasing residential greenness attenuates the increased risk of mortality with different patterns due to chronic air pollutants for ischemic and hemorrhagic stroke, offering valuable insights for precise tertiary stroke prevention strategies.


Subject(s)
Air Pollutants , Air Pollution , Hemorrhagic Stroke , Ischemic Stroke , Particulate Matter , Humans , Air Pollutants/analysis , Air Pollutants/adverse effects , Male , Aged , Female , Middle Aged , Particulate Matter/analysis , Particulate Matter/adverse effects , Cohort Studies , Ischemic Stroke/mortality , Hemorrhagic Stroke/mortality , Hemorrhagic Stroke/chemically induced , Hemorrhagic Stroke/epidemiology , Air Pollution/adverse effects , Environmental Exposure/adverse effects , Ozone/analysis , Ozone/adverse effects , Nitrogen Dioxide/analysis , Adult , Aged, 80 and over , Stroke/mortality
10.
JAMA ; 331(11): 938-950, 2024 03 19.
Article in English | MEDLINE | ID: mdl-38502075

ABSTRACT

Importance: In January 2023, the US Centers for Disease Control and Prevention and the US Food and Drug Administration noted a safety concern for ischemic stroke among adults aged 65 years or older who received the Pfizer-BioNTech BNT162b2; WT/OMI BA.4/BA.5 COVID-19 bivalent vaccine. Objective: To evaluate stroke risk after administration of (1) either brand of the COVID-19 bivalent vaccine, (2) either brand of the COVID-19 bivalent plus a high-dose or adjuvanted influenza vaccine on the same day (concomitant administration), and (3) a high-dose or adjuvanted influenza vaccine. Design, Setting, and Participants: Self-controlled case series including 11 001 Medicare beneficiaries aged 65 years or older who experienced stroke after receiving either brand of the COVID-19 bivalent vaccine (among 5 397 278 vaccinated individuals). The study period was August 31, 2022, through February 4, 2023. Exposures: Receipt of (1) either brand of the COVID-19 bivalent vaccine (primary) or (2) a high-dose or adjuvanted influenza vaccine (secondary). Main Outcomes and Measures: Stroke risk (nonhemorrhagic stroke, transient ischemic attack, combined outcome of nonhemorrhagic stroke or transient ischemic attack, or hemorrhagic stroke) during the 1- to 21-day or 22- to 42-day risk window after vaccination vs the 43- to 90-day control window. Results: There were 5 397 278 Medicare beneficiaries who received either brand of the COVID-19 bivalent vaccine (median age, 74 years [IQR, 70-80 years]; 56% were women). Among the 11 001 beneficiaries who experienced stroke after receiving either brand of the COVID-19 bivalent vaccine, there were no statistically significant associations between either brand of the COVID-19 bivalent vaccine and the outcomes of nonhemorrhagic stroke, transient ischemic attack, nonhemorrhagic stroke or transient ischemic attack, or hemorrhagic stroke during the 1- to 21-day or 22- to 42-day risk window vs the 43- to 90-day control window (incidence rate ratio [IRR] range, 0.72-1.12). Among the 4596 beneficiaries who experienced stroke after concomitant administration of either brand of the COVID-19 bivalent vaccine plus a high-dose or adjuvanted influenza vaccine, there was a statistically significant association between vaccination and nonhemorrhagic stroke during the 22- to 42-day risk window for the Pfizer-BioNTech BNT162b2; WT/OMI BA.4/BA.5 COVID-19 bivalent vaccine (IRR, 1.20 [95% CI, 1.01-1.42]; risk difference/100 000 doses, 3.13 [95% CI, 0.05-6.22]) and a statistically significant association between vaccination and transient ischemic attack during the 1- to 21-day risk window for the Moderna mRNA-1273.222 COVID-19 bivalent vaccine (IRR, 1.35 [95% CI, 1.06-1.74]; risk difference/100 000 doses, 3.33 [95% CI, 0.46-6.20]). Among the 21 345 beneficiaries who experienced stroke after administration of a high-dose or adjuvanted influenza vaccine, there was a statistically significant association between vaccination and nonhemorrhagic stroke during the 22- to 42-day risk window (IRR, 1.09 [95% CI, 1.02-1.17]; risk difference/100 000 doses, 1.65 [95% CI, 0.43-2.87]). Conclusions and Relevance: Among Medicare beneficiaries aged 65 years or older who experienced stroke after receiving either brand of the COVID-19 bivalent vaccine, there was no evidence of a significantly elevated risk for stroke during the days immediately after vaccination.


