ABSTRACT
Background: Cryptogenic stroke (CS) is an exclusion diagnosis that accounts for 10-40% of all ischemic strokes. Patent foramen ovale (PFO) is found in 66% of patients with CS, while having a prevalence of 25-30% in the general population. The primary aim was to evaluate the risk of recurrent stroke following surgical PFO closure plus medical therapy vs. medical therapy alone amongst CS, an embolic stroke of undetermined source (ESUS), or transient ischemic attack (TIA). The secondary aim was to evaluate new-onset non-valvular atrial fibrillation, mortality, and major bleeding. Methods: We conducted an umbrella meta-analysis using PRISMA guidelines on English studies comparing surgical PFO closure plus medical therapy versus medical therapy alone for managing CS. We extracted data on interventions and outcomes and used random-effects models with generic inverse variance to calculate relative risks (RRs) with 95% confidence intervals for outcome calculations. Results: A comprehensive search yielded 54,729 articles on CS and 65,001 on surgical PFO closure, with 1,591 studies focusing on PFO closure and medical therapy for secondary CS, ESUS, or TIA prevention. After excluding non-meta-analyses, 52 eligible meta-analyses were identified, and eight studies were selected for outcome evaluation, excluding non-English, non-human, and studies before January 2019 as of August 31, 2021. Among a total of 41,880 patients, 14,942 received PFO closure + medical therapy, while 26,938 patients received medical therapy alone. Our umbrella meta-analysis showed that PFO closure plus medical therapy had a 64% lower risk of recurrent strokes than medical therapy alone (pooled RR: 0.36). PFO closure plus medical therapy was associated with 4.94 times higher risk of atrial fibrillation. There was no difference in the risk of death or bleeding between both groups. Conclusion: In patients with CS, PFO closure, in addition to medical therapy, reduces the risk of recurrence. More research is needed to assess the efficacy of early closure as well as specific risk profiles that would benefit from early intervention to reduce the burden of stroke.
ABSTRACT
BACKGROUND: Substance use disorders (SUDs) are considered to be a major risk factor for cardiovascular disorders (CVDs). In 2019, as per the National Drug Use and Health Survey (NSDUH), 20.4 million American adults suffered from a substance use disorder. The main purpose of this study is to determine the prevalence of several SUDs (cigarette smoking, cigar, smokeless tobacco, marijuana, cocaine/heroin/methamphetamine, and injectable illegal drug) amongst patients diagnosed with various CVDs (angina pectoris, myocardial infarction, and coronary heart disease). METHODS: This is a retrospective cross-sectional study carried out using the National Health and Nutrition Examination Survey (NHANES) database from 2013 to 2018, and respondents with CVDs were recognized using questionnaires. Different SUDs (active history) were identified amongst the adult population with a history of CVDs and without CVDs. Univariate analysis was performed using chi-square and unpaired t-test/Mann-Whitney test to identify characteristics of respondents with CVDs and mix effect multivariable logistic regression models were generated to find the prevalence of SUDs amongst the CVD population. Datasets were analyzed using Statistical Analysis System (SAS) software, and the p-value of < 0.05 was considered statistically significant. RESULTS: Of the 263465 respondents, 7.90% respondents were diagnosed with CVDs and were noted to be in older age group (median age: 69 years). CVDs were more prevalent amongst 66-years and above (19.36% vs. 45-64 years: 6.81% vs. 18-44 years: 1.17%), male (10.40% vs. female: 5.66%), Non-Hispanic White race (10.92%), and lower annual household income population (<$25000 vs. >$100,000:12.21% vs. 4.01%) (p<0.0001). When compared with respondents without a history of CVDs, respondents with a history of CVDs were noted to be more prevalent with a concurrent diagnosis of hypertension (85.98% vs. 79.53%), hypercholesterolemia (68.78% vs. 34.54%), diabetes (37.86% vs. 12.70%), stroke (17.4% vs. 2.71%), and congestive heart failure (28.80% vs. 1.31%) (p<0.0001). History of CVDs were more prevalent amongst the respondents using marijuana (overall 53.14%; CVD vs. no-CVD 65.42% vs. 52.81%; p<0.0001), cigarette smoking (60.47% vs. 40.41%; p<0.0001), cigar-smoking (47.05% vs. 35.58%; p<0.0001), methamphetamine/cocaine/heroin (23.82% vs. 16.71%; p<0.0001), smokeless tobacco use (18.53% vs. 14.59%; p<0.0001), and injectable illegal drug use (4.67% vs. 2.43%; p<0.0001). Additionally, prevalence of history of CVDs was almost double in respondents using cigarettes without filters (2.28% vs. 1.10%; p<0.0001) when compared with respondents using cigarettes with filters. CONCLUSION: Respondents who used marijuana or hashish, injectable illegal drugs, and e-cigars were at elevated risk for cardiovascular disorders. Providing situational awareness and offering a good support system can be a strategy to prevent the development of cardiovascular disorders among substance users.