Subject(s)
COVID-19 , Influenza Vaccines , Influenza, Human , Ischemic Attack, Transient , Ischemic Stroke , Stroke , Aged , Female , Humans , Male , 2019-nCoV Vaccine mRNA-1273/adverse effects , 2019-nCoV Vaccine mRNA-1273/therapeutic use , Adjuvants, Immunologic/adverse effects , Adjuvants, Immunologic/therapeutic use , BNT162 Vaccine/adverse effects , BNT162 Vaccine/therapeutic use , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/therapeutic use , Hemorrhagic Stroke/chemically induced , Hemorrhagic Stroke/epidemiology , Hemorrhagic Stroke/etiology , Influenza Vaccines/adverse effects , Influenza Vaccines/therapeutic use , Ischemic Attack, Transient/chemically induced , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/etiology , Medicare , Stroke/epidemiology , Stroke/etiology , Stroke/prevention & control , United States/epidemiology , Vaccination/adverse effects , Vaccination/methods , Vaccines, Combined/adverse effects , Vaccines, Combined/therapeutic use , Centers for Disease Control and Prevention, U.S./statistics & numerical data , United States Food and Drug Administration/statistics & numerical data , Ischemic Stroke/chemically induced , Ischemic Stroke/epidemiology , Ischemic Stroke/etiology , Influenza, Human/prevention & control , Aged, 80 and over
11.
Tohoku J Exp Med ; 263(2): 105-113, 2024 Jun 28.
Article in English | MEDLINE | ID: mdl-38382969

ABSTRACT

High-intensity statin (HIS) is recommended for high-risk patients in current guidelines. However, the risk of hemorrhagic stroke (HS) with HIS is a concern for Asians. Pitavastatin carries pharmacological differences compared with other statins. We compared the risk of HS in patients treated with pitavastatin-ezetimibe vs. HIS. We conducted a population-based, propensity score-matched cohort study using data from the Taiwan National Health Insurance Research Database. From January 2013 to December 2018, adults (≥ 18 years) who received pitavastatin 2-4 mg/day plus ezetimibe 10 mg/day (combination group, N = 3,767) and those who received atorvastatin 40 mg/day or rosuvastatin 20 mg/day (HIS group, N = 37,670) were enrolled. The primary endpoint was HS. We also assessed the difference of a composite safety endpoint of hepatitis or myopathy requiring hospitalization and new-onset diabetes mellitus. Multivariable Cox proportional hazards model was used to evaluate the relationship between study endpoints and different treatment. After a mean follow-up of 3.05 ± 1.66 years, less HS occurred in combination group (0.74%) than in HIS group (1.35%) [adjusted hazard ratio (aHR) 0.65, 95% confidence interval (CI) 0.44-0.95]. In subgroup analysis, the lower risk of HS in combination group was consistent among all pre-specified subgroups. There was no significant difference of the composite safety endpoint between the 2 groups (aHR 0.91, 95% CI 0.81-1.02). In conclusion, pitavastatin-ezetimibe combination treatment had less HS compared with high-intensity atorvastatin and rosuvastatin. Pitavastatin-ezetimibe may be a favorable choice for Asians who need strict lipid control but with concern of HS.


Subject(s)
Ezetimibe , Hemorrhagic Stroke , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Quinolines , Humans , Male , Ezetimibe/therapeutic use , Ezetimibe/adverse effects , Ezetimibe/administration & dosage , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Female , Middle Aged , Quinolines/therapeutic use , Quinolines/adverse effects , Aged , Hemorrhagic Stroke/epidemiology , Risk Factors , Taiwan/epidemiology , Adult
12.
J Am Heart Assoc ; 13(4): e030714, 2024 Feb 20.
Article in English | MEDLINE | ID: mdl-38323514

ABSTRACT

BACKGROUND: There is debate over whether statins increase risk of hemorrhagic stroke, so we assessed current evidence, including data from new statin trials and trials of nonstatin low-density lipoprotein-cholesterol (LDL-C)- and triglyceride-lowering therapies. METHODS AND RESULTS: We performed a systematic review of large randomized clinical trials (≥1000 patients with ≥2 years follow-up) of LDL-C-lowering therapy (statin, ezetimibe, and PCSK-9 [proprotein convertase subtilisin/kexin type 9] inhibitor) and triglyceride-lowering therapy (omega-3 supplements and fibrate) that reported hemorrhagic stroke as an outcome. We searched MEDLINE, Embase, and Cochrane Library up to July 2, 2021 and updated a meta-analysis of cardiovascular statin trials published in 2012. Among our several subgroup analyses, we looked at difference depending on stroke status and also depending on age. We identified 37 trials for LDL-C lowering (284 301 participants) and 11 for triglyceride lowering (120 984 participants). Overall, we found a higher risk of hemorrhagic stroke for LDL-C lowering, risk ratio (RR) 1.16 (95% CI, 1.01-1.32, P=0.03). For statins (33 trials, 216 258 participants), RR=1.17 (95% CI, 1.01-1.36); for PCSK-9 inhibitors (2 trials, 46 488 participants), RR=0.86 (95% CI, 0.43-1.74); and for ezetimibe (2 trials, 21 555 participants), RR=1.14 (95% CI, 0.64-2.03). In statin trials of patients with previous stroke/transient ischemic attack, RR was 1.46 (95% CI, 1.05-2.04), and in trials with mean age ≥65 years old, RR=1.34 (95% CI, 1.04-1.73) (Pint=0.14 and Pint=0.23 respectively); for triglyceride lowering (11 trials, 120 984 participants), RR=1.05 (95% CI, 0.86-1.30). CONCLUSIONS: We found evidence for a small increased risk of hemorrhagic stroke events with LDL-C-lowering therapies but no clear evidence for triglyceride-lowering therapies. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42021275363.


Subject(s)
Anticholesteremic Agents , Cardiovascular Diseases , Hemorrhagic Stroke , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Stroke , Humans , Aged , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Anticholesteremic Agents/therapeutic use , Cholesterol, LDL , Hemorrhagic Stroke/chemically induced , Hemorrhagic Stroke/epidemiology , Cardiovascular Diseases/drug therapy , Randomized Controlled Trials as Topic , Ezetimibe/adverse effects , Stroke/epidemiology , Stroke/etiology , Stroke/prevention & control , Triglycerides
13.
Eur Stroke J ; 9(2): 418-423, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38161290

ABSTRACT

INTRODUCTION: To date, risk assessment of suffering ischemic and hemorrhagic stroke in individuals under oral anticoagulation (OAC) is limited to hospital-based cohorts and patients with atrial fibrillation. PATIENTS AND METHODS: Through the combination of three individual datasets, (1) the population-based Tyrolean Stroke Pathway database, prospectively documenting all (unselected) stroke patients in the entire federal state of the Tyrol and (2) nation-wide prescription data, detailing each reimbursed prescription in Austria as well as (3) the Austrian Stroke Unit Registry, a nation-wide registry comprising data on all patients admitted to any of the 38 stroke units in Austria, we assessed risk of stroke in patients with prior oral anticoagulation and compared characteristics of patients taking direct oral anticoagulants and Vitamin-K-Antagonists. RESULTS: In Austria, oral anticoagulant prescription reimbursements increased from 292,475 in 2015 to 389,407 in 2021. In the Tyrol, prior oral anticoagulation treatment was evident in 586 of 3861 (15.2%) patients with ischemic and 131 of 523 (25.0%) with hemorrhagic stroke, with 20% and 35% of those stroke patients respectively having prior oral anticoagulation due to other indications than non-valvular atrial fibrillation. Considering prescription rates, treatment with direct oral anticoagulants was associated with a reduced stroke risk compared to Vitamin-K-Antagonists, especially in ischemic (1.05% vs 0.62%; RR 0.59, p < 0.001) but also in hemorrhagic stroke, even if less pronounced (0.21% vs 0.14%; RR 0.68, p = 0.06). In Austria, prior intake of direct oral anticoagulants was associated with lower risk of suffering acute large vessel occlusion stroke (RR 0.79, p = 0.003). DISCUSSION AND CONCLUSIONS: One in seven patients suffering ischemic and one in four suffering hemorrhagic stroke had prior oral anticoagulation treatment. Both ischemic and hemorrhagic strokes are less frequent in those with direct oral anticoagulant intake compared to those taking Vitamin-K-Antagonists. Establishment of clear standard operating procedures on how to best care for acute stroke patients with oral anticoagulation is essential.


Subject(s)
Anticoagulants , Atrial Fibrillation , Registries , Stroke , Humans , Male , Female , Aged , Anticoagulants/therapeutic use , Anticoagulants/adverse effects , Anticoagulants/administration & dosage , Austria/epidemiology , Stroke/epidemiology , Stroke/drug therapy , Stroke/prevention & control , Aged, 80 and over , Atrial Fibrillation/drug therapy , Atrial Fibrillation/complications , Atrial Fibrillation/epidemiology , Middle Aged , Vitamin K/antagonists & inhibitors , Ischemic Stroke/epidemiology , Ischemic Stroke/drug therapy , Ischemic Stroke/prevention & control , Risk Assessment , Hemorrhagic Stroke/epidemiology , Administration, Oral , Risk Factors , Factor Xa Inhibitors/therapeutic use , Factor Xa Inhibitors/administration & dosage , Factor Xa Inhibitors/adverse effects
14.
Int J Stroke ; 19(2): 217-225, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37697456

ABSTRACT

BACKGROUND: Epidemiological evidence suggests an association between low ambient temperature and stroke risk, but available data are limited particularly on associations with different stroke subtypes. AIMS: The aim of this study is to estimate the relationship between cold spells and stroke admissions, including the effect of cold spells on different stroke subtypes (ischemic stroke and intracerebral hemorrhage (ICH)). METHODS: A total of 144,405 stroke admissions from the Tianjin Centre for Health and Meteorology Multidisciplinary Innovation in China, covering the period from January 2016 to December 2020, were studied, as well as meteorological and air pollutant data. A generalized additive model with a distributed lag nonlinear model was employed to assess the relationship, considering 12 different definitions of a cold spell based on various temperature thresholds and durations. The analysis controlled for lagged and nonlinear effects of temperature. Analyses were performed on all strokes as well as ischemic stroke and ICH. RESULTS: There was a significant increase in stroke admissions during cold spells. Generally, the increased risk during cold spells increased as the temperature threshold decreased, but was not significantly affected by the duration. The optimal model was obtained using the cold-spell definition based on an average daily temperature below the 10th percentile (0.11°C) for 2 or more consecutive days. According to this model, the effect of cold spells on ischemic stroke admissions had a significant lag effect and was long-lasting, with a single-day effect occurring on lag 7d, peaking on lag 13d (relative risk (RR) = 1.05; 95% confidence interval (CI) = 1.02 to 1.09), and lasting until lag 20d. In contrast, the effect on ICH was immediate and short-lived, with the most significant single-day effect occurring on the current day (RR = 1.17; 95% CI = 1.06 to 1.29) and limited within 3 days. 14.15% of stroke cases could be attributed to cold spells, with ICH exhibiting a higher burden than ischemic stroke except for strict temperature threshold definitions. CONCLUSION: Cold spells are associated with an increased stroke risk. Different patterns of association were seen for different stroke subtypes. The effect on ischemic stroke had a lag effect and a longer duration, whereas the effect on ICH had an immediate effect and a shorter duration. These findings support the development and improvement of stroke cold-spell early warning systems and highlight the importance of public health interventions to mitigate the adverse health impacts of cold spells.


Subject(s)
Hemorrhagic Stroke , Ischemic Stroke , Stroke , Humans , Stroke/epidemiology , Stroke/etiology , Hemorrhagic Stroke/epidemiology , Hemorrhagic Stroke/complications , Cold Temperature , Hospitalization , Seizures , Cerebral Hemorrhage/epidemiology , Cerebral Hemorrhage/complications , Ischemic Stroke/complications , China/epidemiology , Temperature
15.
Stroke ; 55(1): 50-58, 2024 01.
Article in English | MEDLINE | ID: mdl-38134264

ABSTRACT

BACKGROUND: The effect of marine omega-3 PUFAs on risk of stroke remains unclear. METHODS: We investigated the associations between circulating and tissue omega-3 PUFA levels and incident stroke (total, ischemic, and hemorrhagic) in 29 international prospective cohorts. Each site conducted a de novo individual-level analysis using a prespecified analytical protocol with defined exposures, covariates, analytical methods, and outcomes; the harmonized data from the studies were then centrally pooled. Multivariable-adjusted HRs and 95% CIs across omega-3 PUFA quintiles were computed for each stroke outcome. RESULTS: Among 183 291 study participants, there were 10 561 total strokes, 8220 ischemic strokes, and 1142 hemorrhagic strokes recorded over a median of 14.3 years follow-up. For eicosapentaenoic acid, comparing quintile 5 (Q5, highest) with quintile 1 (Q1, lowest), total stroke incidence was 17% lower (HR, 0.83 [CI, 0.76-0.91]; P<0.0001), and ischemic stroke was 18% lower (HR, 0.82 [CI, 0.74-0.91]; P<0.0001). For docosahexaenoic acid, comparing Q5 with Q1, there was a 12% lower incidence of total stroke (HR, 0.88 [CI, 0.81-0.96]; P=0.0001) and a 14% lower incidence of ischemic stroke (HR, 0.86 [CI, 0.78-0.95]; P=0.0001). Neither eicosapentaenoic acid nor docosahexaenoic acid was associated with a risk for hemorrhagic stroke. These associations were not modified by either baseline history of AF or prevalent CVD. CONCLUSIONS: Higher omega-3 PUFA levels are associated with lower risks of total and ischemic stroke but have no association with hemorrhagic stroke.


Subject(s)
Fatty Acids, Omega-3 , Hemorrhagic Stroke , Ischemic Stroke , Stroke , Humans , Prospective Studies , Eicosapentaenoic Acid , Docosahexaenoic Acids , Hemorrhagic Stroke/epidemiology , Stroke/epidemiology , Risk Factors
16.
Stroke ; 54(12): 3046-3053, 2023 12.
Article in English | MEDLINE | ID: mdl-37942646

ABSTRACT

BACKGROUND: Stroke is a leading cause of mortality and permanent disability in China, with large and unexplained geographic variations in rates of different stroke types. Chronic hepatitis B virus infection is prevalent among Chinese adults and may play a role in stroke cause. METHODS: The prospective China Kadoorie Biobank included >500 000 adults aged 30 to 79 years who were recruited from 10 (5 urban and 5 rural) geographically diverse areas of China from 2004 to 2008, with determination of hepatitis B surface antigen (HBsAg) positivity at baseline. During 11 years of follow-up, a total of 59 117 incident stroke cases occurred, including 11 318 intracerebral hemorrhage (ICH), 49 971 ischemic stroke, 995 subarachnoid hemorrhage, and 3036 other/unspecified stroke. Cox regression models were used to estimate adjusted hazard ratios (HRs) for risk of stroke types associated with HBsAg positivity. In a subset of 17 833 participants, liver enzymes and lipids levels were measured and compared by HBsAg status. RESULTS: Overall, 3.0% of participants were positive for HBsAg. HBsAg positivity was associated with an increased risk of ICH (adjusted HR, 1.29 [95% CI, 1.16-1.44]), similarly for fatal (n=5982; adjusted HR, 1.36 [95% CI, 1.16-1.59]) and nonfatal (n=5336; adjusted HR, 1.23 [95% CI, 1.06-1.44]) ICH. There were no significant associations of HBsAg positivity with risks of ischemic stroke (adjusted HR, 0.97 [95% CI, 0.92-1.03]), subarachnoid hemorrhage (adjusted HR, 0.87 [95% CI, 0.57-1.33]), or other/unspecified stroke (adjusted HR, 1.12 [95% CI, 0.89-1.42]). Compared with HBsAg-negative counterparts, HBsAg-positive individuals had lower lipid and albumin levels and higher liver enzyme levels. After adjustment for liver enzymes and albumin, the association with ICH from HBsAg positivity attenuated to 1.15 (0.90-1.48), suggesting possible mediation by abnormal liver function. CONCLUSIONS: Among Chinese adults, chronic hepatitis B virus infection is associated with an increased risk of ICH but not other stroke types, which may be mediated through liver dysfunction and altered lipid metabolism.


Subject(s)
Cerebral Hemorrhage , Hemorrhagic Stroke , Hepatitis B, Chronic , Adult , Aged , Humans , Middle Aged , Albumins , Cerebral Hemorrhage/epidemiology , Cerebral Hemorrhage/complications , East Asian People , Hemorrhagic Stroke/epidemiology , Hemorrhagic Stroke/etiology , Hepatitis B Surface Antigens , Hepatitis B, Chronic/complications , Hepatitis B, Chronic/epidemiology , Ischemic Stroke/complications , Prospective Studies , Risk Factors , Stroke/epidemiology , Stroke/complications , Subarachnoid Hemorrhage/complications
17.
Arterioscler Thromb Vasc Biol ; 43(10): e404-e442, 2023 10.
Article in English | MEDLINE | ID: mdl-37706297

ABSTRACT

The objective of this scientific statement is to evaluate contemporary evidence that either supports or refutes the conclusion that aggressive low-density lipoprotein cholesterol lowering or lipid lowering exerts toxic effects on the brain, leading to cognitive impairment or dementia or hemorrhagic stroke. The writing group used literature reviews, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion to summarize existing evidence and to identify gaps in current knowledge. Although some retrospective, case control, and prospective longitudinal studies suggest that statins and low-density lipoprotein cholesterol lowering are associated with cognitive impairment or dementia, the preponderance of observational studies and data from randomized trials do not support this conclusion. The risk of a hemorrhagic stroke associated with statin therapy in patients without a history of cerebrovascular disease is nonsignificant, and achieving very low levels of low-density lipoprotein cholesterol does not increase that risk. Data reflecting the risk of hemorrhagic stroke with lipid-lowering treatment among patients with a history of hemorrhagic stroke are not robust and require additional focused study.


Subject(s)
Anticholesteremic Agents , Dementia , Hemorrhagic Stroke , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Stroke , Humans , American Heart Association , Anticholesteremic Agents/adverse effects , Brain , Cholesterol, LDL , Dementia/diagnosis , Dementia/epidemiology , Dementia/prevention & control , Ezetimibe , Hemorrhagic Stroke/diagnosis , Hemorrhagic Stroke/epidemiology , Hemorrhagic Stroke/prevention & control , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Prospective Studies , Retrospective Studies , Stroke/diagnosis , Stroke/epidemiology , Stroke/prevention & control
18.
JAMA ; 330(7): 636-649, 2023 08 15.
Article in English | MEDLINE | ID: mdl-37581671

ABSTRACT

Importance: Treatments for time-sensitive acute stroke are not available at every hospital, often requiring interhospital transfer. Current guidelines recommend hospitals achieve a door-in-door-out time of no more than 120 minutes at the transferring emergency department (ED). Objective: To evaluate door-in-door-out times for acute stroke transfers in the American Heart Association Get With The Guidelines-Stroke registry and to identify patient and hospital factors associated with door-in-door-out times. Design, Setting, and Participants: US registry-based, retrospective study of patients with ischemic or hemorrhagic stroke from January 2019 through December 2021 who were transferred from the ED at registry-affiliated hospitals to other acute care hospitals. Exposure: Patient- and hospital-level characteristics. Main Outcomes and Measures: The primary outcome was the door-in-door-out time (time of transfer out minus time of arrival to the transferring ED) as a continuous variable and a categorical variable (≤120 minutes, >120 minutes). Generalized estimating equation (GEE) regression models were used to identify patient and hospital-level characteristics associated with door-in-door-out time overall and in subgroups of patients with hemorrhagic stroke, acute ischemic stroke eligible for endovascular therapy, and acute ischemic stroke transferred for reasons other than endovascular therapy. Results: Among 108 913 patients (mean [SD] age, 66.7 [15.2] years; 71.7% non-Hispanic White; 50.6% male) transferred from 1925 hospitals, 67 235 had acute ischemic stroke and 41 678 had hemorrhagic stroke. Overall, the median door-in-door-out time was 174 minutes (IQR, 116-276 minutes): 29 741 patients (27.3%) had a door-in-door-out time of 120 minutes or less. The factors significantly associated with longer median times were age 80 years or older (vs 18-59 years; 14.9 minutes, 95% CI, 12.3 to 17.5 minutes), female sex (5.2 minutes; 95% CI, 3.6 to 6.9 minutes), non-Hispanic Black vs non-Hispanic White (8.2 minutes, 95% CI, 5.7 to 10.8 minutes), and Hispanic ethnicity vs non-Hispanic White (5.4 minutes, 95% CI, 1.8 to 9.0 minutes). The following were significantly associated with shorter median door-in-door-out time: emergency medical services prenotification (-20.1 minutes; 95% CI, -22.1 to -18.1 minutes), National Institutes of Health Stroke Scale (NIHSS) score exceeding 12 vs a score of 0 to 1 (-66.7 minutes; 95% CI, -68.7 to -64.7 minutes), and patients with acute ischemic stroke eligible for endovascular therapy vs the hemorrhagic stroke subgroup (-16.8 minutes; 95% CI, -21.0 to -12.7 minutes). Among patients with acute ischemic stroke eligible for endovascular therapy, female sex, Black race, and Hispanic ethnicity were associated with a significantly higher door-in-door-out time, whereas emergency medical services prenotification, intravenous thrombolysis, and a higher NIHSS score were associated with significantly lower door-in-door-out times. Conclusions and Relevance: In this US registry-based study of interhospital transfer for acute stroke, the median door-in-door-out time was 174 minutes, which is longer than current recommendations for acute stroke transfer. Disparities and modifiable health system factors associated with longer door-in-door-out times are suitable targets for quality improvement initiatives.


Subject(s)
Patient Transfer , Stroke , Aged , Aged, 80 and over , Female , Humans , Male , Brain Ischemia/epidemiology , Brain Ischemia/ethnology , Brain Ischemia/therapy , Hemorrhagic Stroke/epidemiology , Hemorrhagic Stroke/ethnology , Hemorrhagic Stroke/therapy , Ischemic Stroke/epidemiology , Ischemic Stroke/ethnology , Ischemic Stroke/therapy , Patient Transfer/standards , Patient Transfer/statistics & numerical data , Retrospective Studies , Stroke/therapy , United States/epidemiology , Time Factors , Acute Disease , Guideline Adherence , Middle Aged , Black or African American/statistics & numerical data , Hispanic or Latino/statistics & numerical data , White/statistics & numerical data , Registries/statistics & numerical data , Emergency Service, Hospital/standards , Emergency Service, Hospital/statistics & numerical data
19.
Neurology ; 101(3): e267-e276, 2023 07 18.
Article in English | MEDLINE | ID: mdl-37202159

ABSTRACT

BACKGROUND AND OBJECTIVES: In the United States, Black, Hispanic, and Asian Americans experience excessively high incidence rates of hemorrhagic stroke compared with White Americans. Women experience higher rates of subarachnoid hemorrhage than men. Previous reviews detailing racial, ethnic, and sex disparities in stroke have focused on ischemic stroke. We performed a scoping review of disparities in the diagnosis and management of hemorrhagic stroke in the United States to identify areas of disparities, research gaps, and evidence to inform efforts aimed at health equity. METHODS: We included studies published after 2010 that assessed racial and ethnic or sex disparities in the diagnosis or management of patients aged 18 years or older in the United States with a primary diagnosis of spontaneous intracerebral hemorrhage or aneurysmal subarachnoid hemorrhage. We did not include studies assessing disparities in incidence, risks, or mortality and functional outcomes of hemorrhagic stroke. RESULTS: After reviewing 6,161 abstracts and 441 full texts, 59 studies met our inclusion criteria. Four themes emerged. First, few data address disparities in acute hemorrhagic stroke. Second, racial and ethnic disparities in blood pressure control after intracerebral hemorrhage exist and likely contribute to disparities in recurrence rates. Third, racial and ethnic differences in end-of-life care exist, but further work is required to understand whether these differences represent true disparities in care. Fourth, very few studies specifically address sex disparities in hemorrhagic stroke care. DISCUSSION: Further efforts are necessary to delineate and correct racial, ethnic, and sex disparities in the diagnosis and management of hemorrhagic stroke.


Subject(s)
Healthcare Disparities , Hemorrhagic Stroke , Subarachnoid Hemorrhage , Female , Humans , Male , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/epidemiology , Cerebral Hemorrhage/ethnology , Cerebral Hemorrhage/therapy , Healthcare Disparities/ethnology , Healthcare Disparities/statistics & numerical data , Hemorrhagic Stroke/diagnosis , Hemorrhagic Stroke/epidemiology , Hemorrhagic Stroke/ethnology , Hemorrhagic Stroke/etiology , Hemorrhagic Stroke/therapy , Hispanic or Latino/statistics & numerical data , Racial Groups/statistics & numerical data , Stroke/diagnosis , Stroke/epidemiology , Stroke/ethnology , Stroke/therapy , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/epidemiology , Subarachnoid Hemorrhage/ethnology , United States/epidemiology , Sex Factors , Race Factors , Black or African American/statistics & numerical data , Asian/statistics & numerical data , White/statistics & numerical data , Incidence
20.
J Stroke Cerebrovasc Dis ; 32(3): 106987, 2023 Mar.
Article in English | MEDLINE | ID: mdl-36641948

ABSTRACT

BACKGROUND: Studies from early in the COVID-19 pandemic showed that patients with ischemic stroke and concurrent SARS-CoV-2 infection had increased stroke severity. We aimed to test the hypothesis that this association persisted throughout the first year of the pandemic and that a similar increase in stroke severity was present in patients with hemorrhagic stroke. METHODS: Using the National Institute of Health National COVID Cohort Collaborative (N3C) database, we identified a cohort of patients with stroke hospitalized in the United States between March 1, 2020 and February 28, 2021. We propensity score matched patients with concurrent stroke and SARS-COV-2 infection and available NIH Stroke Scale (NIHSS) scores to all other patients with stroke in a 1:3 ratio. Nearest neighbor matching with a caliper of 0.25 was used for most factors and exact matching was used for race/ethnicity and site. We modeled stroke severity as measured by admission NIHSS and the outcomes of death and length of stay. We also explored the temporal relationship between time of SARS-COV-2 diagnosis and incidence of stroke. RESULTS: Our query identified 43,295 patients hospitalized with ischemic stroke (5765 with SARS-COV-2, 37,530 without) and 18,107 patients hospitalized with hemorrhagic stroke (2114 with SARS-COV-2, 15,993 without). Analysis of our propensity matched cohort revealed that stroke patients with concurrent SARS-COV-2 had increased NIHSS (Ischemic stroke: IRR=1.43, 95% CI:1.33-1.52, p<0.001; hemorrhagic stroke: IRR=1.20, 95% CI:1.08-1.33, p<0.001), length of stay (Ischemic stroke: estimate = 1.48, 95% CI: 1.37, 1.61, p<0.001; hemorrhagic stroke: estimate = 1.25, 95% CI: 1.06, 1.47, p=0.007) and higher odds of death (Ischemic stroke: OR 2.19, 95% CI: 1.79-2.68, p<0.001; hemorrhagic stroke: OR 2.19, 95% CI: 1.79-2.68, p<0.001). We observed the highest incidence of stroke diagnosis on the same day as SARS-COV-2 diagnosis with a logarithmic decline in counts. CONCLUSION: This retrospective observational analysis suggests that stroke severity in patients with concurrent SARS-COV-2 was increased throughout the first year of the pandemic.


Subject(s)
COVID-19 , Hemorrhagic Stroke , Ischemic Stroke , Stroke , Humans , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Hemorrhagic Stroke/diagnosis , Hemorrhagic Stroke/epidemiology , Hemorrhagic Stroke/therapy , Ischemic Stroke/diagnosis , Ischemic Stroke/therapy , Ischemic Stroke/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2 , Stroke/diagnosis , Stroke/therapy , Stroke/epidemiology , United States/epidemiology
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